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1. Different approaches to performance assessment and management Some insights for Turkey (part 2)
2. Outline
Caution note
Daring exercise, especially from an outsider perspective
to apply some of this to the Turkish setting / ask questions more than make observations
A few reflections based on what I have learned from the countrys health system, and also more generally what I have observed in a number of countries
certainly the challenges I want to bring about in today-s presentations are challenges faced by the vast majority if not all countries with already a solid purchasing mechanisms who want to move forward and try out some new ideas
Trigger some questions / reflections for the next 2 days / as has been done by Enis this morning, open up the box, set in the wider context, push to have a comprehensive view on hospital performance / serve as orientation for maybe one or two good discussion????
Not for simplification for more complexity but when I see the incentive based payement, you can definitely tackle with complexityCaution note
Daring exercise, especially from an outsider perspective
to apply some of this to the Turkish setting / ask questions more than make observations
A few reflections based on what I have learned from the countrys health system, and also more generally what I have observed in a number of countries
certainly the challenges I want to bring about in today-s presentations are challenges faced by the vast majority if not all countries with already a solid purchasing mechanisms who want to move forward and try out some new ideas
Trigger some questions / reflections for the next 2 days / as has been done by Enis this morning, open up the box, set in the wider context, push to have a comprehensive view on hospital performance / serve as orientation for maybe one or two good discussion????
Not for simplification for more complexity but when I see the incentive based payement, you can definitely tackle with complexity
3. One ultimate goal: improved health Add a few more extracts froom the Tallin Charter which we see in the strategy mapAdd a few more extracts froom the Tallin Charter which we see in the strategy map
4. From generic goals to country-specific objectives actionable by policy Delivering health services to individuals and to populations
Policy-makers throughout the Region value and strive to make possible the provision of quality services for all, particularly for vulnerable groups (
)
Patients also want to have a relationship with their health care provider based on respect for privacy, dignity and confidentiality
Effective primary health care is essential for promoting these aims, providing a platform for the interface of health services with communities and families, and for intersectoral and interprofessional cooperation and health promotion.
Health systems need to ensure a holistic approach to services, involving health promotion, disease prevention and integrated disease management programmes, as well as coordination among a variety of providers, institutions and settings, irrespective of whether these are in the public or the private sector, and including primary care, acute and extended care facilities and peoples homes, among others.
LINK TO NEXT SLIDE: 12. The practical application of these broad goals in each country requires the identification of
objectives that are linked to the goals and actionable by policy, and that are relevant in the
context of the countrys sociopolitical priorities and economic and fiscal means. Improving
access to high quality health care and enhancing peoples knowledge of how to improve their
own health are examples relevant to all countries. The objectives should be specified in a
measurable way to enable explicit monitoring of progress. This approach orients the design,
implementation and assessment of health system reforms.
INTO ACTION
THE STRATEGY MAP
FIND ALL THE ABOVE
.
LINK TO NEXT SLIDE: 12. The practical application of these broad goals in each country requires the identification of
objectives that are linked to the goals and actionable by policy, and that are relevant in the
context of the countrys sociopolitical priorities and economic and fiscal means. Improving
access to high quality health care and enhancing peoples knowledge of how to improve their
own health are examples relevant to all countries. The objectives should be specified in a
measurable way to enable explicit monitoring of progress. This approach orients the design,
implementation and assessment of health system reforms.
INTO ACTION
THE STRATEGY MAP
FIND ALL THE ABOVE
.
5. We find a direct translation into the strategy map for Turkey Your strategy map illustrates how all the strategic priorities are driven by the goal to improve health of the population, not only on average but also in terms of distribution.
Delivering health services to individuals and to populations
Policy-makers throughout the Region value and strive to make possible the provision
of quality services for all, particularly for vulnerable groups, in response to their
needs, and to enable people to make healthy lifestyle choices.
Patients want access to quality care, and to be assured that providers are relying on the
best available evidence that medical science can offer and using the most appropriate
technology to ensure improved effectiveness and patient safety.
