Reporting to consumers - International, national and local experience Principles, guidelines and practical steps Hilary Russell Director - Development, Education and Research - Royal Women’s Hospital

 An Australian Review on Reporting on the Quality of Health Services to Consumers  RWH Maternity Services Report Card  Clinical Report  Annual Quality Report  Maternity Services Performance Indicator Project

The Four Phases of the Review Phase 1 – Literature review on reporting models - USA/UK/Canada/ Australia Phase 1 – Literature review on reporting models - USA/UK/Canada/ Australia Phase 2 – Identify and examine examples of reporting underway in Australia and overseas and conduct a national stakeholder consultation Phase 2 – Identify and examine examples of reporting underway in Australia and overseas and conduct a national stakeholder consultation Phase 3 – Develop a set of principles and guidelines for a program of reporting to consumers Phase 3 – Develop a set of principles and guidelines for a program of reporting to consumers Phase 4 – A national targeted workshop to comment on the Draft Principles and Guidelines Phase 4 – A national targeted workshop to comment on the Draft Principles and Guidelines

Audience/ Purpose Clinicians / AdministratorsSafety/Quality CommunityAccountability GovernmentAccountability/ Health system ConsumersChoice/Empowerment Funding bodiesEfficiency MediaA good story

Examples of Reporting Formats Report Document Format Ontario Hospital Association Report Card 1998 Uses aggregate data Uses aggregate data Tabulates data by 5 numerically numbered and unidentifiable regions e.g. Region 1 Tabulates data by 5 numerically numbered and unidentifiable regions e.g. Region 1 Internal peer review Internal peer reviewVoluntary UK League Tables 1994 Ranks individual health care providers to identify ‘good’ and ‘bad’ performance Ranks individual health care providers to identify ‘good’ and ‘bad’ performance Uses non-risk adjusted data Uses non-risk adjusted data Government Legislation

Examples of Reporting Formats (cont) UK High Level Performance Indicators & Clinical Indicators 1999 Uses aggregate data Uses aggregate data Alphabetically orders and names NHS Trusts and Health Authorities (HA) by locality Alphabetically orders and names NHS Trusts and Health Authorities (HA) by locality Indicators adjusted for age not socio-economic determinants Indicators adjusted for age not socio-economic determinants ‘like’ HA graphed together to enable comparison of social economic and demographics information ‘like’ HA graphed together to enable comparison of social economic and demographics information Government Legislation New York Cardiac Surgery System 1990 The risk-adjusted mortality rates of high volume surgeons who conduct over 200 CABG operations in a single hospital over 3 years are individually ranked and reported The risk-adjusted mortality rates of high volume surgeons who conduct over 200 CABG operations in a single hospital over 3 years are individually ranked and reportedRequired

Australian Case Studies 1993 – The Public Release of Victorian Public Hospital Mortality Data – A Case Study 1993 – The Public Release of Victorian Public Hospital Mortality Data – A Case Study Clinical Reports Clinical Reports Annual Reports Annual Reports Victorian Hospital Services Report Victorian Hospital Services Report New South Wales Mothers and Babies Report New South Wales Mothers and Babies Report The New South Wales Health Survey The New South Wales Health Survey The New South Wales Public Hospitals Comparison Data Book The New South Wales Public Hospitals Comparison Data Book Waiting times Information Waiting times Information Western Australia – Health Sector Performance Indicators report of the Auditor General, June 1999 Western Australia – Health Sector Performance Indicators report of the Auditor General, June 1999

Reporting - Key Issues Clarity in the purpose of reporting and target audience Clarity in the purpose of reporting and target audience The information needs of different audiences The information needs of different audiences Data - risk adjusted, verified, burden, explanation Data - risk adjusted, verified, burden, explanation Shortcomings of information systems - absence of the right data Shortcomings of information systems - absence of the right data

Two Frameworks of Reporting Framework One – Public Release of Information Framework One – Public Release of Information – Placing information in the public domain – Associated with public accountability at a state or national level – Often introduced to monitor performance following a health system review, support transparency or boost public confidence – Examples – NSW Mothers and Babies Health Report; Victoria’s Hospital Services Report

Two Frameworks of Reporting Framework Two - Purposeful Reporting to Consumers Framework Two - Purposeful Reporting to Consumers – Design facilitates consumer access – Consumers are primary audience – Linked to a specific health condition or – A specific decision – Public documents and distributed in the public domain – Tailored to consumers for their use in making health care decisions – Examples – information produced by FAACT

The Impact of Reporting No “report card” on report cards No “report card” on report cards Do the benefits outweigh the disadvantages? Do the benefits outweigh the disadvantages? Can be instrumental in improving quality Can be instrumental in improving quality Poor score – “embarrassed into doing better” Poor score – “embarrassed into doing better” Incentives or disincentives for selected performance outcomes Incentives or disincentives for selected performance outcomes Government and professional regulatory agency sanctions Government and professional regulatory agency sanctions

The Impact of Reporting Few examples of reporting in Australia, that are either accessible or meaningful to consumers Few examples of reporting in Australia, that are either accessible or meaningful to consumers Shortcomings in the reliability and accessibility of data in Australia on the quality of health services which could be reported to consumers, particularly data enabling comparison between health agencies Shortcomings in the reliability and accessibility of data in Australia on the quality of health services which could be reported to consumers, particularly data enabling comparison between health agencies A strong case for purposeful reporting to consumers as a complement to self- regulatory systems, such as peer review A strong case for purposeful reporting to consumers as a complement to self- regulatory systems, such as peer review

Local experience of developing a Clinical Outcome and Services Report to Consumers - A Partnership between two consumer groups and the RWH

RWH Continuous Cycle of Improving Quality RWH Annual Report and Annual Quality Report Public Accountability RWH ClinicalRWH Clinical Effectiveness Outcomes &and Evaluation Services Report  Evidence based practice to Consumers  Clinical Value Compass  Clinical Report  Adverse Events Review RWH ACHS Accreditation RWH Community Advisory Committee Internal Review Processes Consumer Pressure

Aims to – Enhance consumer participation and feedback in RWH – Enable consumers to make informed choices about their health care with confidence as to the quality of RWH services – Improve the accountability to citizens of RWH performance over time – Ensure RWH is focused on the interests of consumers – Establish a process that reports on and promotes continuous improvement

How Partnership with consumers from the outset Consumer consultation Consumer definition of indicators of quality Design and method of reporting based on consumer preference

RWH Clinical Outcomes and services Report - Maternity Services Six Domains of care Six Domains of care Performance data Performance data Explanation Explanation Consumer stories Consumer stories Questions to ask and where to go for further information Questions to ask and where to go for further information

Issues arising Tension between hospital interest in measuring performance and consumer interest in information on services Tension between hospital interest in measuring performance and consumer interest in information on services Consumers want information that they can use to make decisions about their health care - Hospitals want to be accountable and improve performance Consumers want information that they can use to make decisions about their health care - Hospitals want to be accountable and improve performance Limitations of hospital information systems Limitations of hospital information systems Limited information on consumers experience of care Limited information on consumers experience of care A sense that we can’t provide consumers with the information they want A sense that we can’t provide consumers with the information they want Independent verification Independent verification