Using results-based accountability (RBA) to drive improvements in the management of long-term conditions

Transcription

1 Using results-based accountability (RBA) to drive improvements in the management of long-term conditions Ruth Jordan Senior Service Improvement Manager Cardiff and Vale University Health Board

2 Chronic conditions management demonstrators Provide and test a sustainable, affordable generic CCM service model that supported patients needs locally and promoted independent living within the community in order to communicate and inform service change across Wales January 2009-March 2011 Welsh Government (2007) Designed to Improve Health and the Management of Chronic Conditions in Wales: An Integrated Model and Framework for Action

3 Results-based accountability Fiscal Policy Studies Institute Santé Fe, New Mexico (publications)

4 Results-based accountability A disciplined way of thinking and taking action which can be used to improve the quality of life in communities and the performance of services (Mark Friedman) Turns talk about outcomes quickly into actions which improve those outcomes Embeds performance management into planning and delivery Explains both collaborative and service accountability and how they fit back together

5 Results-based accountability is made up of two parts: Population accountability about the wellbeing of WHOLE POPULATIONS for neighbourhoods districts regions - countries Performance accountability About the wellbeing of CLIENT POPULATIONS for projects agencies service providers

6 From talk to action... Population Accountability Performance Accountability OUTCOMES A condition of wellbeing for children, adults, families or communities INDICATORS A measure which helps quantify the achievement of an outcome PERFORMANCE MEASURES A measure to evaluate how well a programme, agency or service system is working

7 Population and performance accountability OUTCOME: All Young People in Cardiff are Healthy Population Accountability INDICATOR Obesity Rate Contribution Young people attending active lifestyle programme All Young People in Cardiff WHOLE POPULATION PERFORMANCE MEASURE % young people attending losing weight Performance accountability

8 The 7 performance accountability questions 1. Who are our customers? 2. How can we measure if our customers are better off? 3. How can we measure if we are delivering services well? 4. How are we doing on the most important of these measures and why? IS THIS OK? 5. Who are our partners that have a role to play in doing better? 6. What works to do better, including no-cost and low-cost ideas? 7. What do we propose to do?

9 THE WELSH EPILEPSY UNIT Service Description: The Welsh Epilepsy Unit is a tertiary referral centre for specialist epilepsy services in South Wales. The immediate catchment population covered is 700,000, but many referrals are also taken from elsewhere in Wales. The Unit offers a multidisciplinary approach to epilepsy care and offers a very broad range of services to people with epilepsy, their families and carers. DEFINED SERVICE USERS Patients with a first suspected seizure or unexplained blackout HEADLINE PERFORMANCE MEASURES 1. % seen by a specialist within 2 weeks 2. % DNA first seizure clinic 3. % have diagnostic tests within 4 weeks 4. % follow the correct pathway DATA DEVELOPMENT AGENDA 1. % on inappropriate treatment 2. % have clinic letters sent within one week of clinic 3. Why patients DNA first seizure clinic HOW ARE WE DOING? % Seen by a Specialist within 2 Weeks % DNA First Seizure Clinic % have diagnostic tests within 4 weeks % follow correct pathway 25% 20% 15% 10% 5% 0% Baseline Prediction Curve to turn 30% 25% 20% 15% 10% 5% 0% Baseline Prediction Curve to turn 35% 30% 25% 20% 15% 10% 5% 0% Baseline Prediction Curve to turn 100% 80% 60% 40% 20% 0% Baseline Prediction Curve to turn STORY BEHIND THE BASELINES Clinic capacity 1 clinic per week with 5 patient slots Unpredictable demand Small MDT unable to cover absence to prevent clinic cancellation Low frequency of clinics causes delay if appointment not suitable Clinic booked by Epilepsy Unit admin staff if admin staff on leave clinic slots not filled Consultant triage s fax referrals delay if unavailable Patient anxiety Stigma attached to Epilepsy Patients put off by unit name diagnosis seems pre-determined Concerns re implications e.g. diving PARTNERS WHO CAN HELP US DO BETTER Emergency Unit/MEAU, Radiology, Neurophysiology, Medical records, A&C staff, Consultants, Ambulance Trust, Cardiology, Psychology, Care of the Elderly, Neurosurgery, Prison, Voluntary Sector, CELT, Practice Nurses, Family members/ witnesses, Drug and Alcohol Services, Occupational Health, Referral Management Centre, Obstetrics. WHAT WE PROPOSE TO DO TO IMPROVE PERFORMANCE Develop nurse led Emergency Unit assessment service Develop nurse led first seizure clinics Enable specialist nurse referral for EEG Change the name of the Epilepsy unit

10 Cardiff and Vale Experience Population accountability Cardiff Integrated Partnership Strategy Vale Community Strategy Health and Social Care Well Being Strategy older people Performance accountability chronic conditions management falls neighbourhood MDTs community pain team epilepsy self care Emergency transfer of care team

11 Local Service Board Integrated Partnership Strategy Population Accountability Organisational Priorities Health & Social Care Well Being Strategy Delivery Plan Population Accountability Chronic Conditions Management Board Performance Accountability Condition Pathways e.g. Epilepsy, COPD Performance Accountability Neighbourhood/Locality MDT Performance Accountability

12 IPS OUTCOME: People in Cardiff are Healthy IPS INDICATOR Unscheduled Hospital Admissions Contribution People in Cardiff with or at risk of developing a chronic condition People in Cardiff WHOLE POPULATION People who are admitted as a result of a presumed seizure People who use health and social care services in Cardiff West CCM BOARD PERFORMANCE MEASURES Acute hospital bed days Readmission rate EPILEPSY TEAM PERFORMANCE MEASURES Acute hospital bed days Readmission rate CARDIFF WEST MDT PERFORMANCE MEASURES Unscheduled admissions Readmission rate

13 Data Final (Year 3) Report from the Chronic Conditions Management (CCM) Demonstrators: Learning to Support Integrated Primary and Community Care across Wales, September 2011, Chronic Conditions Management Demonstrators

14 Data Total Bed Days 2008 Total Bed Days 2010 Difference COPD CHD Epilepsy Diabetes Overall 16,915 13,155-3,760 Final (Year 3) Report from the Chronic Conditions Management (CCM) Demonstrators: Learning to Support Integrated Primary and Community Care across Wales, September 2011, Chronic Conditions Management Demonstrators

15 Participant views 92% of survey respondents stated that RBA is useful as tool for driving improvements. Participants are very positive about the impact that RBA can have on the delivery of services and outcomes for communities, and feel the approach: is ground-breaking is inclusive adopts common methods and language provides impact outcomes results in an end product is motivating. Evaluation of Results Based Accountability, May 2011, Chronic Conditions Management Demonstrators with Opinion Research Services

16 For information and learning from the CCM Demonstrators please visit Thank you