Local Health System Performance Indicators

1. Local Health SystemPerformance Indicators Opening remarks Some of the questions you may have are: Where does performance indicators fit into the LHIN overall processes? What are performance indicators in the first place? How can they be used to improve the management of the health system? What is the role of the Ministry, the LHIN and the health service providers in this process? In this presentation we will answer these questions and hopefully address some of the issues you may have in relation to performance indicators. R�sum� / Abstract This study was designed to examine the effects of brief naps taken after lunch on alertness, performance, and autonomic balance. Three groups each comprising ten healthy subjects, who had slept normally at home the previous night, were randomly assigned to groups taking one of three lengths of nap (0, 15, and 45 min) after lunch. The P300, an event-related potential which is a neurophysiological correlate of cognitive function, subjective sleepiness (visual analogue scale), and electrocardiogram were measured before, 30 min after, and 3 h after the naps. Each measurement was followed by an English transcription task lasting 90 min. The P300 latency was significantly shorter after the 15-min than after the 45-min nap, or after no nap had been taken, while its amplitude was not affected by the length of nap. Subjective sleepiness was lower after both naps than after no nap. The task performance was significantly better during the second half of the last task session after the 15-min nap than after no nap. The highfrequency component of the R-R interval spectrum increased significantly during the 45-min nap, showing a temporary shift to a predominance of the parasympathetic nervous system. Mean total sleep times during the 15- and 45-min naps were 7.3 and 30. 1 min, respectively. These results would indicate that the 15-min nap may serve to shorten the stimulus evaluation time, reducing subjective sleepiness, and slightly improving task performance. Our data demonstrated that in our subjects a brief nap after lunch was effective for enhancing subsequent alertness and performance after normal sleep the previous night. Maintenance of alertness and performance by a brief nap after lunch under prior sleep deficit.Takahashi M, Arito H.National Institute of Industrial Health, Kawasaki, Japan. takaham@niih.go.jpWe examined the effects of a 15-min nap after lunch on subsequent alertness, performance, and autonomic function following a short sleep the preceding night. Subjects were 12 healthy students who had slept for only 4 hours the night before being tested. They experienced both nap and no-nap conditions in a counterbalanced order, at least a week apart. The nap condition included a 15-min nap opportunity (12:30-12:45) in bed with polygraphic monitoring. We measured the P300 event-related potential, subjective sleepiness (Visual Analog Scale), and electrocardiogram (ECG) at 10:00, 13:15, and 16:15, and task performance (logical reasoning and digit span) at 10:00, 11:30, 13:15, 14:45, 16:15, and 17:45. Mean home sleep measured by actigraphy was 3.5 hours under both conditions. At 13:15, the P300 latency after the nap was significantly shorter than after no nap, but its amplitude was not affected by napping. Subjective sleepiness at 13:15 and 14:45 was significantly lower, and accuracy of logical reasoning at 13:15 was significantly higher after the nap than after no nap. No other performance measures or the ECG R-R interval variability parameters differed significantly between the nap and no-nap conditions. Mean total sleep time during the nap was 10.2 min, and no stage 3 and 4 sleep was observed. The above results suggest that under prior sleep deficit, a 15-min nap during post-lunch rest maintains subsequent alertness and performance, particularly in the mid-afternoon.PMID: 11007448 [PubMed - indexed for MEDLINE] Opening remarks Some of the questions you may have are: Where does performance indicators fit into the LHIN overall processes? What are performance indicators in the first place? How can they be used to improve the management of the health system? What is the role of the Ministry, the LHIN and the health service providers in this process? In this presentation we will answer these questions and hopefully address some of the issues you may have in relation to performance indicators. R�sum� / Abstract This study was designed to examine the effects of brief naps taken after lunch on alertness, performance, and autonomic balance. Three groups each comprising ten healthy subjects, who had slept normally at home the previous night, were randomly assigned to groups taking one of three lengths of nap (0, 15, and 45 min) after lunch. The P300, an event-related potential which is a neurophysiological correlate of cognitive function, subjective sleepiness (visual analogue scale), and electrocardiogram were measured before, 30 min after, and 3 h after the naps. Each measurement was followed by an English transcription task lasting 90 min. The P300 latency was significantly shorter after the 15-min than after the 45-min nap, or after no nap had been taken, while its amplitude was not affected by the length of nap. Subjective sleepiness was lower after both naps than after no nap. The task performance was significantly better during the second half of the last task session after the 15-min nap than after no nap. The highfrequency component of the R-R interval spectrum increased significantly during the 45-min nap, showing a temporary shift to a predominance of the parasympathetic nervous system. Mean total sleep times during the 15- and 45-min naps were 7.3 and 30. 1 min, respectively. These results would indicate that the 15-min nap may serve to shorten the stimulus evaluation time, reducing subjective sleepiness, and slightly improving task performance. Our data demonstrated that in our subjects a brief nap after lunch was effective for enhancing subsequent alertness and performance after normal sleep the previous night. Maintenance of alertness and performance by a brief nap after lunch under prior sleep deficit.

