Friday, April 25, 2014

Key performance indicators

Browsing the intranet of my hospital, I came across the quarterly hospital health target report.
The report consisted of parameters the ministry of health requires all hospitals to report. These parameters are in areas the ministry feel are important goals - so called 'health priorities'-  that are to be met in order to fulfill the need of the population accessing healthcare.
This is not a new phenomenon, the idea of key performance indicators (KPIs) is wide spread in business and is used to judge performance as well as highlight areas for improvement.
It is also a useful goal setting strategy that helps keep the goal always in focus. While it can be detrimental in that focus may start to shift to numbers than perhaps what the numbers are trying to achieve, it is felt to be generally a good thing that most organizations and governments imbibe.
A look at the KPIs for this particular health ministry, summarized in a webpage that houses the results reveal targets in:
- Shorter stays in emergency department - 95 percent of patients will be admitted, discharged, or transferred from an emergency department within six hours.

- Improved access to elective surgery - volume to increase by 4000 discharges per year

- Increased immunization - 90 percent of 8 month olds will have their primary course of immunization on time

- Shorter waits for cancer treatment - all patients ready for treatment wait less than 4 weeks

- Better help for smokers to quit - 95 percent of hospitalized patients who smoke and are seen by a health practitioner in public hospitals and 90 percent of enrolled patients who smoke and are seen by a health practitioner in general practice are offered brief advice and support to quit smoking.

- More heart and diabetes checks - 90 percent of the eligible population will have had their cardiovascular risk assessed in the last five years.
The data from different regions are collated and a quarterly reported published. One is then able to compare data across different areas and times for the whole country. The public are aware of it and have certain expectations when they access health care. Staff also have defined targets to work towards in their everyday roles
Over time it is easy to see where one needs to appropriately target interventions or employ different management strategies to ensure improvement. 
These indicators are obviously well thought out, with specific numeric targets. It shows homework has been done and the government has chosen priority areas to invest time and effort to improve the well being of the population. It is also safe to conclude that systems exist to gather this information.

Seeing this, i did a google search for any similarity in the Nigerian health system. To my surprise i came across a national health plan. The plan was laudable in that it was quite a detailed document that had reasonably specific targets and KPIs. The more i read the more obvious it became to me that quite a lot of work had been put into it. But as often is the case with Nigeria, many a great reports are left to rot on government shelves while the status quo carries on.

Where the plan was further let down was the lack of data. Several indicators couldn't be measured as the data just wasn't available. Furthermore the number of KPIs were large, this in my opinion defeats the purpose.

What is needed is something like the much maligned 7 point plan of former president Yar'adua (God rest his soul).

7 indicators with achievable goals, monitored quarterly, easily measurable and impactful in the day to day health of the average individual. This should then be easily accessible to the general public who can compare, contrast and put pressure on the right people when needs be to make sure things get done.

Of course more systems for data collection needs to be put in place to facilitate this and people and healthcare workers need to be educated and carried along. All in all it's not that difficult, all that's needed is the will and we know that when there's a will there's a way!