Are ambulance performance indicators fit for purpose?
Victorian’s have recently seen their state government making funding announcements that are designed to improve the efficiency of the health sector.
The announcements come after media about the sectors failure to cope with Covid. In recent weeks the media has also started to ask questions about what the landscape was like pre-Covid. The AEAV has contributed to this by calling out failures in the health sector that existed in 2017-19 and our belief that the system was destined to fail with the increase in demand and patient flow delays that resulted from Covid.
The current Victorian government has invested heavily in the sector, with particular attention paid to ambulance. When the current government came to power in 2014 the ambulance sector was at crisis point and the focus was on fixing response times. That required money and more staff. There was a honeymoon period from 2015-17 with paramedics at AV feeling the love. Unfortunately, that commitment was non-existent for private non-emerg, ESTA and AV support staff.
Since 2017 that mutual endearment has been taken for granted by the government, and AV were left to their own devices to chase KPI’s. The result being AV squeezing the system and workers harder and harder to satisfy the desire of the government for better performance. This has been reflected on in the Victorian Equal Opportunity & Human Rights Commission’s report into AV.
The hidden damage to the workforce was a result of the insatiable thirst for KPI’s and the fact that AV was able to make those KPI’s look better than they really were and were also instructed to artificially inflate KPI’s that should reflect the impact on the workforce.
Hiding the impact of the KPI’s and ignoring the indicators that the system was failing meant that the government fell into the same old “crisis-investment cycle”, which results in systemic overhaul not happening until people are literally dying.
Welfare figures inflated
AV is not currently required to report to government on staff welfare other than 8 questions that are taken from the annual People Matter Surveys. These figures are also reported in the AV annual Report. This should be the failsafe to ensure that the workforce is not being pushed beyond reasonable limits to achieve the governments KPI’s. Unfortunately though, the government has instructed AV and other public health services to inflate these “welfare” indicators. Sometimes inflating figures by nearly 30%. The consequence being that AV has routinely been able achieve the KPI of 80% of staff with a positive response to safety and culture questions. When in reality, the true figure is more like 60%.
Response data hides underlying systemic failures
The main KPI that AV and the government trots out to the public as their proof that the service is functioning well is the KPI of 85% of Code 1 or Priority Zero cases attended within 15 minutes. This has been a political winner for the government and for many years was a factor in the AV Exec receiving bonuses.
This figure has effectively been used as the indicator for the health sector more broadly and improvements in the KPI has regularly been used as the indicator that the health system was improving and even exceling.
Although the problems are far more deep-seated than ambulance, the Victorian government has still unapologetically used this figure as a broad indicator of a healthy system. This has allowed the government to deflect from the failures of the sector and the increasing pressure that has been the precursor for the crisis we are now in.
As an example, using single officers and community officers to “stop the clock” is one way AV has improved this KPI for many years, but it has hidden the underlying resourcing and workload issues. Obviously, these early interventions can sometimes have a significant impact on patient outcomes but on many occasions the focus has been on stopping the clock to achieve the 15-minute KPI.
So, what needs to change?
Firstly, the government and AV need to understand that it is in everyone’s best interest to have a system that is open and transparent and engages in adult conversations with the public. No longer focusing on making things look good for political purposes. Tell it how it is.
In addition to the above example, there are numerous other examples of how AV has been able to make things look better than they were and how the government has been able to make it seem like the increasing workload pre-Covid was being soaked up without any adverse impact on staff.
Some of these include:
- Increased reliance on continuous overtime
- Decreased opportunity for meal breaks
- Staff asked to work during annual leave
- Community Officer’s working with paramedics in busy regional centres
- Crews requested to clear despite not completing current case.
Review of the indicators
In recent weeks the AEAV has called for an independent review of the indicators that the government and AV use as the litmus test for ambulance and the health sector more broadly.
The government not only has a responsibility to accurately report on whether the health service is operating at sustainable levels but also has a fiscal responsibility to the taxpayers and the community more generally. If reliable and accurate indicators are not in place then how can the community or health workers have any confidence that things will actually improve.
The AEAV will be advocating for reliable indicators which accurately reflect the performance of the sector and the impact of service delivery on the workforce. The AEAV will be calling for indicators similar to:
- Percentage of shifts finished on time
- Percentage of delayed meal breaks
- Sick leave/ WorkCover trends
- Number of dropped shifts
- Average overtime hours worked
Indicators such as these would highlight the strain on the system before decreases in response KPI’s and would result in a deeper understanding of issues that will further impact service delivery if not addressed.
For many years now the government has been happy to just look at the sector from afar and has not wanted to understand the impact of the focus on better response KPI’s. They didn’t want to know, and the health services and others were so set on keeping the government happy that they didn’t want to be the ones to ruin the façade.
The community and the healthcare workers deserve a more resilient health system than what we currently have.