Patients also want to have a relationship with their health care provider based on
respect for privacy, dignity and confidentiality.
Effective primary health care is essential for promoting these aims, providing a
platform for the interface of health services with communities and families, and for
intersectoral and interprofessional cooperation and health promotion.
Health systems should integrate targeted disease-specific programmes into existing
structures and services in order to achieve better and sustainable outcomes.
Health systems need to ensure a holistic approach to services, involving health
promotion, disease prevention and integrated disease management programmes, as
well as coordination among a variety of providers, institutions and settings,
irrespective of whether these are in the public or the private sector, and including
primary care, acute and extended care facilities and peoples homes, among others.
Explain also how well all of the concepts presented above are well reflected in this strategy mapWe find a direct translation into the strategy map for Turkey Your strategy map illustrates how all the strategic priorities are driven by the goal to improve health of the population, not only on average but also in terms of distribution.
Delivering health services to individuals and to populations
Policy-makers throughout the Region value and strive to make possible the provision
of quality services for all, particularly for vulnerable groups, in response to their
needs, and to enable people to make healthy lifestyle choices.
Patients want access to quality care, and to be assured that providers are relying on the
best available evidence that medical science can offer and using the most appropriate
technology to ensure improved effectiveness and patient safety.
Patients also want to have a relationship with their health care provider based on
respect for privacy, dignity and confidentiality.
Effective primary health care is essential for promoting these aims, providing a
platform for the interface of health services with communities and families, and for
intersectoral and interprofessional cooperation and health promotion.
Health systems should integrate targeted disease-specific programmes into existing
structures and services in order to achieve better and sustainable outcomes.
Health systems need to ensure a holistic approach to services, involving health
promotion, disease prevention and integrated disease management programmes, as
well as coordination among a variety of providers, institutions and settings,
irrespective of whether these are in the public or the private sector, and including
primary care, acute and extended care facilities and peoples homes, among others.
Explain also how well all of the concepts presented above are well reflected in this strategy map
6. We find a direct translation into the strategy map for Turkey Your strategy map illustrates how all the strategic priorities are driven by the goal to improve health of the population, not only on average but also in terms of distribution.
Delivering health services to individuals and to populations
Policy-makers throughout the Region value and strive to make possible the provision
of quality services for all, particularly for vulnerable groups, in response to their
needs, and to enable people to make healthy lifestyle choices.
Patients want access to quality care, and to be assured that providers are relying on the
best available evidence that medical science can offer and using the most appropriate
technology to ensure improved effectiveness and patient safety.
Patients also want to have a relationship with their health care provider based on
respect for privacy, dignity and confidentiality.
Effective primary health care is essential for promoting these aims, providing a
platform for the interface of health services with communities and families, and for
intersectoral and interprofessional cooperation and health promotion.
Health systems should integrate targeted disease-specific programmes into existing
structures and services in order to achieve better and sustainable outcomes.
Health systems need to ensure a holistic approach to services, involving health
promotion, disease prevention and integrated disease management programmes, as
well as coordination among a variety of providers, institutions and settings,
irrespective of whether these are in the public or the private sector, and including
primary care, acute and extended care facilities and peoples homes, among others.
Explain also how well all of the concepts presented above are well reflected in this strategy mapWe find a direct translation into the strategy map for Turkey Your strategy map illustrates how all the strategic priorities are driven by the goal to improve health of the population, not only on average but also in terms of distribution.
Delivering health services to individuals and to populations
Policy-makers throughout the Region value and strive to make possible the provision
of quality services for all, particularly for vulnerable groups, in response to their
needs, and to enable people to make healthy lifestyle choices.
Patients want access to quality care, and to be assured that providers are relying on the
best available evidence that medical science can offer and using the most appropriate
technology to ensure improved effectiveness and patient safety.
Patients also want to have a relationship with their health care provider based on
respect for privacy, dignity and confidentiality.
