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HealthStat - Improving Performance

 

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Each year, over 100,000 HSE staff deliver health and social care services costing over €13 billion. Everyone living in Ireland will use a HSE service at least once every year - but to evaluate and ultimately improve those services, we need to accurately measure how they are working. Read more about our performance information system, HealthStat below:

Are we delivering?
What came before HealthStat?
HealthStat - what is it?
HealthStat - who uses it?
How does HealthStat and the HealthStat Forum drive improvement?
HealthStat - how are targets set?
HealthStat - what exactly does it measure?
How are HealthStat results displayed?
HealthStat - Traffic Lights show results against targets
Performance dashboards - are they easy to read?
Who can access HealthStat results each month?
HealthStat - is it a co-ordinated approach?
What are the future plans for HealthStat?

Are we delivering?

Health and social care services hold a wealth of information about the services delivered to the Irish public.  Despite this, it can be a challenge to put a finger on the pulse of service performance. For HSE staff and managers to be able to stand over our work and to enable continuous improvement the HSE need reliable, timely and comprehensive information about how our services are delivered to those who use them. To meet this need, the HSE has designed and implemented a performance information and improvement system called HealthStat.


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What came before HealthStat?

In the past, many hospitals and Local Health Offices (LHOs) i.e. community services in Ireland measured some of their activity in detail, but the targets and the data collected varied from hospital to hospital and LHO to LHO. The information collected was not gathered together in a unified shared system, and did not deliver a dynamic picture of how all our hospitals and LHOs were delivering services to patients, or how they compared to each other.

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HealthStat - what is it?

HealthStat is a comprehensive databank of performance information from Irish public health services. It currently provides detailed monthly results from 33 teaching, regional and general hospitals and 32 Local Health Offices (LHOs) responsible for providing health and social care services in the community.  The results are published online on www.hse.ie. In late 2009, the HSE modified services to achieve closer working between hospital and community services. HealthStat is accommodating these changes by reporting a joint view on the performance of hospitals and LHOs at a regional and area level in order to support the new integrated structures.

The HealthStat team observed many international performance measurement systems in the planning and development of HealthStat. This included systems in the UK, in Australia and in the USA. A particularly successful system, which provided much guidance to HealthStat, was the CitiStat system used in Baltimore, Maryland, USA. Read more about Citistat here.

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HealthStat - who uses it?

HealthStat is used to improve performance by everyone involved in providing hospital and community based services - by clinical directors, service managers and by the HSE. Each month, the information generated through HealthStat is discussed at a HealthStat Forum meeting, led by the HSE CEO and attended by the Regional Director of Integrated Services, the hospital CEOs and Clinical Directors and the Local Health Office managers.

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How does HealthStat and the HealthStat Forum drive improvement?


'What gets measured gets done' is the basis of performance measurement. The aim of HealthStat and the HealthStat Forum is to share best practice and address problem areas in specific hospitals or Local Health Office (LHO) in a positive way. The Forum discusses suggestions for improvement in individual hospitals or LHO and identifies systemic performance issues that need a national approach. What sets HealthStat apart from previous individual hospital and LHOs systems is the specific focus on follow-up - the HealthStat Forum and the online publication of results encourage hospitals and LHOs to work for consistent performance improvement.

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HealthStat - how are targets set?

Irish hospitals and community services have worked with some performance targets in the past and HealthStat has combined some existing targets with a range of national and international standards. A full list of all metrics and targets is published on this site but hospital services examples include an adult elective surgery waiting time of 6 months, or urgent colonoscopy appointmentwithin 28 days of referral and community services examples include childhood immunisations within 12 months and 24 months, new born babies visited by a Public Health Nurse within 48 hours of hospital discharge, waiting time for community services and children in care with a care plan.

HealthStat targets are subject to review and are set at levels to work towards and achieve national and international standards. All hospitals and LHOs are aware of their shared targets and strive for better performance - shorter waiting times, more appropriate services, improved use of resources. The ultimate beneficiaries of the resulting improvements will be those who use health and social services in Ireland.

HealthStat - what exactly does it measure?

HealthStat uses a range of measures to come up with an overall picture of how services are being delivered. It does not yet measure clinical outcomes or standards of care - this is the focus of the HSE's new Clinical Care and Quality Directorate and of the Health Information and Quality Authority and an additional clinical programme will be added.

HealthStat's measures are grouped into three areas - Access, Integration and Resources.

  • Access measures the waiting times that people experience for different services. Are patients able to access consultant led out-patient clinics, diagnostic services, treatments, procedures, therapy services, care group services and emergency services within acceptable timescales?
  • Integration checks that the services received are patient-centred? Are people receiving outpatient or day care when they should be? Where it is suitable, are people being admitted on the day of their procedure? Is the length of stay for inpatients as should be expected? Are patients and their families informed about their treatment and included in discharge planning?  Are access to diagnostic and primary care services appropriate.
  • Resources assesses whether a hospital or Local Health Office (LHO) is making best use of its human and financial resources. Is a hospital or LHO serving acceptable numbers of patients? Are the budget spend and staff numbers as planned? What is the absenteeism rate?

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How are HealthStat results displayed?


HealthStat presents detailed monthly performance information from hospitals and Local Health Offices (LHOs) as a series of graphs, on a performance dashboard. Similar to the dashboard of a car informing the driver about the current status of the vehicle, so the HealthStat performance dashboard shows how an individual hospital or LHO is delivering services to patients day to day.

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HealthStat - Traffic Lights show results against targets


In the HealthStat performance dashboards each hospital's and Local Health Office (LHO) monthly performance is awarded a traffic light result. Green means good performance, amber means average performance, with room for improvement and red means unsatisfactory, requiring attention.

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Performance dashboards - are they easy to read?

The number of patients that pass through hospital and community services in one year can run into hundreds of thousands and the largest hospitals have thousands of people on their staff. With all the different aspects of care - clinics, diagnoses, therapies, treatment and procedures - a hospital's or Local Health Office’s (LHOs) performance can't be summarised into a simplistic percentage - so HealthStat's hospital and LHO dashboards are detailed, and require interpretation. A HealthStat for Hospitals Guide and HealthStat for LHOs Guide has been published, to assist the reader to gain a comprehensive picture of the data sources used, and the composition of the dashboard graphics.

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Who can access HealthStat results each month?

HealthStat is open and publicly available to all who wish to access it on www.hse.ie. HealthStat is a powerful tool, and is breaking new ground in our healthcare system, but it is complex - like the services it represents. It does not offer a simple 'marks out of ten' summary of hospital or Local Health Office performance. It is designed for use by professionals working in the health system, both within hospitals, LHOs and in management, and also by other professional groups with an interest in the health system, to give an expert picture of what is being delivered to patients, and how.

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HealthStat - is it a co-ordinated approach?

Since its establishment in 2005, the HSE has recognised that measuring what we do, against world class targets, is the key to improvement and to the achievement of a 21st century health system for Ireland. HealthStat is another step forward in a co-ordinated approach to monitoring and measuring performance. It reports each month, working hand in hand with the HSE's annual National Service Plan monitoring reports, and the high-level 3 year Corporate Plan objectives.

The development of HealthStat is giving a front-line focus to this health system's regular and rigorous testing of itself.

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What are the future plans for HealthStat?

The main areas of development planned for HealthStat is to bring paediatric, maternity and specialist hospitals into the system.

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