Performance measurement and KPI setting - Wojciech Zielinski, OECD
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This document summarizes a session on performance measurement and KPI setting. It discusses: 1) Sources of performance data and why performance measurement is important for increasing efficiency, effectiveness, and accountability, but also risks like gaming the system. 2) Factors influencing performance management systems like organizational culture and capacity. 3) A 2018 OECD survey on performance budgeting and measurement in healthcare that looked at objectives, challenges, responsibilities, and impact of initiatives. 4) Key observations around benefits but also risks of linking decisions to results, health being a pioneer though mostly for hospitals/ambulatory care, and methodological challenges in defining measures and ensuring reliable data.
Performance measurement and KPI setting - Wojciech Zielinski, OECD
- 1. SESSION IV: PERFORMANCE MEASUREMENT AND KPI SETTING Wojciech Zielinski Senior policy advisor Public Governance Directorate Vilnius, 25-26 April 2019
- 2. • Sources of performance data • Why is performance measurement important? • Why is performance measurement risky? • Factors influencing performance management • Performance measurement in healthcare in OECD countries – presentation of 2018 survey results Outline
- 3. Ministries` financial data Ministries` operational data Ministries` performanc e reports Ministries' performance evaluations Ministries` performan ce reports Policy evaluation Spending reviews Surveys Statistical information Independent performance information 3 Sources of information Good practice: What Works Centres in the UK
- 4. • Cost benefit analysis of measurement • Increase efficiency: use of perf. information in resources allocation process • Increase effectiveness: evaluation of achievement of objectives. • Increase accountability: managerial, social political • Improve functioning of public bodies • Better policy elaboration and evaluation. 4 Why to use performance information?
- 5. • Gaming • Information manipulation • Selective attention • Illusion of control • Altering social relationships, diminishing trust • Administrative overload • Stifled innovation • Etc. 5 Risks related to the use of performance information in decision making Based on: Franco Santos M., Otley D. (2018), Reviewing and Theorizing the Unintended Consequences of Performance Management Systems, in: IJMR, Vol. 20, 696-730
- 6. • Specificity of the legal system • National culture • Organisational culture • Capacity of public servants • Differences between the specificity of programmes • Intended use of performance information 6 Factors influencing the design of performance management systems
- 7. 0 10 20 30 40 50 60 70 80 90 100 power distance individualism masculinity uncertainty avoidance long term orientation indulgence Comparison of National Cultures US Ukraine Lithuania Turkey Example: how national culture could influence management practices Source: https://www.hofstede-insights.com/
- 8. Performance Budgeting and Performance Measurement in Health 8 2018 OECD Performance Budgeting Survey
- 9. 9 Objectives of performance measurement systems in health 0 10 20 30 40 50 60 To improve quality of services To monitor compliance with national standards To measure productivity/improvements To determine budget allocations To measure public spending efficiency To identify effective policy strategies To promote accountability for government spending To improve capacities of service providers To benchmark performance of specific service providers To benchmark sub-national government performance For cost containment To promote learning from good practices To assert budgeting and financial control
- 10. 10 Challenges in performance measurement 0 10 20 30 40 50 60 70 80 Non- cooperation of SNGs Vested interests Cost of obtaining info. Cost of capital and IT Privacy concerns Identification of performance… Data comparability Measuring outcomes Measuring quality Data quality
- 11. 11 Responsibility for performance measurement in Health 58% 27% 8% 3% National Regional Local Other
- 12. 12 Whose performance gets measured? 0 10 20 30 40 50 60 70 80 90 Hospitals Providers of ambulatory health care Providers of preventive care Residential long-term facilities Providers of ancillary services Retailers and other providers of medical goods
- 13. 13 Impact of common health sector initiatives on performance measurement 0 10 20 30 40 50 60 70 80 90 100 The monitoring of health access across population/roups Minimum national standards Public league tables or ratings Patient satisfaction/experience surveys Shift in resources to primary care Adjusting outputs/inputs to account for care quality Linking payment/funding to outputs/outcomes Performance based budgeting Budget caps Shift in resources to preventive care Increased investments in public health Use of performance contracts Use of public-private partnerships
- 14. Use and impact of performance data at the national level 0 10 20 30 40 50 60 70 80 90 100 Policy priorities are determined or adjusted Policy strategies are determined or adjusted Budgets are determined or adjusted Performance targets are determined or adjusted Always and very frequently Occasionally and rarely Never
- 15. 1. Potential benefits of linking decisions to peformance results, but also associated risks. 2. Health has been a pioneer in the use of performance information, although mostly limited to hospital and ambulatory care services 3. Health ministries play a critical role in determining the performance framework, although in a federal system, SNGs may also have a significant role 4. Some initiatives appear more helpful than others in improving performance measurement, including setting targets for access to services and minimum service standards 5. Important methodological and practical challenges remain, including defining output measures, measuring quality and ensuring the reliability and consistency of data. 15 Performance Measurement in Healthcare – Key Observations
- 16. • Presentation by Estonia • Presentation by Kazakhstan Case studies