Effective primary health care is essential for promoting these aims, providing a
platform for the interface of health services with communities and families, and for
intersectoral and interprofessional cooperation and health promotion.
Health systems should integrate targeted disease-specific programmes into existing
structures and services in order to achieve better and sustainable outcomes.
Health systems need to ensure a holistic approach to services, involving health
promotion, disease prevention and integrated disease management programmes, as
well as coordination among a variety of providers, institutions and settings,
irrespective of whether these are in the public or the private sector, and including
primary care, acute and extended care facilities and peoples homes, among others.
Explain also how well all of the concepts presented above are well reflected in this strategy map
7.
Delivering health services to individuals and to populations
Policy-makers throughout the Region value and strive to make possible the provision
of quality services for all, particularly for vulnerable groups, in response to their
needs, and to enable people to make healthy lifestyle choices.
Patients want access to quality care, and to be assured that providers are relying on the
best available evidence that medical science can offer and using the most appropriate
technology to ensure improved effectiveness and patient safety.
Patients also want to have a relationship with their health care provider based on
respect for privacy, dignity and confidentiality.
Effective primary health care is essential for promoting these aims, providing a
platform for the interface of health services with communities and families, and for
intersectoral and interprofessional cooperation and health promotion.
Health systems should integrate targeted disease-specific programmes into existing
structures and services in order to achieve better and sustainable outcomes.
Health systems need to ensure a holistic approach to services, involving health
promotion, disease prevention and integrated disease management programmes, as
well as coordination among a variety of providers, institutions and settings,
irrespective of whether these are in the public or the private sector, and including
primary care, acute and extended care facilities and peoples homes, among others.
Explain also how well all of the concepts presented above are well reflected in this strategy map
Delivering health services to individuals and to populations
Policy-makers throughout the Region value and strive to make possible the provision
of quality services for all, particularly for vulnerable groups, in response to their
needs, and to enable people to make healthy lifestyle choices.
Patients want access to quality care, and to be assured that providers are relying on the
best available evidence that medical science can offer and using the most appropriate
technology to ensure improved effectiveness and patient safety.
Patients also want to have a relationship with their health care provider based on
respect for privacy, dignity and confidentiality.
Effective primary health care is essential for promoting these aims, providing a
platform for the interface of health services with communities and families, and for
intersectoral and interprofessional cooperation and health promotion.
Health systems should integrate targeted disease-specific programmes into existing
structures and services in order to achieve better and sustainable outcomes.
Health systems need to ensure a holistic approach to services, involving health
promotion, disease prevention and integrated disease management programmes, as
well as coordination among a variety of providers, institutions and settings,
irrespective of whether these are in the public or the private sector, and including
primary care, acute and extended care facilities and peoples homes, among others.
Explain also how well all of the concepts presented above are well reflected in this strategy map
8. We find a direct translation into the strategy map for Turkey Your strategy map illustrates how all the strategic priorities are driven by the goal to improve health of the population, not only on average but also in terms of distribution.
Delivering health services to individuals and to populations
Policy-makers throughout the Region value and strive to make possible the provision
of quality services for all, particularly for vulnerable groups, in response to their
needs, and to enable people to make healthy lifestyle choices.
Patients want access to quality care, and to be assured that providers are relying on the
best available evidence that medical science can offer and using the most appropriate
technology to ensure improved effectiveness and patient safety.
Patients also want to have a relationship with their health care provider based on
respect for privacy, dignity and confidentiality.
Effective primary health care is essential for promoting these aims, providing a
platform for the interface of health services with communities and families, and for
intersectoral and interprofessional cooperation and health promotion.
Health systems should integrate targeted disease-specific programmes into existing
structures and services in order to achieve better and sustainable outcomes.
Health systems need to ensure a holistic approach to services, involving health
promotion, disease prevention and integrated disease management programmes, as
well as coordination among a variety of providers, institutions and settings,
irrespective of whether these are in the public or the private sector, and including
primary care, acute and extended care facilities and peoples homes, among others.
