National Healthcare Quality Indicators public presentation

Transcription

1 INTERACTION WITH USERS SESSION B National Healthcare Quality Indicators public presentation Mario Gaarder Norwegian Directorate of Health

2 National Healthcare Quality Indicators public presentation Mario Gaarder 1 The purpose of the National Healthcare Quality Indicator (NHQI) system is to contribute to transparency and to present the quality of the Norwegian healthcare system. The NHQI system aim to communicate results to several target groups, but the knowledge of how well the system is performing is limited. A review of the NHQI system performed by a service design and innovation agency resulted in the need for major revision of how NHQI are presented to the target audiences. The main findings were that the system was largely unknown, and it presented a fragmented picture of the healthcare system. At present, developing a new software platform for handling and communicating results of NHQI is ongoing. Key words: Healthcare quality indicators, communication, system revision. 1 Norwegian Directorate of Health (NDH), Senior Advisor, Oslo, Norway, mario.gaarder@helsedir.no

3 1. Introduction The Norwegian National Healthcare Quality Indicator (NHQI) system was established in March 2012 by the Norwegian Directorate of Health (NDH) after receiving regulatory instructed responsibility to develop, publish and maintain the Norwegian NHQI. The NHQI system aim to be a sustainable and relevant tool for several target groups and its purpose is to; Give patients and their next of kin a basis for making qualified and informed choices. Provide the public with information about the quality in the healthcare services. Provide decision makers with relevant information about the quality in the healthcare services as a basis for prioritization. Provide leaders and healthcare professionals with a tool for quality improvement, and national, regional, and local quality comparisons. The Norwegian NHQI system is based upon the Organisation for Economic Co-operation and Development (OECD) conceptual framework for development of healthcare quality indicators (OECD, 2006). Quality in healthcare services are defined in the Norwegian NHQI system as services that; are effective are safe involves the patient are coordinated and continuous are utilizing resources efficiently are available and equally attainable 2. Background The NHQI are made available to the public via the internet portal By the end of May 2016 there were a total of 113 indicators covering both physical- and mental healthcare services (Helsedirektoratet, 2016). Due to the rapid growth in number of indicators and also the rapid development in online software platforms, the NDH decided to evaluate whether the current NHQI system and its publication platform was fulfilling its purpose. To get an unbiased review of the NHQI system NDH decided to hire EGGS Design, a service design and innovation agency, to do the review. The main aim was to find out whether the different target groups used the NHQI system, and how they perceived the presentation of the NHQI on its current platform.

4 3. The review EGGS performed an analysis of the NHQI system, both the process of developing NHQI and how the NHQI were presented to the public. A workshop held between the administrators of the NHQI system and EGGS, discussed the result of the analysis and decided the strategy for collecting data. Interview was chosen as preferred method of data collection. Informants were recruited from each of the five different target groups for the NHQI system. It was decided to include at least three informants in each group, and no more than 10. The total number of informants in each group (n) was a result of the approached informants availability during the data collection period. The informants were recruited via network and by direct approach. In total 24 informants were interviewed; Patients and next of kin (n=8) Healthcare professionals (n=3) Leaders and owners (n=6) Politicians and decision makers (n=3) Representatives from the public (n=4) The interviews were semi-structured. In addition to the interviewer, a referent took notes during the interviews. All the informants were individually interviewed for approximately one hour each, either face to face or via teleconference. All the interviews were held during a two-week period. The interviews focused on the informants knowledge of, and how they perceived and used, the NHQI system. If an informant did not know the system, a brief presentation was given by the interviewer. 4. Results This section lists the main findings EGGS did when summarizing the interviews. Each topic is further discussed in the subsequent section of this paper. The main findings were; There was a varying degree of knowledge about the NHQI system. The patients and next of kin had the least knowledge of the system. All of the informants agreed upon the importance of the idea of a NHQI system as a contributor to an open and transparent healthcare system. All informants said that the NHQI system gave a fragmented and incomplete picture of the quality of the healthcare system. Not all NHQI were perceived as indicators of quality. Some of the NHQI results were perceived as outdated or no longer relevant for its intended purpose. Some indicators should have real-time data. All of the informants wanted information accommodated to their specific need. By this they meant both at which level the results were presented (local, regional, national), and what information was presented along with the results (whether it was facilitated to suit patients, managers, politicians or healthcare professionals).

