- 1 - For decision on 25.1.2018 AOM-P1352 Hospital Authority 2017 Key Performance Indicator Annual Review Purpose This paper informs Members of the progress of the 2017 Key Performance Indicator (KPI) Annual Review and seeks Members comments and approval for the recommendations made by the KPI Review Working Group (Working Group). Background 2. The KPI framework, covering three pillars, namely clinical services, human resources (HR) and finance, was formulated in 2008 1. Each of the pillars is supported by a collection of KPIs selected based on a set of criteria as set out in Annex 1. For the continuous development of KPIs, the Working Group was formed in 2010 2 to conduct KPI annual review to ensure that the KPIs are in line with the service directions and priorities of the Hospital Authority (HA). Its membership and terms of reference are provided in Annex 2. Development and Review 3. Comments and feedback on the KPIs, which are collected during the course of the year through various channels, such as Administrative and Operational Meeting, Directors Meeting, Cluster Management Meeting, and Coordinating Committees / Central Committees are put forward to the Working Group for consideration during the annual review. A systematic approach to consult the related functional committees (clinical service KPIs to Medical Services Development Committee; HR KPIs to Human Resources Committee and Finance KIPs to Finance Committee) as well as the top management team of HA Head Office and clusters is adopted. The conceptual framework of the current process of KPI development, review, endorsement, implementation and monitoring is presented in Annex 3. 1 Via Administrative and Operational Meeting (AOM) Paper No. 530 on New Framework for Key Performance Indicators discussed on 28 February 2008. 2 via AOM Paper No. 722 on Chief Executive s Progress Report on Key Performance Indicators (AOM Full KPI Report No. 7) presented on16 September 2010.
- 2-2017 KPI Annual Review KPI Proposals 4. In the 2017 KPI Annual Review, the Working Group agreed that the existing three-pillar KPI framework should remain status quo. The Working Group has also recommended some revisions to the existing list of clinical service KPIs while the current KPI lists on HR and finance will remain unchanged. The proposed revisions to the existing clinical service KPIs are outlined in the ensuing paragraphs. Clinical Service KPIs Disease Specific Quality Indicators Cancer 5. The revision for the KPIs on waiting time for cancer treatment involves refinement of the inclusion and exclusion criteria of the following indicators: Waiting time (day) at the 90 th percentile for patients with breast cancer receiving first treatment after diagnosis; and Waiting time (day) at the 90 th percentile for patients with colorectal cancer receiving first treatment after diagnosis. 6. The existing counting rule for the above KPIs only covers cases with diagnosis confirmed in HA. To better reflect the performance in terms of waiting time for first treatment (surgery, chemotherapy or radiotherapy) in HA after diagnosis along the patient journey, the above KPIs are proposed to (i) include cases pathologically confirmed in private health sector and received treatment in HA; and (ii) exclude patients who had received first treatment in private health sector after diagnosis in HA but subsequently received other follow-up treatment in HA. With the revision on inclusion and exclusion criteria, the refined KPIs would better measure the waiting time between pathological diagnosis in HA and private health sector to first treatment in HA. Disease Specific Quality Indicators Mental Health 7. On mental health initiative, the Personalised Care Programme (PCP), launched by phases since 2010/11, was extended to cover 18 districts in 2014/15 to provide personalised support to patients with severe mental illness (SMI) in the community using a case management approach. Patients suffered from SMI usually follow a chronic or recurrent course, with residual symptoms and incomplete social recovery. The primary purpose of PCP is to provide enhanced personalised care and recovery-orientated community support for patients with SMI with a view to facilitating community reintegration and promoting recovery journey. A new KPI is proposed to measure the proportion of compulsory psychiatric admissions for patients receiving active PCP care:
