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EHMA Annual Conference, Athens, Greece. 25 – 27 June 2008. Katrien Verleye. INCREASING IMPORTANCE OF PERFORMANCE MEASURES IN THE HOSPITAL SECTOR. Equity under pressure?. Overview. Context Research questions Methodology Results Discussion. CONTEXT. REGULATORS AND OTHER ENTITIES.

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EHMA Annual Conference, Athens, Greece

25 – 27 June 2008

Katrien Verleye

INCREASING IMPORTANCE OF PERFORMANCE MEASURES IN THE HOSPITAL SECTOR

Equity under pressure?


Overview
Overview

  • Context

  • Research questions

  • Methodology

  • Results

  • Discussion


Context
CONTEXT

REGULATORS AND

OTHER ENTITIES

Internal members

HOSPITAL’S PERFORMANCE

Suppliers

Consumers and purchasers

Kanji & Sá (2003)


Context1
CONTEXT

Ensuring quality as important issue in hospital sector

Focus on controlling the financial performance

Increased attention for quality improvement

cf. lapses in quality

Need to control costs without losing quality

cf. increasing costs and need in budget


Context2
CONTEXT

  • Demand for transparency and accountability

    • PERFORMANCE MEASUREMENT (PM)…

      • … translates the hospital’s performance in quantifiable metrics

      • … informs different stakeholders on the hospital’s performance

      • … enables stakeholders to follow up, coordinate, control and improve (aspects of) the hospital’s performance


Research questions
RESEARCH QUESTIONS

PERFORMANCE MEASUREMENT MODEL

development

performance

measurement

interpretation

management

selection

  • How is performance defined?

  • How is performance measured within the hospital sector?

  • How is performance information used within the hospital sector?

  • How do hospitals evaluate their performance measurement systems?

  • Which are the implications of PM on equity in healthcare?


Methodology
METHODOLOGY

  • Evaluation of PM in hospitals in Belgium

  • FLEMISH CASE

  • subjected to the Belgian government

    Cf. http://www.belgium.be/en/health/index.jsp

  • subjected to the Flemish government

  • Cf.http://www.zorg-en-gezondheid.be/HomeEN.aspx?id=1182


Methodology1
METHODOLOGY

Flemish Region

Flemish Communtiy

Population: 6,117,440

Total area: 13,522 km²

5 Flemish Provinces

  • Acute hospitals:

  • 62 hospitals

  • 104 campuses

  • Universitary hospitals:

  • 4 hospitals

  • 6 campuses


Methodology2
METHODOLOGY

  • Survey in 13 Flemish hospitals

    • 2 to 3 hospitals per Flemish province

    • both universitary and non-universitary

    • interpretation of each PM step


Results
RESULTS

*

  • PERFORMANCE

    - multidimensional

    - influenced by stakeholders

    - context


Results1
RESULTS

*

  • SELECTION AND DEVELOPMENT OF PIs

    - measuring all performance aspects:

    unfeasible and irrelevant

    - several performance aspects and indicators

    - motivation

    • statutory required !!!

    • supportive networks

    • self-developed indicators: result of historical factors

      added value for hospital

*



Results3
RESULTS

*

  • BUT

    • - too many PI’s and unclear definitions

    • - “not reflecting the performance”

    • - “difficult to find reliable and valid indicators”

    • - no participation of employees in the selection

*


Results4
RESULTS

*

  • PERFORMANCE MEASUREMENT

    • - measurement on the departmental level

    • - several employees are involved

    • - mostly supported by ICT


Results5
RESULTS

*

  • BUT

    • - lack of motivation

    • - time consuming

    • - incorrect and incomplete data

    • - overlap


Results6
RESULTS

*

  • ANALYSIS AND INTERPRETATION

    • - focus on deviating measures

    • - supported by ICT: basic analysis

    • - put out the data analysis to supportive network

      • Government

      • Navigator

      • Flemish Hospital Network Leuven


Results7
RESULTS

*

  • BUT

    • - feedback government and supportive networks

    • not satisfactory

    • - no integration of performance indicators

    • - lack of standards


Results8
RESULTS

*

  • USING PERFORMANCE INFORMATION

  • “what gets measured, gets done”

  • = ‘the most famous aphorism of performance measurement’ (Behn, 2003)

  • VERSUS

  • “to raise questions, not to provide answers”

  • (Likierman, 1993)


Results9
RESULTS

*

  • USING PERFORMANCE INFORMATION


Results10
RESULTS

*

  • BUT

  • employees are not informed

  • external use, but limited internal use

  • cf. ‘information is too general to use’

  • cf. ‘PM is not embedded in the decision structure of the organization’

  • PM does not achieve its goal


Discussion
DISCUSSION

  • FOCUS ON USING PERFORMANCE INFORMATION

  • Comparison among hospitals

  • Having decisions made by external stakeholders Cf. accreditation

    • Cf. pay-for-performance

  • Public disclosure of performance information

  • Cf. rankings

Improving the performance of hospitals

(Chandrima, 2005; Hamblin, 2007; Helm, Holladay & Tortella, 2007)


Discussion1
DISCUSSION

  • COMPARISON AMONG HOSPITALS

  • incomplete and incorrect measures

  • different ways of measuring indicators

  • different indicators

    • different definitions

    • based on different strategies

  • different input !


