3.2 Main measures and targets – Northland DHB

District Health Boards: Learning from 2010-2013 Statements of Intent.
Main measures and targets
The SOI should clearly set out the outcomes the DHB seeks to contribute to or influence, AND/OR the impact the DHB aims to have, and identify associated performance measures. These "main" measures of future performance cover the full three year period of the SOI and they sit above the measures of service performance (output measures - which are part of the forecast SSP).

The relationships between these different elements of performance should be clear so that the reader can understand how the DHB believes that the goods and services it is accountable for will ultimately result in improved outcomes.

Northland DHB notes that it has been developing a more rigorous intervention logic to improve its SOI. It says:

"This is encapsulated in our SOI Framework which neatly captures all the elements of the performance story in one diagram."

The framework (set out in an appendix) is a diagram of the different layers of performance information. It starts with Northland DHB’s vision and progresses through high-level outcomes, outcomes, impacts, and outputs. It depicts the relationships between these.

Northland DHB has identified two sets of performance measures in relation to its outcomes and impacts in the framework and a set of output measures.* In the framework it has organised the measures under each impact, which means that the reader can easily identify all measures relating to a particular area (such as cancer). Northland DHB told us that it decided on this structure in preference to organising its measures by output class, because often this would have meant splitting measures for one impact across several output classes (for example, the tobacco impact has measures belonging to prevention, primary care, and hospital services). To help the reader identify output classes, though, the measures have been colour-coded across the impact columns.

High-level outcome measures

At the highest level, Northland DHB has identified four directional measures for its high-level outcomes:

  • increased life expectancy for the Northland population;
  • decreased mortality rate (age-standardised);
  • decreased infant mortality; and
  • decreased gaps between (a) Māori and non-Māori, and (b) Northland and New Zealand.

Although these measures may seem self-evident, including them in the performance framework makes them explicit and signals Northland DHB’s intent to actively monitor them, report on them, work towards achieving them, and keep them in mind during all its planning.

* As previously noted, the presentation of measures for both outcomes and impacts is not required by the Crown Entities Act.

Providing information on trends for high-level outcomes is useful context for impact measures, which reflect more directly the achievements of the DHB.

Impact measures

Northland DHB identifies four of the Impact Measures as its "main" measures of future performance.3 Some of the measures are commonly used by DHBs, such as Proportion of population who smoke and Five-year-olds who are caries-free. Other measures are not – for example, Improvements in quality of life among patients receiving elective surgery.4 These other measures represent Northland DHB’s efforts to identify measures that relate directly to the impacts described, some of which may not yet have reporting systems established.

Output measures

The third layer of performance measures relates directly to the services (outputs) which underpin the achievement of impacts/outcomes.

Example of the “story” told by the performance measures

The following extract of impacts, outputs, and associated performance measures for cancer, from Northland DHB’s framework, shows how the output and impact measures work together to provide a useful picture of planned service delivery and the impact, or effectiveness, of those services.

With appropriate reporting of measures at these levels, the reader should be able to get a picture of both the DHB’s performance in delivering cancer services and its progress towards achieving desired impacts and outcomes. Ultimately, the performance information links through to outcomes (such as Prevention of illness and disease, and Minimal impacts for those with long term conditions).

Impacts Cancer

For curable cancers, increased likelihood of survival.

For incurable cancers, reduced severity of disease
Impact Measures

Main Measures
For breast cancer, cervical cancer and major cancers:
  • new cases
  • survival rates
  • deaths
Outputs Screening for breast and cervical cancers.

Provision of radiation therapy, chemotherapy.
Outputs Measures

Health Targets
Targets for breast cancer screening in eligible populations.

Targets for cervical cancer screening in eligible populations.

People diagnosed with cancer who receive radiation treatment within 6 weeks (till Q1 2010/11) or 4 weeks (from Q2 2010/11).

People diagnosed with cancer who receive chemotherapy within 6 weeks.

The section on the rationale behind the impacts and outputs of the SOI discusses the links between outputs and impacts. This helps the reader to understand the impacts and main measures of performance that Northland DHB is using.

The comments on diabetes, cardiovascular disease, and cancer are set out below, as an example. Screening and early access to treatment are linked to the two impacts of survival rates and reduced severity of symptoms.

Impact Rationale Contribution made by Outputs
Diabetes and CVD
Screening for diabetes and cardiovascular disease (CVD), and waiting times for cancer radiation therapy are two of the six national Health Targets.

Together the three conditions account for about three-quarters of deaths and are major causes of illness and restricted functioning.

They are "long term conditions" (LTCs), so called because once diagnosed, people usually have them for the rest of their lives.

Prevalence of LTCs increases with age, so action now is imperative in the face of an ageing population.
A three-pronged set of strategies is necessary:
  • preventing LTCs (see action above under obesity, tobacco, breastfeeding)
  • screening to pick up conditions as early as possible
  • effectively managing conditions once they have developed through an active partnership between clinicians and patients.
For cancer, some of the biggest gains are to be made in ensuring early access to treatment (both radiation therapy and chemotherapy) to improve the chances of recovery.

NDHB has a Project Manager for LTCs, who is working with providers across the health sector to improve the detection and management of conditions.

3: See section 141(1)(f) Crown Entities Act 2004.

4: It is not clear from the SOI how the DHB will measure this.

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