Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. We searched for relevant performance indicators and their domains across the eight countries. The paucity of research examining the links between indicators and improvement may be due to the difficulty in attributing change to any particular policy initiative or intervention.49, The literature supports the use of performance indicators, suggesting that their impact is more likely to be on provider rather than consumer behaviour.43,50 However, there is a general call for more good quality studies on impact.50–52. The performance indicators were subjected to a detailed assessment and were classified according to whether they applied to community/hospital/population, country of origin and clinical specialty. This will provide comparative cases and information on progress for the benefit of regulators, policymakers and researchers within those countries and elsewhere, but is of particular use to policymakers interested in constructing future frameworks. Thus, indicators tend to be developed in a relatively open and transparent way, with input from individuals and stakeholder organisations. After the audit process is complete, the data are released publicly, including comments on the results from the audit groups.40 Reports on many of the indicators are available on the www.sundhed.dk website. When autocomplete results are available use up and down arrows to review and enter to select. Login failed. A performance indicator is not a synonym for quality, but rather a proxy. FundingThis work was supported, in part, by the National Health Performance Authority, Australia (but no one including the Authority’s officers had a role in the study, its conduct, results, interpretation or publication of this article) and the National Health and Medical Research Council (APP1054146). In reviewing existing targets and indicators for health and social care, this report considers first what the policy framework for public sector bodies tells us about the aims and objectives of the health and social care system. 12). 2010-11 is the last year of the NIS indicators and the Social Care and Mental Health indicators are being replaced by the Adult Social Care Outcomes Framework for 2011-12 onwards. It’s vital to understand how efficiently you are operating while finding areas to improve your services. Cordasev, H, Arne Björnberg, M, Hjertqvist, O. Raleigh, VS, Foot, C. Getting the measure of quality: opportunities and challenges. Be partnership-oriented. Key Performance Indicators define factors the institution needs to benchmark and monitor. For more information view the SAGE Journals Sharing page. Lean Library can solve it. This comprises three performance frameworks: the NHS Outcomes Framework, which focuses on performance and accountability; the Clinical Commissioning Group (CCG) Outcomes Indicator Set aimed at helping the CCG in planning and benchmarking and providing information to consumers and the Quality and Outcomes Framework (QOF) which is a voluntary pay for performance programme for general practice in England.23, The Dutch framework, by comparison, is relatively streamlined and more consumer-focussed. a number of key performance indicators (KPIs) for assessing the performance of healthcare accreditation programmes in order to contribute to the current knowledge in performance measurement and improvement in public sector and specifically health care. A review of the evidence, Australian Institute of Health Innovation, University of New South Wales, Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. By continuing to browse Much of this interest in quality of care has developed in response to recent dramatic transformations of health care systems, accompanied by new organizational structures and reimbursement strategies that may affect quality of care. This article provides a simple framework to analyse key performance issues related to the functions of health financing within the context of social health insurance. While some of the indicators are the same as those listed by SC, there are some additional hospital performance indicators (21 in total).36 Additionally, the Government of Canada37 has a candidate list of 70 indicators that were approved for use by Federal, Provincial and Territorial Ministers of Health in 2004. The Organisation for Economic Co-operation and Development (OECD) publishes 60 internationally comparable indicators of healthcare quality.9 These are useful and influential. Selected countries and indicators for performance evaluation of their health system 4.1. There were 101 performance indicators listed on the SC website.35 The CIHI also has indicators listed under the Canadian Hospital Reporting Project (CHRP). However, many countries, even those with advanced data systems, have difficulty linking practice performance to outcomes because of limitations in data availability and poor capabilities to link data. Number of international indicators by domain and community, hospital and population. As such you will probably find that you are already using KPIs in your practice, but perhaps you don’t realise it. For more information view the SAGE Journals Article Sharing page. Summary of the eight countries: demographic characteristics and health performance frameworks. Most of the eight countries have an overarching framework for the selection and reporting of indicators which establish the broader aims for their implementation activity and play a large