The way healthcare services are now planned, monitored and evaluated has considerably changed in the last decade. Many healthcare organizations have now moved from Activity-Based M&E(ie, what are we really doing?) to Performance-Based M&E which focuses on the overall results (ie what have we achieved?). Therefore the focus now is on the Results and consequences of actions and implementations, rather than on the inputs (treatment, time, human resources) provided. In Secondary Healthcare Management for instance, this is called Results-Based Management (RBM) and Performance-Based M&E play a vital role in Results-Based Management.

1. Victor Chibueze Ijeoma, rhim.
chibuezeijeoma@gmail.com
Health Data Analyst,
FCT Hospitals Management Board,
Abuja, Nigeria.
PERFORMANCE-BASED
SECONDARY HEALTHCARE
MONITORING & EVALUATION.

2. Learning Objectives
By the end of this session, participants should be able to:
1. Appreciate the Importance of Monitoring
and Evaluation in Secondary
Healthcare.
2. Identify and Describe Relevant M&E Tools
and Techniques.
3. Apply M&E Tools in Assessing Key
Healthcare Performance Indicators.
4. Recommend ways of Improving Monitoring
& Evaluation activities at facility levels.

4. Note That…………….

5. So…While You Say “I’m Working”

6. We Say…“ We’re Watching …”

7. “ And Guess What………..You Get Your….

8. How Do We Describe the "Performance” of a
Hospital?
Hospital performance may be described in relation
to explicit goals reflecting the targets and values of
various stakeholders (such as patients, professions,
insurers, regulators and the public).
Can be Described in Terms of its “Opposites”:
1. High Performance
2. Low Performance

9. Low Performance………………
Opposite of High
Performance;
and Hence,
Not Acceptable In
Healthcare!

10. Therefore…………………
Our Definition of
Performance
Will Be Based on
High Performance...

11. High Performance……………..
The provision of cost-effective,
high quality, and appropriately
accessible health services that
involves Inputs and Outcomes
that satisfy the patient, provider,
the community and all other
stakeholders of Healthcare.

12. Providers and patients
agree that high-quality
care is an essential
component of a high
performance healthcare
system.

14. Key Performance Indicators….
Some Healthcare’s Key Performance Indicators (KPIs) that can be
tracked for the purpose of monitoring and evaluation:
 Operations
 Patient Waiting Time
 Bed Occupancy Rate
 Staff-To-Patient Ratio
 Room Or Bed Turnover
 Communications Between Care Providers & Patients
 Finance
 Average Treatment Charges
 Permanent Employee Wages
 Total Hospital’s Running Cost for the Period
 Total Revenue Inflow for the Period
 Communications
 No. of Media Mentions
 Patient Satisfaction

15.  Internal Activities
Staff Training/Training Per Department
Patient Confidentiality (Measures the no. of times a patient’s
confidential medical Records were compromised or seen by
unauthorized persons).
 Public Health Programmes
Childhood Immunizations (Demonstrates the number of children who
have received immunizations, which reflects your contribution to
overall community health).
Number Of Educational Programs (Indicates the time and effort put
into educating the public. This can be broken down into the type of
program as well as the target audience for each program).
Number Of Preterm Births: Counts the number of preterm births
(under 37 weeks) that have occurred within coverage region of the
hospital with particular emphasis on those women who registered at the
hospital for their ANC.
Key Performance Indicators….cont’d

16. Key Performance Indicators…cont’d

18. How Then Do We Measure
Performance in Healthcare?
Firstly:
Performance Measurement is the
regular collection and reporting of data
to track health services rendered and
results or outcomes achieved.
It is the selection and use of
quantitative measures of capacities,
processes, and outcomes to develop
information about critical aspects of
healthcare services.

19.  Different Tools Are Used to Measure Performance based on
the Domains/Components of Healthcare Performance.
Examples:
Outcome Measurement Tool
Patient Satisfaction Surveys
Quality of Care Metrics
Hospital Utilization Metrics
Etc.

20. Outcome Measurement Tool

21. Patient Satisfaction Surveys

22. Quality of Care Metrics

23. Hospital Utilization Metrics

24. Monitoring & Evaluation (M&E)
 Monitoring progress and evaluating results are key
functions to improve the performance of those
responsible for implementing health services.
 M&E show whether a service/program is
accomplishing its goals. It identifies program
weaknesses and strengths, areas of the program
that need revision, and areas of the program that
meet or exceed expectations.
 To do this, analysis of any or all of a performance
domains is required.

