For decision AOM-P1168 on 25.2 - Hospital Authority … decision AOM-P1168 on 25.2.2016 ... the...

For decision AOM-P1168

on 25.2.2016

Hospital Authority

2015 Key Performance Indicator Annual Review

Purpose

This paper informs Members of the progress of 2015 Key Performance

Indicator (KPI) Annual Review and seeks Members’ comments and endorsement on

the recommendations of the KPI Review Working Group (the Working Group).

Background

2. The KPI framework was formulated in 2008, covering three pillars,

namely clinical services, Human Resources (HR) and Finance. Each of the pillars is

supported by a collection of KPIs selected based on a set of criteria as set out in

Annex 1. The Working Group was formed in 2010 to conduct annual KPI review to

ensure that the KPIs are in line with the service directions and priorities of the

Hospital Authority (HA). Its membership and terms of reference are provided in

Annex 2.

Review Process

3. Comments and feedback on the KPIs, which are collected during the

course of the year through various channels, such as Administrative and Operational

Meeting (AOM), Directors’ Meeting, Cluster Management Meeting, Specialty

Services Coordinating Committees and Central Committees, are put forward to the

Working Group for consideration during the annual review. The Working Group’s

recommendations are presented to the related functional groups/committees

(e.g. Medical Policy Group and Medical Services Development Committee for clinical

services KPIs) and the top management team of HA Head Office for comments. The

conceptual framework of the current process of KPI development, review,

endorsement, implementation and monitoring is presented in Annex 3.

Recent Development

4. In the Report of the Steering Committee on Review of HA (the Report)

published in July 2015, recommendations have been put forward for HA to enhance

and refine its KPIs to “better address service demand and management, facilitate

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service planning and resource allocation, and drive best practices amongst various

specialties, hospitals and clusters”. The Report has also recommended that “HA

should coordinate with relevant specialties to address the serious access block

problem in Accident and Emergency (A&E) Departments in concerned hospitals”.

As correspondingly committed in the HA Review Action Plan, mainly Items 66 and

86 respectively thereon, the above set the major directions for KPI development in the

coming year.

2015 KPI Annual Review Recommendations

KPI Proposals

5. HA Review’s recommendations on developing KPIs to reflect HA’s

service efficiency and capacity are among the focuses of the 2015 annual KPI review.

Through efficiency KPIs, HA can facilitate performance benchmarking across clusters

and amongst peers, which in turn can drive organisational learning as well as sharing

of best practices and help develop efficient models of operation. Moreover, HA can

identify the service gaps between capacity and demand through capacity KPIs, thus

provide direction for capacity building and resource allocation. These KPIs are

being further developed and expected to be ready for reporting by phases starting

2016/17 while KPI to help address the access block problem at A&E Department is

being explored.

6. Upon completion of the 2015 KPI review, the Working Group agreed

that the existing three-pillar KPI framework should be maintained. It also

recommended revising the list of clinical services KPIs while the current KPI lists on

Finance and HR would remain unchanged. The proposed new KPIs and refinements

to existing KPIs are outlined in the ensuing paragraphs.

Clinical Services KPIs

New KPIs

� Capacity and throughput for Specialist Out-patient (SOP) services

7. Waiting time for SOP services is one of the key areas in the HA Review.

SOP waiting time is indeed the outcome of many contributing factors and the existing

KPIs on waiting time for SOP new case bookings for the eight major specialties are

not adequate to fully reflect the service gaps between capacity and demand. It is

therefore necessary to develop indicators to reflect service throughput against new

case demand as well as allocation of medical manpower to handle new and old cases.

The related indicators are being developed and are planned as follows for reporting in

2016/17 :

(a) No. of SOP first attendances per doctor;

(b) No. of SOP follow-up attendances per doctor; and

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(c) Growth of waiting list against throughput.

� Capacity and utilisation of Operating Theatre (OT) services

8. On OT services, the KPI “Utilization rate of scheduled elective OT

sessions” is proposed to reflect the utilization of existing OT capacity with a view to

giving insight into the potentials for further optimizing and maximizing the utilization

of OT resources. The proposed KPI is planned for reporting in 2016/17.

� Access block monitoring

9. On access block monitoring, an indicator is being developed to reflect

the time that a patient has to wait at A&E Department before getting admitted.