Explain also how well all of the concepts presented above are well reflected in this strategy mapWe find a direct translation into the strategy map for Turkey Your strategy map illustrates how all the strategic priorities are driven by the goal to improve health of the population, not only on average but also in terms of distribution.
Delivering health services to individuals and to populations
Policy-makers throughout the Region value and strive to make possible the provision
of quality services for all, particularly for vulnerable groups, in response to their
needs, and to enable people to make healthy lifestyle choices.
Patients want access to quality care, and to be assured that providers are relying on the
best available evidence that medical science can offer and using the most appropriate
technology to ensure improved effectiveness and patient safety.
Patients also want to have a relationship with their health care provider based on
respect for privacy, dignity and confidentiality.
Effective primary health care is essential for promoting these aims, providing a
platform for the interface of health services with communities and families, and for
intersectoral and interprofessional cooperation and health promotion.
Health systems should integrate targeted disease-specific programmes into existing
structures and services in order to achieve better and sustainable outcomes.
Health systems need to ensure a holistic approach to services, involving health
promotion, disease prevention and integrated disease management programmes, as
well as coordination among a variety of providers, institutions and settings,
irrespective of whether these are in the public or the private sector, and including
primary care, acute and extended care facilities and peoples homes, among others.
Explain also how well all of the concepts presented above are well reflected in this strategy map
9. We find a direct translation into the strategy map for Turkey Your strategy map illustrates how all the strategic priorities are driven by the goal to improve health of the population, not only on average but also in terms of distribution.
Delivering health services to individuals and to populations
Policy-makers throughout the Region value and strive to make possible the provision
of quality services for all, particularly for vulnerable groups, in response to their
needs, and to enable people to make healthy lifestyle choices.
Patients want access to quality care, and to be assured that providers are relying on the
best available evidence that medical science can offer and using the most appropriate
technology to ensure improved effectiveness and patient safety.
Patients also want to have a relationship with their health care provider based on
respect for privacy, dignity and confidentiality.
Effective primary health care is essential for promoting these aims, providing a
platform for the interface of health services with communities and families, and for
intersectoral and interprofessional cooperation and health promotion.
Health systems should integrate targeted disease-specific programmes into existing
structures and services in order to achieve better and sustainable outcomes.
Health systems need to ensure a holistic approach to services, involving health
promotion, disease prevention and integrated disease management programmes, as
well as coordination among a variety of providers, institutions and settings,
irrespective of whether these are in the public or the private sector, and including
primary care, acute and extended care facilities and peoples homes, among others.
Explain also how well all of the concepts presented above are well reflected in this strategy mapWe find a direct translation into the strategy map for Turkey Your strategy map illustrates how all the strategic priorities are driven by the goal to improve health of the population, not only on average but also in terms of distribution.
Delivering health services to individuals and to populations
Policy-makers throughout the Region value and strive to make possible the provision
of quality services for all, particularly for vulnerable groups, in response to their
needs, and to enable people to make healthy lifestyle choices.
Patients want access to quality care, and to be assured that providers are relying on the
best available evidence that medical science can offer and using the most appropriate
technology to ensure improved effectiveness and patient safety.
Patients also want to have a relationship with their health care provider based on
respect for privacy, dignity and confidentiality.
Effective primary health care is essential for promoting these aims, providing a
platform for the interface of health services with communities and families, and for
intersectoral and interprofessional cooperation and health promotion.
Health systems should integrate targeted disease-specific programmes into existing
structures and services in order to achieve better and sustainable outcomes.
Health systems need to ensure a holistic approach to services, involving health
promotion, disease prevention and integrated disease management programmes, as
well as coordination among a variety of providers, institutions and settings,
irrespective of whether these are in the public or the private sector, and including
primary care, acute and extended care facilities and peoples homes, among others.
Explain also how well all of the concepts presented above are well reflected in this strategy map
10. Satisfactory hospital performance is defined as the maintenance of a state of functioning that corresponds to societal, patient and professional norms.
