Appendix 1

Performance Indicators for Acute Health Care Services

Proposed Project Framework

Overall Goal:

To develop a strategy for the development, implementation and use of performance and quality indicators in the Victorian acute health care sector.

Background:

A significant amount of work has been undertaken in performance indicator development by the Commonwealth, State Health Departments, the Australian Council on Healthcare Standards, hospitals, colleges and other professional bodies.

Within Victoria, a number of indicators are already in use or are being developed in various areas, including, for example, access indicators, elective surgery waiting lists, readmissions, intensive care services. However the approach to the development of indicators in Victoria has not been comprehensive.

The 1995 Quality Review recommended that the Department develop and implement a set of key performance indicators including those with a consumer focus. This position has been endorsed by the Acute Health Quality Committee and agreement reached to develop a framework for an integrated performance indicator program-one that is broadly based, not limited to existing indicators but which builds on and integrates with other work in the area, is consistent with program objectives and capable of implementation within a reasonable time frame.

This document therefore broadly outlines a process by which development of a performance indicator strategy could proceed including the identification and development of specific indicators.

Stage 1: Review and Consultation

Objective:

• To establish a framework for the development of an acute health Performance Indicator Strategy.

Target:

• July 1997

Key Tasks:

• Identify Department needs/wants re performance indicator development and monitoring and current work in progress within the Department which may impact upon the strategy.
• Establish clearly defined and agreed upon objectives for establishment of a performance indicator strategy together with project framework and time lines.
• Establish a performance indicator steering committee to oversee and advise upon development and implementation of the strategy.
• Review current activity/programs for performance indicator development and use at various levels-Network, State, National and International.
• Identify needs/wants/perceptions of key stakeholders (including providers and consumers) re acute health indicator information.
• Flag possible clinical areas for potential indicator development/use and criteria for indicator appraisal and selection.

Deliverables:

• Steering Committee established.
• Detailed report and project framework provided to AHQC.
• Possible indicator areas and selection criteria identified.

Stage 2: Indicator Identification and Validation

Objective:

• To identify a draft suite of valid and reliable quality performance measures.

Target:

• June 1998

Key Tasks:

• Clearly define areas for indicator development which target key areas of hospital performance.
• Identify potential indicators for monitoring within defined areas, drawing in particular upon existing work/programs.
• For all proposed indicators determine potential data collection mechanisms focusing upon ability to extract data through administrative databases with a particular focus upon but not limited to, the VIMD.
• Assess reliability of data collection mechanisms in accurately flagging the events of concern.
• Determine validity of indicators as determinants of quality of care within acute health settings.
• Develop proposed set of indicators based upon outcomes of data collection, reliability and validity assessments.
• Release proposal to industry for discussion and feedback.

Deliverables:

• Draft indicator set for validation and reliability testing.
• Proposed set of performance indicators for industry discussion and feedback.

Stage 3: Indicator Implementation

Objective:

• Establish mechanisms for the implementation, utilisation and dissemination of performance information.

Target:

• December 1998

Key Tasks:

• Establish mechanisms for statewide data collection and monitoring of agreed performance indicators.
• Determine processes for evaluation and feedback of hospital performance information.
• Develop guidelines to promote performance improvement through incentives.
• Establish clear guidelines to govern the release and public dissemination of performance information.
• Establish principles and guidelines to govern non-performance.
• Disseminate information/protocols to health care industry
• Establish processes for periodic review of indicators to ensure ongoing clinical relevance.

Deliverables:

• Department policies re collection, reporting, incentives, disclosure, and non-performance.
• Implementation packages/workshops.

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