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PROactive Management of Integrated

Services & Environments


PROGRESS (PROactive Governance of Recovery Settings and Services) has 4 domains:

  1. Clinical Effectiveness: Metrics for Safe, Effective Efficient Care
  2. Patient Experience: Person Centered Support for Patients and Carers
  3. Staff Engagement: Metrics for Well Led Engaged Staff
  4. Finance: Metrics displaying Value for Money

The KPIs in each Domain to be relevant and inspiring they have to be thought through on three axes:

Individual - Team - Service - Directorate - Organization - System

Pathway: Access - Assessment - Treatment - Discharge etc

Essential - Desirable - Aspirational - Breakthrough

PROGRESS provides the framework to bring KPIs to life.

Key Performance Indicators (KPIs) are nowadays largely accepted as a fundamental part of organisational life within the NHS and beyond. These indicators are intended to measure, evaluate and report on the success of an organisation or a particular system or activity within it. In public organisations like the NHS whilst these KPIs often originate from a commissioning intention to focus organisations on what is important, in reality they can become cumbersome distractions for the direct workforce, often ironically taking attention from the very quality related work they are intended to improve. The seven day follow-up after discharge is an example of this: Initially intended to be a clinical response to this proven high risk time for people post discharge from hospital, in many trusts it has been reduced to an administrative task. In that way the target is reached in a technical sense in that the call is made but the opportunity to make a qualitative, clinical assessment of the person and their situation is lost. So the experience for frontline staff is often that KPIs measure what is measurable rather than focusing on the more difficult to quantify, but more meaningful quality measures that are less tangible and amenable to being measured; measuring the measurable in place of the important, if you will. This is equally true in the context of attempts to reduce restrictive practice where simply focusing on quantitative data might miss vital opportunities for innovation, prevention and creative solutions to very human problems.

Bringing KPIs to life

Managers often struggle to bring KPIs to life for teams due to the sheer volume of targets that they have to hit. So this must feel like they are engaged in an endless game of virtual ‘whack a mole’; just when they have got on top of one, another lags behind and so the cycle continues. This means that translating and interpreting the KPIs  to enable the frontline staff to appreciate how a particular KPI  helps to track quality or improvements in service delivery or is helping make a case to attract more resources gets overlooked. So for frontline staff KPIs can become simply an annoyance that seemingly take them away from face to face time with patients and something that they only do because they have been told to.

The story behind the KPIs

So, we manage what we measure, and this often results in a culture of doing what we count rather than doing what counts. We often hit the target but completely miss the point, as in the seven day follow-up example above. Bringing to life the story behind the key performance indicators which will help us track the improvement journey is vital. It enables a shift from a mind-set that is focused just on delivering the targets to one that sets a premium on positive outcomes for individual patients. Such a premium is at the heart of delivering proactive, person centred, safe and effective care and keeps goals and targets meaningful for everyone.

PROGRESS - Governance Framework

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