High hospital performance should be based on professional competences in application of present knowledge, available technologies and resources; efficiency in the use of resources; minimal risk to the patient; responsiveness to the patient; optimal contribution to health outcomes.
Within the health care environment, high hospital performance should further address the responsiveness to community needs and demands, the integration of services in the overall delivery system, and commitment to health promotion.
High hospital performance should be assessed in relation to the availability of hospitals services to all patients irrespective of physical, cultural, social, demographic and economic barriers.
The Performance Assessment Tool for quality improvement in Hospitals (PATH) Many definition of hospital performance to draw on. This is just one for illustrative purpose only (note in parenthesis that ¨Turkey is participating to PATH and PATH was presented here last year - hence resonate well here)
2 messages here:
Performance is not just about clinical effectiveness, productivity/financial sustainability, staff orientation but it is also about responsive governance
look up the PATH definition.. Much highlighted in Enis presentation. And again in my presentation.
performance = very complex construct
not just a list of dimensions but all inter-related. Should have been presented by Francois
but I will provide a few slides excerpts from his presentationMany definition of hospital performance to draw on. This is just one for illustrative purpose only (note in parenthesis that ¨Turkey is participating to PATH and PATH was presented here last year - hence resonate well here)
2 messages here:
Performance is not just about clinical effectiveness, productivity/financial sustainability, staff orientation but it is also about responsive governance
look up the PATH definition.. Much highlighted in Enis presentation. And again in my presentation.
performance = very complex construct
not just a list of dimensions but all inter-related. Should have been presented by Francois
but I will provide a few slides excerpts from his presentation
11. The Performance Assessment Tool for quality improvement in Hospitals (PATH) Focus is on the SYSTEM what matters is : interlinked dimensions (or perspectives) on hospital performance.
2 cross-cutting perspectives on 4 dimensions but in reqlity, qll couold very well have been move transversally
Patient centerdness patient at the core across the hospital but all episode of care --- relate to Enis presentation
Safety 2 out of 4 yesterday during course indicate great emphasis at the core, a culture of safety Focus is on the SYSTEM what matters is : interlinked dimensions (or perspectives) on hospital performance.
2 cross-cutting perspectives on 4 dimensions but in reqlity, qll couold very well have been move transversally
Patient centerdness patient at the core across the hospital but all episode of care --- relate to Enis presentation
Safety 2 out of 4 yesterday during course indicate great emphasis at the core, a culture of safety
12. On the importance and difficulty of aligning incentives / one country example Discrepancy between strategic statement, performance measurement and internal accountability measures
Lack of data
Lack of knowledge and tool
Lack of leadership
National Hospital Development Plan:
Ensure access to high quality care
Optimize the cost for establishing and operating hospital network
Optimize network through for instance sharing of facilities and specialization for increase volume
What is looked at by governance board, matters is volume and prices, and patient satisfaction (patient complaints essentially) as it relates to market share and hence volume
The strategic focus is marked by the recent hospital reforms and aligned on the Hospital Network Development Plan (Government of Estonia, 2003) which states that the three objectives for the hospital network are (1) to ensure access to high quality care, (2) to optimize the cost for establishing and operating the hospital network and (3) to ensure the sustainability of the hospital network. Measurable targets were set to assess the achievement of those objectives in terms of (a) reducing the average length of stay in acute care (b) reducing acute care beds and (c) increasing the bed occupancy rate in acute care. We observed that hospital strategic priorities are aligned to the measurable targets (a to c) rather than to the stated objectives (1 to 3). Access, and quality of care (objective 1) as well as optimization of the network (objective 2) (through for instance sharing facilities or specializing for increased volume) are largely under-represented. In the context of hospital reforms and relative uncertainty regarding survival, what matters, and hence what is measured and looked at with scrutiny by the supervisory board and the management board, are volume and prices (content of the contracts with EHIF) and patient satisfactions (patient complaints essentially). Hence, we generally observe significant discrepancies between strategic statements, performance measurement and internal accountability structures. The discrepancies between stated priorities and performance measures were explained by a lack of data (though a lot of data are being collected, see below), a lack of knowledge of the tools (indicators, reports) and a lack of leadership or interest in investing in an integrated performance management system.
