1. Creating and using Performance Indicators in Dutch Hospitals Jan Haeck Dutch Health Supervisory OECD 1

2. Outcome is pivotal! OECD 2

3. An indicator is a signal; further investigation is mandatory OECD 3

4. Intentions Health authorityPatientsafety Effectiveness Appropriateness HospitalAccountability; Transparency Quality-improvement Patient Choice Quality-assurance HealthinsuranceValue for money World Health Care Congress 1 OECD 4

5. Selection criteria Feasibility Focus on hospital care Clinical relevance Frequent manifestation Obvious and rapid improvement of quality outcome OECD 5

6. ….All Dutch hospitals participate ….All data are publicly available....Hospitals present data and their interpretation on www.... Annualy maximal 25% of the set will be renewed IMPORTANT CONDITIONS OECD 6 !

7. The Set: External Indicators Internal Indicators Clinical Scientific Societies oecd 7

8. 2004 2003 6% 11% Annual pressure-ulcer point-prevalence measurement oecd 8

9. Results Set Performance Indicators + Results specific inspections Annual meeting with the executive board Disciplinary measures (if necessary) oecd 9

10. 2003 ( 78%) 2004 (79%) Percentage of patients to get surgery after a hip fracture within 24 hours oecd 10

11. Innovations in quality 2003/2004 oecd 11

12. Data available about readmissions for heartfailure within 12 weeks after discharge (number of hospitals) oecd 12

13. 2003 2004 Data available for standardized pain measurement within 72 hours postoperative (number of hospitals) Recovery room All hospital wards oecd 14

14. 2003 2004 Oesophagus-cardia resectie oecd 16

15. 2003 oecd 18

16. Conclusions Health authoritySupervision only in risk-bearing hospitals HospitalMore data; improved quality of care; 100% transparent; guidelines by professionals Patient Safety indicators; choice because of transparency Health insuranceValue for money (yet to be proven) oecd 20

17. Perverse effects? 'gaming the numbers‘ Increase in bureaucracy: An obstacle for innovations and ambitions A decrease in solidarity between hospitals oecd 21

18. Thank you Oecd 22