Serious access block problem poses threat on patient safety and affects the standard of

care. An indicator is being developed to reflect the frequency of the occurrence of

access block problem.

Refinement of Existing KPIs

� Access to General Outpatient Clinic (GOPC) services

10. Following the call flow simplification of the GOPC Telephone

Appointment System (the System) in 2013 in response to the feedback from members

of the public, the System could no longer capture some pre-requisite data for the

reporting of the existing KPIs “% of interactive voice appointment system (IVAS)

call-in elderly patients offered with GOP appointment in two working days” and “%

of IVAS call-in elderly, Comprehensive Social Security Assistance Scheme (CSSA)

and non-CSSA waiver patients offered with GOP appointment in two working days”.

Therefore, a new KPI namely “GOPC Quota Availability (for Elders)” is proposed to

replace the existing KPIs to reflect the accessibility of the service to the elderly from

another perspective.

� Day and same day surgery

11. On day and same day surgery services, the existing cluster-based KPI

covering 18 selected procedures and other elective surgeries managed by anaesthetists

for Ear Nose and Throat, Gynaecology, Ophthalmology, Orthopaedics and

Traumatology (O&T) and Surgery across different specialties and different clinical

management teams is not specific enough to reflect service performance and drive

best practices. Therefore, it is proposed to replace the existing KPI by a

specialty-based KPI on ‘Rate of day surgery plus same day surgery’ for each of

Surgery, O&T and Ophthalmology. These three specialties are chosen because they

are the specialties with large variation in performance among clusters as far as the rate

of day plus same day surgery is concerned. Besides, the proposed specialties have

already covered a significant proportion of day surgery cases. The proposed KPI is

ready for reporting in 2016/17.

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Implementation of Revised KPI List in 2016/17

12. The revised list of clinical services KPI, incorporating the

recommendations of the Working Group mentioned above, is set out in Annex 4.

Subject to the Board’s endorsement, the first report with the revised KPI list will

commence by phases in 2016/17.

Other Development related to KPIs

13. Apart from the above, the following initiatives, which will have impact

on KPI development, are being undertaken :

(a) The list of Controlling Officer’s Report items, which are part of KPIs,

is being reviewed with consideration being given to removing the

following items from the list, subject to discussion with the Food and

Health Bureau :

• Average length of stay (ALOS) for infirmary and mentally

handicapped services; and

• Unit cost per inpatient discharged for infirmary and mentally

handicapped services.

The above items are proposed to be removed because for long stay

patients, ALOS and unit cost per inpatient discharged are not

meaningful indicators to reflect performance and utilisation of the

services for the year. Instead, “Unit cost per patient day” is a better

indicator for service utilisation.

(b) An information system (HA Management Information System) is

being developed for phased implementation within three years to

facilitate reporting, performance monitoring and information

dissemination of KPIs. This system will facilitate the KPI reporting

and report generation processes as well as disseminate relevant KPI

information to different levels of staff within HA. User requirements

have been developed and are being reviewed. It is anticipated that KPI

reports will be made available through the system in phases starting

from 2017/18 (HA Review Action Plan Item 67).

(c) The KPI reporting and monitoring mechanism has been enhanced

with more active involvement of functional committees to support the

HA Board in reviewing and monitoring HA’s KPI performance with

effect from the fourth quarter of 2015. With this enhancement, KPI

reports on clinical services, HR and Finance are submitted to their

respective functional committees for scrutiny and in-depth discussion

with issues of concern or outlying performance brought up to the Board

for attention and focused discussion. Through the enhanced

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mechanism and reporting platform, the Board’s role in steering the

development of KPIs will be strengthened, including identification of

strategic areas for KPI development and setting of targets and standards.

This is in line with the HA Review’s recommendation related to

enhancing the role of the Board in setting KPI standards and targets to

drive performance and best practices (HA Review Action Plan Item 65).

(d) Continuous efforts are made to refine the format of KPI Report to

enhance its readability. Under the refinement proposals, the statistical

reports for clinical services KPIs (Appendix 1 to KPI Quarterly Report

submitted to AOM), which are available at the Members’ Corner for

access by Members, will be simplified with effect from 2016/17.

Besides, the report on Finance KPIs will also be refined. A summary

of changes is given in Annex 5.

(e) The third edition of the Guidebook on KPIs will be published in

2016/17, covering the latest revision mentioned above.