Optimize network through for instance sharing of facilities and specialization for increase volume
What is looked at by governance board, matters is volume and prices, and patient satisfaction (patient complaints essentially) as it relates to market share and hence volume
The strategic focus is marked by the recent hospital reforms and aligned on the Hospital Network Development Plan (Government of Estonia, 2003) which states that the three objectives for the hospital network are (1) to ensure access to high quality care, (2) to optimize the cost for establishing and operating the hospital network and (3) to ensure the sustainability of the hospital network. Measurable targets were set to assess the achievement of those objectives in terms of (a) reducing the average length of stay in acute care (b) reducing acute care beds and (c) increasing the bed occupancy rate in acute care. We observed that hospital strategic priorities are aligned to the measurable targets (a to c) rather than to the stated objectives (1 to 3). Access, and quality of care (objective 1) as well as optimization of the network (objective 2) (through for instance sharing facilities or specializing for increased volume) are largely under-represented. In the context of hospital reforms and relative uncertainty regarding survival, what matters, and hence what is measured and looked at with scrutiny by the supervisory board and the management board, are volume and prices (content of the contracts with EHIF) and patient satisfactions (patient complaints essentially). Hence, we generally observe significant discrepancies between strategic statements, performance measurement and internal accountability structures. The discrepancies between stated priorities and performance measures were explained by a lack of data (though a lot of data are being collected, see below), a lack of knowledge of the tools (indicators, reports) and a lack of leadership or interest in investing in an integrated performance management system.
13. On the importance and difficulty of aligning incentives / one country example Stated objectives Measurable targets:
Reduce average length of stay
Reduce acute care beds
Increase bed occupancy
14. Focus on economical and financial indicators rather than quality
Don't use the word performance in Estonia. This word is mostly understood by the stakeholders and politicians as financial balance and economical sustainability. What matters for them is 1) finance, 2) volume of services (and waiting list), and 3) complaints (scandals in newspapers).
Focus on long-term survival and access to scarce resource
The strategic priority is to survive in a difficult environment with less funding and more waiting time -- Supervisory board are essentially interested on financial and economical issues; they do not interfere in quality issue. The only quality discussed by supervisory board are volume and bed use
With competition,
Either define a unique competitive advantage
Either compete on all fronts to maximise volume
with the competition, are we supposed to increase our volume or to do what we are supposed to do and cooperate with primary care?
In this context, build reputation on quality of care, scrutinized by supervisory board: volume, prices and patient satisfactionFocus on economical and financial indicators rather than quality
Don't use the word performance in Estonia. This word is mostly understood by the stakeholders and politicians as financial balance and economical sustainability. What matters for them is 1) finance, 2) volume of services (and waiting list), and 3) complaints (scandals in newspapers).
Focus on long-term survival and access to scarce resource
The strategic priority is to survive in a difficult environment with less funding and more waiting time -- Supervisory board are essentially interested on financial and economical issues; they do not interfere in quality issue. The only quality discussed by supervisory board are volume and bed use
With competition,
Either define a unique competitive advantage
Either compete on all fronts to maximise volume
with the competition, are we supposed to increase our volume or to do what we are supposed to do and cooperate with primary care?
In this context, build reputation on quality of care, scrutinized by supervisory board: volume, prices and patient satisfaction
15. Health promotion in hospitals Health promotion: the process of enabling to increase control over and to improve their health (Ottawa Charter for health promotion)
Aims at improving the health of hospital patients both
by improving the quality of hospital services
and by offering additional services when necessary
Strategies for all target groups aim at improving
self management of health (including health / disease literacy, lifestyles etc.)
the co-production of health
the health impact of the hospital setting
at supporting communities to improve their health impacts on the target groups.
