Managing provider performance

Managing the performance of providers against the Key Performance Indicators specified in the contract is key. It covers service provision, financial risk management, financial forecasting, and monitoring outcomes.

Tips on searching the web:

When searching the internet, suggested terms include…

  • provider* AND (“performance management” OR performance OR “managing performance” or monitor*)
  • “quality improvement” / “quality assurance”
  •  To limit to NHS papers, try combining your results with: (ccg OR nhs). To look for CCG publications add the following to your google search:  site: ccg.nhs.uk (note the space before the CCG.)
  • You can search for terms such as “board paper” / “strategy” to help to locate Trust papers

Also have a look at our summary of tips on searching the web.

The term ‘metrics’ refers to measures of performance, such as indicators, targets, or benchmarks, which are used to assess and monitor the quality of care that patients receive in health services. The Healthcare Commission uses a range of metrics as part of its annual health check. Metrics can also help trusts to set local targets and drive improvements in the quality of their services at a local level.


NHS Networks Commissioning Zone
The Commissioning Zone includes resources on monitoring. To find these, conduct a search on monitoring, and browse through monitoring in the Process section.

NHS Indicators
A really useful summary of statistical indicators (as of Feb 2015) for NHS England compiled by the House of Commons Library including Hospital Activity and Capacity, Staff Numbers, Waiting Times and other performance indicators. In each case, the report includes data frequency, source and trends over the past few years.

Good Indicators Guide: Understanding how to use and choose indicators, NHS III 2010 (pdf)
A short, practical resource for anyone in any health system who is responsible for using indicators to monitor and improve performance, systems or outcomes.

Better metrics [Archived Content]
The better metrics project aimed to improve the way the performance of health services is measured and monitored by:

  • developing metrics that are more relevant to the work of doctors, nurses, and others who provide care to patients
  • identifying metrics that are already being used successfully by organisations to monitor and improve performance

Better metrics – list of metrics [Archived Content]

Commissioning for Quality and Innovation (CQUIN) payment framework guidance [Archived content]- From 2009/10 a proportion of providers’ income is conditional on quality and innovation. Current guidance and FAQs relating to CQUINs are available on the NHS England website NHS Standard Contract page.

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Hospital Episode Statistics (HES)   Part of the Health & Social Care Information Centre (HSCIC) formerly NHS Information Centre (NHS IC) . Some HES data is included in the HSCIC Indicator portal including Hospital activity by procedure and Outcomes (discharged, readmissions and deaths) (data to hospital level and trends) as well as Summary Hospital-level Mortality Indicator (SHMI).
See the RCP Hospital episode statistics for physicians guide, 2007.

Quality Observatories
SHA based collections of information about quality of services across their region. Designed to facilitate local benchmarking, development of metrics and the identification of opportunities to help frontline staff innovate and improve. Not available for all SHA regions.

Quality Indicators – East Midlands Quality Observatory
“A quality indicator is a measurement of the variance between the relevant organisations… in a specific area. Inputs, processes or outcomes can be measured, with the ambition to focus on outcomes.”  Includes care pathways, QIPP, CQUIN, PROMS.

NHS North East Regional Repository of Quality Metrics
A Microsoft Access database which can be used to identify useful metrics.

Painting by numbers: a guide for systematically developing indicators of performance at any level of healthcare by R Perera, A Dowell, P Crampton. Health Policy 2012 v108 p 49-59
The SID method (Systematic Indicator Development) method developed following a review of the literature and interviews comprising 6 stages – prioritisation; intent; implementation requirements; measure specifications; indicator assessment; target development.

KPI Workshop –  presentation from a workshop by United Health, November 2011.

Demonstrating the Value of Community Services – A number of indicator templates for different community services including adult audiology, falls prevention services, MSK physiotherapy and wheelchair services, are available for testing and discussion through work by the FTN aspirant Community Foundation Trust (aCFT).

Outcome based contracting

A series of reports from Optimy Advisory on Outcomes Based Contracting, published in 2015. Topics include System Readiness, Business Case, Outcome Measures, Business Intelligence, Payment and Reimbursement and Governance. See the series here.

Need to nurture: outcomes-based commissioning in the NHS  (Health Foundation, September 2015).
An examination of outcomes-based commissioning – what it means, the evidence to support it, progress to date on introducing the approach in England, and the optimum role of national policy in response to it. Includes a map showing details of outcomes-based commissioning contracts in England that have already been awarded, or are being planned.

International Consortium for Health Outcomes Measurement (ICHOM) – purpose is “to transform health care systems worldwide by measuring and reporting patient outcomes in a standardized way.”  CHOM organizes global teams of physician leaders, outcomes researchers and patient advocates to define Standard Sets of outcomes per medical condition. Standard sets so far include Low back pain, Prostate cancer, Parkinsons disease, Coronary Artery Disease and Cataracts.

Outcomes Based Healthcare – a range of resources and background reading from a number of reputable sources.

Contracting for Outcomes: A Value-Based Approach – a technical paper from Capsticks (published July 2014) offering an understanding of the different contracting, reimbursement and incentive mechanisms available to deliver Value and Outcomes-Based Healthcare in a UK context.

Outcomes-based commissioning a description and slide set from NHS Confederation and link to  briefing Beginning with the end in mind: How outcomes-based commissioning can help unlock the potential of community services.(Sept 2014)

Beginning with the end in mind: outcome-based commissioning and community services – Briefing from a workshop (Feb 2014) by PWC and NHS Confederation describing the benefits of outcomes based commissioning with particular reference to community services.

Value-Based Contracting This guide, published in 2013 by the US organisation Hospitals in Pursuit of Excellence (HPOE) provides specific guidance related to assessment, and financial, operational and implementation issues organizations should examine as they consider value-based contracting arrangements.

Leading for outcomes a series by IRISS including Leading for Outcomes – a guide (2010) which “aims to provide support on how to lead teams in the adoption and implementation of an outcomes-focused approach.”

Commissioning for outcomes: Driving the delivery of value based care – a 2 page briefing describing models of outcome based approaches and their value. Writtenby the Outcome Based Commissioning Alliance (OBC Alliance) formed of PwC, Wragge & Co,Cobic and Beacon.

COBIC Explained – Capitated and Outcome-Based Incentivised Contract. “The COBIC approach to commissioning allows commissioners to get the best out of their responsibilities handed to them from the NHS reforms, and ensures they best meet their obligations as commissioners”

COBIC  – an organisation aimed at implementing outcomes based contracting

Outcome based commissioning
A collection of resources on NHS Networks including definitions, useful reading and examples.

Commissioning for outcomes: a resource guide for commissioners of health and social care
A collection of useful models including the ABC Commissioning for Outcomes model from Liverpool PCT.

An approach to outcomes based contracting Chapter 9 of the Commissioning ebook.

Analysed: Oxfordshire’s ‘outcomes-based commissioning’ – HSJ case study (7 May 2013) of Oxfordshire’s plans to move maternity, adult mental health and frail elderly services to a new outcomes-based commissioning contract. (Subscription may be required)

Patient reported outcome measures (PROMs)
Data from all providers of NHS-funded care covering four clinical procedures (hip replacements, knee replacements, hernia and varicose veins) since April 2009 published by the Health & Social Care Information Centre, PROMs calculate the health gain after surgical treatment using pre and post operative surveys.

PROMs resources
Resources available free to anyone having an interest in the use, availability and development of PROMs.  Provided by the Patient-Reported Outcomes Measurement Group developed as part of the National Centre for Health Outcomes Development (NCHOD).

CCG pages

Croydon CCG new approach to commissioning services for people over 65

Oxfordshire CCG’s page on OBC

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