Performance monitoring website for Australia?

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

In February 2010, the Australian government was reported to be considering developing a website enabling the nation's 768 public hospitals to be compared in terms of infection rates, ICU mortality rates, medication errors and waiting times. In May 2010, the Sun-Herald newspaper used publicly available information to create the MyHospital website enabling comparison of NSW public hospitals in terms of emergency response times, surgery waiting times and other performance measures.

Purpose of health policy or idea

The purpose of this idea was to present statistical information about NSW hospitals in a form ordinary people can understand and use. The information about an individual hospital can be compared to others in the same category based on size, location or specialisation. The newspaper stated that making this information available to the general public will result in the NSW government becoming more accountable for meeting its own minimum standards.

Main points

Main objectives

• To present statistical information about NSW hospitals in a form ordinary people can understand and use.
• To enable the comparision of hospitals based on size, location or specialisation.
• To make the NSW government more accountable for meeting its own minimum standards.

Type of incentives

The incentives for a newspaper to create this type of website are based on premises that doing so will sell additional newspapers, will create interest in the website (of the newspaper) which again will lead to increased sale and on a perception of public good.

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

Although innovative for Australia, in comparison with the information available via websites in other countries, this idea is not new.

It has not caused any noticable controversy, largely because it reports information already publicly available and does not attempt to rank hospitals in any way.

As it is not an official website and not connected to any funding or other consequences, it will not have any impact on the performance of NSW's public hospitals.

It is not obvious that the website has much public visability beyound that initially created by the newspaper.

This idea is not system-dependent.

Political and economic background

The creation of the website seems to have been prompted partly by a reported interest in the notion by the Australian government as well as a history of this sort of performance reporting being discussed in the Australian media in terms of how this type of policy has been developed and implemented in other countries such as the USA.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

The origins of the idea lie with similar websites in the USA and the UK.

Initiators of idea/main actors

• Government: The federal government was reported to be considering the introduction of a performance monitoring website

• Media: One newspaper has developed a website using publicly available data in NSW

Approach of idea

The approach of the idea is described as:
renewed:

Stakeholder positions

There have been no publicly reported reactions to the website. The reported interest in the development of such a website by the Australian government was welcomed cautiously by the Australian Medical Association and Catholic Health Australia (which represents a group of operaters of hospitals in Australia) who indicated that additional information about the types of patients treated (eg high-risk, rich etc) would be required.

Actors and positions

Government
Australian government	very supportive		strongly opposed
Media
Media (one newspaper)	very supportive		strongly opposed

Influences in policy making and legislation

n/a

Actors and influence

Government
Australian government	very strong		none
Media
Media (one newspaper)	very strong		none

Positions and Influences at a glance

Adoption and implementation

The Sun-Herald was responsible for the development of the website. It used information made publicly available by NSW Health in its "Yellow Book" which is available on the Department's website. The report is published annually and contains a great deal of information in addition to that provided on the website.

Monitoring and evaluation

n/a

Expected outcome

It is not clear how many people have accessed the information and/or what use they are able to make of it. For each hospital the website reports:

• the proportion of individuals requiring elective surgery and assessed by a doctor as being in one of three "urgency" categories who are not admitted within the maximum waiting time set for that category (Category 1, 30 days, Category 2, 90 days, Category 3, 1 year)
• the proportion of patients admitted to an emergency department and assessed as being in one of five "urgency" categories who are seen by a doctor within the time set for that category (Category 1 (most urgent) 2 minutes, Category 2, 10 minutes, Category 3,  30 minutes, Category 4, 1 hour, Category 5, 2 hours).
• the average length of stay (excluding day surgery), average cost per in-patient stay (adjusted for complexity) and the proportion of day surgery as a percentage of all surgeries.

Thus, it is clear that if a prospective patient looks at this information, even if she or he knows what category of urgency they are (for elective surgery) or were (for emergency care) she or he will not be able to compare themselves with someone with the same diagnosis etc. No variances are reported so even if the average performance is below the target, it is not clear how likely it is that this will be the case on a particular occasion. It is also not clear what impact length of stay, cost and day cases have on the quality of care of a particular hospital.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

As mentioned above, because it is not an official website, contains publicly available information and does not attempt to rank hospitals it is unlikely to have more than a marginal impact. Nor does it seem to have had any effect on the Australian government in terms of developing an official website.

References

Sources of Information

Vicellaris R. Federal government considering site to allow patients to compare nationally. The Courier Mail, February 21, 2010.

Pollard R. Greater accountability can only make the system healthier. Sydney Morning Herald. May 9, 2010.

How we placed all the facts at your fingertips. The Sydney Morning Herald, May 9, 2010.

http://www.smh.com.au/multimedia/national/select-a-hospital

 

Author/s and/or contributors to this survey

Marion Haas

Suggested citation for this online article

Marion Haas. "Performance monitoring website for Australia?". Health Policy Monitor, October 2010. Available at http://www.hpm.org/survey/au/a16/2