Increasing prevalence of lifestyle related disease requires a more expended scope and systematic provision of activities such as education, effective communication strategies to enable patients to take an active role in chronic disease management or motivational counselling
This concept aims at improving the health of hospital patients, staff and the community population, both by means of improving the quality of hospital services, and by offering additional services where necessary. Strategies for all target groups aim at improving self management of health (including health / disease literacy, lifestyles etc.), improving the co-production of health, at improving the health impact of the hospital setting, and at supporting communities to improve their health impacts on the target groups. Increasing prevalence of lifestyle related disease requires a more expended scope and systematic provision of activities such as education, effective communication strategies to enable patients to take an active role in chronic disease management or motivational counselling
This concept aims at improving the health of hospital patients, staff and the community population, both by means of improving the quality of hospital services, and by offering additional services where necessary. Strategies for all target groups aim at improving self management of health (including health / disease literacy, lifestyles etc.), improving the co-production of health, at improving the health impact of the hospital setting, and at supporting communities to improve their health impacts on the target groups.
16. Health promoting hospitals Strategies for the
hospital managers:
Variety of experiences with some evidence in the region
From a hospital manager perspective, what can be done
Evidence on activities which work
But how to measure what is done and the impact?
And then how to provide financial incentives?
From a hospital manager perspective, what can be done
Evidence on activities which work
But how to measure what is done and the impact?
And then how to provide financial incentives?
17. Health promoting hospitals Strategies for the hospital managers:
How to measure health promotion?
From a hospital manager perspective, what can be done
From a stewardship perspective, what can be done
-
From a hospital manager perspective, what can be done
From a stewardship perspective, what can be done
-
18. Health promotion in hospitals Strategies for steward/purchaser: financial incentives?
Incentives aimed at the provider: how to purchase for education activities? Pilot to introduce a component in the DRG in DK issue with documentation of soft services
Incentives aimed at the patient
From a hospital manager perspective, what can be done
From a stewardship perspective, what can be done
-
From a hospital manager perspective, what can be done
From a stewardship perspective, what can be done
-
19. Integration and continuity of care Strategies for the hospital manager
Cross-setting clinical care pathways (Belgium and Slovenia)
Establish function for coordination and early discharge preparation (e.g. case manager, discharge planer)
Monitor readmissions
Understand reasons for delayed discharge
Undertake surveys among other care providers
Collaboration agreements with other care providers
Cross training programs for GPs, home nurses, etc.
Again directly link to Enis
Definitions
From a hospital manager perspective, what can be done
Clinical care pathways see example of Belgium and Slovenia
Establish function for coordination and early discharge preparation (e.g. case manager, discharge planer)
Monitor readmissions
Understand reasons for delayed discharge
Undertake surveys among other care providers
Collaboration agreements with other care providers
Cross training programs for GPs, home nurses, etc.
From a stewardship/financing perspective, what can be done
Reduce fragmentation in the delivery process integrated primary care with specialist services works better than
How to align incentives for ¨providers (hospitals, primary care, but also LTC/rehabilitation) along the continuum of care? ? calls also for appropriateness / allocative efficiency can they share a market? Are they competitors?
Establish indicators covering this E.G. NIP Denmark, planned outpatient treatment at discharge
Readmissions partially financed
Hospital stay not financed if discharge letter not sent within 48 hours
P4P also from the GPs e.g. admission for ambulatory care sensitive conditions
Section on the hospitals annual report
Hospital governance accountability population perspective into the governing board
Again directly link to Enis
Definitions
From a hospital manager perspective, what can be done
Clinical care pathways see example of Belgium and Slovenia
Establish function for coordination and early discharge preparation (e.g. case manager, discharge planer)
Monitor readmissions
Understand reasons for delayed discharge
Undertake surveys among other care providers
Collaboration agreements with other care providers
Cross training programs for GPs, home nurses, etc.
