Health System Performance Assessment (HSPA) Framework

Ireland has a growing, yet ageing population and over the next 20 years, the number of people aged 85 and over is projected to increase by around 6,000 each year which will present challenges in terms of access to and capacity of the health system. In acknowledgment of the requirements to transform the health system to respond better to the needs of the population and to put a stronger focus on prevention and primary care, the Sláintecare 10-year reform programme was launched in 2017.

Sláintecare sets out to improve effectiveness, accessibility, resilience and fiscal sustainability of the health system. An important component of the programme was the setup of a health system performance assessment (HSPA) process to measure, monitor and report on achievements against the objectives of Sláintecare and broader policy and decision-making cycles.

This is in recognition that the current system, which is based on activity- based indicators, needs to move towards a measurable and quantifiable outcome-based model strongly embedded in the policy making cycle which will monitor effective working of the health sector including policies and reform measures. This will allow for better evidence informed health policy decisions.

The project was supported by the European Commission Structural Reform Support Service who provided funding for the Phase 1 development that was launched on 10 September. The University of Amsterdam were chosen as the project providers.

Governance structures were put in place to progress the project, including:

• a small core project team led by the Department of Health and the University of Amsterdam
• a Project Working Group chaired by the DoH including key intra-departmental officials, HSE personnel and external stakeholders including the Health Research Board
• a Steering Board consisting of Senior Managers from the DoH and HSE
• an International Advisory Board involving HSPA experts from different European countries

Additionally, the department was in close contact with the EU Expert Group on HSPA to align activities with international experiences.

Phase 1 of the project consisted of four main phases running from September 2019 to March 2021. The four phases included the following:

• developing the focus of a HSPA framework in Ireland. This phase included a series of kick-off meetings to develop a detailed work plan and define the scope for the HSPA framework. It also included reviews of HSPA processes in the literature, frameworks in other countries and relevant Irish policies and strategic documents
• identifying domains (and sub-domains) of the HSPA Framework. This phase included convening a series of workshops and engagements with citizens, internal and external stakeholders to discuss what the HSPA should capture. In parallel, an assessment of the health information system in Ireland was conducted to identify and explore data sources
• populating the framework with indicators. A preliminary indicator map was developed based on indicators currently reported in Ireland, extracted from the literature review, or mentioned during the stakeholder panels. This list was consolidated and reviewed by domain through a workshop series, discussing the measurability and relevance (by purpose of use)
• final HSPA framework. Materials were consolidated in a framework with defined domains and subdomains, methodological guide on indicators identified, action plan for implementation and mock application

Three main purposes were defined for the development of the Framework:

• measure performance of the delivery system (health and social services)
• provide information (accountability) to the public regarding the effectiveness of policies and strategies of the DoH and HSE on overall population health
• monitor the progress of the Sláintecare reform to enable evaluation of the priority areas of the reform and to ensure that the healthcare system is more responsive to the needs of the population

The framework being presented is organised into five clusters and 16 domains:

• outcomes (health status)
• outputs (access, person-centredness, quality, costs)
• processes (coordination of care, integration of services, continuity of care)
• structures (finances, health workforce, health services structures, health technologies, health information
• cross-cutting cluster (resilience, equity, efficiency)

Each domain is further specified by subdomains and related features, which were populated with a total 260 indicators for all three purposes of the framework.

All indicators were accompanied by an indicator passport which includes the original indicator source, the primary and alternative uses of the indicator, and expected source of data (e.g, surveys, administrative data, clinical data, civil registries, disease-specific registries, incident reporting system). In some instances, a specific indicator or suitable data source will require further development in the future.

The virtual event that was held on 10 September presented the newly developed Framework and discussed its implementation across the health system. This involved the department, the HSE, the University of Amsterdam, EU Commission and Trinity College Dublin. Currently work is underway between the department and relevant stakeholders to plan for the commencement of Phase 2 of the project which involves implementation across the health system.

The importance and impact of having reliable data readily available has strengthened decision-making during the COVID-19 pandemic. The development of the HSPA framework presents a unique opportunity to support the continued strengthening and resilience of Ireland’s health and social care system and will be an important element to enable the impact of policies on the health service and on patient outcomes to be measured and will help inform future development.

The virtual event that took place on 10 September can be viewed at the following link:

https://youtu.be/2HhvZ80dybc

As mentioned above, phase 1 of the project finalised at the beginning of March and the service providers, University of Amsterdam, submitted the following deliverables:

1. Final report

D2: Methodological report

Supplementary File 1a: HSPA Framework Overview

Supplementary File 1b: Indicator Passports

D3: Assessment Modules

Assessment modules for specific policies and reforms. (*available on request)

D4: Action Plan 1st HSPA Report

Action plan for a first HSPA report. (*available on request)

D5: Report of the Workshop

Reporting of the outcomes of the international workshop on health outcomes frameworks. (*available on request)

D6: Semi-populated HSPA Framework

HSPA framework based on sample indicators. (*available on request)

Should you have any questions regarding the HSPA framework or to access the files marked (*available on request), please contact the Performance Management Unit at: PMU@health.gov.ie

The Health System Performance Assessment (HSPA) Visualisation Platform was launched by the Department of Health and the Health Service Executive on Monday 19th June 2023 and is an innovative new online visual health data monitoring tool.

The HSPA Platform is an important component of the overall HSPA Framework project which will help policymakers, healthcare providers, researchers, and patients to better assess and improve system accountability, fairness and efficiency.

Along with providing data and visualisation on the HSPA Framework indicators, the platform includes a number of functions to enhance data understanding and comparison including a data download function and links to the original data source

For access to the HSPA visualisation Platform www.hspa.gov.ie

Should you have any questions regarding the HSPA Visualisation Platform or the HSPA framework, please contact: HSPA@health.gov.ie

Press Release/Q&A/User Guide

Minister for Health launches online Health System Performance Assessment (HSPA) platform to monitor health outcomes and support continued improvements in Ireland’s health service

HSPA Platform

Health System Performance Assessment Platform Metadata Repository