Kras And Kpis 1n4654

KRA‟s and KPI‟s

Key Result Area • KRA‟s group strategic objectives into a small number of „areas‟, which make sense. • Focuses effort on a limited number of issues • Prevents fragmentation of effort • Facilitates communication

KRA‟s • For example KRA‟s for the Health Service Management Development Unit are: – Curriculum development – Collaboration with internal and external stakeholders – Financial performance – Offshore developments – Research Development

KRA‟s • Example (cont) – Curriculum • Review Financial Management Topic • Aboriginal Health • Aged Care • Mental Health • Health Informatics • Web-based delivery

KRA‟s Example • Hospital – Patient services – Quality and safety – Financial resource management – Human Resource Management – Community Development – Research

NHS (UK) – “New Directions” 2005- 2008 • Patients more in control • Contribute to the community and economy • Improve health for everyone, especially the poorest • Priorities: – – – – –

Access to and quality of services Chronic disease management pathways Commisioning skills Appropriate (outcome based) financial incentives Nb – 5% of patients use 42% of hospital bed days

Reference: Health Service Journal 22April2004 p5 (www.hsj.co.uk)

KRS‟s in the NHS • QUALITY DOMAINS – Safety – Clinical effectiveness – Cost effectiveness – Governance – Patient focus – Accessible and responsive care – Amenities and environment – Public health Reference: www.dh.gov.uk/consultations/LiveConsultations/fs/en

NHS and Performance Management • Independent inspecting agency : The Healthcare Commission • Standards for “Better Health” • Policy driven parameters of good practice • Apply to whole of health system • Focus is on chronic disease and the patient experience • Standards depend on consensus of what constitutes “good healthcare” Reference: Health Service Journal 22 April2004: p16 – 18 (www.hsj.co.uk)

KRA‟s • Example – Department of Human Services (SA) • Key Strategic Directions – Improving services for better outcomes – Increasing the State‟s capacity to promote quality of life – Redistributing resources in a changing environment – Strengthening a culture of working together – Providing sound management

KPI‟s • Key performance indicators are measures for all strategic objectives and core processes, to answer the questions: – How will you (we) know that you have achieved your strategic objectives, or at least are making progress towards achieving them? – How do you (we) know that your core processes are working well

KPI‟s • Assumes that you have a strategic plan and have been through a strategic planning process • Need to measure OUTCOMES (results and outputs) and DRIVERS (processes and inputs) • Focus on what is important and relevant Core process: major impact on customer, profitability or viability of the organisation

KPI‟s • KPI measures (general) – Quantity – Quality – Cost – Revenue – timeliness

HOSPITAL KPI - 1 For KRA “patient services”:

• Patient throughput by department or service e.g. emergency department, outpatients, surgical, medical • Number of patient episodes by DRG (Diagnostic Related Group) and ALOS (Average Length of Stay) • Waiting times in emergency department • Waiting times for elective surgery Compare this information with previous years, predicted (planned) activity or benchmark data

KPI – Patient Services (cont) • Patient satisfaction levels (PSF surveys) • New patient services developed (milestones, throughput) e..g diabetic footcare services, women‟s health services; health screening clinic Were anticipated milestones and throughput achieved; are we maintaining or improving levels of customer satisfaction?

HOSPITAL KPI‟s - 2 • Quality and safety: – Accreditation inspections by external agencies – Clinical performance indicators: • • • • •

– – – –

Wound infection; IV site infection Unplanned return to theatre Unplanned re-ission to hospital Anaesthetic deaths Perinatal mortality rate

Adverse drug events Critical incident notifications Death reviews and case record audits Patient complaints by category

HOSPITAL KPI‟s - 3 Financial performance • • • • •

Revenue and expenditure against budget Debts (30 days, 90 days, written off) Capital works within budget Debt reduction Specific funding program deliverables

Hospital KPI‟s - 4 HUMAN RESOURCE MANAGEMENT • • • • •

Staff turnover Absenteism rates Total FTEs (Full time equivalent) Salaried staff to visiting staff ratio % staff undergoing training and examination results • awards

Hospital KPIs – 4 Community Development • • • • •

Hospital as employer of local people Number of community programs Health promotion activities Links with schools Volunteer work force

Hospital KPIs – 5 Research • Research grants ($ p.a.) • Publications in refereed journals • Revenue from commercialization of research • Number of PhD students employed

Health System KPIs - Australia • Effectiveness (e.g. 5 yrs cancer survival; immunisation rates)

• Appropriate (e.g. hospital rates for Caesarian section, tonsillectomies and meringotomies, drug prescribing)

• Efficient (e.g. cost per casemix (DRG) adjusted hospital ission; average LOS)

• Responsiveness (e.g.Emergency department waiting times by triage category; elective surgery waiting times

• Accessiblity (e.g.Number of nursing home places per 1000 > 70 yrs old)

• Safety (e.g.Hospital separations with adverse event) • Sustainability (e.g. %General Practitioners over 50 yrs old) • Others - e.g. continuity of care; capability)

SMART KPI‟s and strategic objectives • • • • •

SPECIFIC or SIMPLE MEASURABLE ACHIEVABLE REALISTIC TIMELY --------------------