4.4.1 RationaleKey performance indicators are a central component of health service quality improvement processes. They also provide a basis for accountability and monitoring, allowing assessment of whether a program or service does what it is intended to do and whether it does it well.
The absence of performance data on the mental health sector contrasts sharply with the increased profile being given to mental health in public policy. The Report on Government Services, an annual cross-jurisdictional publication produced under the auspices of the Council of Australian Governments, has made mental health a priority for reporting since 1999. Similarly, as noted earlier, the National Health Performance Committee has identified development of mental health indicators as a priority for inclusion in future editions of its biennial National Report on Health Sector Performance Indicators publication for Australian Health Ministers.
As discussed in section 2.10, a set of 'stage one' performance indicators has been agreed by the National Mental Health Working Group, based on the national health performance framework adopted by Health Ministers.25 The task ahead is to progressively implement and refine these indicators in a way that meets the needs of key stakeholders.
The publication of indicators alone is not sufficient to stimulate a culture of quality improvement and benchmarking throughout the mental health industry.26 The introduction of performance measurement systems requires attention not only to the technical issues, but also to the process of building interest, capacity and leadership within service organisations to use them creatively.
Lessons from the acute health sector have shown the benefits of applying roundtable and related methods to the health field. The engagement of organisations in learning about their performance through comparison with peer organisations grounds performance measurement in practice and provides a means for quality improvement to be realised.
A recent Australian report reviewed the status of benchmarking in mental health and concluded that much work was needed to make this a reality: "The challenge for the mental health sector is clear. The use of performance indicators and the movement towards benchmarking is becoming routine in the Australian health care system. The challenge for the mental health sector is to develop a set of meaningful performance measures and to develop the culture and the processes so that benchmarking becomes the norm".27Top of page
4.4.2 Consolidation activities
Implementing the agreed key performance indicatorsOver the period 2003-08, States and Territories will implement the agreed 'stage one' indicators within a timetable that is consistent with each jurisdiction's capacity. This will be supported by the establishment of a National Mental Health Performance Sub-committee that will be responsible for preparation of technical documentation and the ongoing development of the national performance measurement framework for mental health services.
4.4.3 New initiatives
Further development of the national performance framework for mental healthCollaborative work between jurisdictions will be undertaken to refine the indicators based on experience, fill gaps where key aspects of health system performance are not currently covered, and extend the 'stage one' indicators to improve their utility beyond the specialist public mental health sector. Significant gaps in the current framework are indicators that measure the domains of responsiveness and safety of mental health care.
Establishment of benchmarking forumsOptions will be explored for creating incentives for organisations to participate in collaborative benchmarking, whereby the indicators are used as tools for quality improvement. Experience in the acute health sector has highlighted that such activities have start up costs due to them being data intensive. Benchmarking partners need to prepare their data as well as make resources available to investigate differences in performance, encourage changed practices and evaluate results.
National reporting on the performance of the mental health systemSteps will be taken to publicly report on the performance of Australia's mental health services in a form that protects agency confidentiality but provides sufficiently detailed information for comparative evaluation and monitoring of trends. National reports on mental health system service performance will be designed to provide benchmarks to support the use of indicators by service organisations while also satisfying accountability expectations under the current Australian Health Care Agreements.Top of page
25 NMHWG Information Strategy Committee Performance Indicator Drafting Group (2005). Key Performance Indicators for Australian Public Mental Health Services. ISC Discussion Paper No 5 Australian Government Department of Health and Ageing, Canberra.
26 The concept of benchmarking is used here to refer to " ... the systematic process of searching for and implementing a standard of best practice within an individual service or similar groups of services. Benchmarking activities focus on service excellence, customer/client needs, and concerns about changing organisational culture" (Bullivant, 1994).
27 Eagar K, Burgess P and Buckingham W (2003). Towards National Benchmarks for Australian Mental Health Services. Information Strategy Committee Discussion Paper No.4. Commonwealth Department of Health and Ageing, Canberra.