Performance Indicators in Accountability Agreements

1
Performance Indicators in Accountability
Agreements
Marilyn Bruner Co-Chair, Multi-Year Funding
Performance Indicators Committee April 21,
2005
2
Overview of Presentation

• Background on JPPC Multi-Year Funding Project
• Performance Indicator Domains Application
• Proposed indicators for 2005/06 Accountability
  Agreements
• Issues Challenges
• Next Steps

3
Origins and Context

• Dialogue under the previous government stable,
  multi-year funding and performance agreements
• Accountability Agreements tied to legislation
  through The Commitment to the Future of Medicare
  Act, 2004 (Bill 8)
• Issue came to JPPC in 2003. Six work groups
  created to lead work in key areas

4
JPPC Milestones

• JPPC Hospital Accountability Framework developed
  and tested in simulated negotiations between
  reference hospitals and Ministry in Summer 2004
• Draft Policy Statement on Accountability and
  Accountability Agreement Template tabled in
  December 2004
• Consultations on Accountability documents in
  January-February

5
JPPC Philosophy

• Accountability Agreements are vehicle for
  consolidation of numerous funding streams and
  requirements
• Balanced approach and slow start
• Ministry and hospitals negotiate targets for
  indicators
• Proactive remediation and joint problem-solving
• Focus on performance improvement

6
Draft JPPC Accountability Agreement

• Two components
• Accountability Agreement sets out general
  provisions for managing accountability
  relationships, including planning, funding, and
  performance improvement. Common template for all
  hospitals
• Schedules specific to each hospital and funding
  category. Negotiable performance targets and
  corridors

7
Accountability Agreement Performance Indicator
Domains
Patient Access Outcomes
Financial Health
Organizational Health
System Integration
8
Application

• Accountability Agreement will cover both global
  budget and other funding categories (for example,
  PCOP or wait-times). Indicators apply only to
  base/global budget
• A variance beyond a performance corridor leads to
  performance improvement process outlined in
  agreement (a corridor is a range of
  toleration around a negotiated results or
  performance standard)
• Accountability Agreement recognizes factors
  beyond hospital influence and control (e.g.
  infectious disease outbreaks lack of community
  resources)

9
Types of Indicators

• Performance Indicators indicators for which
  Ministry and hospitals negotiate a result. A
  variance in a performance indicators may trigger
  action under agreement.
• Monitoring Indicators provide context and
  support negotiation and problem solving between
  Ministry and hospitals. Important for planning
  and measuring progress
• Developmental Indicators data and methodology
  require further work. May graduate to monitoring
  or performance indicators

10
Financial Health Indicators
Need to develop method to determine the average
age of capital
11
Organizational Health Indicators
12
Patient Access Outcomes Acute Care
13
Patient Access OutcomesComplex Continuing Care
14
System Integration

• Integration domain concerns linkages of hospital
  to broader sector
• More design and development is necessary before
  selection of performance indicators in this
  domain
• Ministry may include monitoring indicators drawn
  from specific areas for example
• Hospital Report, System Integration and Change
• DHC report, Access, Equity, and Integration
• MOH Balanced Budget Plan Process (e.g. propensity
  to discharge)

15
Summary of Proposed AA Performance Indicators for
FY 2005-06
16
Issues Challenges (1)

• Opportunity costs
• Avoid directing resources to measured at the
  expense of unmeasured areas of activity
• Performance corridors
• Need to develop approach and method for setting
  and implementing corridors
• Consolidation
• Accountability agreements should be a vehicle to
  consolidate performance requirements and
  expectations for hospitals

17
Issues Challenges (2)

• Achieving a balanced approach
• Indicators in certain domains have more validity
  and reliability than those in other domains (but
  we have to start somewhere)
• Alignment and consistency
• Need to avoid (or at least recognize) conflicting
  indicators (e.g. nursing FTE versus balanced
  budgets)
• Approach to variance
• What triggers consequences under the
  accountability agreement? How much variance from
  negotiated targets can be tolerated?

18
Issues Challenges (3)

• Ensuring performance improvement
• Negotiation of indicator results should reflect
  hospital capacity and expectation of improvement.
  Remedying variance will require hospital and
  Ministry commitment to working together
• Data availability and validity
• Agreements will require improvement in
  performance measurement infrastructure.
  Availability and validity of data will constrain
  regular reporting accurate assessment of current
  performance
• Reconciliation
• Need process for reconciliation of previous year
  performance with planning and negotiation for
  current year
• This relates to the term of the agreement (i.e. 1
  or 2 years)

19
Next Steps

• JPPC Report on Performance Indicators and
  Corridors for 2005/06, including recommendations
  re continuing indicator work (May 2005)
• Potential JPPC sessions to orient field to 05/06
  accountability agreement templates, schedules,
  and indicators (May/June 2005)
• JPPC to provide advice to Ministry re planning
  processes and documents for 05/06 and beyond
  (April/May 2005)
• Continue discussions with Hospital Report and
  Ministry about appropriate organization to
  continue work on indicators