Overview and Summary of Recommendations

This paper has been prepared following a commitment by the Acute Health Quality Committee of the Department of Human Services, to develop a suite of performance indicators for implementation and use within the Victorian acute health care sector.

Part A of this paper reviews the current status of indicator development as a means of informing the Victorian strategy. A brief overview of indicators currently in use in Victoria is provided, as well as within other States and Territories. Indicator initiatives at Commonwealth level are also reviewed, including, but not limited to, the work of the ACHS Care Evaluation Program, Indicators of the National Health Ministers Benchmarking Working Group and the Quality and Outcome Indicators for Acute Health Services Project.

Many indicator programs are in existence within the United States to monitor quality of care and for external accountability and reporting. A synopsis of five of the better known programs is provided, including that of the Joint Commission on Accreditation of Healthcare Organisations and Maryland Hospital Association. Indicator development and use within the United Kingdom has not been established to the same extent however, some recent work to define clinical outcome indicators is examined.

Part B of this paper proposes a framework for indicator development within Victoria drawing upon and extending the work of others, which have been reported. The framework embraces an organisational wide approach to performance evaluation with a strong focus on the clinical care provided to patients.

It is proposed that indicators be developed and/or refined in nine areas of evaluation:

Potential indicator categories and examples of indicators are also provided to focus development activity. In some areas work is already underway in Victoria and indicator data are being reported, for example, indicators of access. In other areas, work could be initiated in cooperation with various Divisions/Sections within the Department, for example, Ambulatory Section and Public Health Division; leaving five areas for prioritised development, with clinical care, safety of care and effectiveness of care being nominated as the initial priorities.

To advance development in a timely way, it will be necessary to target key areas and categories for attention and preliminary work in the clinical care area is reported. Key indicator attributes are also identified to provide a mechanism for initial indicator selection and assessment.

Input from The Acute Health Quality Committee and Performance Indicator Sub-Committee (to be established) is required to provide clear direction, and to oversee development activities.

Issues relating to indicator implementation and reporting will need careful consideration by the Committee(s) with a view to developing a future position for the Department. An outline of those issues requiring particular attention is provided, and include:

Summary of Recommendations

The Acute Health Quality Committee has considered and endorsed:

1. The proposed framework for performance indicator development within the Victorian acute health care sector as depicted in Table 7.

2. The nine areas for evaluation and the suggested allocation and priorities for development work as specified in 6.1.

3. Use of the key attributes for indicator identification and selection as specified in Table 9.

4. The establishment of a performance indicator sub-committee to oversee and advise upon indicator selection and development in prioritised areas.

5. Further discussion and consultation surrounding issues of indicator implementation, prior to the adoption of a defined Departmental approach.

6. Publication and release of the performance indicator discussion paper for industry comment and feedback.

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