Not everything that can be counted counts, and not everything that counts can be counted.”
– Albert Einstein
How do you know when your care home is performing well?I believe that a lot of care home operators have some kind of efficiency system in place that can inform them if the home falling under the bridge or remain financially efficient.
However from the operation perspective a care home operation requires more than just a strong finacial acumen.Fist of all we should not forget that our primary concern is to be and remain CQC compliant.
In 2010,CQC published a report about how to be CQC compliant and the main headings of the report fall under these standards:
Involvement and information
Outcome 1: Respecting and involving people who use services
Outcome 2: Consent to care and treatment
Outcome 3: Fees
Personalised care, treatment and support
Outcome 4: Care and welfare of people who use services
Outcome 5: Meeting nutritional needs
Outcome 6: Cooperating with other providers
Safeguarding and safety
Outcome 7: Safeguarding people who use services from abuse
Outcome 8: Cleanliness and infection control
Outcome 9: Management of medicines
Outcome 10: Safety and suitability of premises
Outcome 11: Safety, availability and suitability of equipment
Suitability of staffing
Outcome 12: Requirements relating to workers
Outcome 13: Staffi ng
Outcome 14: Supporting workers
Quality and management
Outcome 15: Statement of purpose
Outcome 16: Assessing and monitoring the quality of service provision
Outcome 17: Complaints
Outcome 18: Notifi cation of death of a person who uses services
Outcome 19: Notifi cation of death or unauthorised absence of a person who is detained or liable to be detained under the Mental Health Act 1983
Outcome 20: Notifi cation of other incidents 37
Outcome 21: Records 40
Suitability of management
Outcome 22: Requirements where the service provider is an individual or partnership
Outcome 23: Requirement where the service provider is a body other than a partnership
Outcome 24: Requirements relating to registered managers
Outcome 25: Registered person: training
Outcome 26: Financial position
Outcome 27: Notifi cations – notice of absence
Outcome 28: Notifi cations – notice of changes
Although the list summarises the outcomes and standards the managers and operators must use KPI framework to judge and improve compliance.
Clearly the media portrays the bad practices but our jobs as managers is to highlight the good practices and share with others and one of the topic I thought as helpful is the KPI in care home sector.
I don’t juxtapose the importance of compliance but I want to stress about how we perform considering the wave of brexit phenomena and cuts related to the care sector.Nevertheless there are some incentive utilised by home operators but the KPI clearly can be used to tell commissioners,stakeholders and not at least to our people who utilise our services on how we perform.
Knowing your key performance indicators may not show the full picture; you need to be able to compare your KPI’s against KPI’s for previous years, your budget and just as importantly against the sector standard however as CQC now utilise the star rating it may be useful to list down the KPI as per 5 outcomes eg safe;effective,responsive,caring and well led.
So what should we be measuring and how do we measure it?
A good place to start is about the assurance about compliance with essential standards that registration will provide which we describe as assessments of quality.
These assessments include: periodic reviews of the performance of the service, trends within current economy and commissioners strategy in regards health care, efficiency and effectiveness; and operational needs and demands.
In term of financial reviews a better comparison would be to look at earnings before interest, tax, depreciation and amortisation. This eliminates many of the variables between operating models.
Other operating ratios are staff costs as percentage of turnover. This will depend on the type of care home you are operating and the number of staff, and the pay level of the staff. That is to say that a nursing home may have a higher staff costs than a personal care home, but the nursing home will have a higher income per room than the personal care home to offset the higher staff costs. This can either be reported as a percentage of turnover, or be broken down to a cost per resident day.
Another KPI is the individual cost of items of expenditure or groups of items of expenditure; this can show how efficient you are at purchasing and controlling waste. Examples would be the cost of food per resident per day, or the cost of cleaning per resident per day. To calculate this information you need to record detail occupancy, which should be available, and the actual cost of items used. The actual cost of items used may not be the same as the expenditure in the month, if stock levels have changed, or items have been used but not yet paid for.
Target efficiencies in these areas highlighted efficiencies within existing fixed contractual arrangements. However, the performance against these targets can be used in the future consideration of contract requirements and direction of resources into existing contracts to enable the savings to be realised.
In addition to the potential financial efficiencies, it is anticipated that the developments will have a qualitative impact which will also be evaluated, in terms of the quality of service, the quality of life of residents, and the improvement in partnership working across health, social care and provider services. Furthermore to remain compliant the managers hence the care operators need to identify resources to sustain required elements monitoring of services and delivery of objectives. This is anticipated to include information relating to service activity and progress, qualitative information on outcomes and quantitative data. The evaluation of the data could be listed as such but the list is could be populated as required by the care home and person who uses the service needs.To maintain a good service delivery requires lots of quality improvements tools and quality metrics but I do advise to revisit the CQC standard and revamp the outcomes based on the 5 ratings and look at these standards as potential risks if become non compliant.
So where to start?
I would recommend the key performance indicators to be broken down into these bullet points however feel free to populate the list as per standards. Eg
How safe is your service?
- Numbers of safeguarding
- Numbers of incidents
- Training for personnel
- Safety of environment
- Health and safety measures
- Internal policies and procedures
- Staffing level
- Care management in regards to clinical operation eg nutritional needs,medication errors
- Staffing ratio
- Turnover rate
- Culture of the organisation
- Recruitment and retention
How effective is your service ?
- Timescale of incidents and complaints
- Communication across person served ,staff and stakeholders
- Person centre planning
- Positive risk management
- Staff overtime
- Financial eg employees cost,equipment maintenance
- Health and safety cost
How responsive is your service?
- Complaints and compliments
- Person centred care planning
- Risk assessment
- Recreational activities
- Social inclusion
- Death within service
- Staff vs service users ratio
Is your service caring?
- Person centred care planning
- Family involvement
- Positive risk assessments
- Medication management eg medication errors
- Rate of incidents
- Fall management
- Diabetes management
- Continence care
- Education of person served
Is your service well led?
- Leadership of manager
- Training and support for manager
- Quality assurance
- Quality improvement
- Person served satisfaction
- Staff satisfaction
- Retention and reward management
- Culture performance
- Equality and diversity compliance
- Governance assessment
- Financial planning
- Contract monitoring
The managers and care operators should look at these key performance indicators as classified risks.
Finally, a risk which should be considered in advance, is that anticipated target efficiencies are not met. In order to manage this risk, regular assessment and evaluation of the impact of the initiatives will be undertaken and fed back
“After all is said and done, more needs to have been done than said.”
– Neil Mason
The whole point of measurement and analysis is that it leads to different outcomes. KPIs is about making better decisions and reducing risk in care home. There’s no point having good data and sophisticated analysis if the results are not acted upon, either because of the organization’s culture or organisational processes. Successful use of KPIs requires organizational agility to bring change and measure results.