2. Overview Introduction to Performance Indicators and the LHIN Accountability agreements and beyond� Terminology explained A Framework for Performance Indicators Criteria for Indicator Selection Performance Indicators and CSS Agencies

3. LHIN Core Functions

4. Accountability & Performance Management Local area accountability and performance frameworks Accountability Agreements with Health Service Providers Setting performance priorities, baselines, improvement targets In accordance with provincial framework and with health service providers

5. Accountability & Performance Management A broad framework to: Provide clarity on the roles and responsibilities of MOHLTC, LHINs, and HSPs Balance devolution of authority for local system management with strengthened accountability for results Link performance expectations for LHINs and HSPs to health system objectives and strategic directions

6. Summary of Roles & Responsibilities for Health System Performance Indicators Plan and Deliver services to patients/ clients/ consumers Adhere to Accountability Agreements Collaborate with LHINs to set and achieve performance targets Monitor and report performance, including integration measures

7. Balancing Devolution of Authority with Increased Accountability

8. Linking Indicators and Objectives

9. Developing Measures of Performance

10. LHIN Integrated Health Services Plan Priorities Access to Care Access to Primary Health Care Access to Specialty Care Access to Mental Health Services Access to Addiction Services Access to Rehabilitation Servcies Transportation To and From Care

11. LHIN Integrated Health Services Plan Priorities Availability of Long Term Care Services Integration of Services along the Continuum of Care Engagement with Aboriginal Communities Ensuring French Language Services Integration of E-Health Regional Health Human Resources Plan

12. Community Support Services� the Goal GOAL: To enable people to remain as independent as possible in their homes/communities, by making support services available to them and their caregivers

13. CSS and LHIN IHSP Priorities Community Support Services address the following goals of the Integrated Health Services Plan Access to Care Availability of Long-Term Care Integration of Services along the Continuum of Care Integration of E-health

14. Terminology Indicator Baseline Target Benchmark Corridor

15. Terminology Indicator Types Structural Indicators Process Indicators Output Indicators Outcome Indicators

16. Terminology - Indicators Structural Indicators Provide descriptive information such as the number beds in a facility, number of volunteers etc. Process Indicators Commonly used to improve management and quality examples for CSS � performance appraisals include client or caregiver feedback, agency collaborates with other service providers to coordinate service and care plans and to promote consistent information to the client Output Indicators Amounts of activity recorded such as surgeries performed or meals delivered

17. Terminology - Indicators Outcome Indicators Measures of the health system�s goals such as mortality rates or measures of population health� difficult to relate directly to the actions of the health care system

18. Logic Model for CategorizingHealth Indicators

19. Terminology�continued Baseline The current level at which an organization, process, or function is performing - a location used as a basis for comparison Benchmark A level of care/service set as a goal to be attained Target Specifies a desired level of performance and often involves some increment of improvement over an existing performance level� realistic, achievable, challenging steps toward a goal Corridor Acceptable range around a target allowing for natural variation

20. Linking Baselines, Benchmarks and Targets

21. Framework for developing Performance Indicators

22. Framework for developing Performance Indicators

23. Service Agreement Development April 1, 2007 - existing service agreements assigned to the LHINs Ministry and LHINs will work together to transition all LHIN-funded health service providers to new Service Accountability Agreements with LHINs, and will continue to develop a strong set of aligned measures and targets, demonstrating health system performance. The draft regulation proposes the following timelines for negotiating revised SAAs

24. Performance Indicators for CSS sector?

25. Indicator Development� System-level examples? �Home at Last� Patient and caregiver satisfaction with: Length of stay in ER Timeliness of discharge Care received or coordinated though HAL lead community support agency Total # of patients served # of admissions and readmissions averted Alternative Level of Care patients diverted Top 10 Case Mix of patients referred to HAL

27. Associated Outcome Measures? Reduced use of hospital and emergency services ED and Inpatient Reduced ALC days in hospital Increased use of services in the community Community support services and CCAC Reduced wait times in ED Reduced number of cancelled surgical procedures Increased number of patients deciding to stay in the community when LTC bed becomes available (receiving appropriate care for current health status)

28. What does this mean for CSS agencies? Identify performance indicators organization-specific, within sectors, across sectors Evaluate indicators meets provincial/IHSP priority? meets criteria for indicator development? Collect key measures Set baselines, targets and corridors Monitor change

29. Setting PerformanceIndicators for HSP�s Process begins now� Discussion and identification of key measures Principles�. Organizational, sectoral, cross-sectoral Process, Output and Outcome focused Access, Quality, Integration, Sustainability

30. South East LHIN Contacts