Post on 26-Jun-2015
Health Improvement Performance Management Review:
Supporting Outcome-Based Approaches to Planning and Performance
Neil Craig & Tamara MulherinPolicy Evaluation and Appraisal
NHS Health Scotland
Outline
• Why a review?• How is the ‘performance landscape’ changing?• Threats or opportunities?• Outcomes ‘tools’:
- that may help make the most of the opportunities
Why a review?NHS performance management • dissatisfaction with Health Improvement (HI) section (the ‘H’ bit) of
the HEAT targets.
Barriers to effective performance management for HI• Too many health improvement priorities• Inter-sectoral, partnership-based delivery – all too complex, knowing
who did what and their impact difficult to determine, varied accountability requirements
• Performance targets for HI lay with one sector (NHS) • NHS targets were unspecific to delivery and beyond direct control of
NHS• Uncertainty about effective actions
Main aims of the Review• Specify more clearly the unique contributions of
specific sectors to delivering HI (including health inequalities) and the contributions which need to be delivered in partnership
• Develop PM arrangements for shared HI outcomes in a multi-level, cross-sector, partnership-based delivery system
How is the performance landscape changing?
SOAs: Guidance for 2009/10
• SOAs are the “means by which CPPs agree their strategic priorities for their local area and express those as outcomes to be delivered by partners, … while showing how they contribute to the Scottish Gov’t’s relevant National Outcomes”
• The SOA “must be a strategic document … underpinned by robust performance management arrangements… [and] a very clear line of sight from the SOA document.”
SOAs: AccountabilityLetter from SG to Chief Execs
Signing up to an SOA means that partners:• “are corporately committed to the agreed outcomes …
and … will take every opportunity to promote and support the achievement of outcomes.”
• “doing this is likely to include each partner looking at how they individually can contribute to outcomes” and
• “each partner will need to show that a ‘golden thread’ runs from the SOA through their planning, resourcing and performance management processes.”
Threats?• Top-down priorities?• If outcomes are uncertain, might funding be cut?• Partners or competitors?• End of ring-fenced funding?
Opportunities• To contribute to setting local priorities• To show the contribution that partners, including 3rd
sector organisations, could make to improving health• To show the contribution that partners, including 3rd
sector organisations, do make to improving health
Outcomes ‘tools’• What do you currently do?• Who do you hope to reach?• What would you love to see?• What would you like to see?• What would you expect to see?
Well-being
Population health
Health inequalities
Individual behaviours and capabilities to achieve behaviour change
Social, economic, and physical environments e.g. social capital
What would you love to see?
What would you like to see?
What can you expect
to see?
Outputs: e.g. no. of people involved, no. of mtgs held
Inputs: e.g. community workers, land, co-producers’ time
Processes: e.g. partnership working, advocacy
Performance management
Public ReportingNational Performance
Framework
Outcomes related to service delivery e.g. increased self-esteem
What do you want to see & how can you (help to) do it?
What do you do?
Outcomes Triangle – Physical Activity (PA)
GreenerSafer & StrongerHealthierSmarterWealthier & Fairer
Increased physical activity levels
LONG-TERM
HIGH LEVEL OUTCOMES
INTERMEDIATEOUTCOMES
SHORT-TERM OUTCOMES
Outcomes related to service delivery
Increased availability and affordability of leisure
facilities
NATIONAL OUTCOMES
Our children have the
best start in life
Improved child
development
Reduced deaths from CHDImproved mental well-being
Reduced illnesses due to obesity
Reduced inequalities in healthy life expectancy
We live longer, healthier lives
We have tackled the significant
inequalities in Scottish society
Built & Natural environments that encourage PA
More use of the outdoors for PA (NI)
Safer streets and roads More journeys to work/school
by active travel (NI)
We create well-designed,
sustainable places
We value and protect the natural environment and
cut our environmental impact
ProcessesOutputs
Inputs
INTERMEDIATE OUTCOMES
Linking activities to outcomes
LONG-TERM OUTCOMES
Reduced Type 2
Diabetes
Reduced CHD and
stroke
Reduced cancer
NATIONALOUTCOMES
Longer, healthier
lives
Tackled significant inequalities
Other non-health
outcomes?
Reduced prevalence of overweight and
obesity
Improved energy balance
Model a
Model b
Model c
Model d
Model e
Increased food industry corporate
and social responsibility
Changes in availability and affordability of
energy-dense/low energy dense
food
Improved early years nutrition
Increased individual
empowerment and food literacy
Improved media and social
environment
Increased physical activity
Physical Activity – Who might do what and why?
Inputs
Activities
Outputs
Reach
Short-term outcomes
Intermediate outcomes
High level outcomes
NHS
Assessment/ Advice in
Primary Care
No. assessed and given
brief advice
Patients at risk
Still active at 3 month follow up
Behaviour Increased physical activity levels in population
Reduced inequalities in healthy life expectancy; Reduced morbidity due to obesityReduced inequalities in CHD; Improved mental well-being.
Comm & Vol orgs
Walking clubs
Memberships of clubs
At risk groups in population
More people walking
regularly
Councils: Education
Curriculum development
Increased PE in curriculum
School age children
Increased PA in school time
Councils: Transport
Promoting active travel to
work/school
Increased cycle lanes and safe
routes to school
Commuters and school pupils
More short journeys by active travel
Councils: Planning/
Environment
Creating green space
Creation of more/better green space
General (inactive)
population
Increased use of green space
Environments Built, Road & Natural environments enhanced
to create more and safer PA opportunities
What it is & what it’s not!• Not just rationalising what you currently do
- challenging and promoting it- on the basis of evidence, logic and engagement
• Not being told what to do- contributing to debates on priority outcomes- articulating contributions to shared priority outcomes- providing a rationale for working towards and measuring particular outcomes
• Not a way of describing complex reality- a way of critically reflecting on, prioritising and accounting for what you do