Performance Measurement and Analysis for Health Organizations Dr. Mohammed Alahmed Dr. Mohammed Alahmed http://fac.ksu.edu.sa/alahmed alahmed@ksu.edu.sa

Introduction Why measure ? To Plan To Comply To Manage To Monitor To Optimize To Innovate Dr. Mohammed Alahmed First, a healthcare leadership team should deploy a measurement system to reinforce their organization’s mission. A common joke about measurement systems is, “If we didn’t measure things, we wouldn’t know how good we are at measuring the things we are measuring!” Yes, a measurement system should have a purpose. Secondly, a healthcare leadership team should deploy a measurement system to promote a reduction in medical errors and work process perfection. A study recently conducted to identify medical errors asserts that as many as 90% of hospital mistakes go overlooked. Finally, a good healthcare measurement system will associate patient outcomes with the performance and protocols of the system’s experts. Accuracy, accountability and purpose are three essential characteristics of a healthy performance measurement system, but the number one reason a healthcare organization should deploy key performance indicators can be summed in one word = PRODUCTIVITY!

What to measure? It is important to choose only the critical activity(ies) to be measured. Choosing the area to be measured should be based on the importance of the problem, service-user safety, potential for improvement and controllability by health or social care system/professionals. To measure and quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality care. Accurate performance measurement is dependent on information that is of good quality, comparable and can be shared within the health sector Dr. Mohammed Alahmed To measure and quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality care Health is information-intensive, generating huge volumes of data every day. It is estimated that up to 30% of the total health budget may be spent one way or another on handling information, collecting it, looking for it, storing it. It is therefore imperative that information is managed in the most effective way possible in order to ensure a high quality, safe service.

What is performance and where is it measured? “Performance” must be defined in relation to explicit goals reflecting the values of various stakeholders (such as patients, professions, insurers, regulators). Measurement is central to the concept of quality improvement When performance is measured, there always has to be an entity that is performing. The entity may be as small as a single clinician or as large as a comprehensive health care system Dr. Mohammed Alahmed

What is Performance Measurement? Performance measurement is the regular collection of data to assess whether the correct processes are being performed and desired results are being achieved Performance measurement including: Selection and use of quantitative measures that provide information about critical aspects of activities, including their effect on patients. Measures of what “actually happened” can be compared to goals set by your organization.  Performance measurement analyzes the success of a work group, program, or organization's efforts by comparing data on what actually happened to what was planned or intended. Performance measurement asks, “Is progress being made toward desired goals? Are appropriate activities being undertaken to promote achieving those goals? Are there problem areas that need attention? Successful efforts that can serve as a model for others?” Dr. Mohammed Alahmed

Terminology Performance Measure Performance Standard A specific quantitative representation of a capacity, process, or outcome deemed relevant to the assessment of performance (a generic term that includes standards, targets, indicators) Performance Standard Standards are one form of performance measure; they are generally objective standards or guidelines that are used to assess performance. Performance Target The planned or expected level of performance Performance Indicator Indicators are another form of performance measure; they are the data or information that is used to assess progress toward a performance standard Dr. Mohammed Alahmed

Why Measure Performance? Measuring performance can help you understand how well your organization is accomplishing its goal There are many reasons why an organization should measure performance: Quality Improvement Transparency Accreditation Dr. Mohammed Alahmed Quality Improvement.  Measuring performance can tell you what you’re doing well so you can share your successes and also reveal areas where you need to make adjustments.  Measuring performance tells you whether you are achieving your ultimate goal of improving patient outcomes.   Transparency.  Stakeholders outside of the organization--patients, funders, patient advocates--want to know about the quality of care being provided.  Patients want information that allows them to make informed choices about their health care services.  Sharing performance information can also help an organization gain support and funding for its programs. Accreditation.  Organizations, such as NCQA, the Joint Commission, and the Accreditation Association for Ambulatory Health Care (AAAHC), evaluate health care provider organizations to provide accreditation or certification signifying that those places meet certain performance standards. Recognition as a Patient Centered Medical Home (PCMH).  A Patient Centered Medical Home (sometimes known as a Primary Care Medical Home) is defined as “an approach to providing comprehensive primary care…that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family” (Joint Principles of the Patient Centered Medical Home ).  NCQA, the Joint Commission, and AAAHC offer accreditation programs for recognition as a Patient Centered Medical Home. Participation in financial incentive programs or demonstrations.  For example, The Centers for Medicare and Medicaid Electronic Health Record Incentive Programs provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified Electronic Health Records (EHR) technology.  Eligible professionals and hospitals who participate in the program must be able to record, store, and report clinical quality measures (CQM), which CMS defines as the “processes, experience, and/or outcomes of patient care, observations or treatment that relate to one or more quality aims for health care such as effective, safe, efficient, patient-centered, equitable, and timely care.”   It allows for an analysis of where and what changes need to be made in order to improve performance and the quality of care provided.  Measuring performance also allows providers to understand what is working well; information that can be shared with other providers who can learn from their success

