Transcript Document

Performance Management:
The Results Based Accountability Approach
Ruth Jordan, Project Manager Cardiff CCM Demonstrator and Vicki Myson, Epilepsy Specialist Nurse, Cardiff and Vale UHB
EPILEPSY SERVICE DEVELOPMENT DIRECTIVE REQUIREMENT:
Each Health and Social Care partnership will establish a performance management mechanism to review the implementation of their plans
WHAT IS RESULTS BASED ACCOUNTBILITY
(RBA)?
A disciplined way of thinking and taking action which can be
used to improve the quality of life in communities and the
performance of services
(Mark Friedman)
• Turns talk about outcomes quickly into actions which
improve those outcomes
• Embeds performance management into planning and
delivery
• Explains both collaborative and service accountability and
how they fit back together
THE RBA REPORT CARDS
WHAT WE’VE ACHIEVED
Service Description: The Welsh Epilepsy Unit is a tertiary referral centre for specialist epilepsy services in
South Wales. The immediate catchment population covered is 700,000, but many referrals are also taken from
elsewhere in Wales. The Unit offers a multidisciplinary approach to epilepsy care and offers a very broad range of
services to people with epilepsy, their families and carers.
DEFINED SERVICE USERS
Patients with a first suspected seizure or unexplained blackout
HEADLINE PERFORMANCE MEASURES
DATA DEVELOPMENT AGENDA
1. % seen by a specialist within 2 weeks
2. % DNA first seizure clinic
3. % have diagnostic tests within 4 weeks
4. % follow the correct pathway
1. % on inappropriate treatment
2. % have clinic letters sent within one week of clinic
3. Why patients DNA first seizure clinic
HOW ARE WE DOING?
% Seen b y a Sp ecialist wit hin 2 W eeks
% have d iag no st ic t est s wit hin 4 weeks
% D N A F ir st Seiz ur e C linic
30%
25%
35%
B as el i ne
15%
B asel i ne
20%
P r edi c t i on
15%
Cur v e t o t ur n
10%
P r edi ct i on
Cur ve t o t ur n
2008
2009
2010
2011
2012
2009
2010
2011
WHAT WE DID
Following introductory training on RBA the Epilepsy Steering
Group have carried out RBA performance accountability
exercises for:
• People experiencing a first seizure/unexplained blackout.
• Women with epilepsy who may become or who are
pregnant.
The performance measures identified have been baselined
and performance against these measures is being monitored
monthly.
Resources
Mark Friedman Trying Hard Is Not Good Enough (Trafford Publishing, 2005)
www.raguide.org or www.resultsaccountability.com
P r edi ct i on
Cur ve t o t ur n
0%
2007
2012
40%
20%
0%
2008
STORY BEHIND THE BASELINES
RBA provides a structure to firstly identify appropriate
performance measures and then to select the most
important of these measures to baseline and monitor.
P r edi ct i on
Cur ve t o t ur n
5%
2007
B asel i ne
60%
10%
0%
2007
• How much did we do? (quantity)
• How well did we do it? (quality)
• Is anyone better off as a result? (quantity and quality of effect
or customer/client outcomes)
B asel i ne
15%
5%
0%
“All Performance Measures that have ever existed for any
programme in the history of the universe involve answering
two sets of interlocking questions….”
80%
25%
20%
10%
% f o llo w co r r ect p at hway
100%
30%
25%
20%
5%
USING RBA TO PERFORMANCE MANAGE
RBA has not only supported the identification of appropriate
performance measures; it has also provided a structure to
develop service improvement action plans to improve
performance against these measures.
THE WELSH EPILEPSY UNIT
2008
2009
2010
2011
2012
2007
2008
2009
2010
2011
2012
PARTNERS WHO CAN HELP US DO BETTER
Clinic capacity – 1 clinic per week with 5 patient slots
Unpredictable demand
Small MDT – unable to cover absence to prevent clinic cancellation
Low frequency of clinics causes delay if appointment not suitable
Clinic booked by Epilepsy Unit admin staff – if admin staff on leave clinic slots not
filled
Consultant triage’s fax referrals – delay if unavailable
Patient anxiety
Stigma attached to Epilepsy
Patients put off by unit name – diagnosis seems pre-determined
Concerns re implications e.g. diving
Emergency Unit/MEAU, Radiology, Neurophysiology, Medical records, A&C staff,
Consultants, Ambulance Trust, Cardiology, Psychology, Care of the Elderly,
Neurosurgery, Prison, Voluntary Sector, CELT, Practice Nurses, Family members/
witnesses, Drug and Alcohol Services, Occupational Health, Referral Management
Centre, Obstetrics.
