SERVICE AGREEMENT PERFORMANCE FRAMEWORK

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Version 1.0

Final

Amended

December 2014

2014-2015

SERVICE AGREEMENT

PERFORMANCE

FRAMEWORK

Activity Based Funding and

Management

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1 Executive Summary

This document presents the 2014-2015 Service Agreement Performance Framework and consolidates work commenced and progressed in the 2012-2013 and 2013-2014 versions.

The 2014-2015 version reinforces the focus on Activity Based Funding (ABF) and management and has matured to include:

 Specific activity Key Performance Indicators (KPIs) that are directly aligned to the funded outputs of the Tasmanian Activity Based Funding Model.

 Selected process KPIs that recognise the importance of accurate and timely coding of patient data in maintaining the integrity of the ABF system.

Furthermore, while mental health services transferred to THOs from 1 July 2013, no specific KPIs were included in 2013-2014 Service Agreements, thus enabling the services to consolidate within THO

structures before the introduction of formal performance management processes. The 2014-2015 version addresses this previous gap through the inclusion of three specific KPIs that enable a broad analysis of the performance of the mental health service system across a number of performance domains, including quality, effectiveness, efficiency and access.

Drawing on lessons learned, the 2014-2015 version retains the performance monitoring and management processes outlined in 2013-2014. These processes were practically applied by both the Department of Health and Human Services (the Department) and THOs throughout 2013-2014, providing clarity to both parties in relation to the identification, escalation and de-escalation of identified performance issues. The 2014-2015 version reinforces the over-arching objective of facilitating long term, sustainable

improvement in areas where a performance concern has been identified. While performance escalations remain a central feature, they will generally only be recommended in circumstances where a THO is unable to demonstrate to the Department that:

 The performance concern is being actively managed and monitored by the THO.

 A robust and transparent plan for sustainable performance improvement is in place within the THO.  It possesses the necessary skills to achieve sustainable performance improvement in the area of

concern.

In 2014 the Minister approved delegation of certain Ministerial powers and functions that enables the Secretary to escalate or de-escalate concerns for;

 Level 1 (unsatisfactory performance), requesting a Performance Improvement Plan from THOs.  Level 2 (sustained unsatisfactory performance), ability to appoint a Performance Improvement Team. The Minister retains the power to appoint a Ministerial Representative to assist the Governing Council, if considered necessary, as part of a Level 2 performance escalation. The Minister also retains the power to approve a Level 3 performance escalation.

The 2014-2015 version moves to address any previous uncertainty regarding the carryover of existing performance escalations from one Service Agreement year to the next. Whereas previously performance escalations ceased at 30 June of the Service Agreement year in which they were initiated (regardless of whether the performance issue had been remediated at that time or not), escalations will now remain in place until such time as the requirements of any associated performance escalation are met.

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Executive Summary Where possible, the 2014-2015 version continues to be aligned to state and national strategic priorities. The annual (rolling) Statement of Purchaser Intent, which signals purchaser intentions over the coming five years, provides detail on the annual purchasing priorities and policy drivers for the Department.

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Background

2 Background

Overview of the Department’s Performance Framework

Under the Tasmanian Health Organisations Act 2011 (the Act), the Minster for Health (the Minister) enters into annual Service Agreements with THO Governing Councils. The development of, and advice regarding these Agreements originates from the Department (acting on behalf of the Minister as the Purchaser). The Department’s purchasing function is supported by a number of governing instruments, including the 2014-2015 Purchasing Framework, which outlines the process followed in purchasing services, and this document, the 2014-2015 Service Agreement Performance Framework, which codifies the process of monitoring THO performance against the requirements of Service Agreements.

In addition to its role as the Purchaser, the Department has a broader responsibility as System Manager to undertake such strategic, planning and monitoring functions and activities as necessary to enable it to provide assurance to the responsible Ministers (the Minister for Health and the Treasurer have joint

responsibilities under the Act) that the Tasmanian health system is being managed effectively and efficiently. There are many activities that occur in the Tasmanian health system, outside of those that are purchased directly from THOs through Service Agreements that should be subject to ongoing monitoring. The Monitoring Suite (currently under review as part of the One Health System reform programme), governed by the Monitoring Suite Operational Guidelines, enables the System Manager to gain an understanding of the state of Tasmania’s publicly funded health services, supplementing the quasi contractual arrangements of Service Agreements. Should there be a patient safety issue that requires an urgent response, it will be guided by the Clinical Governance Framework.

The functions of Purchaser and System Manager cannot be viewed in isolation of each other - the nature and volume of services purchased will impact on the effectiveness and efficiency of the Tasmanian health system and the primary mechanism for effective system management is through informed, appropriate purchasing. Purchasing is a necessarily transactional process, and so must be contextualised to be effective as a mechanism to enact Government policy in health and to ensure that purchasing decisions reflect the longer term application of strategy.

An annual (rolling) Statement of Purchaser Intent (currently under review as part of the One Health System reform programme), which signals purchaser intentions over the coming five years, will act as the bridge between the functions of the Purchaser and System Manager. This will be the translational implement linking the activities of the Purchaser to the priorities of the System Manager and will be released in the first quarter of every calendar year.

The dual role of the Department as both Purchaser and System Manager is represented graphically in Figure 1.

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Background

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Purpose of the Service Agreement Performance Framework

3 Purpose of the Service Agreement Performance

Framework

Annual Service Agreements between the Minister and THO Governing Councils set out the expectations of each THO in terms of the volume and quality of services to be delivered and the funding provided in relation to the delivery of those services.

It is the responsibility of Governing Councils to ensure that THOs deliver the requirements of Service Agreements once established. It is the responsibility of the Department to ensure that THO performance against those requirements is monitored and managed to ensure that where necessary, the performance intervention options available to the Minister under the Act are effectively implemented.

