1. Public Sector Scorecard in Health & Social Care Service Transformation
Context
The Sheffield Right First Time programme took a whole systems approach to health and social care service transformation for older people’s care pathways with a view to reducing reliance on the urgent care system. This was a forerunner to current Better Care Fund and place-based Sustainability and Transformation Plans.
Our approach
For the city’s leaders to have effective oversight of the change processes across health and social care services and their outcomes, a systems thinking approach was brought to the design of a balanced metrics portfolio, employing the Public Sector Scorecard (PSS) model.
Why the PSS approach?
The PSS model is amenable to complexity and able to incorporate core characteristics of the programme of citizen involvement, partnership and integration. It enables the construction of a balanced metrics panorama at the system level, from which performance dashboards can be modelled.
How was it done?
This involved a collaborative approach based on a series of workshops at director and senior / middle manager level from Sheffield Teaching Hospitals NHSFT, Sheffield Health and Social Care NHSFT, Sheffield City Council adult social care & public health, and a Citizen’s Reference Group.
Public Sector Scorecard – Three Phases
The Public Sector Scorecard
The seven perspectives of the PSS relate the desired strategic outcomes to the effectiveness of service delivery and the capability of organisations to support people and processes to achieve this.
Outcomes
Over the three years of the programme the PSS-derived monitoring dashboard tracked a progressive reduction in emergency bed-nights for avoidable hospital admissions (known as ambulatory care sensitive admissions) and associated secondary care spend, which was a primary aim, reflecting reduced utilisation of the acute care system.
The underlying PSS portfolio of system metrics provided a template of related and/or linked measures across health and social care services, that allowed positive and negative process and capability contributions to outcomes to be tracked via a performance dashboard that went monthly to the Programme Board and Operational Management Group.
Overview dashboard excerpt (pre and post commencement):
Outputs
An intermediate product of the PSS is a strategy map that describes key system components and their interrelationships. providing a framework onto which metrics are mapped. The Right First Time strategy map shows the various aspects required to deliver the desired outcomes. The involvement of directors and managers from across health and social care in developing the strategy map enabled the programme board to understand the various linkages and to monitor the whole picture.
“It’s very helpful to be able to see what's happening across the whole health & social care system, and where the balance of risks lie”. John Mothersole, Chief Executive Sheffield City Council:
Within-year monitoring dashboard excerpt:
John Soady
Sheffield City Council & School of Health & Related Research, University of Sheffield
Max Moullin
Public Sector Scorecard Research Centre, Sheffield & Visiting Fellow, Sheffield Business School |