Healthcare Performance Measurement Research Articles

Impact of IFRS 15 adoption on performance measurement in healthcare – the case of National Health Service Foundation Trusts

Impact of IFRS 15 adoption on performance measurement in healthcare – the case of National Health Service Foundation Trusts

Refocusing primary health care performance measurement on governance and management: A multi-country, joint learning approach applied in the WHO European Region

Refocusing primary health care performance measurement on governance and management: A multi-country, joint learning approach applied in the WHO European Region

Review of the National Quality Forum's Measure Endorsement Process.

The National Quality Forum (NQF) evaluates healthcare performance measures for endorsement based on a broad set of criteria. We extracted data from NQF technical reports released between spring 2018 and spring 2019. Measures were commonly stewarded by federal agencies (44.29%), evaluated for maintenance (67.14%), classified as outcome (42.14%) or process (39.29%) measures, and used a statistical model for risk adjustment (48.57%). For 80% of the measures reviewed, a patient advocate was present on the reviewing committee. Validity was evaluated using face validity (65.00%) or score-level empirical validity (67.14%), and reliability was frequently evaluated using score-level testing (71.43%). Although 91.56% of all reviewed measures were endorsed, most standing committee members voted moderate rather than high support on key assessment criteria like measure validity, measure reliability, feasibility of use, and whether the measure addresses a key performance gap. Results show that although the Consensus Development Process includes multidisciplinary stakeholder input and thorough evaluations of measures, continued work to identify and describe appropriate and robust methods for reliability and validity testing is needed. Further work is needed to study the extent to which stakeholder input is truly representative of diverse viewpoints and improve processes for considering social factors when risk adjusting.

Comparative Ethics of Modern Payment Models

Comparative Ethics of Modern Payment Models

Development of national framework for health status and health system performance indicators in Saudi Arabia

BackgroundThe global shift to value-based care has highlighted the necessity for performance measurement in healthcare. While the implementation may be incomplete, governments and providers have been moving towards value-based models of care delivery, funding and performance measurement. ObjectivesThe purpose of this report is to illustrate the steps taken in designing the framework in Kingdom of Saudi Arabia (KSA), using a 4-step approach: Key Input Analysis, Hierarchy Design, Indicator Analysis and Selection, and Indicator Profile Development. Furthermore, it presents a comprehensive view of the indicators collected to measure performance at the level of the Health System and Health Status in KSA and highlights main patient concerns, thus providing an overview of a new, unified national framework. MethodsThe methodology entailed examined the following components’ remits and roles, reporting mechanisms and channels, and performance indicators across all pertinent National Health agencies (NHA), by conducting a SWOT analysis of each of the components across the ecosystem. Engagement with the Steering Committee members was achieved through research and interviews. ResultsA total of 109 indicators were identified, of which 51 were Health Status Indicator Profiles and 58 Health System Indicators. The indicator profiles were developed with consideration of the KSA context in terms of the healthcare ecosystem as it stands today. The findings of this report, alongside the best practices arising from the benchmarking, will be key inputs into the design of the National Framework. ConclusionThe regulatory entity has set out to establish a National Framework, which aims to unify performance measurement in KSA from both health system and public health perspectives across all sectors providing healthcare services, based on a list of prioritized KPIs and their complete profiles, outlining the formulae, key responsibilities, and reporting mechanisms pertaining to each one.

An Empirical Framework for Assessing the Balanced Scorecard Impact on Sustainable Development in Healthcare Performance Measurement.

Performance appraisal has become an essential tool for healthcare managers due to the frequent and rapid changes in the healthcare sector. Sustainable performance management implies increasing organizations' efficiency and effectiveness while considering all vectors of sustainability. This study examines the impact of digital transformation, accounting information systems, and strategic human resource management improvements on organizational performance and sustainable development. The paper uses the balanced scorecard (BSC) for organizational performance assessment. The paper proposes a theoretical model that integrates the traditional and digital information systems and human resources engagement with the BSC dimensions for sustainable organizational development. The theoretical model is tested in an empirical study involving a questionnaire-based survey of 387 employees with management experience in the healthcare sector. Based on structural equation modeling, the research results showed that the efficiency and effectiveness of strategic human resources management and the accounting information system significantly positively affect the BSC dimensions. Furthermore, the use of BSC in measuring organizational performance has significant effects on sustainable development, with the internal process dimension being the most influential.

