Performance Management Andrew Crow Manager Rehabilitation and - PDF document

Performance Management Andrew Crow Manager Rehabilitation and Hospital at Home

Presentation Outline Performance Management • What are we all trying to achieve? • The levels at which it occurs • Activity targets and other areas we are monitoring • Processes

Performance management What is performance management? • includes activities which ensure that goals are consistently being met in an effective and efficient manner • can focus on the performance on an organisation, a program or even the processes to build a product or service, are well as many other areas

Why performance manage? • Improve knowledge around what is occurring • Ensure quality of services • Accountability for funding (significant tax payer $) • Transition to ABF & monitoring maintenance of effort

Equity • A key reason for performance management • Fair playing field • All in this together and want the same outcomes-the best for clients • Aim for equity in terms of access to services (quantity) and quality of services

Department’s Performance management tools & mechanisms • P olicy and Funding Guidelines • E quitable processes • R eports • F rameworks • O pportunities • R ecall • M onitoring maintenance of effort • A ctivity targets • N etworking • C alculating & monitoring National Weighted Activity Unit (NWAU) • E xcellence

Victorian health policy and funding guidelines Victorian health policy and funding guidelines Policy and funding guidelines (P&FG) • Main document that outlines department’s expectations • Outlines the parameters that health services are expected to work to and within • Strengthened for subacute in 2013-14 - greater focus on policy • Performance requirements at a health service level and at a program level Annual Statement of Priorities (SoP) • Sets out policy priorities of government, health service specific priorities and expected levels of performance in key areas for financial year • Signed off by CEO and Chair of the board with the minister • For Pall care NGO’s this is usually a SAMS agreement

2013-14 performance management framework Health Service performance monitoring • The goal of this level is to monitor overall health service budget, activity against target and quality measures • Tools used – PRISM and Monitor reports • Who-Quarterly meetings with CEO and Performance area of DH

2013-14 performance management framework Program Monitoring The goal of this level of monitoring is to be more specific and allow: – a comparison of the current year and previous year(s) activity using historical units of measure. – benchmarking model of care and comparison with peers for patient characteristics. – Inform services of their progress towards the national model units of count. • Tool used – subacute / program stream benchmark reports • Who- Subacute exec and managers in health services and Continuing Care section of DH

13-14 Activity targets Admitted • Weighted beddays • Public and private • DVA Non admitted • Service events & monitoring of existing units

Maintenance of effort • Monitoring existing units • Non admitted – also monitoring effort against any growth for HIP • Calculating and monitoring National Weighted Activity Units (NWAU) • Other measures including quality measures

2013-14 Subacute Wrap & Funding Recall Policy • Admitted: Consider activity across a number of admitted subacute inpatient funding streams (GEM, Rehab and pall care, private and public) when deciding to apply funding recall or to provide additional funding. This process is referred to as the ‘subacute wrap’ • Same percentages this year (over and under) • Simplified process in weighted bed days

Admitted recall example Step 1 Step 2 Step 3 Step 4 Health Revised Health Service Private/Public Service Actual Targets based Cash Flow Revised Weighted Weighted Budget For Weighted on percentage Adjustment Funding For Subacute bedday Bedday Health Bedday % of private /public To Health Health Service price (TBC) Targets Service Activity activity actual Service Service Subacute Public (Rehabilitation, GEM and Pall Care public combined) $483 18,000 $8,686,080 17,860 95% 19,000 $482,560 $9,168,640 Subacute Private (rehabilitation, GEM and Pall Care private combined ) $448,781 $449 2,000 $897,562 940 5% 1,000 ‐ $448,781 Total 20,000 $9,583,642 18,800 100% 20,000 $33,779 $9,617,421

Recall example continued Step 5 part 1 Step 5 part 2 Difference Difference $ Actual Revised Private/Public Activity Amount Weighted Targets based on To For Bedday percentage private Revised Revised Subacute Service Activity /public actual Targets Targets Subacute Public 17,860 19,000 ‐ 1,140 ‐ $550,118 Subacute Private 940 1,000 ‐ 60 ‐ $26,927 Total 18,800 20,000 ‐ 1,200 ‐ $577,045 PROPORTION OF FUNDING FOR ‐ 6.0% Step 6 RECALL

Recall example Step 7 Therefore Margin Variance Marginal Recall 0 ‐ 2% ‐ $192,348 33% ‐ $63,475 2 ‐ 3% ‐ $96,174 50% ‐ $48,087 3 ‐ 5% ‐ $192,348 66% ‐ $126,950 >5% ‐ $96,174 100% ‐ $96,174 Total ‐ $577,045 ‐ $334,686 Step 8 Total recall as per above ‐ $334,686 Cash flow adjustment based on revised targets $33,779 Total financial adjustment for health service ‐ $300,907

2013-14 Subacute Wrap & Funding Recall Policy • Non admitted: Funding recall will not be automatically applied. When determining whether recall applies, the department will consider maintenance of effort in relation to service events and pre-existing units as well as utilisation of any growth funds for the Health Independence Program. It is expected consistent recall policy will apply in 2014-15 • Non acute care will not be recalled in 2013-14 • TCP state based component will be subject to recall (more than 5% variance) • Equity

Reports • Getting the data back to health services • PRISM used by CEO and Executive to monitor activity 2013-14 subacute program reports: • Subacute admitted and streams reports (Rehab, GEM, Palliative Care) • Non admitted – Health Independence Program report (& stream reports), Community Palliative Care, Family Choice, VRSS • Reports will be modified to include changes related to classifications and funding models

Frameworks • Performance is not just activity • Subacute capability and access planning framework • Quality expectations • Palliative care service delivery • National definitions of care framework • Focus mapping current service • 7 components provision; identifying service  service description & mix gaps and what health services need to address  Catchment • Health service requirements  clinical staff mix articulated in the 2013-14 P&FG  networking & integration  quality standards/clinical guidelines  equipment & supporting services  teaching & research

Opportunities • New system • New focus • To transition • To learn and build

Networking • Through frameworks in regions • Through forums focusing on benchmarks and model of care

Key Messages • Performance management is an important aspect to ensuring our goals are met and there is a level playing field • Lets work together • Read the policy and funding guidelines • Data is important- VAED, VINAH, AIMS (and cost data) • Not just activity! Systems are changing so quality of service very important and using resources in best interest of patients