How could performance be managed?

Section 5

Provider networks need strong performance management systems so they can respond quickly to issues that could have a negative impact on outcomes and lead to risk of overspending the capitated budget.

Effective performance management will also support provider networks to refine new models of care in response to population need so that they can constantly improve the care they are providing for their local population.

Provider networks will need to collectively performance manage multi-disciplinary teams, as well as teams that perform more specialist functions.

The six elements of a best practice performance management system are:

  1. Set aspirations so there is a clear view of what success. Provider networks will need to make sure that success matches the outcomes set by commissioners.
  2. Establish accountabilities which are clear and metrics and scorecards which cover relevant and specific areas and cascade to multi-disciplinary teams and individual professionals.
  3. Create plans and targets that are realistic yet stretching and fully owned by the multi-disciplinary teams, provider members and are supported by appropriate resource. These decisions link with the model of care and resource allocation described above. They should also involve concrete expectations of time-lines.
  4. Track performance effectively using reporting that gives a timely view of performance at appropriate detail without burdening team members and providers. Best practice suggests having a fewer number of metrics that encourage positive behaviours in a whole range of areas that you do not need to measure, as they are all contributing towards the overall goal. The module working group suggested metrics should be organised around:
    • Outcomes including clinical and social-care measures
    • Experience of individuals receiving care
    • Cost that could be measured based on activity (e.g., non-elective admissions or bed days) or innovative ideas like time individuals spend away from home
    These metrics should also be designed with reference to the service standards agreed as part of the model of care.
  5. Hold performance dialogues which are challenging and supportive, focused, fact-based, and action orientated. These need to take place regularly within the multi-disciplinary teams to support individuals. They must also take place as the collected provider network board with the multidisciplinary team leaders.
  6. Ensure actions are taken to improve performance and that there are incentives for good performance and consequences for poor performance.

Check and challenge

  • What metrics will your provider network use to monitor performance?
  • How often and with who will you discuss the performance of your network?
  • What incentives and consequences will you have for good and poor performance?