The 2014-2015 Service Agreement Performance Framework codifies the process of monitoring THO

performance against the requirements of Service Agreements to ensure that where determined necessary, the performance management options available to the Minister under the Act are effectively implemented. It describes an integrated process for the monitoring and assessment of THO performance against the requirements of Service Agreements and provides both the Department and THOs with a clear delineation of roles, responsibilities and expectations in response to identified Service Agreement performance issues. It should be read in conjunction with the following key documents:

 2014-2015 THO Service Agreements;

 State-wide Clinical Governance Framework; and

 2014-2015 THO Funding Guidelines - Activity Based Funding and Management (yet to be released). In addition, a number of key “system management frameworks” have been committed to under the One Health System reform programme. These include:

 Statement of Purchaser Intent;

 2014-2015 Purchasing Framework; and  Monitoring Suite of Indicators.

These frameworks are currently in the early stages of review and development and are due for completion by 31 January 2015.

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Service Agreement Performance Monitoring and Reporting Process

4 Service Agreement Performance Monitoring and

Reporting Process

Service Agreement Performance Monitoring

Annual Service Agreements between the Minister and THO Governing Councils include specific KPIs and associated targets.

KPIs and targets are systematically considered and adopted in the following order of preference where practical:

 Existing national policy based targets.

 Existing Tasmanian health policy based targets.

 New targets based on previous performance baselines.

KPI targets establish the levels of performance that determine whether any action is required regarding the identification and management of Service Agreement performance issues.

Not all national or state based targets form part of Service Agreements. Some have been determined as better placed within the Monitoring Suite as broader markers of the effective and efficient management of the Tasmanian health system.

Further information regarding the target source is provided in Section 8.

Exceptional Events

There may be circumstances beyond the reasonable control of THOs which may prevent the achievement of KPI targets and it is important that such circumstances are recognised.

At its discretion, and on a case-by-case basis, the Department will consider requests from THOs to consider such circumstances as part of the ongoing performance monitoring process. The intention is to recognise extraordinary and generally unforseen events beyond the reasonable control of the THO, but not planned service interruptions such as capital works or ad hoc operational difficulties.

THOs are expected to provide the Department with timely advice of such circumstances and to actively mitigate any risk(s) to achieving KPI targets.

Service Agreement Performance Reporting

At the end of each quarter, the Department provides the responsible Ministers with THO Quarterly Service Agreement Performance Reports, outlining Service Agreement performance against all KPIs over the preceding quarter and, where necessary, recommended performance interventions. The reports are compiled by the System Purchasing and Performance (SPP) Unit of the Department following completion of quarterly Service Agreement performance review meetings with THOs.

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Service Agreement Performance Monitoring and Reporting Process

Service Agreement Quarterly Performance Review Meetings

Quarterly performance review meetings are co-ordinated by SPP. Meetings are characterised by:  Common standard agenda for all meetings, varied for specific local performance issues and the

escalation status.

 THO led discussion that enables THO representatives to describe their proactive performance management from an operational-level perspective.

 Aiming to reduce the need for further escalation of the performance response.

 Clear recording and communication of actions and requirements of the THO and the Department. Core attendance is kept to a minimum to facilitate smooth and efficient conduct of business ensuring coverage of each performance domain. Additional attendees may be included where attention to specific areas of performance requires the involvement of staff with specialist expertise and knowledge.

Each meeting will have the following core attendees: The Department:

 SPP Deputy Secretary and the Chief Financial Officer will attend all meetings.  Other Departmental Directors or their representatives will attend as required.

 Generally, representatives of SPP will also attend and provide secretariat support if required. THOs:

 The attendance of the THO Chair is required.

 Attendance by other members of the Governing Council and/or senior executives is at the discretion of the Chair, unless attendance of a specified executive is requested by the Secretary or delegate. It is anticipated that the THO Chief Executive Officer will attend.

The Secretary of the Department may attend if and when a performance issue has been escalated and is unsatisfactory.

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2014-2015 Changes to KPIs

5 2014-2015 Changes to KPIs

New KPIs

Finance and Activity Based Management  THO cash liquidity.

 Acute admitted raw separations.

 Admitted patient episode (clinical coding) including contracted care – timeliness.  Admitted patient episode (clinical coding) including contracted care – accuracy. Mental Health

 28 Day re-admission rates.

 Acute 7 day post discharge community care.  Seclusion rates.

Primary Health and Aged Care

 Aged Care Assessment Team (ACAT) priority category one clients seen on time in all settings.  Aged Care Assessment Team (ACAT) priority category two clients seen on time in all settings.  Aged Care Assessment Team (ACAT) priority category three clients seen on time in all settings.

Changes to Existing KPIs

Finance and Activity Based Management

Acute admitted weighted separations (replaced by the following KPI);  Acute admitted inlier weighted units (same day and multi-day). Emergency Department

Ambulance offload delay (replaces the following two KPIs);

 Incidence of ambulance presentations to emergency departments experiencing offload delay.  Total time (hours) spent by ambulance presentations in offload delay.

Removal of KPIs

Alcohol & Drug

 Number of individual clients accessing the Pharmacotherapy Program (removed from Service Agreement – to be included in Monitoring Suite).

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Service Agreement Performance Management Process

6 Service Agreement Performance Management

Process

Principles of the Service Agreement Performance Management

Process

The Department’s approach to performance monitoring, assessment and response is shaped by the principles outlined in Table 1 below.

Table 1: Principles of the Performance Framework

Realistic _{Performance and funding expectations will be balanced with the resources and} capacity of the health system and the current fiscal environment.

Consistency and

Transparency The Department will apply a consistent and transparent method for assessing _{performance against clear, agreed KPI targets, and responding where} appropriate. The default response to the non-achievement of performance targets will be escalation, with the Minister (or delegate) maintaining discretion to waive such escalations.

Accountability _{The Department and THOs have distinct and separate roles and accountabilities} as Purchaser and Provider respectively. The Department, on behalf of the Minister, will negotiate Service Agreements with THOs and monitor performance against the requirements of those agreements. THOs are accountable for delivering services to the agreed standards outlined in Service Agreements and ensuring that an effective internal performance framework is in place that demonstrates processes to actively monitor the requirements of those agreements.

