a hospital “balanced scorecard”...“balanced scorecard” 1 lifting the performance of new...

A S S E S S I N G T H E P E R F O R M A N C E O F N E W Z E A L A N D P U B L I C H O S P I T A L S O N A C R O S S -

D I M E N S I O N A L S E T O F I N D I C A T O R S , 2 0 0 1 - 2 0 0 9 .

P E T E R D A V I S , B A R R Y M I L N E , K A R L P A R K E R

6 T H . W E L L I N G T O N C O L L O Q U I U M

A U G U S T 3 , 2 0 1 2

A Hospital “Balanced Scorecard”

1

Lifting the performance of New Zealand’s health system.

A research collaborative

2

Framework – Performance matrix4

The Basic Research Question

Do hospitals exhibit a congruent profile across performance dimensions, and is this maintained consistently over time?

Dimensions and indicators of performance:Efficiency

1. Relative Stay Index

2. Day-Stay Usage

Effectiveness

1. Patient Safety

2. Unplanned Readmissions

3. 30-day Post-admission Mortality

Equity

1. Ethnicity

5

Efficiency

6


0.7

0.8

0.9

1

1.1

1.2

1.3

1.4

1.5

Points represent hospitals (ordered from low to high)

Efficiency

7


0.7

0.8

0.9

1

1.1

1.2

2002-3 2004-5 2006-7 2008-9

Efficiency

8

1. Relative Stay Index by ethnicity

0.8

0.9

1

1.1

1.2 Asian

Maori

Other

Pacific

European

Points represent ethnic groups within hospitals (ordered from most spread to least spread)

Efficiency

9

2. % day stay surgery

40

45

50

55

60

65


Efficiency

10

35

40

45

50

55

60

65

70

02-03 04-05 06-07 08-09

2. % day stay surgery over time

Efficiency

11

2. % day stay surgery by ethnicity

0.8

0.9

1

1.1

1.2Asian

Maori

Other

Pacific

European




Dimensions and indicators of performance:Efficiency


2. Day-Stay Usage

Effectiveness

1. Patient Safety

2. Unplanned Readmissions

3. 30-day Post-admission Mortality

Equity

1. Ethnicity

12

Effectiveness

1. Patient safety events (post-operative)

13

0

1

2

3

4

5

6

Ra

te p

er

100


Effectiveness

1. Patient safety events (post-operative) by year

14

2.5

3

3.5

4

4.5

5

5.5

2002-3 2004-5 2006-7 2008-9

PS

I P

ost

-Op

(p

er

100

ad

mis

sio

ns)

Effectiveness

15

1. Patient safety events (post-op) by ethnicity

0.7

0.8

0.9

1

1.1

1.2

1.3

1.4

1.5 Asian

Maori

Other

Pacific

European


Effectiveness

2. Unplanned readmissions

16

6

8

10

12

14

16

Ra

te p

er

100


Effectiveness

2. Unplanned readmissions by year

17

9

10

11

12

13

14

15

16

2002-3 2004-5 2006-7 2008-9

Re

ad

mis

sio

ns

(pe

r 10

0 a

dm

issi

on

s)

Effectiveness

18

2. Unplanned readmissions by ethnicity

0

0.5

1

1.5

2 Asian

Maori

Other

Pacific

European


Effectiveness

3. 30-day post-admission mortality

19

0

1

2

3

4

Ra

te p

er

100


Effectiveness

3. 30-day post-admission mortality by year

20

2

2.3

2.6

2.9

3.2

3.5

3.8

4.1

2002-3 2004-5 2006-7

30

d M

ort

ali

ty (

pe

r 10

0 a

dm

issi

on

s)

Effectiveness

3. 30-day post-admission mortality by ethnicity

21

0.6

0.8

1

1.2

1.4

1.6 Asian

Maori

Other

Pacific

European


Profiles – good performing hospital

22

Overall rate(rank)

Equity: max/min(rank)

RSI (where ‘average’ hosp = 1) 0.96 (10) 1.02 (2)

day stay surgery (per 100) 61 (2) 1.01 (1)

PSI – post operative (per 100) 1.48 (1) --

Unplanned readmissions (per 100) 9.05 (7) 1.59 (10)

30 day mortality (per 100) 1.64 (2) 1.50 (18)

Profiles – poorly performing hospital

23

Overall rate(rank)

Equity: max/min(rank)

RSI (where ‘average’ hosp = 1) 0.96 (11) 1.16 (27)

day stay surgery (per 100) 52.8 (18) 1.07 (16)

PSI – post operative (per 100) 2.43 (8) --

Unplanned readmissions (per 100) 10.4 (22) 2.05 (23)

30 day mortality (per 100) 3.00 (17) 1.69 (20)



Although we are able to collate the data relevant to this question, we are not yet in a position to provide a precise answer.

24

Subsidiary Research Questions

Efficiency and Effectiveness - Descriptive1. How do hospitals compare on the basket of indicators?

Quite a range across hospitals, even after adjusting for case-mix

2. How are hospitals changing over time for these indicators?Hospitals tend to maintain rank across time. Some overall trends (day stay surgery, readmissions increasing; RSI, 30day mortality decreasing)

Efficiency and Effectiveness - Analytical1. Do hospitals exhibit congruent profiles on these indicators?

Some are reasonably good and others reasonably poor across the board, but the overall pattern is mixed - there are no strong correlations either within or across dimensions.

2. Are these profiles maintained over time?Still to investigate

25

Subsidiary Research Questions

Social Equity - Descriptive1. How do hospitals compare for equity over the basket of indicators?

Again, quite a range; some have large variations, others very little.

2. How do these profiles change over time?Still to investigate

Social Equity - Analytical1. Do hospitals exhibit congruent indicator profiles with equity?

Again, a mix. Hospitals with equitable outcomes for one indicator will not necessarily have equitable outcomes for other indicators

2. Are these profiles maintained over time? Still to investigate

26

A S S E S S I N G T H E P E R F O R M A N C E O F N E W Z E A L A N D P U B L I C H O S P I T A L S O N A C R O S S -

D I M E N S I O N A L S E T O F I N D I C A T O R S , 2 0 0 1 - 2 0 0 9 .

P E T E R D A V I S , B A R R Y M I L N E , K A R L P A R K E R

6 T H . W E L L I N G T O N C O L L O Q U I U M

A U G U S T 3 , 2 0 1 2

A Hospital “Balanced Scorecard”

27

a hospital “balanced scorecard”...“balanced scorecard” 1 lifting the performance of new...

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