6.H. Workshop: Towards improved performance measurement and universal health coverage in oral health care

Abstract Oral diseases are increasingly recognized as one of the most prevalent conditions in Europe, affecting nearly half of the European population. They are the third most expensive diseases to treat in the EU and dental expenditures are set to rise substantially. Within EU countries, oral health policy and financing are most often separated from the general health system and vary considerably between countries with different public and private organisation structures providing oral health services, different levels of out-of-pocket payments for patients and a variety of financing models. Oral diseases are a main driver of unmet need and financial hardship in the EU and particularly affect poorer and marginalized groups. However, current provider payment systems prioritize expensive invasive and technology-based methods which drives public expenditure while disserving the healthcare system's central objective of better health outcomes and reducing waste. Moreover, broad and effective oral health promotion policy that spans various care settings and areas of life is not sufficiently implemented. Oral health care systems thus face complex challenges regarding efficiency, quality and integration of care which requires good evidence to steer oral health policy. However, current health information systems only collect few indicators on oral health and oral health care. There is thus need for an improved evidence base for more meaningful assessments and comparisons of oral health systems performance which would allow better informed policy decisions and enable more targeted and effective oral health interventions. In May 2021 the World Health Assembly approved an historic resolution on oral health which urges Member States to include oral health in universal health coverage (UHC) benefit packages and to shift from the traditional curative approach towards a preventive approach. Oral health and the urgent needs for improving the financing of oral health systems have thereby received increased policy attention also in Europe. In this workshop evidence from a cross-country comparison of oral health financing, access and provision in Europe will be presented and the lack of supportive information systems for oral health system performance assessment will be highlighted. Recent research activities will be discussed such as the Horizon Europe project DELIVER (DELiberative ImproVEment of oRal care quality) which aims to create a synergistic problem-solving ecosystem to improve oral health systems. Debates in oral health research and policy in Europe are influenced by global developments such as the WHO resolution. To this end, the recent call for urgent system reform and policy action to address the burden of oral diseases will be set in context and discussed. Key messages • Oral care systems are still dominated by a traditional curative and technology-driven approach which fail to sufficiently encourage prevention and support holistic and integrated oral health care. • Lack of harmonized data reporting on oral health and oral health system indicators impedes oral care systems performance monitoring and evidence-informed policy-making.

Tools and Methods Used in Performance Measurement in Healthcare

Son yıllarda, sağlık sistemlerinde, hastaların artan beklenti ve ihtiyaçları doğrultusunda hızla gelişmekte olan bağımsız ve tarafsız performans değerlendirme kavramı, denetlenebilir, hasta odaklı, hesap verebilirliği fazla olan, verimli, iyileştirilebilir, sürdürülebilir ve erişilebilir sistemler meydana getirebilmek açısından büyük bir önem taşımaktadır. Performans değerlendirme sürecinin ana aktörlerinden biri, belirli performans göstergelerinin tanımlanabileceği ve sağlık sisteminde gereken alanlarda düzenli olarak kullanılabilecek bir yapının sunulması olmakla beraber, bu sürece netlik kazandırmak amacıyla performansın bütünsel bir görünümünü oluşturabilmek için konuyu odak noktası alan araştırmacılar tarafından, sağlık sisteminin çeşitli yapıtaşlarında farklı araç ve yöntemler kullanılarak çalışmalara devam edilmektedir. Sağlık hizmetlerinde performans değerlendirme, her ne kadar zor ve karmaşık bir süreç olsa da sistemin iyileştirilebilmesi-geliştirilebilmesi adına kritik bir önem taşımaktadır. Bu derleme çalışmasında, sağlık alanında 2011-2021 yılları arasında gerçekleştirilen çeşitli performans değerlendirme çalışmalarında kullanılan araç ve yöntemler incelenerek özetlenmiş, çalışmalarda öne çıkan kavramlar sınıflandırılmıştır. Çalışmanın sonucunda literatürdeki eksikliklerin gözlemlenmesiyle, gerçekleştirilen çalışmanın, mevcut literatüre katkı sağlaması amaçlanmıştır.

Impacts of patient and family engagement in hospital planning and improvement: qualitative interviews with patient/family advisors and hospital staff