Informed

Purchasing The Department’s System Manager role will inform the establishment of _{purchasing priorities and KPIs, in turn shaping negotiation of Service} Agreements.

Integration _{The Department recognises change or variation in a particular aspect of} performance may require changes to other, interdependent, elements of the system. The Department acknowledges that influences outside the control of THOs may affect performance and such factors will be considered when performance is assessed.

Recognition _{Superior performance will be recognised and reviewed by the Department for} lessons to be shared across THOs.

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Elements of Service Agreement Performance Management

Service Agreement performance management will involve:

 On-going monitoring and review of THO performance against the requirements of Service Agreements.

 Identifying a performance concern and determining the appropriate response.

 Determining when a performance intervention is necessary and the level of intervention required.  Determining when the performance intervention needs to be escalated or can be de-escalated.

Performance Intervention Levels

As in 2013-2014, there are four performance levels in the 2014-2015 Service Agreement Performance Framework.

The level of performance response and intervention dictates the action required by THOs and/or the Department. In 2014 the Minister approved delegation of certain Ministerial powers and functions that enables the Secretary to escalate or de-escalate concerns for;

 Level 1 (unsatisfactory performance), requesting a Performance Improvement Plan from THOs.  Level 2 (sustained unsatisfactory performance), ability to appoint a Performance Improvement

Team.

The Minister retains the power to appoint a Ministerial Representative to assist the Governing Council, if considered necessary, as part of a Level 2 Performance Escalation. The Minister also retains the power to approve a Level 3 Performance Escalation.

The non-achievement of any individual Service Agreement KPI target will lead to the immediate

identification of a performance concern and application of the performance intervention process outlined below. Service Agreement KPIs require compliance and the achievement of assigned targets within the specified assessment period. Generally, a performance escalation will only be recommended in

circumstances where a THO is unable to demonstrate to the Department that:

 The performance concern is being actively managed and monitored by the THO.

 A robust and transparent plan for sustainable performance improvement is in place within the THO.  The THO possesses the necessary skills to achieve sustainable performance improvement in the area

of concern.

The Minister may waive any recommendation received from the Department to proceed with a performance escalation.

Based on the response provided by THOs to performance concerns, an issue may be escalated or de-escalated in a non-sequential fashion.

Service Agreement KPIs are viewed independently of each other - that is, escalation or de-escalation is managed on the basis of each KPI, without mitigation by performance in other KPIs.

Performance Escalation Level 0 (Satisfactory Performance)

If a Service Agreement KPI target is achieved by a THO, the KPI will be assigned Level 0 (satisfactory performance). Satisfactory performance will be noted in the THO Quarterly Service Agreement Performance Reports provided to the Minister and performance may be reviewed for lessons to be shared across THOs. Performance Escalation Level 1(Unsatisfactory Performance)

The non-achievement of a Service Agreement KPI target will lead to the immediate identification of a performance concern and the application of the performance intervention process. In the event of

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non-Service Agreement Performance Management Process achievement, the Secretary will consider escalating the performance issue to Level 1 (unsatisfactory

performance).

Before taking this action, the Chair and CEO will be advised of the intention to escalate and be provided with an opportunity to provide more information to the Department in relation to the performance issue. In such circumstances, CEOs must provide supporting information within 7 days from receipt of the request.

Performance Escalation Level 2 (Sustained Unsatisfactory Performance)

At Level 2, direct intervention will occur due to sustained unsatisfactory performance. Formal notification of the intention to escalate to Level 2 will be provided by the Secretary to the Chair and the CEO. Depending on the nature of the performance concern, at Level 2, the Secretary may appoint a Performance Improvement Team or the Minister may appoint a Ministerial Representative to assist the Governing Council in its oversight of the THO’s functions.

Performance Escalation Level 3 (Challenged and Failing)

For sustained performance concerns that have not been resolved, the Secretary may recommend to the Minister that a higher level of response be initiated (Level 3 – challenged and failing). Formal notification of the intention to recommend to the Minister that escalation to Level 3 should occur will be provided by the Secretary to the Chair and the CEO.

Table 2 summarises the escalation/de-escalation response process. Figure 2 demonstrates the escalation/de-escalation decision process.

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Service Agreement Performance Management Process Table 2: Performance Escalation/De-escalation Response Framework

Level of Response Point of Escalation Response Point of _{De-escalation} THO Act _reference

Level 0

Satisfactory Performance

No action required

Not applicable. Satisfactory performance noted in monthly Service Agreement

Performance Report.

Performance that exceeds expectations recognised.

Not applicable. Not applicable.

Level 1

Unsatisfactory Performance

Performance Improvement Plan (PIP) required

Non-achievement of a Service Agreement KPI performance target. 0

The Secretary formally requests the Governing Council to: o Provide a PIP for approval;

o Comply with the requirements of the PIP, and

o Meet with the Department to formally monitor the PIP. The Department prepares an Escalation Notice for the THO.

The requirements of the

PIP are met. Part 7, Division 3 (sections 60-62)

Level 2 Sustained Unsatisfactory Performance Performance Improvement Team OR Appointment of a Ministerial Representative to assist the Governing Council.

PIP targets are not achieved and the Department is of the opinion that the performance concern is unlikely to be resolved without:

The involvement of a Performance Improvement Team OR

The appointment of a ministerial representative to assist the Governing Council to improve performance.

The Secretary will:

o Formally notify the Governing Council that a Performance Improvement Team is to be appointed in respect of the THO. The THO will provide all reasonable assistance to the Performance Improvement Team OR

o Recommend that the Minister give notice to the Governing Council of the appointment of a representative to the Governing Council. The instrument of appointment of the Ministerial Representative will specify the terms and conditions of the appointment.

