What do we mean by productivity?

The drive to measure productivity in the health service has recently intensified. Earlier this month, the Minister for Health Stephen Donnelly brought a memo to Cabinet on the issue. The memo outlined how continued future development funding will be prioritised for hospitals and services that demonstrate they are making the most efficient use of existing funds.

“I have engaged extensively with the HSE on the issue of productivity and on the importance of performance management and reporting tools, the adoption of which will be critical when it comes to the deployment of new development funding and of capital investment,” according to the Minister.

New data reports from the Department of Health are focusing on productivity levels across all hospital sites. Investment in health workforce numbers and associated levels of activity across all hospital sites are among the metrics displayed.

The first of the ‘Productivity and Savings Taskforce Indicator Dashboard’ reports was published in July.

According to a statement from the Department, the data shows “significant variations” in the average number of outpatients being seen by consultants in the same specialty.

Shortly after the Department’s statement was released, the IMO issued a response.

The Organisation said that further examination of hospital productivity is needed in order to understand the issues involved.

Prof Matthew Sadlier, Chair of the IMO consultant committee, said: “While we welcome the publication of this productivity data today, it is important to note that the kind of blanket approach of comparing hospital sites is of little value in terms of understanding what is happening at individual hospital level.”

The IMO said correspondence it received from the HSE in June acknowledged that “key factors” affecting productivity are not considered in the data.

According to the Organisation, the correspondence said that “there are a number of reasons why there will be variances [in productivity] between hospitals, within clinical specialties”.

These include the delivery of care through multidisciplinary teams; different types of consultant outpatient work; and greater inpatient demands.

“The IMO has repeatedly called for the introduction of measures that will enable consultants to see more patients,” stated Prof Sadlier.

“The trend identified in this report needs further analysis so that all the factors at play are understood and appropriate supports put in place. Blaming consultants is not the solution.”

In addition to the issues raised by the IMO, questions have also been asked about the health performance visualisation platform (HPVP) procured by the HSE. The refusal of voluntary hospitals to share information with the platform was reported in this newspaper, as well as the national media. However, a HSE spokesperson told the Medical Independent earlier this year that all the relevant voluntary hospitals have confirmed their commitment to participate with the HPVP programme.

Measuring productivity in the health service isn’t straightforward and depends upon many variables. Connecting funding with performance is a worthy goal, but risks oversimplifying the extremely complex interplay of factors that underpin our healthcare system.