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

Creating and using Performance Indicators

inDutch Hospitals

Jan Haeck

Dutch Health Supervisory

OECD 1

Outcome is pivotal!

OECD 2

An indicator is a signal; further investigation is mandatory

OECD 3

IntentionsHealth authority Patientsafety

Effectiveness Appropriateness

Hospital Accountability; TransparencyQuality-improvement

Patient ChoiceQuality-assurance

Healthinsurance Value for money

World Health Care Congress 1

OECD 4

Selection criteria

• Feasibility• Focus on hospital care• Clinical relevance• Frequent manifestation• Obvious and rapid improvement of quality

outcome

OECD 5

….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

!

The Set: External Indicators

Internal Indicators

Clinical Scientific Societies

oecd 7

0,0

5,0

10,0

15,0

20,0

25,0

1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65

hospitals

perc

en

tag

e

0

5

10

15

20

25

30

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67

hospitals

per

cen

tag

e

2004

2003

6%

11%

Annual pressure-ulcer point-prevalence

measurement

oecd 8

Results Set Performance

Indicators

+

Results specific inspections

Annual meeting with the executive

board

Disciplinary measures(if necessary)

oecd 9

0

20

40

60

80

100

120

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55

Hospitals

Per

cen

tag

e

2003 (78%)

2004 (79%)

Percentage of patients to get surgery after a hip fracture within

24 hours

0

20

40

60

80

100

120

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61

Hospitals

Per

cen

tag

e

oecd 10

0102030405060708090

100

pa

inse

rvic

e

inte

gra

ted

dia

be

tesc

are

he

art

failu

reo

utp

atie

ntc

linic

stro

kese

rvic

e

bre

ast

can

cer

ou

tpa

tien

tclin

ic

ho

sp

ita

ls (

%) service available in

2003service available in2004data available in 2003

data available in 2004

Innovations in quality2003/2004

oecd 11

2004

6514

20

6

known

unknown

no answer

not applicable

2003

36

49

14

6

Data available about readmissions for heartfailure within 12 weeks after

discharge

(number of hospitals)

oecd 12

25

20

50

2

all patients

selected patients

no

no answer

85

15

3 2

73

25

5 2

2003

2004Data available for standardized pain

measurement within 72 hours postoperative

(number of hospitals) Recovery room

All hospital wards

oecd 14

0

10

20

30

40

50

60

70

80

90

1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89

hospitals

num

ber o

f OC

R p

roce

dure

s

0

10

20

30

40

50

60

70

80

90

1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89

Hospitals

Nu

mb

er o

f O

CR

pro

ced

ure

s

2003

2004

Oesophagus-cardia resectie

oecd 16

0

2

4

6

8

10

12

Ave

rag

e ve

nti

lati

on

per

iod

in

day

s

level 3 level 2 level 1

2003

oecd 18

Conclusions

Health authority Supervision only in risk-bearing hospitals

Hospital More data; improved quality of care; 100% transparent; guidelines by professionals

Patient Safety indicators; choice because of transparency

Health insurance Value for money (yet to be proven)

oecd 20

Perverse effects?

• 'gaming the numbers‘• Increase in bureaucracy: • An obstacle for innovations and ambitions• A decrease in solidarity between hospitals

oecd 21

Thank you

Oecd 22