TRUST BOARD/DIRECTORS GROUP 2016 Key Performance Indicators Introduction This paper provides an update on our progress towards our vision to be England s best acute teaching trust in 2016 and beyond. The Trust Board on 25 th April 2013 approved a trajectory for thirteen key performance indicators (KPIs) and a methodology for measuring our overall performance. It was agreed that our progress would be reviewed every six months (April and October). It is also recognised, following Board discussions, that there is a desire to refresh the dialogue with employees, patients and carers and other stakeholders regarding the delivery of the vision to 2016 and beyond. Trust Progress towards 2016 Vision By aiming to be within the top three (top quartile performance), 8 of the 13 KPIs have already been achieved and the remainder are expected to be achieved by the end of 2016/7. Table 1: Trust Progress towards 2016 Vision Ambition Met Strategic Aims Indicator (Top Quartile Performance) Summary Hospital-Level Mortality (SHMI) - Index Clinical MRSA cases per 100000 bed days Outcomes C-Diff cases per 100000 bed days Will be met by 2016 Standardised emergency readmissions within 28 days of discharge Patient Patient Experience: Friends and Family test Experience Performance Aggregate (Number of performance targets not achieved) Will be met by 2016 Percentage of staff receiving job-relevant training, learning or Will be met by 2016 development in last 12 months (staff survey) Teaching and GMC survey of doctors in training - Overall Satisfaction Score [2] Learning Will be met by 2016 Nurses & AHPs - league table university courses (Complete University Guide: overall satisfaction score) Research and Development Patients recruitment into clinical trials (per 1000 outpatient first attendances) Staff Staff engagement metric satisfaction Value for Money Monitor Continuity of Services Risk Rating Reference Cost Index (RCI) MFF Adjusted Will be met by 2016 KPI Trajectory For each of the 13 KPIs, Appendix 1 shows the definition of being the best and the expected trajectory for the 5 years to 2018/19. 5 trajectories have been revised, with the original shown in parentheses. Our peer trusts are also seeking to improve their performance and the top quartile ambition has become more challenging for three KPIs: mortality (SHMI), staff receiving training and reference costs (RCI). As our peers are likely to continue to improve we will need to work hard to maintain and improve our relative position. Each top quartile target and trajectory will be reviewed every six months and is likely to become increasingly challenging.
Progress by Indicator The KPI Dashboard (Table 2) shows current NUH performance. The horizontal bar chart shows NUH relative performance to both the peer mean and the general spread (in quartiles) of all other acute trusts in England. SHMI Our SHMI is significantly better than the all acute trust average and is within top quartile peer performance. Compared to 2012, our SHMI has improved in the 12 months to June 2013 (from 93.2 to 91.4), whereas top quartile performance among peers has declined (from 91.7 to 93.0). The future trajectory is flat: i.e. we aim to maintain an SHMI of 92 or below. MRSA - In the 11 months to February 2014, we are the top performing trust among our peers and within the top quartile for all acute trusts. The trajectory for MRSA has been revised downwards to show us maintaining (or improving) the current rate of 0.4 cases for 100000 bed days. C-DIFF Our performance in 11 months to February 2014 is better than the trajectory target, but is not as good as the average of peers or the average of all trusts. We have maintained a ranking of 9 th among the 12 peers. The trajectory has been revised to reflect the more challenging peer upper quartile of 14 cases per 100,000 bed days. 28 day Readmissions - Our performance has improved significantly in the 12 months to January 2014. We are within the top quartile and we are now ranked 3 rd among the 12 peers. The future trajectory has been revised to show us maintaining our current level. Friends and Family Test Our improving score places the Trust within the top quartile among peers and within the top quartile among all acute providers. We are now ranked 3 rd among the 12 peers. The future trajectory has been revised to show us maintaining our current level. Performance Targets We are currently failing to achieve three performance targets. Although this is close to the top quartile for peer trusts, our aim is to meet all of our performance targets. Staff receiving relevant training Following top quartile performance in 2012, the proportion of staff receiving training at NUH fell slightly in 2013 and is now close to peer average (which improved) and we are ranked 7 th among peers. The trajectory has been amended to reflect 2013 performance of NUH and its peers. Doctor satisfaction with training Although we are ranked 10 th among peers, our satisfaction score is close to the peer top quartile because there is very little variation in the score among the best performing peers. We expect to reach top quartile performance by 2016. Student Nurses and AHP satisfaction - We remain in the top quartile of peers. In 2013, we were ranked second, behind Manchester, in the Complete University Guide, after being ranked first in 2012. Patients recruited to clinical trials We remain in the top quartile of peers, ranked fourth. Staff engagement metric - We remain in the top quartile of peers, ranked third. Monitor continuity of services risk rating Our risk rating falls within the peer top quartile and we are ranked equal third among peers. Reference Cost Index Our RCI has fallen significantly from 102 to 99, but the reference costs of our peers have also improved. Our reference costs are better (lower) than the average for peers and all trusts and we