BackgroundPatient engagement (PE) in hospital planning and improvement is widespread, yet we lack evidence of its impact. We aimed to identify benefits and harms that could be used to assess the impact of hospital PE.MethodsWe interviewed hospital-affiliated persons involved in PE activities using a qualitative descriptive approach and inductive content analysis to derive themes. We interpreted themes by mapping to an existing framework of healthcare performance measures and reported themes with exemplar quotes.ResultsParticipants included 38 patient/family advisors, PE managers and clinicians from 9 hospitals (2 < 100 beds, 4 100 + beds, 3 teaching). Benefits of PE activities included 9 impacts on the capacity of hospitals. PE activities involved patient/family advisors and clinicians/staff in developing and spreading new PE processes across hospital units or departments, and those involved became more adept and engaged. PE had beneficial effects on hospital structures/resources, clinician staff functions and processes, patient experience and patient outcomes. A total of 14 beneficial impacts of PE were identified across these domains. Few unintended or harmful impacts were identified: overextended patient/family advisors, patient/family advisor turnover and clinician frustration if PE slowed the pace of planning and improvement.ConclusionsThe 23 self reported impacts were captured in a Framework of Impacts of Patient/Family Engagement on Hospital Planning and Improvement, which can be used by decision-makers to assess and allocate resources to hospital PE, and as the basis for ongoing research on the impacts of hospital PE and how to measure it.

The Performance Measurement Frameworks in Health Care: Appropriateness Criteria for Measuring and Evaluating the Quality-of-Care Performance through a Systematic Review

While quality management has become essential in the industrial field, it is still looking for a place in the social field. Experiences remain very divergent, and consensus on the appropriate method and effective tools is still far from being reached. This paper aims to review the literature in the field of performance measurement and management in health care. Studies concerning performance measurement and management in health in all settings were included. Studies before 2018 were identified from PubMed, Scopus, Web of Science, and Google Scholar. We conducted a thematic analysis of the international literature, identifying themes around the terms “performance assessment, performance evaluation, performance measurement, health indicators, conceptual framework, assessment framework, health system performance, and monitoring and evaluation. Thirty-seven articles were reviewed, and a set of conceptual frameworks were analyzed. Results were interpreted following the seven areas of the conceptual framework: Fundamental questions in performance evaluation, aims and objectives, role and goals, performance, conceptual frameworks, dysfunction of the health system, and performance assessment. All areas of care were involved, health promotion, preventive and curative care. For most organizations, performance measurement was in a relatively early stage of development or implementation. However, some dysfunctions were identified: a lack of systematic outcome assessment, a lack of documentation, a lack of resource evaluation related to quality for specific diseases, and persisting variations among providers in care for similar patients.

The current and potential uses of Electronic Medical Record (EMR) data for primary health care performance measurement in the Canadian context: a qualitative analysis

BackgroundElectronic Medical Records (EMRs) are a rich data source to measure and improve quality of care. As Canadian primary health care (PHC) EMRs mature, there is increasing potential use of EMR data for performance measurement. This study identifies and describes current uses of EMR data for performance measurement and considerations to further its potential in the Canadian context.MethodsWe applied a qualitative case study design and descriptive assessment in three phases, consulting multiple data sources including scientific and grey literature, system leaders (n = 41), and clinician/researchers (n = 20). Phases included a multimethod approach to identify initiatives using EMR data for performance measurement across Canadian jurisdictions; in-depth review of current initiatives identified from a healthcare performance intelligence lens; and triangulation and thematic analysis across data sources to explore considerations for advancing performance measurement uses of EMR data in the Canadian context.ResultsSix initiatives of EMR data use for performance measurement were identified: one multi-jurisdictional; five jurisdiction-specific in the provinces of British Columbia, Manitoba and Ontario. EMR data uses were predominately for micro-level PHC physician and team performance improvement, with some use for meso-level organization/network-wide improvement. Indicator sets varied in number, though shared emphasis on chronic disease management and prevention/screening and to a lesser extent medication management. Key considerations for governing, resourcing and implementing EMR data for performance measurement were identified.ConclusionsThe extent of EMR data use for performance measurement varies across Canada. To further its potential, pan-Canadian data and privacy standards, performance intelligence competencies and renewed core PHC indicators should be prioritized. Experiences across countries, coupled with increasing momentum for performance measurement using real-world data, should be leveraged to avoid unnecessarily slow progress in Canada and abroad.

A performance measurement model for the housekeeping services in healthcare facilities

PurposeThe purpose of this study is to develop a customised model to measure the performance of housekeeping (HK) services in Sri Lankan health-care facilities.Design/methodology/approachAn exploratory sequential mixed approach was adopted in the study to collect and analyse data. A case study strategy was adopted in the initial phase to explore the current HK practices, and to determine the applicable key performance indicators (KPIs) found through literature. Semi-structured interviews were used as the data collection method in the selected case studies. A questionnaire survey was conducted in the next phase to verify the validity of case study findings. Quantitative data were analysed using descriptive statistics. One sample t-test was used to identify significant KPIs and to formulate the customised performance measurement (PM) model.FindingsThe study identified and ranked 46 KPIs, which can be used to measure the performance of HK divisions of health-care facilities, in balanced scorecard perspectives. The findings also revealed that the KPIs determined using the model have a significant impact on implementing effective health-care HK services and could be used to measure both real and subjective cleanliness.Practical implicationsThe developed model can be used for numerous PM requirements in health-care setups in both developing and developed countries. The KPIs determined using this model can be presented in quality audits and government inspections as proof of effective HK management. The HK managers of the health-care sector can effectively monitor the performance of their divisions using the proposed PM model and this model can be customised to match the other facilities management service divisions.Originality/valueMany studies focus on overall health-care PM. This study expands the knowledge on HK PM in the health-care sector by presenting a collection of performance indicators centred on HK function.