25. Monitoring Evaluation
A planned, systematic
process of
observation that
closely follows a
course of activities,
and compares what
is happening with
what is expected to
happen.
A process that assesses
an achievement
against preset
criteria.
Has a variety of
purposes, and follow
distinct
methodologies
(process, outcome,
performance, etc).

26. Evaluation versus Monitoring
Evaluation Monitoring
• A systematic process to
determine the extent to
which service needs and
results have been or are
being achieved and analyse
the reasons for any
discrepancy.
• Attempts to measure
service’s relevance,
efficiency and effectiveness.
It measures whether and to
what extent the
programme’s inputs and
services are improving the
quality of people’s lives.
• The periodic collection and
review of information on
programme implementation,
coverage and use for
comparison with
implementation plans.
• Open to modifying original
plans during
implementation
• Identifies shortcomings
before it is too late.
• Provides elements of
analysis as to why progress
fell short of expectations

27. Monitoring & Evaluation
Monitoring and Evaluation (M&E) is
about collecting, storing, analyzing
and finally transforming data into
strategic information so it can be used
to make informed decisions for
program management and
improvement, policy formulation, and
advocacy. Global Health.

28. Let’s Compare Activities Involve Between Monitoring & Evaluation…
Attribute Monitoring Evaluation
Main Focus Collecting Data on Progress Assessing Data At Critical
Stages of the Process
Sense of Completion Sense of Progress Sense of Achievement
Time Focus Present Past-Present-Future
Main Question What Needs To Happen Now To
Reach Our Goal?
Have We Achieved Our Goal
Going Forward… How Do We Make It Happen? What Can We Achieve Next?
Attention Paid To… Details The Big Picture (The Target)
Inspires…. Motivation Creativity
Periodicity Continuous Throughout The whole
Process
Intermittent; At the Beginning
of End of Significant
Milestones.
Supports… Implementation of a Plan Designing the Next Planning
Cycle
Skills Required Management Leadership
Output Processing Progress Indicators Needs To Be
Monitored By a Few People.
Evaluation Results Needs to
be Discussed, Processed &
Interpreted by many
Stakeholders.

29. Let’s Take A Closer Look At…
Evaluation!

30. Evaluation of Secondary Healthcare may focus on different
aspects of service delivery:
• Inputs
Resources provided for Service Delivery: Human Resource for Health,
Patient-friendly Environment, Supplies , Equipment & Devices, Proper
Training, etc.
• Processes
Systems that transform inputs into outputs: Healthcare Coordination, etc
• Outputs
The specific products or services that a service delivery is expected to
achieve as a result of receiving the inputs: Treated & Discharged.
• Outcomes
Refers to patients’ responses to the care they receive based, essentially on
their expectations: Patient Satisfaction
• Impacts
Effects of the Secondary Healthcare on the people and their surroundings.
These may be economic, social, organizational, health, environmental,
or other intended or unintended results of service delivery. Impacts are
usually long-term effects: Environmental Pollution.

32. So What Do You Think?
When is Evaluation desirable?

33. When Is Evaluation Desirable?
 Prospective Evaluation:
Sets to Determine
What ought to happen
(and Why should it)
 Retrospective Evaluation:
Sets to Determine
What actually happened
(and why did it)

34. Evaluation Matrix
No Matter the Approach to Evaluation, there are Two(2) main
Classifications of Evaluation:
1. Formative Evaluation.
Evaluation of components and activities of
treatment procedure (or a program) other than the
treatment outcomes. (Structure and Process
Evaluation).
2. Summative Evaluation.
Evaluation of the degree to which a treatment
procedure has achieved its desired outcomes, and
the degree to which any other outcomes (positive or
negative) have resulted from the procedure.

35. Evaluation Matrix...

36. How Do We Monitor &
Evaluate the
Performance of a Given
Key Indicator of
Secondary Healthcare
Service delivery?

37. Group Activity…………..
Pick Up A Key Indicator
and Discuss How It Can Be
Used To Monitor and
Evaluate The Performance
of A Named Secondary
Healthcare Facility.

38. Group Discussion……
How Do We Improve
the Process of
Monitoring
&
Evaluation
in our Facilities?