From a stewardship/financing perspective, what can be done
Reduce fragmentation in the delivery process integrated primary care with specialist services works better than
How to align incentives for ¨providers (hospitals, primary care, but also LTC/rehabilitation) along the continuum of care? ? calls also for appropriateness / allocative efficiency can they share a market? Are they competitors?
Establish indicators covering this E.G. NIP Denmark, planned outpatient treatment at discharge
Readmissions partially financed
Hospital stay not financed if discharge letter not sent within 48 hours
P4P also from the GPs e.g. admission for ambulatory care sensitive conditions
Section on the hospitals annual report
Hospital governance accountability population perspective into the governing board
20. Integration and continuity of care Mechanisms available to the steward/purchaser
Key issues:
How to reduce fragmentation in the delivery process?
How to align incentives for providers along the continuum of care?
Some potential ways forward:
Develop indicators for integration and continuity, e.g. NIP Denmark, planned outpatient treatment at discharge
Generate evidence provide guidance: clinical pathways
Establish some purchasing mechanisms
Readmissions partially financed
Hospital stay not financed if discharge letter not sent within 48 hours
P4P also from the GPs e.g. admission for ambulatory care sensitive conditions
Increase accountability for integration and continuity:
Section on the hospitals annual report
Hospital governance
Population perspective into the governing board
Key issues:
How t reduce fragmentation in the delivery process integrated primary care with specialist services works better than gatekeeper function
How to align incentives for providers along the continuum of care? ? calls also for appropriateness / allocative efficiency can they share a market? Are they competitors?
Some potential ways forward:
Develop indicators for integration and continuity, e.g. NIP Denmark, planned outpatient treatment at discharge
Readmissions partially financed
Hospital stay not financed if discharge letter not sent within 48 hours
P4P also from the GPs e.g. admission for ambulatory care sensitive conditions
Increase accountability for integration and continuity: Section on the hospitals annual report
Hospital governance accountability population perspective into the governing board
Key issues:
How t reduce fragmentation in the delivery process integrated primary care with specialist services works better than gatekeeper function
How to align incentives for providers along the continuum of care? ? calls also for appropriateness / allocative efficiency can they share a market? Are they competitors?
Some potential ways forward:
Develop indicators for integration and continuity, e.g. NIP Denmark, planned outpatient treatment at discharge
Readmissions partially financed
Hospital stay not financed if discharge letter not sent within 48 hours
P4P also from the GPs e.g. admission for ambulatory care sensitive conditions
Increase accountability for integration and continuity: Section on the hospitals annual report
Hospital governance accountability population perspective into the governing board
21. Responsiveness to community needs District health authorities/boards
Contractual arrangements
Population participation
Hospital autonomy
District health authorities/boards
Contractual arrangements
Population participation
Enter into contractual arrangements --- e.g. buy beds District health authorities/boards
Contractual arrangements
Population participation
Hospital autonomy
District health authorities/boards
Contractual arrangements
Population participation
Enter into contractual arrangements --- e.g. buy beds
22. Responsiveness to community needs
23. Responsiveness to community needs
24. Healthcare providers performance a complex and diverging construct Performance is a divergent problem (Schumaker 1977) and as such is paradoxical: it involves opposite ideas which, although they appear contradictory, are equally necessary to reflect the reality that neither propositions contain in themselves (Slaate 1968)
Assesment of performance using different criteria/models will lead to different judgments
27. EGIPSS conceptual meta model
28. Several frameworks 2 universal problems According to Christopher Murray et Julio Frenk (2000), approaches to health system performance fall into two related traps:
Some are inclusive lists of multiple, and often overlapping, desirable attributes of health system
Others start from a consideration of which indicateurs are readily available
Ť Both approaches are unsatisfactory for a comprehensive and meaningful assessment of health system performance ť
Ť A Framework for assessing the performance of health systems ť
Bulletin of the World Health Organization, 2000,78 (6), 717-731
Starting point : what are health systems for? And what are hospital for?
This is the key message we tried to conveyed during those 2 presentationsAnd what are hospital for?
This is the key message we tried to conveyed during those 2 presentations