The Performance Measurement Frameworks in Healthcare: Scopus Study

Object: The purpose of this article is to analyse and compare the frameworks of performance measurement in primary health care in the world. The objective is to determine whether the frameworks of performance measurement in primary health care have an influence on the performance of health centres. Method: We conducted a systematic review of the literature to: (a) identify a conceptual framework for measuring quality management systems; and (b) assess the effects of the conceptual framework on quality improvement and quality of care outcomes. We chose frameworks highly cited in the literature and analysed and compared these frameworks. Results: Eight dimensions were identified for assessing performance in primary health care facilities (PHCFs) in more than 50% frameworks: effectiveness, safety, accessibility, equity, efficiency, acceptability, patient-centredness and timeliness. Conclusion: Even if the links are not established within the framework of a scientific research, quality approaches are generally recognised as an essential tool to help establishments improve their quality of care and the safety of their patients. Until now, the evaluation of the quality of care in the 'PHCF' is not yet in place, a blatant need for performance measurement tools, relevant information, coherence between the operational and strategic levels, integration of organizational objectives in the measurement of performance in order to direct the structures towards a true management by quality.

Bir Diş Kliniğinin Performansını Etkileyen Faktörlerin Analizi

Quality and productivity management in healthcare has received considerable attention over the past four decades. Many research papers dealing with various aspects of healthcare performance have been published in the literature. However, medical organizations and hospitals are still lacking enough technical knowledge related to performance and quality improvement tools. This paper presents a procedure to study the effects of various factors on healthcare performance measures in a dental clinic. Particularly, we have analyzed a dental clinic system and investigated the effects of treatment types, dentist experience, and the patient age on treatment times using design of experiment and related analysis. The procedure presented here demonstrates a useful application of performance and quality improvement tools in healthcare organizations for healthcare managers.

Do performance measurement models have any impact on primary health care? A systematic review

PurposeThe purpose of this article is to analyze and compare between the frameworks of performance measurement in primary health care in the world. The subject of search is to compare if the frameworks of performance measurement in primary health care have an influence on performances of health centers.Design/methodology/approachWe conducted a systematic review of the literature to (1) identify the conceptual framework for measuring quality management systems, (2) assess the effects of conceptual framework on quality improvement and quality of care outcomes. We opted for the frameworks that are more cited in the literature and we analyzed and compared between these frameworks.FindingsEight dimensions were identified for assessing performance in Primary Health Care Facilities “PHCF” in more than 50% frameworks: Effectiveness, Safety, Accessibility, Equity, Efficiency, Acceptability, Patient Centeredness and Timeliness.Research limitations/implicationsThe limits of this study can be represented by the following elements: (1) lack of exhaustiveness with regard to the current Frameworks. (2) The evaluation of reliability and validity of the qualitative studies remains difficult to appreciate. (3) Most of the evaluation tools of the primary health care are not validated yet. (4) The difference in performance levels between countries, especially for the developed countries and the multitude of the frames of measure of performance, limits the comparability of the results.Practical implicationsThis study provides a conceptual and descriptive literature on the different conceptual frameworks for performance measurement in primary health care, and a practical and useful tool for comparison between the different conceptual frameworks. Several organisations of accreditation or certification introduced, developed, incorporated and checked the indicators of clinical quality in the organizations of health care. Some studies revealed links with the governance, the access, the continuity, the coordination, the efficiency and the strength primary care (Dionne Kringos, 2018). Improvements in the quality of care have been observed in the results of accreditation and certification bodies regarding hospital infection control infrastructure, organization and performance.Originality/valueEven if the links are not established within the framework of a scientific research, quality approaches are generally recognized as an essential tool to help establishments to improve the quality and the safety of the patients. Until now, it is not still common to make evaluation of the quality of care in the “PHCF” to obtain the relevant information. The necessity of having performance measurement tools, which puts in coherence the piloting of the operational level with the strategy, to integrate the organizational objectives into the measures of operational performances and make estimate its structures towards a real management by the quality.

