1. Lies, Damned Lies & KPIs Part Deux Improving quality: Developing KPIs for Stage 0 & beyond 20 th September 2011 National Improvement Leads NHS Improvement

2. The purpose of the last workshop… Gain a better understanding of outcomes, Key Performance Indicators (KPIs) & measures… …Explore within the context of the CR Commissioning Pack… …With particular focus on Stage 0… …Followed by an interactive session- have a go at constructing some KPIs

3. Then it was your turn… Had a go at constructing KPIs for Stage 0… –Thought about the key questions you need answers to/ objectives/ outcomes –What will indicate successful achievement? (KPIs) –How are you going to measure it? (measures) –What targets/ thresholds will you set? Were they SSMARTT? Consider dimensions of quality (safety, effectiveness, experience) and efficiency

4. Why KPIs? Key Performance Indicators (KPIs) help organisations (and their stakeholders) to understand how well they are performing in relation to their strategic goals and objectives, i.e. whether the organisation (or its services/ activities) is on track or not –Actual performance v target –Improvement based on fact not guesswork –Highlight problem areas –Suggest areas for further examination –Help prioritise improvement activity –Enable comparisons over time & between organisations

5. Health Check A KPI provides an indication of whether defined and agreed service levels (or outcomes) will be achieved (and how efficiently) A Measure is a unit of workload or performance

6. Example: Stage 0 The Outcome –Prompt referral of all in scope patients to CR The KPI –Proportion of in scope patients referred to CR <3 days of diagnosis The Measure(s) –No. of patients referred to CR < 3 days of diagnosis expressed as a % of all patients referred

7. CRCP: Key Service Outcomes Increase in number of patients offered cardiac rehabilitation Increase in number of patients completing cardiac rehabilitation Reduction in number of acute re-admissions due to secondary cardiac events and unplanned procedures Increase in the number of patients satisfied with the service they receive for cardiac rehabilitation Supported by a set of indicators (and thresholds) that enable commissioners to manage the contract and to ensure that key objectives for service delivery are met

8. Outcome, Indicators & Measures

10. Errrrrr……….. Stages 3 and 4?!

11. Remember, remember 4 th November?

12. Cardiac Rehabilitation Pathway (all stages) Referred Offered Commenced Wait <10 Wait <10 AssessedPCPMeasuredCompleted LMP Readmitted

13. Draft Measures: Questions we considered… Is the measure meaningful? (the ‘so what’ factor) Is the measure feasible or practical to collect? Does the outcome have the potential for improvement? Does the measure make sense in terms of the patient pathway? Does the measure have the most appropriate denominator for capturing improvement? What’s the optimal frequency of collection for each measure? What measure of patient experience should be used? Should any other measures be included?

14. What was supposed to happen next? Decide on local measures Agree local thresholds Set up on Improvement System Agree tools, e.g. Patient Satisfaction Q Identify mechanism(s) & process for collection Establish baselines Report Seek help

15. What did happen next?

16. METRICS What’s going to happen next?

17. Characteristics of Good KPIs Specific (and appropriate) Simple to understand (visual) Measurable (with unambiguous means of calculation) Aligned (to strategy) Realistic (easy, low cost data collection) Timely (frequency and duration) Target-oriented (target or performance threshold)

18. How to Design KPIs The question is the answer… Objectives/ outcomes: what are we trying to achieve? –May be more than one KPI per objective/ outcome KP Indicator(s): what are you going to measure? –used to assess the present state of progress and to suggest an appropriate course of action Measures: how are you going to measure it? –can be qualitative or quantitative data related to inputs, processes or outputs Targets: what is the result that you want? –can be performance thresholds, stretch targets or a combination

19. Now it’s your turn Take a look at the outcomes and indicators in the CRCP service specification Take another look at the metrics we proposed at the start of the national project Consider the patient pathway for cardiac rehabilitation Think about your own service specs, organisations, services or activities….

20. Now it’s your turn…on tables Dance (only kidding) Discuss (and agree) any additional or revised (quality) outcomes, e.g. timely referral Discuss (and agree) what will indicate progress towards or achievement of these outcomes, e.g. % in scope patients referred to CR <3 days of diagnosis Discuss (and agree) some targets or thresholds, e.g. 80% of in scope patients to be referred <3 days of diagnosis Discuss (and agree) what measures you could employ….

22. A Reminder of the Pathway… Cardiac rehabilitation pathway The following diagram sets out the pathway for cardiac rehabilitation services. It shows seven stages in the pathway. Stages 1 to 6 reflect core stages in the cardiac rehabilitation pathway. Stage 0 is included in the service specification to confirm the obligations to be placed on the Stage 0 Provider by the commissioner. This is important since Stage 0 reflects the prerequisites that should be in place for Stages 1 to 6 to be effective.

23. Next Steps Future of Cardiac Rehabilitation work! Meeting dates for remainder of year National meetings 15 th November 2011(changed!) Now Thursday 8 th December 2011! Evaluation of today