Abstract

Background: Since 2004, Tuscany Region (Italy) has adopted a performance evaluation system (PES) for the whole health care system (12 Local Health Authorities and 4 Teaching Hospitals) Known as the Target diagram. In 2012, Tuscany Region has started a process to assess NH quality and performance variability with the aim to adopt a PES also for facilities for the elderly. In Tuscany there are 300+ public e and private NH account for ~12,000 hospital beds. The project started with 64 facilities that voluntarily participated and consists of two stages: (1) a census of their services; (2) the development of a systematic performance management framework. The aim of the paper is to present the PES tested in 50 NH.

Methods: To evaluate NH performance in a multidimensional way, an initial set of 30 indicators was defined by NH managers and health operators during a 3 week training and research course, where the results of smaller workgroups were shared in plenary sessions through a Delphi method. The performance management framework is characterized by multidimensionality, transparency and accountability and is now composed of ~130 performance indicators, grouped into five main quality dimensions, namely: B. organization of social care; C. health and healthcare; D. patients' and family experience/satisfaction; E. staff satisfaction; F. financial efficiency. There is another dimension, i.e.“A. Health of population", that doesn’t contribute directly to the performance evaluation but it serves to detect the characteristics of users and the complexity of care. Each dimension has its indicators. While few indicators can be calculated with data from institutional data flows, most indicators are calculated with data collected directly from the NH. Participants can review all indicators and data online, on a dedicated site. Performance evaluation for each indicator is either based on quality standards to achieve or on the regional average and distribution in a benchmarking fashion.

Results and conclusions: The introduction of such framework has helped nursing homes go beyond self-reference, making them more aware and responsible to users and their families as well as in the use of resources. It was used by NH managers to identify critical areas and discuss with their workers the improvement actions to be undertaken, the organizational changes to be introduced, and the investments which require priority. It is acting as a stimulant for quality and data management system improvement. In addition, NH are thus encouraged to compare their performances and identify best practices. On the Region’s side, it is also acting as a stimulant in resource and care planning and the results were so positive that the Region has called for the accession of all the facilities to the evaluation system. Debate is still ongoing regarding the publication of these performance indicators to the greater public.

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