Social Risk Adjustment in Health Care Performance Measures

Social Risk Adjustment in Health Care Performance Measures

The NQF Scientific Methods Panel

In the summer of 2017, the National Quality Forum (NQF) announced the formation of a Scientific Methods Panel (hereafter referred to as "the Panel") as part of a redesign of its endorsement process. NQF created the Panel in response to stakeholder request during a Kaizen improvement event held in May 2017. Given the Panel's role in the endorsement of performance measures used in national payment programs, the objective of this article is to describe the work of the Panel, and to describe its function in the larger context of the NQF measure endorsement process and in the measurement enterprise writ large. This article also serves as an introduction to a series of planned white papers being authored by the panel on specific technical issues in the area of health care performance measurement.

Identification and ranking of specific balanced scorecard performance measures for hospitals: A case study of private hospitals in the Klang Valley area, Malaysia.

Performance measurement is a necessity for private hospitals as they need to be efficient, attract customers, increase profitability, and survive in the competitive environment of the health care industry. Hospitals typically struggle to identify appropriate performance measures because of lack of reliable source of performance measures for private hospitals. Despite numerous studies on performance measurement, few studies have focused on performance measures in private hospitals. This paper aims to fill that gap by identifying and ranking a specific set of performance measures that are feasible and relevant for private hospitals. Forty-four health care performance measures in four balanced scorecard (BSC) performance perspectives (financial, customer, internal business processes, and learning and growth) were compiled and filtered based on "feasibility" and "relevance" criteria using a questionnaire survey in private hospitals in the Klang Valley area, Malaysia. Since all collected data were in numeric format, data analysis was performed quantitatively. Consequently, 31 BSC performance measures were identified for private hospitals. Next, the 31 performance measures went through a ranking survey in Klang Valley private hospitals. Therefore, a weight between 0 and 1 with a range of 0.095 to 0.207 was obtained for each performance measure to help hospitals quantify their overall performance more accurately.

An on-site health home for homeless men in addiction recovery.

Patients with comorbid substance abuse, mental health disorders, and chronic health conditions face difficult challenges when attempting to access health care. A large gospel rescue mission developed an onsite wellness center, based on an integrated, embedded practice health home model, to promote health care access among homeless men in addiction recovery. The center model integrated primary care with behavioral health, specialty care referrals, and wellness services to address the multifaceted needs of the population. Standardized health care performance measures and resident and staff feedback support the effectiveness of the model in promoting improved health care access and treatment adherence. Future directions for program expansion include infrastructure development, expanded community outreach, and evaluation of effectiveness of the onsite health home through systematic program evaluation and research.

Governance and performance measurement in integrated care. An Evidence Based Integrated Care Approach

Introduction: Healthcare institutions in The Netherlands are faced with the facts of increasing extent of internal and external accountability. This is related to the fact that healthcare institutions and their professionals are obliged to register a full set of indicators which are required input to effect this accountability. This is also known as governance. One of the definitions is: to control and to account for Minderman 2008 or controlling accountability Hoek 2007. On the one side in integrated care, care pathways are characterized by the delivery of care interventions proof of concept and on the other side pathways are characterized by the organization of the delivery of care interventions proof in context. Both concept and context of care are related to governance and performance measurement in healthcare. In general governance in healthcare in The Netherlands focuses on control, accountability and controlling the boards, mostly within one care organisation. However in integrated care governance and performance measurement should ideally be on cooperation and trust between the organizations. Governance therefore includes various forms of accountability, concerning several areas: from government national and local, to organizations and commissioners, to organizations and their supervisory boards, to organizations and their financiers and the patient. Healthcare organisations must be accountable to e.g.: The Dutch Healthcare Inspectorate, The care insurance companies and The National Healthcare Institute. Furthermore, healthcare institutions have to account for their efforts to deliver quality of healthcare. The way this is done is through a system administrating their internal performance indicators. In this respect, one can ask how indicators are administrated within healthcare organisations and how external accountability is designed. Different gaps of governance and accountability can thus be found e.g.: A gap between what accountancy data in care institutions is collected, their network and what is externally justified to the involved parties. The gap between governance and is the ones accountable to people and municipals are involved in decentralization. Gap of citizens and governance. Theory/Methods: A systematic review of literature on what is the current knowledge on governance in integrated care, and an extensive case study which will be conducted in Dutch healthcare organisations and healthcare network organisations. One of the characteristics of case study method is: a narrow domain with several research units, in depth rather than a broad view, the supposed concerns in many cases the entire research area instead of a few variables like in a survey study. Discussion: What should governance as an accountability tool look like within the context of evidence-based integrated care and what knowledge is gained and how can this knowledge be used to meet accountability issues?