The period for which the Performance Improvement Team was formed expires

OR

The terms and conditions of the ministerial representative’s

appointment have been met.

Part 7, Division 4 and Division 5 (sections 63-68)

Level 3

Challenged and failing

Changes to the governance of the THO may be required

The Department is of the opinion the Governing Council has ceased to perform satisfactorily and no other action may be taken other than to dissolve the Governing Council.

The Secretary will recommend that the Minister appoint an administrator who has the functions and powers of the Governing Council.

The period and conditions specified in the administrator’s instrument of appointment are complete. Part 7, Division 6 (sections 69-73)

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2014-2015 Key Performance Indicators Data Summary

7 2014-2015 Key Performance Indicators

Data Summary

Domain Code

Finance and Activity Based Management KPI

Source of KPI

Target F&ABM_1 Variation from budget - full year projected DHHS-Budget

and Finance

Balanced budget

F&ABM_2 THO cash liquidity DHHS-Budget

and Finance

THO Operating Account has a favourable balance F&ABM_3 Acute admitted raw separations Tasmanian

Activity Based Funding Model (DHHS SPP). Negotiated with THOs. Recognises prevailing State Government policy directions As per individual THO Service Agreements

F&ABM_4 Acute admitted inlier weighted units (same day and multi-day)

Tasmanian Activity Based Funding Model (DHHS SPP). Negotiated with THOs. Recognises prevailing State Government policy directions As per individual THO Service Agreements

F&ABM_5 Admitted patient episode coding (clinical coding) including contracted care - timeliness

DHHS (SPP) 100% within 42 days of

separation F&ABM_6 Admitted patient episode coding (clinical

coding) including contracted care - accuracy DHHS (SPP) 100% within 30 days of advice from SPP Domain Code

Safety and Quality KPI Source of KPI

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S&Q_1 Hand Hygiene compliance ACSQHC 70%

S&Q_2 Healthcare associated staphylococcus aureus (including MRSA) bacteraemia infection rate National Standard 2.0 per 10,000 patient days Domain Code

Emergency Department KPI Source of KPI

Target ED_1 Percentage of Triage 1 emergency

department presentations seen within recommended time Australasian College for Emergency Medicine 100%

ED_2 Percentage of Triage 2 emergency department presentations seen within recommended time Australasian College for Emergency Medicine 80%

ED_3 Percentage of all emergency department presentations seen within recommended triage time NPA Hospital and Health Workforce Reform 80%

ED_4 Percentage of emergency department did not wait presentations

DHHS (SPP) </= 5% ED_5 Time until most admitted patients (90%)

departed emergency department

National Health Performance Authority As per individual THO Service Agreements

AMB_1 Ambulance offload delay Australasian

College for Emergency Medicine 85%</= 16 minutes 100%</= 31 minutes Domain Code

Elective Surgery KPI Source of KPI

Target ES_1 Elective surgery quarterly admission

targets.

This KPI excludes activity associated with any additional Commonwealth or State Government funded activity as outlined in Schedules E and F (Schedules F and G for the North West)

Tasmanian Activity Based Funding Model (SPP). Negotiated with THOs. Recognises prevailing State Government policy directions As per individual THO Service Agreements

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2014-2015 Key Performance Indicators Data Summary ES_2 Percentage of category 1 patients admitted

within the recommended time

DHHS SPP. Negotiated with THOs. Recognises prevailing State Government policy directions As per individual THO Service Agreements

ES_3 Number of over boundary, category 1 patients on the waiting list

ES_6 Number of patients on the waiting list waiting longer than 365 days

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Code KPI

MH_1 28 Day re-admission rate NMDS </= 14.7%

MH_2 Acute 7 day post discharge community care NMDS 75%

MH_3 Seclusion rates To be included

in NMDS

< 9.6 per 1,000 patient days Domain

Code

Oral Health KPI (THO South only) Source of KPI

Target OH_1 Number of Dental Weighted Activity Units

(DWAUs) delivered between 20 December 2012 and 30 June 2015 NPA on Treating More Public Dental Patients Sep14: 80,945 Dec14: 91,794 Mar15: 102,470 Jun15: 111,868 OH_2 Proportion of 'Emergency' clients managed

on the same day that they are triaged

THO South (OHST)

>/= 75% Domain

Code

Primary Health and Aged Care KPI Source of KPI

Target PH_1 Aged Care Assessment Team (ACAT) -

Priority Category one clients seen ‘on time’ in all settings

ACAP

Minimum Data Set

>85%

PH_2 Aged Care Assessment Team (ACAT) - Priority Category two clients seen ‘on time’ in all settings

ACAP

Minimum Data Set

>85%

PH_3 Aged Care Assessment Team (ACAT) - Priority Category three clients seen ‘on time’ in all settings

ACAP

Minimum Data Set

>85%

The timeframes for data collection are specified against each KPI in the following Section 8 Service Agreement Key Performance Indicator Definitions.

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Service Agreement Key Performance Indicator Definitions

8 Service Agreement Key Performance

Indicator Definitions

Finance and Activity Based Management

Variation from budget – full year projected

Definition _{This measures the variance between full year budget and full year projected actual} on a cash basis for all funding types.

For Service Agreement performance monitoring, this indicator applies to the THO as a whole.

Calculating

performance Calculated by subtracting the full year projected cash forecast from the full year cash _{budget on an all funds basis including carry forwards.} KPI target _{Balanced budget.}

KPI target source DHHS – Budget and Finance. Frequency of data

collection and performance assessment

This KPI will be monitored by Budget and Finance on a monthly basis. Performance will be assessed on a quarterly basis.

Data Source _{Finance 1}

THO cash liquidity

Definition _{This KPI is a measure of a THOs ability to meet all their financial commitments} when they fall due. If a THO is unable to meet their financial commitments within a given month, an advance of future funding is required to ensure the THO complies with Treasurer’s Instruction (TI) 402. This KPI is an early indicator that there is the potential for a liquidity problem impacting on the THOs ability to meet financial commitments within the current financial year.