- 3 - Percentage of compulsory psychiatric admissions under the Mental Health Ordinance via Accident & Emergency Department (AED) for patients receiving active Personalised Care Programme care 8. With reference to the international outcome measures, unplanned admission to psychiatric institution is commonly used as an indicator for measuring the quality of mental health services. Compulsory admission via AED to a psychiatric facility may hamper patient recovery and put pressure onto the public healthcare resources. If appropriate and timely personalised care is provided when in need (including the arrangement of planned psychiatric admission via specialist outpatient clinic or patients accompanied by case managers to attend AED when specialist outpatient service is unavailable), such undesirable outcome in terms of compulsory admission can be avoided. The proposed KPI would provide information to facilitate assessing programme effectiveness in providing appropriate care to enhance recovery outcomes for patients with SMI. List of KPIs on Clinical Services, Finance and HR for Monitoring in 2018/19 9. The revised list of clinical service KPIs, incorporating the recommendations of the Working Group mentioned above, is set out in Annex 4. The list of KPIs on HR and Finance, which remain unchanged, are set out in Annexes 5 and 6 respectively. Other Developments Related to KPIs 10. Opportunity is also taken to update Members on other developments related to KPIs. The following initiatives which will have impact on KPI development and reporting are being undertaken : (a) (b) An information system, HA Management Information System (HAMIS) is being developed for phased implementation to facilitate reporting, performance monitoring and information dissemination of KPIs to different levels of staff. The system will be ready for report production in March 2018 and access to report archives in April 2018, with the first KPI report to be released through the HAMIS in May 2018. A governance structure for official statistics, involving the Committee on Official Statistics (CoOS), has been put in place to oversee the development and implementation of corporate-wide data standardisation for production of HA official statistics (excluding HR and financial statistics). Since clinical service KPIs are a key component of HA official statistics, the KPI Review Working Group will work closely with CoOS for initiation, development and review of clinical service KPIs.
- 4 - (c) Continuous efforts are made to refine the Guidebook of KPIs (Guidebook). The fifth edition of the Guidebook will be published within the first quarter of 2018/19 to cover the latest revisions mentioned in the preceding paragraphs. Decision Sought 11. Members are invited to comment on and approve the recommendations made by the Working Group as detailed in paragraphs 4 to 9 and the revised list of clinical service KPIs in Annex 4; and note the direction on KPI development as described in paragraph 10. Members may wish to note that the Medical Services Development Committee, after deliberation at its meeting held on 4 December 2017, has supported the proposed changes on clinical service KPIs and also noted the direction on KPI development. Hospital Authority AOM\PAPER\1352 18 January 2018
- 5 - Annex 1 to AOM-P1352 Key Performance Indicator (KPI) Framework KPI Selection Criteria (a) Relevance to the overall corporate priorities and organizational objectives to facilitate ongoing monitoring in key areas at hospital, cluster and corporate levels; (b) Availability of automated data to minimize manual efforts in the collection of data and compilation of reports; (c) Reliability of available data to enhance confidence of stakeholders in using the data for performance benchmarking and service improvement; (d) Comparability of data across clusters to facilitate meaningful discussion on service improvement and establishment of best practices; (e) Materiality of the selected KPIs in affecting managers and clinicians behavior to drive changes in service organization or clinical practices for better quality and higher efficiency; (f) Impact on service outcome and cost efficiency to maximize the benefits of KPIs; and (g) Burden of disease in clinical services to ascertain relevant focus on diseases with high patient volume or diseases which consume significant proportion of the HA s resources.