5 5. The consequences and road ahead The purpose of the NHQI system is to contribute to transparency and show the quality of the Norwegian healthcare system. Its aim is to communicate results to the five different target groups listed previously. The knowledge of the systems performance was limited prior to the review. The main findings from the review were that the knowledge of the system among the informants was limited, the impression when presented to it was that it gave a fragmented and incomplete picture, the data was outdated for some purposes, and the communication was not perceived as adapted to any of the target groups. However the informants all agreed that a NHQI system was important to achieve transparency and to provide different target groups with relevant information to; be able to prioritize, do quality improvement work, and compare healthcare service providers. A key finding was that the knowledge about the system among the patients and next of kin was low or non-existent. Among the other informants the knowledge was varying. To increase the common knowledge among the target groups of the NHQI system and its purpose, a more active communication strategy, such as the use of press releases, has been adopted when new and updated NHQI are published. As the informants commented, a good NHQI system as a contributor to transparency and level of quality in the healthcare system is important. Its importance, however, is dependent on the publics awareness of the system. This underlines the need for a long term communication strategy to raise the awareness of the systems existence with its intended target audiences. The informants also perceived the system as fragmented and as giving a skewed impression of the quality of care. This was mainly caused by the fact that all of the NHQI were individually presented. The impression of the system as fragmented was further strengthened by a relatively long delay when loading data for each indicator, making it inexpedient as a platform for summarizing and comparing quality of care for different healthcare service providers. These comments were made by informants from all of the five different target groups, and were to some degree coinciding with our pre-understanding. To improve this, the planned new platform will have a design that is more user-friendly and responsive. A key functionality will be the possibility of cluster presentation of NHQI to give more complete and complementary insight in the quality of the selected healthcare service or service provider. Not all NHQI were perceived as indicators of quality. The informants found some indicators to be indicators on efficiency, rather than quality. An example of an indicator perceived as such is the indicator measuring delay from discharge to the discharge summary is sent to the general practitioner, nursing home or other relevant follow-up institution. Efficiency is included as a dimension of quality in the NHQI system. Indicators covering this dimension contribute as part of a set of indicators describing a service, to give a balanced picture of the total quality. However, the individual presentation of each of the indicators makes it harder to see each individual indicators relevance and contribution in showing the quality of the healthservice in question. A bundle presentation of indicators would give a far better impression of the totality of the quality, as well as show each indicators part in the total

6 picture. The new and improved platform will accommodate the demand for bundled presentation. A key area of improvement is the frequency with which the NHQI are updated. As a tool for decision making for the leaders in the healthcare institutions that are measured, it is of vital importance that the data is more recent than it is today. More recent data is also wanted by the healthcare professionals, to enable a better base for quality improvement work. At present there is a delay of at least four to five months from the data is reported until they are made available in the National Patient Registry, due to handling and quality control. This results in a publication delay of up to eight months for some data, due to the NHQI systems need for further adaption of the data to the present publication platform. When results are stable over time, and historical data are available, this delay is not crucial for the users of the service as it still gives a good indication of the long term quality level. For politicians, owners and leaders that need feedback on e.g. implemented change, a delay of this magnitude is more problematic. This is, however, a problem which the NHQI administration is not able to affect, as the data are mainly reported from the hospitals directly to the registers. Hence, the update frequency is dictated by the hospitals and registers. However, the new software platform should have a hugely improved functionality in regards to extracting data from different data sources, and reading data in different formats. The manual loading of received data will also be improved, shortening the delay created by the present data logistics. This will limit the delay, from when the hospitals report data until the NHQI system publish the indicators, significantly. A more frequent update of data in the registries would further decrease the delay, and thus improve the indicators validity, but the NHQI administration is unable to influence this aspect of the data logistics. Informants found it difficult to understand at which organizational level the results for each NHQI was presented. It was unclear whether it was national-, regional- or local results, and whether the hospital or unit in question was compared to similar units or national/regional results. The informants also noted that the presentation of the results should be adapted to its intended audience. Both language and level of detail should be different in results presented to the public and results presented to healthcare professionals. The new platform should be able to display clustered results for more than one healthcare provider at the time. The user will then be able to select which unit, hospital or region to compare, to make the results relevant to users from different target groups. The explanation of the statistics and the terminology used in the presentation should also be adapted to the different target groups. This functionality is a software issue, but is mainly dependent of the NHQI developers feeding the system the correct information for each target audience. The platform will have a drill-down functionality that allows for more detailed information, useful for healthcare professionals that need specific information for follow-up or initialization of quality improvement projects. This review has its limitations. The number of informants was low, which make it difficult to extrapolate the results to the population at large. However the informants all pointed to the same key areas of improvement. These results also, to some extent, coincided with what was expected to find, which made the need for a system revision even more clear. The chosen method provided the opportunity to follow up on the informants answers during the

7 interview, which made it possible to elaborate and reach a deeper understanding of the answers than what would be possible in a survey in a larger population. 6. Conclusion A better communication strategy is needed to make the public aware of the NHQI systems existence. Furthermore, the NHQI system need to present the indicators in a way that gives the user a more complete picture of the quality of a healthcare service, or a healthcare service provider. Work is in progress with a platform that is both more interactive and up to date, than the present.

8 7. References OECD (2006). Health care quality indicators project conceptual framework paper. Available at: (accessed 31. March 2016) Helsedirektoratet (2016). NHQI. Available at: (Accessed 31. march 2016)