role in indicator selection and use. Few studies make comparative assessments of different countries’ performance indicator frameworks. Although we presented the self-reported domains by country, consistency of definitions between countries and the level of semantic overlap was not tested; however, these are likely to be substantial. The search in eight countries found 401 indicators that fulfilled the ‘nationally consistent and locally relevant’ criteria we applied. Health system performance comparison: an agenda for policy, information and research. The quality of health care is on the agenda in most health care systems. the UK NHS’s ‘star-ratings’ system of 2001–2005)47 and those that use results for non-publicised feedback to organisations to stimulate improvement. Table 5. A large amount of comparative information about international performance indicators is now available.53 We examined the systems in use in eight countries. Of the 11 frameworks published in five countries and the OECD, the most frequently used (self-reported) domains were effectiveness (eight), access and safety (seven each) and efficiency (five; Table 2). For example, the OECD considers these two domains as separate while the Australian framework considers appropriateness as a subset of effectiveness.6,18 Because of this, and hierarchical relationships between domains within some frameworks, it is difficult to report the number of indicators used against each domain for each country. For more than two decades, regulators, policymakers, researchers and clinicians have endeavoured to improve the quality of healthcare by designing and applying indicators of performance. Please check you selected the correct society from the list and entered the user name and password you use to log in to your society website. Within these, eight domains of health system performance are defined.19,21. The role of NICE in England exemplifies a thorough and considered approach to continued indicator development. In Australia, the National Health Performance Authority (NHPA)16 was established under the Australian National Health Reform Act 201117 as an independent portfolio agency to monitor and report on healthcare system performance; it has since been merged with the Australian Institute of Health and Welfare. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Definitions for these domains are often not explicit in the policy documents.20 Definitional consistency between countries should be the subject of more research or efforts to internationally standardise. Developing indicators for the Commissioning Outcomes Framework (COF): interim process guide. Other indicators of family health could be extrapolated from the addi-tional concepts that King identified as impor-tant for understanding social systems: orga- Identification of comparable international indicators and analyses of their characteristics and of their broader national frameworks and contexts were undertaken. We’ve assembled a collection of sample Key Performance Indicators for you to use as a starting point when building scorecards. Of these, 45 indicators are reported in more than one country. Australia’s health 2010 (Australia’s Health Series No. Nationally consistent and locally relevant indicators by disease group. Access to society journal content varies across our titles. 1.2.2 Recognize that there are multiple dimensions of health. Standards and indicators for care services. Nationwide continuous quality improvement using clinical indicators: the Danish National Indicator Project, Connections between quality measurement and improvement, Clinical indicators in accreditation: an effective stimulus to improve patient care, Performance management in healthcare: part II – state of the science findings by stage of the performance measurement process, Using performance indicators to improve health care quality in the public sector: a review of the literature, What’s measured is what matters: targets and gaming in the English public health care system, Does providing feedback on patient-reported outcomes to healthcare professionals result in better outcomes for patients? As part of its Strategic Plan 2012–2015,16 NHPA is required to regularly review its Performance and Accountability Framework (PAF) to ensure it remains relevant and continues to address the needs of the Australian public for high-quality healthcare. The progress they have made, and choices taken in selecting and using indicators, might be of value for other health systems in contemplating the development of their indicators or frameworks, or modifying their performance mechanisms. Cross border care EU: how to choose the best hospital? A key finding was the widespread support for implementing a healthcare system performance framework. NICE has developed guides,32,33 which set out in detail the processes involved in managing the development of indicators. Publication date: 2005 Van den Berg, M, Heijink, R, Zwakhals, L. National Institute for Health and Clinical Excellence . Performance Indicators* Pre-K-Grade 2 1.2.1 Identify that healthy behaviors impact personal health. For example, the Health Indicators 2013 report20 provides results for 88 indicators, 13 of which were additional indicators chosen to be included to measure performance by socioeconomic status at provincial and national levels.20 Although this appears confusing from an external perspective, variable reporting may be more effective in some instances, as CIHI addresses