- 6 - Annex 2 to AOM-P1352 Membership of Key Performance Indicator (KPI) Review Working Group I. Membership * Coordinating Committees / Central Committees representatives & KPI subject officers are invited to attend the meeting II. Terms of Reference 1. To review the current KPI list to ensure that: a. The indicators in force are in keeping with current service needs b. The indicators are reported to the appropriate forums (Food and Health Bureau, Administrative and Operational Meeting, HA Board s Functional Committees, Directors Meeting, Cluster Management Meeting, etc.) 2. To advise on inclusion of new indicators and deletion of existing indicators taking into account input from Coordinating Committees / Central Committees, clusters and Head Office divisions 3. To advise on matters relating to KPI development
- 7 - Annex 3 to AOM-P1352 Current Processes of Key Performance Indicator (KPI) Development and Review COCs / CCs: Coordinating Committees / Central Committees CS: Cluster Services Division, HAHO Q&S: Quality and Safety Division, HAHO S&P: Strategy and Planning Division, HAHO
- 8 - Annex 4 to AOM-P1352 List of Clinical Service Key Performance Indicators (KPIs) for 2018/19 Service Growth in response to Population Change & Ageing Effect Service capacity - No. of hospital beds (total) - No. of community nurses - No. of geriatric day places - No. of community psychiatric nurses - No. of psychiatric day places Service throughput Inpatient Services - No. of inpatient discharges and deaths (overall) - No. of patient days (overall) - No. of day inpatient discharges and deaths Accident & Emergency Services - No. of attendances - No. of first attendances for - Triage I (Critical cases) - Triage II (Emergency cases) - Triage III (Urgent cases) Specialist Outpatient Services - No. of specialist outpatient (clinical) new attendances - No. of specialist outpatient (clinical) follow-up attendances - Total no. of specialist outpatient (clinical) attendances Primary Care Services - No. of general outpatient attendances - No. of family medicine specialist clinic attendances - Total no. of primary care attendances Allied Health Outpatient Services - No. of allied health (outpatient) attendances Day Hospital Services - No. of rehabilitation day and palliative care day attendances - No. of geriatric day attendances - No. of psychiatric day attendances Community and Outreach Services - No. of home visits by community nurses - No. of allied health (community) attendances - No. of geriatric outreach attendances - No. of geriatric elderly persons assessed for infirmary care service - No. of Visiting Medical Officer attendances - No. of psychiatric outreach attendances - No. of psychogeriatric outreach attendances KPI
- 9 - List of Clinical Service KPIs for 2018/19 (con t) Quality Improvement as a result of Technology Advancement or Implementation of New Service Quality & Access Initiatives Waiting Time for Accident & Emergency (A&E) Services % of A&E patients seen within target waiting time for - triage I (critical cases 0 minute) - triage II (emergency cases 15 minutes) - triage III (urgent cases 30 minutes) - triage IV (semi-urgent cases 120 minutes) Waiting Time for Specialist Outpatient (SOP) New Case Bookings Median waiting time (week) for first appointment at specialist outpatient clinics for - Priority 1 (P1) patients - Priority 2 (P2) patients For each of ENT, GYN, MED, OPH, ORT, PAE, PSY and SUR - % of patients seen within 2 weeks for P1 patients - % of patients seen within 8 weeks for P2 patients - Waiting time (week) for 90 th percentile of Routine cases Waiting Time for Allied Health Outpatient New Case Bookings For each of OT and PT - % of patients seen within 2 weeks for P1 patients - % of patients seen within 8 weeks for P2 patients - Waiting time (week) for 90 th percentile of Routine cases Waiting Time for Elective Surgery Total Joint Replacement - Waiting time (month) at 90 th percentile of patients receiving the treatment of total joint replacement Benign Prostatic Hyperplasia - % of patients provided with surgery within 2 months for P1 patients - % of patients provided with surgery within 12 months for P2 patients Waiting Time for Diagnostic Radiological Investigations For each of CT, MRI and US - % of urgent cases with examination done within 24 hours For each of CT, MRI, US and Mammogram - Median waiting time (week) for P1 patients - Median waiting time (week) for P2 patients - Waiting time (week) for 90 th percentile of Routine cases Access Block Monitoring [Exception reporting in KPI Report] - No. / % of patients with access block time more than [4 hours, 12 hours] Access to General Outpatient Clinic (GOPC) Episodic Illness Service - GOPC quota availability (for elders) (%) Appropriateness of Care - Standardised admission rate for A&E patients (%) - Unplanned readmission rate within 28 days for general inpatients (%) Breastfeeding Rate - Breastfeeding rate on discharge (%) Infection Rate - MRSA bacteraemia in acute beds per 1 000 acute patient days Access to Outreach Service - % of RCHEs covered by CGATs or VMOs under CGATs KPI