expect to be within the peer top quartile by 2016. The trajectory has been amended to reflect 2012/13 performance of NUH and its peers. Recommendations We ask the Trust Board to: 1. Note current performance 2. Approve the summary of progress towards 2016 for incorporation into the Annual Report 3. Comment on the additional actions required to ensure delivery by 2016 4. Review and approve the revised KPI trajectory for incorporation into the Integrated Business Plan. 5. Receive an update every 6 months Sam Porter Strategic Planning Manager 9 h April 2014
Appendix 1: Trajectory for 13 KPIs Strategic Aims Clinical Outcomes Patient Experience Teaching and Learning Research and Development Summary Hospital-Level Mortality (SHMI) - Index MRSA cases per 100000 bed days C-Diff cases per 100000 bed days Standardised emergency readmissions within 28 days of discharge Patient Experience: Friends and Family test Performance Aggregate (Number of performance targets not achieved) Percentage of staff receiving job-relevant training, learning or development in last 12 months (staff survey) GMC survey of doctors in training - Overall Satisfaction Score [2] Nurses & AHPs - league table university courses (Complete University Guide: overall satisfaction score) Patients recruitment into clinical trials (per 1000 outpatient first attendances) Staff satisfaction Staff engagement metric Value for Money Indicator Monitor Continuity of Services Risk Rating Reference Cost Index (RCI) MFF Adjusted Period of current data Current NUH perfor mance Target 2013/ 14 2014/ 15 2015/ 16 2016/ 17 2017/ 18 Definition of "Being the best" Jul 2012-93.0 91.4 92.2 92.2 92.2 92.2 92.2 92.2 SHMI significantly better than the average for Jun 2013 (91.7) (93.2) all acute trusts and in top quartile among peers 2013 To Feb 14 1.1 0.4 2.3 0.4 0.4 0.4 0.4 0.4 Continue reduction in MRSA rates to achieve (0.4) (0.6) (1.7) (1.3) (1.0) (0.7) and remain in best quartile 2013 To Feb 14 14 17.9 20 16 15 14 13 13 Eliminate all avoidable Cdiff cross infections 2016 (2013) (20) Feb 2013-96 91 108 91 91 91 91 91 Achieve a continued improvement and be in the 2013 (2016) Jan 2014 (106) (104) (101) (98) (98) (98) top 3 (top quartile) among peers by 2016 Jan-14 76 79 68 79 79 80 80 80 Achieve a continued improvement and be in the 2013 (2016) (77) (72) (76) top 3 (top quartile) among peers by 2016 Latest 3 3 0 0 0 0 0 0 Achieve all performance targets 2014 (2013) Data (2) 2013 84% 82% 76% 84% 84% 84% 84% 84% Achieve results within the top 3 (top quartile) 2014 (2012) (82%) (84%) (78%) (79%) (80%) (80%) (80%) 2018/ 19 2013 81.3 80.2 80.2 80.8 81.3 81.3 81.3 81.3 Achieve results within the top 3 (top quartile) 2013 98 98 98 98 98 98 98 Maintain best performance among peers 2012 2012/13 60 65 65 65 65 65 65 65 2013 3.8 3.9 (3.8) Q4 2013/14 Current top quartile peer performance [1] 2012/13 Achieve results within the top 3 (top quartile) 3.8 3.8 3.8 3.8 3.8 3.8 Achieve results within the top 3 (top quartile) 2.8 3 3 3 3 3 3 3 99 (102) NUH Performance Trajectory 101 98 (100) We will maintain a Continuity of Services Risk rating of 3 and remain within the best 3 of our 12 peers Our costs will be below average for all acute trusts and in top quartile among peers NOTES Where there are changes from the table presented at TB in October 2013, original shown in parentheses [1] Peer performance is also likely to improve so the upper quartile target will be reviewed every six months and is likely to become increasingly challenging [2] Measure revised to overall satisfaction score (out of 100) Year Ambition First Achieved 2016 2012 (2016) 2012 2012 2016 (2015)
Appendix 2 Dashboard Progress Strategic Aims Indicator Basis Period Trend NUH Rank 1 = Best 13 = Worst Top performing peer trust Summary Hospital-Level Mortality (SHMI) Annual Jul 2012- Jun 2013 4 Cambridge University Hospitals NHS FT Clinical Outcomes: Our patients will achieve the best health outcomes in England through our delivery of safe, effective, evidence-based care MRSA per 100,000 Occcupied Bed Days C-Diff per 100,000 Occupied Bed Days YTD To Feb 14 1 YTD To Feb 14 9 Nottingham University University Hospital Southampton Patient Experience: Our patients and their families choose NUH as their care provider of choice because of the high quality of care we deliver and the active way we involve them in care decisions Teaching and Learning: We will be recognised for having a learning environment where all students and staff continuously and pro-actively seek knowledge and skills to achieve excellence in all aspects of healthcare delivery Standardised emergency readmissions within 28 days of discharge Annual Feb 2013- Jan 2014 Friends and Family Test Month Jan-14 3 Performance Aggregate Latest Data Available Staff Survey - Percentage of staff receiving job-relevant training, learning Annual 2013 7 or development in last 12 months GMC survey of doctors in training - Overall Satisfaction Nurses & AHPs - league table university courses Annual 2013 10 Annual 2013 1 3 =3 Of Leicester NHS Trust Royal Liverpool and Broadgreen University Hospitals The Newcastle Upon Tyne Hospitals NHS Nottingham University Research and Development: We will develop internationally recognised research and innovation, which helps deliver excellent care to our community Patient recruitment to clinical trials per 1000 outpatients attendances Staff Satisfaction: Our staff are recognised as among the best in the country in terms of the Staff survey results Staff provision of caring, safe and thoughtful care. NUH will ensure each individual Engagement metric is able to contribute to and influence the future of the organisation, the job they do, their career and skills and our role in the community Value for Money: We will be known as a high performing care provider, with consistently excellent service delivered cost effectively. We will continuously challenge our established business models. Monitor Financial Risk Rating (FRR) Reference Cost Index (RCI) MFF Adjusted Annual 2012/13 4 Annual 2013 3 Quarterly Q4 2013/14 Annual 2012/13 5 =3 Cambridge University Hospitals NHS FT Cambridge, Birmingham (=1) Leeds Teaching