Saturday, March 1, 2008

Performance monitoring in hospitals

The Australian Federal Government has reached agreement with State Governments to implement reciprocal performance reporting of public hospitals. This is a step in the right direction. It is not possible to improve performance without first collecting data for analysis. The reality is, of course, that hospitals already collect vast amounts of information about themselves. It might be that collecting the data is not the issue, the real issue might be that they chose not to act upon the information they collect.

Talk is cheap. In the past the State Government's have not been keen to be placed under scrutiny through performance monitoring. The New South Wales State Government has been particularly opposed to the idea. Only time will tell as to what the performance measurements will be, and how well the State Governments support the process.

In theory all hospitals should be the same. This suggests measurement parameters would provide comparable information. In theory consumers should be able utilise the information provided through monitoring to help them choose where they would like to go for care. The reality is different to the theory. Often consumers have little option where they go for hospital care. Even for those with private health insurance, freedom of choice, long touted by private insurers, is limited by the availability and location of services. Politically it may not be in any Governments best interests for its health service to come under close public scrutiny.

Consumers want certain information. For example, they want to know that hospital waiting lists are becoming shorter. They want to know about the safety record within hospitals. They want to know which hospitals experience outbreaks of infection within the hospital. They want to know which hospitals experience high levels of deaths by accident.

Hospital administrators also need information. They need to know what their patients think of their service. They need to know the level of staff turnover, the average length of hospital stay, the time taken for triage, the number of day procedures, financial data, the level of in-hospital infection, bed availability, number of surgical procedures. Much of this information is already collected within hospitals.

Hospitals have expressed reservations about the validity of 'league tables' comparing one hospital against another. Such reservations are often well founded, except, that is when the hospitals use the shortcomings of league tables to avoid overall scrutiny. There does not appear a lot of evidence to support the theory that creating league tables leads to improved productivity. League tables imply all hospitals are equal. They may well have been created equal but they do not operate in equitable environments. League tables do not take into consideration additional, regional, factors that individual hospitals may have no control over. It is unlikely league tables will provide consumers with usable information.

Consumers may not want ‘league’ tables. Tables can make for interesting, and sometimes controversial fodder for the media, however consumers have neither the time nor the inclination to analyse such tables. It is not even a given that consumers want raw data. It is possible all they require is reassurance the processes designed to minimise the impact and maximise the benefit to them are in place.

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