- 10 - List of Clinical Service KPIs for 2018/19 (con t) KPI Quality Improvement as a result of Technology Advancement or Implementation of New Service Quality & Access Initiatives (con t) Disease Specific Quality Indicators Stroke - % of acute ischaemic stroke patients received IV tpa treatment Hip Fracture - % of patients indicated for surgery on hip fracture with surgery performed 2 days after admission through A&E Cancer - Waiting time (day) from decision to treat to start of radiotherapy (RT) for 90 th percentile of cancer patients requiring radical RT - Waiting time (day) at 90 th percentile for patients with colorectal cancer receiving first treatment after diagnosis (refinement of inclusion / exclusion criteria) - Waiting time (day) at 90 th percentile for patients with breast cancer receiving first treatment after diagnosis (refinement of inclusion / exclusion criteria) - Waiting time (day) at 90 th percentile for patients with nasopharynx cancer receiving first treatment after diagnosis Diabetes Mellitus - % of diabetes mellitus patients with HbA1c < 7% Hypertension - % of hypertension patients treated in GOPCs with BP < 140/90 mmhg End Stage Renal Disease - % of end-stage renal disease patients receiving haemodialysis treatment Mental Health Services - Average length of stay (LOS) (day) of acute inpatient care (with LOS 90 days) - % of compulsory psychiatric admissions under the Mental Health Ordinance via AED for patients receiving active Personalised Care Programme care (new) Cardiac Services - % of acute myocardial infarction patients prescribed with Statin at discharge - % of ST-elevation myocardial Infarction patients received primary percutaneous coronary intervention Technology - % of medical equipment with age beyond the expected life Efficiency in Use of Resources Capacity and Throughput of Specialist Outpatient (SOP) Services For each of ENT, GYN, MED, OPH, ORT, PAE, PSY and SUR - Throughput for SOP services - No. of SOP first attendances per doctor - No. of SOP follow-up attendances per doctor - Waiting list management - Growth of waiting list against throughput (%) Operating Theatre (OT) Utilisation - Ratio of scheduled to expected elective OT session hours (%) - Utilisation rate of scheduled elective OT sessions (%) Bed Management - Bed occupancy rate (%) (inpatient overall midnight) - Average length of stay (day) for general inpatients Day and Same Day Surgery Services For each of OPH, ORT and SUR - Rate of day surgery plus same day surgery (%) Productivity - Total weighted episodes (WEs) of acute inpatient services - Growth index for non-acute inpatient services (%) - Growth index for ambulatory and community care services (%) Proposed revision under 2017 KPI Annual Review
- 11 - Annex 5 to AOM-P1352 List of Human Resources KPIs for 2018/19 (Nil revision under 2017 KPI Annual Review) Manpower Situation Manpower Position - By Staff Group Attrition (Wastage) Rate / Resignation 5 Years Trend Attrition (Wastage) Rate - By Cluster - By Staff Group No. of Resignations (Doctor) - No. of resignations - No. of resignations per 100 staff (Resignation rate) No. of Resignations (Nursing) - No. of resignations - No. of resignations per 100 staff (Resignation rate) No. of Resignations (Allied Health) - No. of resignations - No. of resignations per 100 staff (Resignation rate) No. of Resignations (Supporting (Care-related)) - No. of resignations - No. of resignations per 100 staff (Resignation rate) Staff Wellness Sick Leave Average Sick Leave Days taken per staff - By Staff Group Percentage of staff with Sick Leave taken 50 days - By Staff Group Injury on Duty (IOD) No. of IOD Cases per 100 FTE staff - By Staff Group No. of IOD Leave Days per 100 FTE staff - By Staff Group
- 12 - List of Finance KPIs for 2018/19 (Nil revision under 2017 KPI Annual Review) Budgetary Performance Budget Performance Report Report on Capital Expenditure Untaken Leave Balance Drug Stock Balance and Stock Holding Period Annex 6 to AOM-P1352