The document discusses the role of performance measurement and reporting in driving change in healthcare systems. It describes how data is collected and transformed into information and knowledge. Performance measurement can be used to stimulate change through various levers like regulation, incentives, and quality improvement initiatives. The document uses examples from New South Wales to illustrate how reporting on metrics like emergency department wait times and mortality rates can influence healthcare providers through coercive, normative, and cognitive levers. It also discusses insights from the NSW experience, noting that while multiple organizations can foster innovation, they can also create confusion if responsibilities are not clear.

1. Levers for change in
healthcare systems:
The role of performance measurement and reporting
Jean-Frederic Levesque, MD, PhD
Chief Executive Officer, Bureau of Health Information
Conjoint Professor, Centre for Primary Health Care and Equity, UNSW
27 August 2015

2. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Healthcare systems are complex
and supporting them with
knowledge is as fundamental
as it is challenging
Levesque, Sutherland & Corscadden 2013

3. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Concepts
Knowledge organisations
Enablement
Insights
1
2
3
4

4. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
What do we mean by
Performance?
Knowledge?
Enablement?
1

5. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Performance happens
when structures, resources,
providers and patients
interact in real contexts
Levesque, Sutherland & Corscadden 2013

6. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Hollnagel, Braithwaite & Wears 2013
The difference between
theory and practice is larger
in practice than in theory

7. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
If actors perform on stage,
athletes perform on the field,
surgeons perform in surgical theatres
and nurses perform at the bedside
or in community centres
Levesque, Sutherland & Corscadden 2013

8. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

9. Knowledge
Information
Data
Action
Change

10. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Data
Data represents the codification of
real phenomena into a form that
can be analysed

11. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Information
Data becomes information
by interpretation

12. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Knowledge
Knowledge signifies understanding
of real things or abstract concepts
that data and information have
enabled to decipher and analyse

13. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Accessibility
Prevalence
Avoidable
deaths
Unmet needs Adverse
events
Quality of life
High users
Duplications
Health risks
Team climate
Health literacy
Disability
Hospital
mortality
Costs
Safety
Resources
Satisfaction
Coordination

14. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
The application of performance
indicators may involve simply
reporting data to actors for
accountability purposes, or it may
involve, in addition, taking action
to stimulate change
Leatherman 2002

15. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Action
Knowledge supports action through
behaviour and decisions

16. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Change
Healthcare systems constantly
change in terms of structures,
processes and their outcomes

17. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Peer learning
Hug
Training
Benchmarking
Regulation
Continuous
education
Pay for
outcomes
Pay for
performance
Quality
improvement
Awareness
Self-regulation
Peer-
pressure
Monitoring
Incentive
Judge
Provider
feedback
Cross-
fertilisation
Nudge
Contract
management
Monitoring
Shove
Push

18. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
planned
emergent
internal external
supportive
formative
coercive
normative
structural
competitive
cognitive
mimetic

19. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Multimodal approaches have the
biggest impact
OECD 2002

20. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

21. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Australian Commission for
Safety and Quality in
Healthcare
National Health
Performance
Authority (NHPA)
Independent Hospital
Pricing Authority
UK Care Quality
Commission The King’s Fund
The Nuffield Trust
Dr Foster
RAND Corporation
Centres for Medicare and
Medicaid Services (CMS)
Agency for
Healthcare Research
and Quality (AHRQ)
USA Institute for
Health Improvement
Ambulatory Care
Quality Alliance (AQA) Hospital Quality
Alliance (HQA)Joint Commission on
Accreditation of Healthcare
Organizations (JCAHO)
National Committee for Quality
Assurance (NCQA)
National Quality
Forum (NQF)
Physician Consortium
for Performance
Improvement (AMA)
Leapfrog Group
Bureau of
Health Information (BHI)
USA Accountable
Care Organisation
Quebec’s Health
and Welfare
Commissioner
La haute autorité
de santé France
Canadian Institute of
Health Information
Ontario Care
Quality Council

22. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Goals pursued and national
context influence the mix of
health system stewardship
functions required to achieve
health system goals
Veillard 2012

23. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Knowledge
organisations
in New South Wales
2

25. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

26. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

27. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

28. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

29. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
BHI reports
•Annual performance report
•Hospital Quarterly
•Insights into Care
•Patient Perspectives
•Snapshots, briefs,
dashboards and profiles

30. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Garling Report
The public reporting of information about the
health system and hospital performance is
essential for the future of NSW Health.
It is the single most important driver (or lever)
for the creation of public confidence in the
health system, engagement of clinicians,
improvement and enhancement of clinical
practice and cost efficiency.

31. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

32. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

33. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

34. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

35. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

36. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Using information to
enable performance
in New South Wales
3

37. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Coercive and cognitive levers
The example of hospital timeliness performance measures

38. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Percentage of patients leaving in four hours – hospitals

39. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Time from presentation to treatment – NSW

40. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
planned
emergent
internal external
supportive coercive
cognitive
competitive

41. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Normative and supportive levers
The example of mortality

42. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
30-day mortality following hospitalisation

43. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
30-day mortality following hospitalisation – hospital outliers

44. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
planned
emergent
internal external
supportive
normative
cognitive
mimetic

45. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Normative and structural levers
The example of Cancer ED performance measures

46. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
ED use at the end of life – NSW

47. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
ED use for cancer patients – hospital outliers

48. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
planned
emergent
internal external
normative
structuralcognitive

49. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Insights from the NSW
experience
4

50. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
No organisation can use all levers
all the time…some levers are
synergistic, some are in tension

51. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Small organisations are more agile
and responsive… lack economies
of scale and depth of resources

52. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Specialisation brings focus and
concentration of expertise…
brings the risk of fragmentation
and duplication

53. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Splitting and overlapping
responsibilities enable emulation,
competition and diversity and
brings resilience

54. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Multiple organisations
can create confusion and impose
burdens on stakeholders

55. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
A knowledge organisation acts in a
negotiated space

56. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Concepts
Knowledge organisations
Enablement
Insights
1
2
3
4

57. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
planned
emergent
internal external
supportive
formative
coercive
normative
structural
competitive
cognitive
mimetic

58. Knowledge
Information
Data
Action
Change

59. Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Thank you!