Calculating

performance This indicator is calculated by subtracting the total of the advance from the closing _{balance of the THO Operating Account at the end of the month to demonstrate} what the unadjusted position would have been.

KPI target _{THO Operating Account has a favourable balance.} KPI target source DHHS – Budget and Finance.

Frequency of data collection and performance assessment

This KPI will be monitored by Budget and Finance on a monthly basis. Performance will be assessed on a quarterly basis. In the instance where a THO requires an advance of funds in one month, quarterly will enable a THO to take corrective action in the following month(s) to return the Operating Account to a favourable position.

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Service Agreement Key Performance Indicator Definitions Acute admitted raw separations

Definition _{This indicator measures acute admitted raw separations.} For Service Agreement performance monitoring, this indicator:

 applies to Tasmania’s four major hospitals only (the Royal Hobart Hospital, Launceston General Hospital, North West Regional Hospital and Mersey Community Hospital).

 excludes activity associated with any additional Commonwealth or State Government funded activity as outlined in Schedules E and F (F and G for THO NW).

Calculating

performance Calculated using the total number of acute admitted raw separations Acute Inpatient _{Activity (Care Type 1), including acute mental health inpatient activity, but excluding} Outside Referred Patients and activity associated with any additional

Commonwealth or State Government funded activity as outlined in Schedules E and F (F and G for THO NW).

Numerator: Acute admitted raw separations reported for acute care public hospitals (as specified above).

Denominator: No denominator

KPI target _{As per individual THO Service Agreements.}

KPI target source Tasmanian Activity Based Funding Model (DHHS SPP). Negotiated with THOs. Recognises prevailing State Government policy directions.

Data collection is continuous.

Performance monitoring is undertaken on a monthly basis.

Performance reporting and assessment is undertaken on a quarterly basis against agreed year-to-date targets.

Performance is assessed on a year-to-date basis.

Performance reporting and assessment is based on data collected through Health Central from iPM on the 4th working day of the month immediately following the end of each quarter.

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Service Agreement Key Performance Indicator Definitions Acute admitted inlier weighted units (same day and multi day)

Definition _{This indicator measures acute admitted inlier weighted units (same day and multi} day) which indicate the costliness of an Australian Refined Diagnosis Related Group (AR-DRG) relative to all other AR-DRGs such that the average cost weight for all separations in 1.00. A separation for an AR-DRG with a cost weight of 5.0, therefore, on average costs 10 times as much as separations with a cost weight of 0.5.

For Service Agreement performance monitoring, this indicator:

 applies to Tasmania’s four major hospitals only (the Royal Hobart Hospital, Launceston General Hospital, North West Regional Hospital and Mersey Community Hospital).

 excludes activity associated with any additional Commonwealth or State Government funded activity as outlined in Schedules E and F (F and G for THO NW).

Calculating

performance Calculated using the total number of inlier weighted units for Acute Inpatient _{Activity (Care Type 1), including acute mental health inpatient activity, but excluding} Outside Referred Patients and activity associated with any additional

Commonwealth or State Government funded activity as outlined in Schedules E and F (F and G for THO NW).

The average cost weight used to construct this indicator is calculated from the National Hospital Morbidity Database, using AR-DRG public cost weights published by the Department of Health and Ageing. However the following costs are

excluded as the Tasmanian funding model funds these separately (with the exception of depreciation);

 Depreciation  ICU

 Mechanical ventilation  ED

Casemix adjustment is based on the round of cost weights attributed to the AR-DRG assigned to each separation.

National Hospital Cost Data Collection (NHCDC) Round 16 (2011-2012) AR-DRG v6.0x public sector estimated cost weights will be applied to calculate inlier unit separations for 2014-2015.

Numerator: Acute admitted inlier weighted units reported for acute care public hospitals.

Denominator: No denominator.

KPI target _{As per individual THO Service Agreements.}

KPI target source Tasmanian Activity Based Funding Model (DHHS SPP). Negotiated with THOs. Recognises prevailing State Government policy directions.

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Service Agreement Key Performance Indicator Definitions agreed year-to-date targets.

Data source _iPM

Admitted patient episode coding (clinical coding) including contracted care – timeliness Definition _{This KPI measures the percentage of admitted patient episodes coded within 42}

days of the episode separation. Calculating

performance This KPI is measured as a percentage.

All admitted patient episode separations within the specified assessment period are within scope. The coding date (considered to be the date recorded against the principal diagnosis field in iPM) will be compared with the separation date. All records not coded within 42 days of the separation date will be considered to fail. KPI target _{100% within 42 days of separation.}

KPI target source DHHS – System Purchasing and Performance (SPP). Frequency of data

Performance against this KPI will be assessed on a quarterly basis, based on performance over the most recent quarter against which the 42 day period can be applied (e.g. the December 2014 quarterly assessment will be based on the

percentage of admitted patient episodes coded within 42 days of the episode separation for all episode separations dated between 1 July 2014 and 30 September 2014).

Performance assessment will be based on data collected through Health Central from iPM on the 4th_{working day of the month (e.g. the December 2014 quarterly} assessment for all episode separations dated between 1 July 2014 and 30 September 2014 will be based on data collected from Health Central through iPM on the 4th working day in January 2015).

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Service Agreement Key Performance Indicator Definitions Admitted patient episode coding (clinical coding) including contracted care - accuracy Definition _{This KPI measures the percentage of fatal data errors (as specified in the schedule}

below) that are corrected within 30 days of being reported by DHHS to THOs. Calculating

At the end of each month, DHHS will provide THOs with a list of fatal data errors detected over the previous month. Errors not corrected by THOs within 30 days of receipt of the list will be considered to fail. The date of receipt will be

considered to be the date upon which the list of fatal data errors is e-mailed to THO CEO’s by SPP. The list will clearly indicate the date by which the correction of fatal data errors is to occur.