LESSONS LEARNT
WHAT WE PROPOSE TO DO TO IMPROVE PERFORMANCE
•
•
•
•
 Develop nurse led Emergency Unit assessment service
 Develop nurse led first seizure clinics
 Enable specialist nurse referral for EEG
 Change the name of the Epilepsy unit
THE WELSH EPILEPSY UNIT
Service Description: The Welsh Epilepsy Unit is a tertiary referral centre for specialist epilepsy services in
South Wales. The immediate catchment population covered is 700,000, but many referrals are also taken from
elsewhere in Wales. The Unit offers a multidisciplinary approach to epilepsy care and offers a very broad range of
services to people with epilepsy, their families and carers.
DEFINED SERVICE USERS
Women taking medication for Epilepsy between the ages of 14 – 45 who may become or who are pregnant
HEADLINE PERFORMANCE MEASURES
DATA DEVELOPMENT AGENDA
1. % prescribed optimum medication
2. % on polytherapy
3. % having major Epilepsy related convulsions during pregnancy
4. % have pre-conception counselling
1. % receive consistent and correct information
2. % professional feel confident to provide service independently
3. % follow the correct pathway
4. % feel fully informed
HOW ARE WE DOING?
% having majo r Ep ilep sy r elat ed
co nvulsio ns
% o n p o lyt her ap y
% Pr escr ib ed O p t imum M ed icat io n
% have pre-conception counselling
30%
100%
B as el i ne
60%
40%
20%
Baseline
20%
P r edi c t i on
15%
Cur v e t o t ur n
10%
Predict ion
Curve t o t urn
5%
0%
2008
2009
2010
2011
2012
80%
10%
Baseline
8%
6%
4%
2%
2007
2008
2009
2010
2011
2012
STORY BEHIND THE BASELINES
Some people can’t have their medication changed
Access to specialist knowledge
Social issues e.g. driving – have to stop if medication changed
People anxious to change medication
Pregnancy related problems can cause mal-absorption of drugs
Increased tiredness increases the risk of seizures
Conflict of decreasing medication or decreasing seizures
Lack of knowledge and awareness for patients/schools/primary care/non-specialists/obstetrics
Denial that problems may happen
Time and people resource
Not recognised practice
Unplanned pregnancy
Previous bad experiences
Knowledge of services available
Changed metabolism leading to lower medication levels
Fear of medication side effects
Increasing polytherapy may decrease side effects
Worried to initiate change
Baseline
60%
Predict ion
40%
Curve t o t urn
20%
Predict ion
Curve t o t urn
0%
0%
0%
2007
100%
12%
25%
80%
These action plans are currently being implemented and
include:
• The development of a nurse led Emergency Unit
assessment service for first seizure patients
• The development of a protocol to enable nurse led EEG
referral
• Changing the name of the Epilepsy Unit
• The implementation of education packages for partners
• The development of patient information sheets/cards
• Linking with the Epilepsy Pregnancy Register
2007
2008
2009
2010
2011
2012
2007 2008 2009
2010
2011 2012
PARTNERS WHO CAN HELP US DO BETTER
Obstetrics, Midwifery (Consultant led and Midwife led), GP, Practice Nurses,
Paediatricians, Paediatric Epilepsy Nurses, Epilepsy Specialist Nurses, Neurologists,
Learning Disability Team, Parentcraft, School Nurses, Social Services, Pharmacy,
Voluntary Sector, Epilepsy Pregnancy Register, Managed Clinical Network,
Occupational Health, Obs & Gynae Management, Psychiatry, Genetic Counselling
WHAT WE PROPOSE TO DO TO IMPROVE PERFORMANCE
 Implement the education package for partners
 Define the correct pathway
 “Three key messages” for professionals
 Patient information sheets/cards
 Link with Epilepsy Pregnancy Register – increase benefit to patients by providing info/
newsletter
It’s not easy to get going
Needs time and organisational commitment
Training is vital
Challenges the data we collect
BUT
• RBA provides a structure to identify appropriate performance
measures and enables performance management
• It provides a mechanism to think differently
• Focuses on patient outcomes, not processes
SO….
the hard work is worth it!
“RBA is a really useful tool; it
helps focus on outputs and places
less emphasis on pure activity
figures. Good as a vehicle for
engaging all stakeholders and
placing greater value on patient
experience and perception”
Service Manager
“RBA takes us beyond
audit and emphasises
patient outcomes to give
more meaningful data
collection”
Consultant Neurologist