Performance Monitoring in the Victorian Health Care System: An Exploratory Study

Article excerpt

Abstract

This paper reports on an exploratory study which aims to improve our understanding of how the Chief Executive Officers of Victorian health services monitor strategic and operational performance in their organisations. As a component of a large scale human resource management study, we surveyed 130 Chief Executive Officers (CEOs) of Victorian health sector agencies. Our findings suggest that performance monitoring was more advanced among the larger Victorian health sector organisations, and that there were areas for improvement throughout the system. Overall, the CEOs reported limited use of performance indicators related to service and clinical perspectives, with financial and volume indicators most widely used. There was little evidence that these organisations had processes in place (such as benchmarking and linking required outcomes to staff performance management) to understand the implications of the performance information and translate them into management action. The findings suggest that the sector requires technical expertise and support in data reporting, benchmarking and quality improvement in order to improve performance monitoring and ensure its relevance to strategic control, but further study is required.

Aust Health Rev 2005: 29(1): 17-24

STRATEGIC DIRECTION, sound operations and effective performance monitoring are required to ensure high quality, safe and financially sustainable health care. Yet, in all industries we have seen the difficulty decision makers have in detecting poor performance early enough to respond effectively.1 In the health sector there are many examples of health services that appear to be operating effectively, but which experience financial, quality or other crises in a relatively short time frame. In the absence of agreed national or statewide performance monitoring frameworks, many health services collect a vast amount of information, but appear to be unable to detect looming issues. This lack of strategic understanding and response may result because the organisation has not defined and does not collect the correct information (possibly because there is no agreement on what comprises the correct information) or does not have an effective system for translating this feedback into appropriate action.2-4

The strong positive link between monitoring performance and improving organisational performance has been well documented. Performance information is important to improving organisational effectiveness, ensuring accountability, monitoring management and fostering collaboration within the sector.7 The experience of health service organisations in monitoring performance has suggested the need to consider a range of performance indicators including financial indicators; service indicators that focus on satisfaction with service delivery; and clinical indicators that evaluate the processes of care and/ or the resulting patient outcomes.8 These indicators can be realised and acted upon through regular reporting to and monitoring by decisionmaking bodies and key stakeholders,9 through benchmarking with like organisations and through making links to staff performance.11,12

This exploratory study was conducted to improve our understanding of how the Chief Executive Officers of health services in Victoria think about performance and the methods they use to monitor strategic and operational organisational performance. As most health care organisations base performance management on measured indicators, this paper has broad implications for the health sector.

Methodology

As a component of a large scale human resource management study, we surveyed the Chief Executive Officers (CEOs) of Victorian health sector agencies. One hundred and thirty questionnaires were mailed to the CEOs of metropolitan health services (n = 12), regional health services (n = 15), district health services (n = 61) and community health services (n = 42). Sixty-four completed questionnaires (49%) were returned from the CEOs, categorised as follows: metropolitan health services (8; 67% response rate), regional health services (7; 46%), district health services (28; 46%) and community health services (21; 50%). …