Decision Sought

14. Members are invited to comment on and endorse the proposed changes

recommended by the Working Group as detailed in paragraphs 7 to 12 and the revised

list of clinical services KPI in Annex 4; and note the direction on KPI development as

described in paragraph 13.

Hospital Authority

AOM\PAPER\1168

17 February 2016

2015 KPI Annual Review - 1 - AOM 2016 02 25

Annex 1

HA KPI Framework

[endorsed by the AOM on 28 February 2008 (AOM-P530)]

Selection Criteria

(a) Relevance to the overall corporate priorities and organizational objectives to

facilitate ongoing monitoring in key areas at hospital, cluster and corporate

levels;

(b) Availability of automated data to minimize manual efforts in the collection of

data and compilation of reports;

(c) Reliability of available data to enhance confidence of stakeholders in using the

data for performance benchmarking and service improvement;

(d) Comparability of data across clusters to facilitate meaningful discussion on

service improvement and establishment of best practices;

(e) Materiality of the selected KPIs in affecting managers and clinicians’ behavior

to drive changes in service organization or clinical practices for better quality

and higher efficiency;

(f) Impact on service outcome and cost efficiency to maximize the benefits of

KPIs; and

(g) Burden of disease in clinical services to ascertain relevant focus on diseases

with high patient volume or diseases which consume significant proportion of

the HA’s resources.


Annex 2

Membership of KPI Review Working Group

Terms of Reference of KPI Review Working Group


Annex 3

Current Processes of KPI Development and Review


Annex 4

Revised list of clinical services KPIs

KPI Target

Quality Improvement as a result of Technology Advancement or Implementation of New Service Quality & Access Initiatives

Waiting time for A&E services

- % of A&E patients seen within target waiting time

- triage I (critical cases – 0 minutes) 100%

- triage II (emergency cases – 15 minutes) 95%

- triage III (urgent cases – 30 minutes) 90%

- triage IV (semi-urgent cases – 120 minutes) 75%

Waiting time for SOP new case bookings

- Median waiting time for 1st appointment at specialist outpatient clinics

- 1st priority patients 2 weeks

- 2nd priority patients 8 weeks

- For each of MED, SUR, ORT, PSY, ENT, OPH, GYN & PAE

- % of patients seen within 2 weeks for 1st priority patients

- % of patients seen within 8 weeks for 2nd priority patients

- Waiting time for 90th percentile of 'Routine' cases

Waiting time for Allied Health Outpatient new case bookings

- For each of OT & PT

- % of patients seen within 2 weeks for 1st priority patients

- % of patients seen within 8 weeks for 2nd priority patients

- Waiting time for 90th percentile of 'Routine' cases

Waiting time for elective surgery

- Waiting time for Total Joint Replacement

- Waiting time (month) at 90th percentile of patients receiving the treatment of Total Joint Replacement

- Waiting time for cataract

- % of patients provided with surgery within 2 months for Priority 1 (P1) patients 80%

- % of patients provided with surgery within 12 months for Priority 2 (P2) patients 90%

- Waiting time for TURP

- % of patients provided with surgery within 2 months for Priority 1 (P1) patients

- % of patients provided with surgery within 12 months for Priority 2 (P2) patients

Waiting time for diagnostic radiological investigations

- % of urgent cases with examination done within 24 hours for CT, MRI and US cases

- Median waiting time for 1st priority patients for CT, MRI, US and Mammogram cases

- Median waiting time for 2nd priority patients for CT, MRI, US and Mammogram cases

- Waiting time for 90th percentile of ‘Routine’ cases for CT, MRI, US and Mammogram cases

Access Block Monitoring

- Indicator on frequency of the occurrence of the access block problem (new item)

Access to GOPC episodic illness service

- % of IVAS call-in elderly patients offered with GOP appointment in 2 working days (replaced) 95%

- % of IVAS call-in elderly and CSSA and non-CSSA waiver patients offered with GOP appointment in 2 working

days (replaced) 95%

- GOPC Quota Availability (For Elders) (modification of definition and calculation methodology ) 95%

Appropriateness of care

- Standardized admission rate for A&E patients

- Unplanned readmission rate within 28 days for general inpatients (%)