The focus of performance measurement is less on the individual provider and more on the organization as a whole to evaluate whether an adequate structure and correct processes are in place to achieve the org Performance measurement is a process that systematically evaluates whether your efforts are making an impact on the clients you are serving or the problem you are targeting. Performance measurement promotes accountability to all stakeholders including the public, service users, clinicians and the Government by facilitating informed decision-making and safe, high quality and reliable care through monitoring, analyzing and communicating the degree to which healthcare organizations meet key goals Dr. Mohammed Alahmed

Distinguish what appears to be happening from what is really happening There are other typical circumstances of why an organization may choose to measure its performance, such as: Distinguish what appears to be happening from what is really happening Establish a baseline; i.e., measure before improvements are made Make decisions based on solid evidence Demonstrate that changes lead to improvements Allow performance comparisons across sites Monitor process changes to ensure improvements are sustained over time Recognize improved performance Dr. Mohammed Alahmed

Performance Measures Must Be Clearly defined Easily understood Directly related to planning objectives Relevant to decision makers and stakeholders Capable of addressing risk and uncertainty Dr. Mohammed Alahmed

Performance Measurement Process How Do We Develop a Performance Measurement Process? Step 1: Evaluate organizational priorities Step 2: Choose performance measures Step 3: Determine a Baseline Step 4: Evaluate Performance Step 5: Report Results Step 6: Develop a plan and make changes to improve performance Step 7: Monitor performance over time Dr. Mohammed Alahmed

What are the methods of performance measurement? Accounts- describe the overall effect of an alternative in a specific area (e.g. cumulative economic impacts) Metrics- statistical or numerical measure of system performance There are four types of performance measures: Process measure quantifies a health care service provided to, on behalf of, or by a patient, that is based on scientific evidence of efficacy or effectiveness. It quantifies a specific system; e.g., to get a test done or a service performed. Outcome measure quantifies a patient’s health status resulting from health care. In the clinical area, it often measures a patient outcome so it can be compared to a care standard, such as, a patient’s test value. Balancing measure ensures that changes to improve one part of the system are not causing new problems in other parts of the system. It examines another part of the system to ensure that improvements in one area have no unexpected consequences in another. Structure of care measure quantifies a feature of a health care organization (or clinician) relevant to its capacity to provide health care. Dr. Mohammed Alahmed

Measurement methodologies There are several ways of measuring and presenting provider quality, and these are growing in sophistication as more detailed clinical information about patients becomes easily accessible. Three commonly-used methodologies are: Percent compliance Actual vs. expected performance Performance against a benchmark Dr. Mohammed Alahmed

PERFORMANCE MEASUREMENT MODEL development selection measurement interpretation management 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? Dr. Mohammed Alahmed

Performance Measurement* TERM DEFINITION Performance What is done and how well it is done to provide healthcare (JCAHO 2002) Performance Measurement* The use of both outcomes and process measures to understand organizational performance and effect positive change to improve care (Nadzam and Nelson 1997) Performance Indicator** Markers or signs of things you want to measure but which may not be directly, fully or easily measured (Alberta Government 1998) Performance Measure A quantitative tool, such as rate, ratio or percentage, that provides an indication of an organization's performance in relation to a specified process or outcome (JCAHO 2002) Process Measure A measure focusing on a process that leads to a certain outcome, meaning that a scientific basis exists for believing that the process, when executed well, will increase the probability of achieving a desired outcome (JCAHO 2002) Outcome Measure Not simply a measure of health, well-being or any other state; rather, it is a change in status confidently attributable to antecedent care (intervention) (Donabedian 1968) Dr. Mohammed Alahmed

Performance Measurement In Public Health Are there things about public health that make performance measurement unique or different? Measuring performance in public services is different from measuring performance in private enterprises in some ways, but not in many! Dr. Mohammed Alahmed