Euro Observer - The Health Policy Bulletin of the European Observatory on Health Systems and Policies

Spring 2008 - Volume 10, Number 1

Principles of performance measurement

"Information plays a central role in the ability of a health system to deliver effective health care and secure population health. It is used for a variety of different purposes in health care: to secure accountability within the system, to determine appropriate treatments for patients, to facilitate patient choice and/or for managerial control. Information also plays an important broader role in assuring governance of the health system. Early efforts at health system performance measurement can be dated as far back as 250 years ago.
Later, in the 1800s and early twentieth century, Florence Nightingale and Ernest Codman advocated using systematically collected data to inform and improve performance. Yet, because of insuperable professional,
practical, and political barriers performance policies were never generally applied.
It is only in the past few decades that sustained developments in health system performance measurement and assessment have emerged. On the demand side, citizens require increasing accountability from health
care professions and institutions and want to make more informed choices as patients. On the supply side, advances in information technology have made it much cheaper and easier to collect and process data.
However, despite the increasing use of performance measurement tools in developed health systems, questions still remain about the best way to collect, disseminate and use performance data efficiently. This issue of Euro Observer will explore some of the issues more closely through case studies on composite
indicators in performance measurement, attribution and causality, and the use of performance measurement in long term care and cardiac surgery. Here, we provide a brief overview of the principles of performance
measurement, highlighting some of the main policy implications.
Defining and measuring performance Performance measurement evaluates the extent to which a health system meets its key objectives. These objectives reflect different historical trajectories, political, financial and organizational priorities and the power of interest groups and stakeholders. The World Health Report 2000 defined three intrinsic goals of health systems - improving health, increasing responsiveness to the legitimate demands of the population, and ensuring that financial burdens are distributed fairly.
Generally, ‘health’ is taken to represent both health outcomes from health care and improvements in general health status. ‘Responsiveness’ captures dimensions not directly related to health outcomes, such as
dignity, communication, autonomy, prompt service, access to social support during care, quality of basic services and choice of provider. Improvements in responsiveness depend on a health system’s ability to deliver these dimensions more effectively."

continuar a ler

Artigos:

Principles of performance measurement

Long term care quality monitoring using the interRAI Common Clinical Assessment Language

Public reporting of performance in the USA: The New York State CSRS

Using composite indicators to measure performance in health care

Attribution and causality bias in health care performance measurement

(imagem aqui)

Ouvi falar de Benchmarking ainda associado à gestão e ao planeamento estratégico, há uns anos (largos) atrás, em contexto hospitalar. Enquanto processo sistemático de comparação (de produtos, de serviços, de práticas) entre departamentos considerados líderes nas suas áreas.Procura-se o melhor – aliás, conseguir o melhor entre os melhores e forma(s) de oferecer elevada qualidade ao mais baixo custo possível (o que é racional e razoável).Utiliza-se um processo contínuo (e aqui, o primeiro requisito), numa investigação que fornece informações e que é simultaneamente um processo de aprendizagem e uma ferramenta. Requer disciplina e organização, até porque é demorado, tem controle em todas das etapas, desde o planeamento à implementação com elevado senso de competitividade.

Benchmarking pode ser assumido tanto como instrumento como escola: analisar, aprender e adaptar para ser competitivo. Notaria ainda que se trata de um compromisso para a melhoria contínua da qualidade, baseado na reciprocidade, pois os envolvidos partilham e beneficiam dessa partilha de informação.

Vale a pena ler

o texto de JVC, em relação ao ensino clínico e  enfermagem (QAA, UK).