- Breastfeeding rate on discharge

Infection rate

- MRSA bacteraemia in acute beds per 1 000 acute patient days < 0.1258

new KPI item

item with refinement

item removed / replaced from the list


Annex 4

Revised list of clinical services KPIs

KPI Target

Quality Improvement as a result of Technology Advancement or Implementation of New Service Quality & Access Initiatives (con’t)

Service Coverage

- % of RCHEs covered by CGATs or VMOs under CGATs

Disease specific quality indicators

- Stroke

- % of stroke patients ever treated in Acute Stroke Units (ASUs)

- % of acute ischaemic stroke patients received IV tPA treatment ≥ 3%

- Hip Fracture

- % of patients indicated for surgery on hip fracture with surgery performed ≤ 2 days after admission through A&E > 70%

- Cancer

- Waiting time (day) from decision to treat (DTT) to start of radiotherapy (RT) for 90th percentile for cancer patients

requiring radical radiotherapy (RT) < 31 days

- Waiting time (day) at 90th percentile for patients with colorectal cancer receiving first definitive treatment after

diagnosis < 60 days

- Waiting time (day) at 90th percentile for patients with breast cancer receiving first definitive treatment after diagnosis < 60 days

- Waiting time (day) at 90th percentile for patients with nasopharynx cancer (NPC) receiving first definitive treatment

after diagnosis < 60 days

- DM

- % of DM patients with HbA1c < 7% > 35%

- HT

- % of HT patients treated in GOPC with BP < 140/90 mmHg > 65%

- Renal

- % of ESRD patients receiving HD treatment

- Mental Health

- ALOS of acute IP care (with LOS ≤ 90 days) ≤ 30 days

- Cardiac

- % of AMI patients prescribed with Statin at discharge ≥ 90%

- % of ST-Elevation Myocardial Infarction (STEMI) patients received primary PCI

Technology

- % of medical equipment with age beyond expected life

Efficiency in the Use of Resources

Bed Management

- Bed occupancy rate (%) (IP overall mid-night)

- ALOS (day) for general inpatients

Day surgery services

- Rate of day surgery plus same day surgery for selected procedures (replaced)

- For each of SUR, ORT & OPH

- Rate of day surgery plus same day surgery (change of definition and calculation formula)

SOP services

- For each of MED, SUR, ORT, PSY, ENT, OPH, GYN & PAE

- Throughput for SOP services

- No. of SOP first attendances per doctor (new item)

- No. of SOP follow-up attendances per doctor (new item)

- Waiting list management

- Growth of waiting list against throughput (new item)

Operating Theatres services

- Utilization rate of scheduled elective OT sessions (new item)

Productivity

- Total weighted episodes (WEs) of acute inpatient services

- Growth index for non-acute inpatient services

- Growth index for ambulatory and community care services

new KPI item

item with refinement

item removed / replaced from the list

Annex 5 `


Refinement of Clinical Services KPI Report (I) Service throughputs (i.e. COR items)

Before refinement After refinement

• Performance on HA Overall and its variance against YTD target and prior year

• Cluster breakdown and trend graphs on selected items

• Performance on HA Overall and its variance against YTD target and prior year

• Remove cluster breakdown and trend graphs

Annex 5 `


Refinement of Clinical Services KPI Report (II) Clinical KPIs (i.e. waiting time, disease-based, etc.)

Before refinement After refinement

• Performance on individual clusters and HA Overall • Variance against prior year for HA Overall • Trend graphs for HA Overall on selected items

• Performance on individual clusters and HA Overall • Variance against prior year for HA Overall • Remove trend graphs for HA Overall

Annex 5 `


Refinement of Finance KPI Report (I) Untaken Leave Balance

Before refinement Average untaken leave days per person was adjusted for minimum leave taking requirement under HA’s human resources policy.

After refinement

To present the average untaken leave days per person without adjustment for minimum leave taking requirement, which is more appropriate from corporate’s perspective.

Annex 5 `


Refinement of Finance KPI Report (II) Drug Stock

Before refinement

Only drug stock balance and holding period as of financial year-end was presented.

After refinement To provide more timely information to facilitate performance monitoring, quarter-end position of drug stock balance and holding period will be reported on top of financial year-end position.

Annex 5 `


Refinement of Finance KPI Report (III) Budget Performance Report

Before refinement

After refinement Change of report format for better presentation.

For decision AOM-P1168 on 25.2 - Hospital Authority … decision AOM-P1168 on 25.2.2016 ... the...

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