reporting needs by acknowledging different audiences and tailoring reporting for their requirements. For example in the Australian PAF, the domain appropriateness is subordinate to, or sub-class of, the domain effectiveness.18 In Canada, these two domains are not grouped, but are classified as separate concepts. NI125, NI127, NI130, NI145, NI146, NI149 and NI150 will appear in the new framework, although there will be some small changes to the definitions. It seeks to answer the question ‘performance of what – and to what ends?’6 Reasons given for developing such a framework are as follows: (1) to define the scope and dimensions of measurement;24,6 (2) to help align the performance measurement system with other policy priorities and financial exigencies;43 (3) to provide a clearly defined vision to encourage buy-in by clinicians and consumers24,43 and (4) by involving potential end-users of the data in the design of the framework, to ensure its future usefulness.44 A conceptual framework encompassing multiple domains and with balanced representation across structure, process and outcome indicators is considered to be a key element of health reform over time.45. The HCP integrated commissioning framework defines KPIs as: Organisation for Economic Co-operation and Development . The timing and mechanism of reporting on indicators were not consistent between countries, nor were they always internally consistent. The framework first illustrates how performance in the health financing functions of revenue collection, pooling and purchasing affects the realisation of health financing targets of resource generation, optimal resource use and financial accessibility of health services for all. People performance management is important and doing it well has a big impact on the quality of care that your service provides. The health system performance frameworks for each country were reviewed together with their accompanying online and published documentation. The Canadian framework has two main goals: to determine (1) the health of Canadians and (2) how well the health system performs and operates according to the published principles of providing reports that respect Canadians’ privacy and are also consistent, relevant, flexible, integrated, user-friendly and accessible.19,20 The indicator framework is conceptualised in terms of the provision of high-quality comparative information across four dimensions. Although there is a substantial literature dealing with the design, properties and scientific soundness of individual indicators, there is considerably less attention given to how indicators are used in practice and the impact they may have on the behaviour of health professionals, or on the quality of care. We classified the indicators, where possible, into major disease groups (Table 5). Indicators reported locally (at regional levels) occur via the Dutch Hospital Database. Concepts that focus on both health promotion and risk reduction are included in the performance indicators. The email address and/or password entered does not match our records, please check and try again. While there is no answer to questions such as how many indicators, which domains should be targeted or what should be the right mix of indicators, there is a fundamental debate centred on whether the purpose of performance indicators is accountability or quality improvement.41–43,46 Internationally, there is a split between those countries which emphasise public reporting and accountability (e.g. At the time of the study, this provides advanced indicators and applies them throughout the country. Assessment techniques provide the mechanism for measuring and evaluating the defined factors to evaluate progress or impact. . There are national and international incentives for rating the performance of health systems. Papanicolas, I, Kringos, D, Klazinga, NS. In this study, the eight countries selected for review were using indicators and had implemented a performance framework, several over more than a decade. Sign in here to access free tools such as favourites and alerts, or to access personal subscriptions, If you have access to journal content via a university, library or employer, sign in here, Research off-campus without worrying about access issues. However, only of late has systematic evidence about quality of care begun to be collected in most health care syst… Some indicators were classified into more than one category (Table 4). The focus of this set of indicators is directed towards the question how care homes can measure and manage improvements with regard to the quality of life of their clients, and the related issues of quality of care, management, economic performance and relationships with external stakeholders. Several low- and middle-income countries are interested in extending their existing health insurance for specific groups to eventually cover their entire populations. However, it is difficult to gauge how many indicators are in use, because only certain indicators are selected for inclusion in the annual reports and there appear to be various degrees of overlap. Typically is expressed in term… important role in achieving our mission to provide excellent and efficient services working in partnership with residents and the wider local community SAGE Publications Ltd, unless otherwise noted. This site uses cookies. We selected eight prominent health systems for review and assessment based on purposively selecting a sample that were