KPI target _{100% within 30 days of advice.}

KPI target source DHHS – System Purchasing and Performance (SPP). Frequency of data

Performance against this KPI will be assessed on a quarterly basis, based on performance over the most recent quarter against which the 30 day period can be applied (e.g. the December 2014 quarterly assessment will be based on the

percentage of fatal data errors corrected within 30 days of receipt of the monthly list of fatal data errors for the months of July 2014, August 2014 and September 2014).

Performance assessment will be based on data collected through Health Central from iPM on the 4th_{working day of the month (e.g. the December 2014 quarterly} assessment for the months of July 2014, August 2014 and September 2014 will be based on data collected from Health Central through iPM on the 4th_{working day in} January 2015).

Data source _iPM

Schedule: Coding accuracy ‘fatal’ validations

Number Name Rule Rationale Action to Fix

ICDF1 Unspecified reason for admission Principal diagnosis must not be R69 Unknown and unspecified causes of morbidity in any admitted episode.

Every admitted episode must have the reason for admission identified by the Clinician and coded in accordance with Australian Coding Standards.

It is expected that after study, this would normally be a condition, symptom, sign, health problem or status that is described more specifically by other codes within the

Notify SPP of any episode where it is verifiable that, after study, the patient was admitted for an unknown or unspecified cause of morbidity; in any instance where this occurs SPP will manually remove the fatal

validation from the episode.

Assign PD in accordance with ACS 0001 Principal Diagnosis.

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Service Agreement Key Performance Indicator Definitions classification.

ICDF2 Other ill-defined and unspecified causes of mortality

R99 Other ill-defined and unspecified causes of mortality must not be coded in any admitted episode (unless verifiable that the patient died and that the cause of death is ill defined or unable to be specified). A code reflecting mortality is only compatible in the episode in which a patient dies. In an episode where a patient dies, the cause of death should be coded (where this meets Australian Coding Standards).

Notify SPP of any episode where it is verifiable that the patient died and that the cause of death is ill defined or unable to be specified; in any instance where this occurs SPP will manually remove the fatal validation from the episode.

For all other episodes: If the patient has not died, delete R99 from coding string and check that coding is accurate and complete.

If the patient has died, check episode notes and any autopsy report for cause of death and code accordingly.

ICDCF3 Qualified (acute) singleton newborn without morbidity codes A newborn episode (≤ nine days) must not have a qualified (acute) status if the only ICD code is Z38.0 Singleton, born in hospital.

Singleton newborns can only be qualified if they remain in hospital without their mother or are admitted to an intensive care facility in a hospital, being a facility for provision of special care.

In these instances there must be at least one other code that reflects the patient’s conditions or relevant status.

Check code assignment and qualification status and amend as necessary.

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Service Agreement Key Performance Indicator Definitions ICDCF4 ICD code/

admission weight conflict

ICD codes in the range P07.01 Extremely low birth weight to P07.13 Other low birth weight must be assigned in accordance with Australian Coding Standards and directives (NCCH). Where a preterm baby has a low birth weight, a code in the range P07.01

Extremely low birth weight to P07.13 Other low birth weight must be assigned in the birth episode. Combinations of reported admission weight < 2500g and ICD codes are valid in the birth episode only as follows: P07.01 Extremely low birth weight 499g or less is only valid for

admission weight range 0 to 499g P07.02 Extremely low birth weight 500 - 749g is only valid for admission weight range 500 to 749g P07.03 Extremely low birth weight 750 - 999g is only valid for admission weight range 750 to 999g P07.11 Other low birth weight 1000 - 1249g is

In accordance with Australian Coding Standards 1618 Low Birth Weight and Gestational Age and NCCH Coding Rule ‘Low Birth weight and Prematurity’, (ref Q 2648 published 15-Dec 2012) codes P07.01 –P07.13 should be assigned in the birth episode for preterm babies who have a low birth weight. For preterm newborns there must be

correlation between the admission weight recorded and the ICD code assigned in the birth episode.

Check code assignment and reported admission weight and amend as necessary.

(27)

Service Agreement Key Performance Indicator Definitions admission weight

range 1000 to 1249g P07.12 Other low birth weight 1250 - 1499g is only valid for admission weight range 1250 to 1499g P07.13 Other low birth weight 1500 - 2499g is only valid for admission weight range 1500 to 2499g Supporting Notes:

ICDF1

 The responsibility for recording accurate diagnoses and procedures, in particular principal diagnosis, lies with the clinician, not the clinical coder.1

 The principal diagnosis is defined as:

“The diagnosis established after study to be chiefly responsible for occasioning an episode of admitted patient care, an episode of residential care or an attendance at the health care

establishment, as represented by a code” (METeOR: 391326) (Australian Institute of Health and Welfare 2012).

The phrase after study in the definition means evaluation of findings to establish the condition that was chiefly responsible for occasioning the episode of care. Findings evaluated may include

information gained from the history of illness, any mental status evaluation, specialist consultations, physical examination, diagnostic tests or procedures, any surgical procedures, and any pathological or radiological examination. The condition established after study may or may not confirm the admitting diagnosis.

The circumstances of inpatient admission will always govern the selection of principal diagnosis. In determining principal diagnosis, the coding directives in the ICD-10-AM manuals take precedence over all other guidelines (see ICD-10-AM Tabular List: Conventions used in the Tabular List of Diseases and ICD-10-AM Alphabetic Index: Conventions used in the Alphabetic Index of Diseases).

The importance of consistent, complete documentation in the clinical record cannot be

overemphasised. Without such documentation the application of all coding guidelines is a difficult, if not impossible, task.2

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Safety and Quality

Hand Hygiene compliance

Definition _{This indicator measures the compliance rate as the percentage of correct hand} hygiene performed by hospital staff.

For Service Agreement performance monitoring, this indicator applies to Tasmania’s four major hospitals only (the Royal Hobart Hospital, Launceston General Hospital, North West Regional Hospital and Mersey Community Hospital).

