Hospital Reform Implimentation and Evaluation

7/31/2019 Hospital Reform Implimentation and Evaluation

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Hospital Reform

Implementation and Evaluation

Dr Hong FUNG28 January 2010


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Health System Goals

Health status

Financial risk protection

Public/ patient satisfaction

(WHO, 2000)


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Institute of Medicine, 2001


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Institutions

OrganizationsProviders

National policy

Regulation

Financing

Hospitals

Clinics

Doctors

Nurses

Modern Health Systems


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Five Control Knobs

Macro-organization

Financing/ resource mobilization and pooling

Provider payment

Regulations Social values/ persuasion

(After Hsiao)


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State Authority in Health Sector

Command

& Control

Steer &

Channel

Entities with full state ownership

Entities with full state ownership but managerial

independence

Private not-for-profit entities with statutory responsibilities

Private not-for-profit entities without statutory

responsibilities

Private for-profit provides under tax-funded or statutory

social insurance systems

Private for-profit companies


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Marketizing Reforms

Separation of payer and provider

Continued funding, contracting or purchasing by

government

Quasi-markets/ internal market/ regulatedcompetition

Autonomization/ corporatization/ privatization


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Critical Factors for Organization Reform

Direct Budget Allocation

Vertical Hierarchy

Public Purse

Direct Hierarchical Control

Management Autonomy

Non Budgetary Revenues

Private Owner

Rules, Regulations and

Specified, Funded and

Unspecified & Unfunded Mandate

Decision

Rights

Market

Exposure

Residual

Claimant

Accoun-

tability

Social

Functions

Budgetary

Unit

B

Autonomized

Unit

A

Corporatized

Unit

C

Privatized

Unit

P

Regulated

Contracts


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Incorporating Modern Management

Introducing entrepreneurship

Management decentralization

Self-governing hospital structures

Performance related payment

Quality and outcome culture

Market competition

Increased technical efficiency


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Summary of Recent Health Reforms

From Preker AS and Langenbrunner JC, 2005


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Three Key Strategies

1. Enhancing government stewardship

2. Strengthening hospital governance

3. Developing a system ofperformance management


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Government Stewardship

The ultimate responsibility for the overall performance

of a countrys health system must always lie with

government.

(WHO, 2000)

Stewardship is the careful and responsible management

of the well-being of the population.


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The Role of Government

3 core tasks ofStewardship (WHO, 2000)

Formulating health policy

Regulating the health sector

Collection and using intelligence

Strategies for collecting revenues and pooling of

funds

Effective resource allocation and/ or purchasing


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The Evolution of Governments

Row less, steer more

Steering = making strategic policy decisions and

establishing the vision

Rowing = operational service delivery andimplementing the vision

Regulation &Strategic Purchasing


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Regulations

Regulation as a process to ensure compliance withstated policy objectives within a definedframework of action.

Regulations on Quality and effectiveness

Patient access

Provider behavior

Payers Pharmaceuticals

Physicians


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Examples in HK

Centre for Health Protection

Centre for Food Safety

Registration of Chinese Medicine practitioners and herbal

medicines Pharmaceuticals

..

..

Accreditation of hospitals Health insurance products


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Strategic Purchasing

The proactive or strategic allocation of resources in

the light of health gain, responsiveness and

efficiency goals.

involves a continuous search for the best ways

to maximize health system performance by

deciding which interventions should be

purchased, how, and from whom.


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What is involved?

Splitting purchaser from provider

Separating of governance of funding agency

Active process of contracting, purchasing and

commissioning

Focusing on outputs and outcomes

Capacity building in regulation and coordination of

non-governmental providers


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Examples in HK

Using Hospital Authority as a platform

Setting pricing benchmarks

Purchasing of care from private sector

Cataract surgery Primary care in deprived areas

Shared care in chronic disease management

Diagnostic radiology

Pay-for-performance mechanisms

Using Electronic Health Records as a vehicle

Shared electronic patient records (ePR)


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Hospital as Reform Targets!

Local boards play a key role

in health sector reforms


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Hospital Governance

2 levels of governance

Corporate governance

Clinical governance


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Corporate Governance

The processes, and the related organizational

structures, by which organizations are

directed, controlled and held to account.