  • Discussion2
    DISCUSSION

    • DECISION-MAKING BY EXTERNAL STAKEHOLDERS AND PUBLIC DISCLOSURE

    • reflecting performance?

    • cf. tunnel vision(Vakkuri & Melkin, 2006)

    • is standardization possible?

    • cf. differences between hospitals

    • cf. do hospitals have a sector-specific strategy?

    • getting a good score in stead of improving performance

    • cf. risk of misrepresentation(Vakkuri & Melkin, 2006)

      • specializing in a few domains

      • refusing patients who lower score

  • risk of ossification (Vakkuri & Melkin, 2006)


  • Discussion3
    DISCUSSION

    • CAUTION IS RECOMMENDED

    • revising previous steps before use

    • - reflection

    • - systematization

    • adjustment for patients’ characteristics

    • performance measures are “flags requiring cautious

    • interpretation in the light of local circumstances”

    • (Veillard et al., 2005; p. 492)

    • involvement of different stakeholders


    Interesting references
    Interesting references

    • Behn, R.D. (2003). Why measure performance? Different purposes require different measures. Public Administration Review, 63( 5), 586-606.

    • Aidemark, L.-G. (2001). The meaning of balanced scorecards in the health care organisation. Financial Accountability & Management, 17(1), 23-40.

    • Bauer, K. (2004). KPIs – the metrics that drive performance management. DM Review, 14(9), 63-64.

    • Becker, B., Formisano, A., & Roger, M.D. (2006). Strategic planning for departmental divisions in an academic health care centre. The American Journal of Medicine, 199(4), 357-365.

    • Chandrima, B.C. (2005). Accreditation in hospitals. Expressed Healthcare Management. Retrieved May 7, 2008, from http://www.expresshealthcaremgmt.com/20050915/accreditation01.shtml.

    • Heemskerk, P., & Van Zandwijk, M.C. (2004). Verantwoordingsprocessen in de zorg op basis van de balanced scorecard. Zoetermeer: het Expertise Centrum.

    • Helm, C., Holladay, C., & Tortorella, F.R. (2002). What’s in a name? Reporting data from public institutions. CMAJ, 22(2), 193-194.

    • Kanji, G.K., & Sá, P.M. (2003). Sustaining healthcare excellence through performance measurement. Total quality management, 14(3), 269-289.


    Interesting references1
    Interesting references

    • Kollberg, B. Elg, M., Lindmark, J. (2005). Design and implementation of a performance measurement system in Swedish health care services. Quality Management in Health Care, 14(2), 95-111.

    • Rooney, A.N., & van Ostenberg, P.R. (1999). Licensure, accreditation, and certification: approaches to health services quality. Center for Human Services. Retrieved May 4, 2008, from http://www.qaproject.org/pubs/PDFs/accredmon.pdf

    • Tarantino, D.P. (2003), Using the balanced scorecard as a performance management tool. The Physician Executive, September-October, 69-72.

    • Ten Asbroek, A.H.A., Arah, O.A., Geelhoed, J., Custer, T., Delnoij, D.M., & Klazinga, N.S. (2004). Developing a national performance indicator framework for the Dutch health system. International Journal for Quality in Health Care 16(1), 165-171.

    • Vakkuri, J., & Meklin, P. (2006). Ambiguity in performance measurement: a theoretical approach to organisational uses of performance measurement. Financial Accountability & Management, 22(3), 235-250.

    • Veillard, J., Champagne, F., Klazinga, N., Kazandjian, V., Arah, O.A., & Guisset, A.I. (2005). A performance assessment framework for hospitals: the WHO regional office for Europe PATH project. InternationalJournal for Quality in Health Care, 17(6),487-496.

    • Yap, C., Siu, E., Baker, G.R., Brown, A.D., & Lowi-Young, M.P. (2005). A comparison of systemwide and hospital-specific performance measurement tools. Journal of Healthcare Management, 50(4), 251-264.


    Contact information
    Contact information

    Vlerick Leuven Gent Management School

    Reep 1

    B-9000 Gent

    Belgium

    www.vlerick.com

    Katrien Verleye

    Scientific Staff Member

    + 32 9 210 98 30

    [email protected]


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