exemplars in using indicators and making their data and performance systems available: Australia, Canada, Denmark, England, the Netherlands, New Zealand, Scotland and the United States. Secondly, it reviews the evidence as to how we might develop targets and indicators as Several of the indicators will measure progress towards more than one of the National Health … The World Health Organisation (WHO)1 and others2,3 have attempted to rank health systems for the insights gained from global comparisons, while consumers have an interest in selecting the best provider for treatment for their particular condition and knowing that their taxes are being spent wisely.4 To meet these multiple demands, performance indicators (‘measurable elements of practice performance for which there is evidence or consensus that they can be used to assess the quality, and hence change of quality, of care provided’) and performance frameworks (‘conceptual frameworks that set out the rationale and design principles for an indicator set’)5,6 are typically designed to routinely monitor aspects of healthcare performance such as effectiveness, efficiency, safety and quality.7 The quest for a single composite indicator of quality, prevalent in the early days of indicator development, has largely been abandoned in favour of multidimensional frameworks.1 Indicator sets commonly contain a combination of structure, process and outcome assessments.8. The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes and identify areas for improvement. This study identifies and compares frameworks and performance indicators used in selected Organisation for Economic Co-operation and Development health systems to measure and report on the performance of healthcare organisations and local health systems. Understand, in particular, how the performance of adult social care and NHS services are dependent on each other, and that there is a shared imperative to prevent health Then, within each health financing function, key performance issues and associated measurable indicators are developed. The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes … Performance indicators are a popular mechanism for measuring the quality of healthcare to facilitate both quality improvement and systems management. An example of a framework which operates at multiple geographical levels is that used in England’s National Health Service (NHS). Languages: English. Scotland conceptualised its Quality Measurement Framework on three levels to structure and coordinate the range of measurements that are taken across NHS Scotland. Australian Institute of Health and Welfare . Healthcare and Social Assistance KPIs. If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box. Our single indicator menu is made up of 3 types of indicator: General practice indicators suitable for use in the QOF; General practice indicators suitable for use outside of the QOF; Clinical Commissioning Group indicators. Create a link to share a read only version of this article with your colleagues and friends. Performance indicators are quantitative tools and are usually expressed as a rate, ratio or percentage. Devising primary care performance indicators for New Zealand, A conceptual framework for the OECD Health Care Quality Indicators Project, Primary health care reform in Australia – report to support Australia’s first National Primary Health Care Strategy, 2011 National healthcare quality and disparities reports, Rising to the challenge – results from a scorecard on local health system performance, Conceptual frameworks for health systems performance: a quest for effectiveness, quality, and improvement, Correlates of health and healthcare performance: applying the Canadian health indicators framework at the provincial-territorial level, International profiles of health care systems, Developing a national performance indicator framework for the Dutch health system, Health care performance in the Netherlands: easy access, varying quality, rising costs, OECD reviews of health care quality: Denmark: executive summary, assessment and recommendations, About the Quality and Outcomes Framework (QOF), Unintended consequences of performance measurement in healthcare: 20 salutary lessons from the English National Health Service, Health indicators 2013: definitions, data sources and rationale, Canadian Hospital Reporting Project technical notes – clinical indicators, Healthy Canadians: a federal report on comparable health indicators. This can be seen in the reporting on Canada’s health system performance, where various indicators are reported via multiple channels. This paper outlines the core suite of indicators, summarising the rationale for inclusion and information on the proposed definition and data source for each indicator in section . Used to promote consumer choice at a regional or local level in May 2013 the system... You will probably find that you are operating while finding areas to improve your.., Denmark, England, the Netherlands, New Zealand, Scotland the..., coronavirus disease outbreak ( COVID-19 ) », Applied health Economics and Policy... Enter to select point when building scorecards 1.2.2 Recognize that there are multiple dimensions the., Lim, Y-W, Mattke, S. does public release of performance indicator use is shown Tables. Coronavirus disease outbreak ( COVID-2019 ), coronavirus disease outbreak ( COVID-2019 ), coronavirus disease outbreak COVID-2019! 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