Calculating

performance Data is collected by authorised Hand Hygiene auditors in accordance with the Hand _{Hygiene Australia, Hand Hygiene Manual.} Numerator: Number of times hand hygiene was performed correctly at the correct time.

Denominator: Number of hand hygiene opportunities that were observed. KPI target _70%.

KPI target

source An interim national benchmark of 70% for hand hygiene reporting on MyHospitals _{has been advised by the Australian Commission on Safety and Quality in Health} Care. Frequency of data collection and performance assessment

Data is submitted by each of the hospitals individually and is entered directly onto the Hand Hygiene Australia database via the Hand Hygiene Australia website through a secure portal. TIPCU give final approval before the data is available to Hand Hygiene Australia.

Data is submitted to Hand Hygiene Australia three times per annum:  March 31st

 June 30th  October 31st

Publically identified hospital data is published quarterly by the Tasmanian Infection & Control Unit and is available on the TIPCU DHHS website.

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Service Agreement Key Performance Indicator Definitions Healthcare associated staphylococcus aureus (including MRSA) bacteraemia infection rate Definition _{This indicator measures the rate of Healthcare Associated Staphylococcus aureus}

bacteraemia infection. This indicator is concerned with cases of this infection which are associated with a patient receiving healthcare.

For Service Agreement performance monitoring, this indicator applies to Tasmania’s four major hospitals only (the Royal Hobart Hospital, Launceston General Hospital, North West Regional Hospital and Mersey Community Hospital).

Calculating

performance The definitions applied are consistent with national definitions which are published _{by the Australian Commission on Safety and Quality in Healthcare Data set} specification – Surveillance of Healthcare Associated Infections: Staphylococcus aureus bacteraemia and Clostridium difficile infection (Version 4.0).

Numerator: Number of cases of healthcare associated Staphylococcus aureus bacteraemia.

Denominator: Number of patient days for the given period (matching the numerator period).

KPI target _{No more than 2.0 cases per 10,000 patient days.} KPI target

source The national benchmark for states and territories (public hospitals) is no more than _{2 cases per 10,000 patient days.} Frequency of

data collection and

performance assessment

In line with the TIPCU Staphylococcus aureus Bacteraemia Surveillance Protocol V3, 2011 data is collected and reported on as per the following process:

 TIPCU receive notification of a SAB from the Communicable Diseases Prevention Unit (CDPU).

 Participating hospitals will receive notification of a SAB from TIPCU and are requested to provide additional information via a SAB Surveillance Form.  All SAB which were collected before the end of the month should have

completed surveillance information submitted to TIPCU by the 10th calendar day of the following month or nearest work day.

 The TIPCU obtain a monthly summary report detailing all SABs from the participating laboratories. This data will is used TIPCU to validate that all forms received by the IC Teams and GPs correspond with the individual reports of SABs provided by the laboratories.

 Publically identified hospital data is published quarterly by the Tasmanian Infection & Control Unit and is available on the TIPCU DHHS website. Data source _TIPCU

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Emergency Department Access

Percentage of Triage 1 emergency department presentations seen within the recommended time

Definition _{This indicator measures the percentage of patients that are treated within the} national recommended benchmark for waiting times for triage category 1 in public hospital emergency departments.

Calculating

performance The definitions applied are consistent with the national definitions used for reporting _{against the National Partnership Agreement on Hospital and Health Workforce} Reform. The definitions include presentations that have been assigned a triage category between 1 and 5. Presentations that are ‘did not wait’, ‘dead on arrival’ or the waiting time to service delivery is invalid are excluded for the purpose of

calculating this indicator. See Australasian Triage Scale from the Australasian College for Emergency Medicine for a description of each triage category, including indicative clinical descriptors.

Time to treatment is calculated by subtracting the date and time the patient presented to the emergency department from the date and time treatment commenced. The time to treatment is then compared to the recommended treatment time for the allocated initial triage category.

The indicator is calculated for triage category 1 and presented as a percentage. Computation: 100 x (Numerator ÷ Denominator)

Numerator: Total number of presentations to emergency departments that were treated within benchmarks for triage category 1:

 Triage category 1: seen within seconds, calculated as less than 2 minutes (being a waiting time of 2 or below, which allows for 2:59 seconds*).

* This is in line with the national reporting standards.

Denominator: Total number of triage 1 presentations to emergency departments.

KPI target _100%

KPI target

source Australasian College for Emergency Medicine. Frequency of

data collection and

Performance reporting and assessment is undertaken on a quarterly basis against agreed quarterly targets.

A new performance assessment period commences at the beginning of each quarter (i.e. performance is not measured on a year-to-date basis).

Performance reporting and assessment is based on data collected through Health Central from EDIS on the 4th working day of the month immediately following the end of each quarter.

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Service Agreement Key Performance Indicator Definitions Percentage of Triage 2 emergency department presentations seen within the

recommended time

Definition _{This indicator measures the percentage of patients that are treated within the} national recommended benchmark for waiting times for triage category 2 in public hospital emergency departments.

Calculating

The indicator is calculated for triage category 2 and presented as a percentage. Computation: 100 x (Numerator ÷ Denominator)

Numerator: Total number of presentations to emergency departments that were treated within benchmarks for triage category 2:

 Triage category 2: seen within 10 minutes (being a waiting time of 10 or below, which allows for 10:59 seconds*).

Denominator: Total number of triage 2 presentations to emergency departments.

KPI target _80%

KPI target

data collection and

(32)

Service Agreement Key Performance Indicator Definitions Percentage of all emergency department presentations seen within the recommended time

Definition _{This indicator measures the percentage of patients that are treated within national} recommended benchmarks for waiting times for each triage category in public hospital emergency departments.

Calculating

The indicator is calculated for the five triage categories as a whole and presented as a percentage.

Numerator: Total number of presentations to emergency departments that were treated within benchmarks for each triage category:

 Triage category 1: seen within seconds, calculated as less than 2 minutes (being a waiting time of 2 or below, which allows for 2:59 seconds*).