(HKSA, 2004)


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3 Basic Principles

Openness

Disclosure of information and communication

Decision making processes and actions

Integrity Straightforward dealing and completeness

Honesty and objectivity

Accountability

Stewardship of public funds

Performance


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4 Dimensions

Standards of behavior

Organizational structures and processes

Risk management and control

Accountability, reporting and disclosure


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7 Principles of Great Governance

Understanding of and commitment to the mission

Articulate and embrace the core values

Clear on fiduciary role and basic responsibilities

Strict adherence to conflict-of-interest policies

Recruitment, education, self-assessment of members and

accord priority to goal setting processes

Create a respectful and collegial governance environment

Respect the distinction between the roles of governance

and management


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Clinical Governance

Clinical Governance is the system by which the

governing body, managers and clinicians share

responsibility and are held accountable for patient

care, minimizing risks to consumers and forcontinuously monitoring and improving the quality

of clinical care.

Australian Council on Healthcare StandardsACHS News 2004; 12:1-2


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Copyright 1998 BMJ Publishing Group Ltd.

Integratingapproachesof clinicalgovernance


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Clinical Governance Framework in NTEC


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Hospital Chief Executive

Clinical Governance CoordinatorDept Q&RM Coordinator

Chief of Service

Accountability Structure in NTEC Hospitals

Hosp Q&RMCoordinator


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Chair of Clinical GovernanceDept Q&RM Coordinator

ClinicalQuality

System& Risks

Information& Performance

Key Responsibilitiesin Clinical Departments in NTEC

- Clinical protocols- Clinical standards- Clinical audits

- Manpower- Equipment- Workload- Workflow/ processes- Incidents

- Performance reporting- Disease coding- Data quality- Web communication


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A System ofPerformance Management

The proactive measurement of performance for

securing health system improvement and

accountability

It involves monitoring, evaluating andcommunicating the extent to which various aspects of

the health system meet their key objectives

A built-in system of evaluation against health system

goals


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The Balanced Scorecard

From: Kaplan & Norton,

The Balanced Scorecard, 1992


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Frameworks ofPerformance Measurement

The first requirement of any performancemeasurement system is to formulate a robust

conceptual framework within which performancemeasures can be developed.

Smith, 2008


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Framework of PerformanceMeasurement in Australia

1st Tier: Health outcomes

How healthy are we as a nation?

2nd Tier: Determinants of healthAre we trending towards or away from health?

3rd Tier: Health system performanceAre our acute, primary care & population health

interventions of the highest quality at the least cost?

4th Tier: Health system infrastructure and

community capacityIs our system infrastructure sustainable in to the future?


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Dimensions of Health System Performance(Australia)

Effectiveness Appropriateness Safety Capability

Service,

intervention

achieves desired

results

Service provided is

relevant to patient needs

& based on established

standards

Potential risks of an

intervention or the

environment are

avoided or minimized

Individual

knowledge/skills

appropriate to

care/serviceprovided

Continuity Accessibility &Equity

Acceptability Efficiency

Ability to provide

uninterrupted,

coordinated service

across

organizations &

over time

Ability of patients to

obtain service at the right

place & time, based on

needs and is equitable

Service provided

meets expectations of

patients, community,

providers & paying

organization

Achieving desired

results with most

cost effective use

of resources


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HAs Service Performance KPIs

Access Quality Efficiency

1. Waiting Times

A&E WT

New case bookingfor SOP services

1. Appropriateness

Admission rate for AED pts

2. Safety

Infection rate

Unplanned readmission rate forGeneral IP

3. Service Coverage

CGAT & VMO scheme

4. Disease Specific Indicators

Stroke

Fracture Hip

Cancer

Diabetes Mellitus (DM)

1. Drug consumption

Ca-channel blocker/ ACEI/Inhaler for asthma/ Biggun/overall antibiotics

2. Day surgery plus same

day surgery

3. GOP services

% of GOP attendances forchronic diseases

4. Bed Management

Ratio of excess beds to1000 in-use beds

IP occupancy rate (MN)

General IP ALOS


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Incentives for Quality Improvement in HA

12 key performance indicators

Accessibility (waiting time)

Appropriateness of care

Patient safety Clinical outcome

Achievements against international or local

benchmarks

Improvements towards targets


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Thank you!

Hospital Reform Implimentation and Evaluation

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