New health sector System Level Measures have quality improvement focus

13 Apr 2016 | Health Quality Intelligence

The new System Level Measures for the health sector have a strong quality improvement focus. The six new measures were announced recently by Minister of Health Hon Dr Jonathan Coleman.

The Ministry of Health worked closely with the sector to co-develop the new measures. Four of the six measures will be implemented from 1 July 2016. They are:

  • Ambulatory Sensitive Hospitalisation (ASH) rates per 100,000 for 0–4 year olds (ie, keeping children out of hospital) 
  • Acute hospital bed days per capita (ie, using health resources effectively)
  • Patient experience of care (ie, person-centred care)
  • Amenable mortality rates (ie, prevention and early detection).

Two further System Level Measures will be developed during 2016–17:

  • Number of babies who live in a smoke-free household at six weeks postnatal (ie, healthy start)
  • Youth access to and utilisation of youth appropriate health services (ie, teens make good choices about their health and wellbeing).

Quality improvement focus

The Health Quality & Safety Commission has been involved in the development of the new measures. Health Quality Evaluation Director Richard Hamblin says the measures are closely linked to quality improvement.

"System Level Measures are high-level goals of the health system that help show how it is performing and the value the country is receiving from it. What each part of the system does can affect how well the overall goal is met.

"For example, the measure 'Acute hospital bed days per capita' may be affected by good primary care, discharge planning, and good ongoing communication about a person's care between hospital and community care.

"Because many local conditions may affect the System Level Measure, each has a range of linked contributory measures which describe a number of things that can be improved locally to affect the overall System Level Measure.

"For example, contributory measures for 'Acute hospital bed days per capita’ include length of stay, acute readmissions and flu vaccinations in the elderly. The most important contributory measures to address can be chosen locally, based on the needs and priorities of local communities and health services.

"Contributory measures have a quality improvement focus – the better the quality of the care, the better the service provided. They reflect meaningful and effective interaction between clinicians and patients in the care provided every day.

"By identifying the correct contributory measures to address, and using quality improvement methods to improve their performance, the System Level Measure should also improve."

Transitioning from IPIF to the System Level Measures Framework

The new measures are part of the System Level Measures Framework, formerly known as the Integrated Performance and Incentive Framework (IPIF). While IPIF focused mainly on primary care, the focus has now been broadened to include the whole health system. This broader focus reflects feedback from the sector and the priorities of the updated New Zealand Health Strategy.

IPIF is therefore transitioning to the ‘System Level Measures Framework’ to reflect this broadening of approach and the increased focus on outcomes, and value and high performance.

Implementation of the measures

Primary health organisations (PHOs), district health boards (DHBs) and district alliance leadership teams, will drive implementation of the new measures.

In their 2016–17 Annual Plans, DHBs are expected to commit to providing an improvement plan. The plan will be developed with and agreed by their PHOs and district alliances. It will be provided to the Ministry of Health at the end of quarter one 2016–17 through the DHB Annual Plan quarterly reporting database.

The improvement plan will include:

  • improvement milestones for the four System Level Measures (total acute hospital bed days, ASH rates for 0–4-year-olds, patient experience of care and amenable mortality) 
  • contributory measures for each of the four System Level Measures
  • district alliance stakeholder agreement.

Further information on the development of the improvement plans will be available in the DHB Annual Planning Guidance on the National Service Framework Library by 2 May 2016.

For more information

More information about the System Level Measures Framework is available from the Ministry of Health website. Here you can find an overview of the framework, information about the 2016–17 System Level Measures, frequently asked questions and programme newsletters.

Last updated 13/04/2016