High performing health systems are accountable to their communities for the delivery of health services. Greater transparency in information about the performance of the health system will lead to choices, responsibility and accountability, in terms of health outcomes including improved quality of health care and taxpayer value. Transparent reporting of accurate and relevant information about the health system’s performance will help to drive improvements throughout the metropolitan health system and to direct the allocation of resources.
Health outcomes framework
Existing performance reporting has gaps, in particular in the ability to measure and report health outcomes, patient experience, efficiency and effectiveness.
A comprehensive Health Outcomes Framework (widely supported by the Committee and through the consultations) that uses a set of indicators that reflect the quality of care delivered across all dimensions and domains is proposed, with a focus on measuring and improving patient health outcomes. Development and implementation of a Health Outcomes Framework will need to ensure there is minimal or no duplication of existing reporting requirements and that new requirements are not overly burdensome for providers.
A Health Outcomes Framework would be used: — by the community, to gain an understanding
of the overall performance of the metropolitan health care system, health status of the
population and the care they can expect to receive
— by government to report health sector performance and current priorities (which will change over time) to the community and as a means of accountability (to the community and parliament) and transparency
— by health sector providers to review and monitor their performance and determine areas for improvement
— by the department to monitor and evaluate health outcomes and inform resource
allocation and improvement initiatives, such as those to be led through the Health Innovation and Reform Council.
The Health Outcomes Framework would be developed in consultation with the sector and other key stakeholders.
Indicators that comprise the Health Outcomes Framework should be developed to reflect high-quality health outcomes and work in concert with clinical guidelines and patient pathways.
Governance
The Committee indicated the roles of all providers and players in the health system need to be clearly defined so that throughout the continuum of care, they can take greater responsibility for health service provision. To enable providers to implement changes, effective governance arrangements are needed. Current barriers to action must be removed and permission for action given where required. Through better designed stewardship obligations and transparent reporting, health services’ accountability and financial monitoring can be improved.
The governance of hospitals and health
services is a central task in the safe, efficient and cost effective delivery of high quality health care. This governance is regulated by the appropriate acts of parliament. Board members, a strength of the Victorian health care system, are required to act within the terms of relevant legislation and as trustees of health services.
There is also a need for sufficient input into clinical governance and health service governance from clinicians - doctors, nurses and allied health professionals. This will ensure that their voices and experience input into the governance and decision making by health services.
Delivering greater transparency and accountability:
To be truly transparent, the health system must provide the Victorian community with full reports on outcomes and performance. These reports should include accurate and relevant information about the state of our hospitals and health system, for example, by reporting openly on waiting lists. Increasing transparency and accountability in reporting of accurate and relevant information about the health system’s performance will empower people of metropolitan Melbourne to judge the effectiveness of the health care system. The government will:
1. Establish a hospital performance website to provide transparent information regarding the performance of major metropolitan and regional hospitals. This website will be launched in June 2011 and will publish data including:
a. ED attendances by urgency category, median wait times, admissions, and activity b. ambulance diversions, including ambulance
bypass and Hospital Early Warning System (HEWS) incidences
c. the number of ambulance patient transfer occasions and hours
d. the data reported on the website is likely to increase over time to include new indicators as they are developed.
2. By the end of 2011, publish outpatient waiting lists for public hospital specialist clinics, including the time patients wait to get an appointment.
The Victorian Government will require each metropolitan health service to formally report as part of their annual report, on the mechanisms they have employed and the actual consultation that has taken place to engage with their staff and relevant clinicians. These new reporting requirements will be implemented in the 2011–12 financial year.
Planning and development priorities for metropolitan health services will include:
1. Developing a Health Outcomes Framework that encompasses the measurement of patient experiences, health outcomes (specifically including a focus on quality and safety), efficiency and effectiveness that does not generate any unnecessary additional data reporting and better coordinates and rationalises existing reporting processes (both state and national).
2. Auditing adherence to key initiatives such as the establishment and utilisation of clinical guidelines and patient pathways (including monitoring through Clinical Networks). 3. Reviewing the existing legislative approaches
that drive governance and accountability arrangements for health services such as the Health Services Act as amended by the
Health Services (Governance) Act 2000, the Mental Health Act 1986 and the Mental Health
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