Denominator: Total number of presentations to emergency departments.

KPI target _80%

KPI target

source NPA Hospital and Health Workforce Reform. Frequency of

data collection and

(33)

Service Agreement Key Performance Indicator Definitions Central from EDIS on the 4th working day of the month immediately following the end of each quarter.

Data source _EDIS

Percentage of emergency department did not wait presentations

Definition _{This indicator measures the percentage of emergency department presentations that} concluded with the patient leaving the emergency department before being attended by a health care professional.

Calculating

performance The definitions applied were set by the Emergency Care Network Steering _{Committee. The definitions include presentations that have been assigned a triage} category between 1 and 5. Presentations that are ‘dead on arrival’ or the waiting time to service delivery is invalid are excluded for the purpose of calculating this indicator. See Australasian Triage Scale from the Australasian College for Emergency Medicine for a description of each triage category, including indicative clinical

descriptors.

The indicator is presented as a percentage.

Numerator: Total number of presentations who have been identified as ‘did not wait’.

Denominator: Total number of presentations to emergency departments. KPI target _{</= 5%}

KPI target

source DHHS – System Purchasing and Performance (SPP). Frequency of

data collection and

(34)

Service Agreement Key Performance Indicator Definitions Time until most admitted patients (90%) departed emergency department

Definition _{The 90th percentile of total time for emergency department stays for patients} who physically leave the emergency department for admission to hospital. Calculating

performance Numerator: _• _{include records with the triage categories from 1 to 5.} • exclude records if the Waiting time to service is invalid, i.e.

- Length of stay < 0.

- Presentation date or time is missing. - Physical departure date or time is missing.

The 90th percentile (the ninetieth percentage value in a group of data arranged from lowest to highest value for time waited) represents the time within which 90% of patients were admitted and physically left the emergency department.

For example, if there were 100 observations admitted to the hospital, the 90th percentile will correspond to the average time for the 90th and 91st observations. If there were 101 observations, the 90th percentile will correspond to the time for the 91st observation.

Emergency department stay time is calculated by subtracting the date and time the patient presented to the emergency department from the date and time the patient physically left the emergency department.

Denominator: Not applicable.

KPI target _{As per individual THO Service Agreements.} KPI target

source National Health Performance Authority. Frequency of

data collection and

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Service Agreement Key Performance Indicator Definitions Ambulance offload delay

Definition _{This KPI measures the percentage of ambulance presentations to an emergency} department to experience delay in complete transfer of clinical care to the emergency department, specifically due to lack of available clinical space in the emergency department.

Calculating

The definitions applied were recommended by the Australasian College for

Emergency Medicine. The definitions include presentations that have been assigned a triage category between 1 and 5. Presentations that are 'dead on arrival' are

excluded for the purpose of calculating this indicator. The definition includes presentations that arrive by ambulance (arrival modes such as police, non-emergency patient transport are out of scope).

Numerator: Total number of ambulance presentations to public hospital emergency departments that were transferred to ambulance ramped location (ambulance waiting) and subsequently transferred to ED staff care within the following benchmarks:

 85% of presentations transferred within 15 minutes  100% of presentations transferred within 30 minutes Denominator:

Total number of ambulance presentations transferred to ambulance ramped location (ambulance waiting).

KPI target _{85% within15 minutes} 100% within 30 minutes KPI target

data collection and

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Elective Surgery

Elective Surgery quarterly admissions

Definition _{This indicator measures the number of patients that have been removed from the} elective surgery waiting list as admitted to the hospital (or contracting hospital) and receiving their waiting list procedure. For Service Agreement performance

monitoring, this indicator excludes activity associated with any additional

Commonwealth or State Government funded activity as outlined in Schedules E and F.

Calculating

performance The definitions applied are consistent with the national definitions used for reporting _{against the National Partnership Agreement on Improving Public Hospital Services.} The definitions applied include admission from the elective surgery waiting list where the planned procedure was completed. This also includes patients admitted for the waiting list as an emergency. For Service Agreement performance monitoring, this indicator excludes weighted separations funded by the National Partnership Agreement on Improving Health Services in Tasmania.

Indicator procedures as defined in the Tasmanian wait list procedure code (TWLPC) set and specify which procedures are included in the calculation of this indicator in accordance with national definitions.

Numerator: Total number of admissions from the elective surgery waiting list to the hospital (or contracting hospital) where the planned procedure was completed (this includes admissions from the waiting list as an emergency).

Denominator: No denominator.

KPI target _{As per individual THO Service Agreements.} KPI target

source Tasmanian Activity Based Funding Model (SPP). Negotiated with THOs. Recognises _{prevailing State Government policy directions.} Frequency of

data collection and

Performance reporting and assessment is undertaken on a quarterly basis against agreed year-to-date targets.

SERVICE AGREEMENT PERFORMANCE FRAMEWORK

Version 1.0

Final

Amended

December 2014

2014-2015

SERVICE AGREEMENT

PERFORMANCE

FRAMEWORK

Activity Based Funding and

Management

Contents

1 Executive Summary

2 Background

Overview of the Department’s Performance Framework

3 Purpose of the Service Agreement Performance

Framework

4 Service Agreement Performance Monitoring and

Reporting Process

Service Agreement Performance Monitoring

Exceptional Events

Service Agreement Performance Reporting

Service Agreement Quarterly Performance Review Meetings

5 2014-2015 Changes to KPIs

New KPIs

Changes to Existing KPIs

Removal of KPIs

6 Service Agreement Performance Management

Process

Principles of the Service Agreement Performance Management

Process

Elements of Service Agreement Performance Management

Performance Intervention Levels

7 2014-2015 Key Performance Indicators

Data Summary

8

Service Agreement Key Performance

Indicator Definitions

Finance and Activity Based Management

Safety and Quality

Emergency Department Access

Elective Surgery