System Level Measures Annual Plan Guidance for 2017/18 – released 1 May 2017
Context: This Guidance supplements previous Guidance. It describes the two additional System Level
Measures (SLMs) to be implemented from 1 July 2017 as developmental SLMs. These are:


Proportion of babies who live in a smoke-free household at six weeks post natal and
Youth access to and utilisation of youth appropriate health services.
The Ministry is aware that there are currently quality and integrity issues with the data associated with both
SLMs hence why the SLMs are developmental for 2017/18. Placing a spot-light on particular data sets has
resulted in data quality improvement in the past. This is anticipated to occur for these data sets as well.
Alliances are encouraged to work with the relevant health providers in their district to identify pragmatic
approaches which will improve the robustness and accuracy of their data collection processes.
As developmental SLMs, the Ministry seeks feedback from alliances as they work with the definitions and the
data sets throughout the year. This will inform confirmation of definition(s) and data sets. Feedback can be
provided either through the Measures Library or through the DHB quarterly reporting.
Individual SLM definitions (including rationale, eligible population, numerator/denominator, data sources,
data extraction sources, measure calculation process, measure development notes and suggested
contributory measures) are available on the Measures Library along with the other SLMs.
There are no financial incentives assigned for these developmental SLMs.
System Level Measure: Proportion of babies who live in a smoke-free household at six weeks post natal
Outcome: A healthy start
Why is this measure important?
This measure is important because it aims to reduce the rate of infant exposure to cigarette smoke by
focussing attention beyond maternal smoking to the home and family/whānau environment. Maternal
smoking is associated with a range of poor neonatal and child health outcomes such as SUDI (Sudden
Unexpected Death in Infancy) and low birth weight. Evidence also suggests that children are more likely to
become smokers if they grow up in a smoking household.
This measure will drive integration between primary care, Lead Maternity Carers (LMCs) and Well Child
Tamariki Ora (WCTO) providers. The timing of the collection of this information, six weeks post-natal, aligns
with the handover of mother and baby from the LMC back to general practice and entry into the WCTO
environment. Effective handover also ensures that all family members are enrolled with the appropriate
ongoing service providers (eg mothers who are not enrolled with primary care enrol with a PHO, siblings who
are not receiving WCTO services are enrolled with the WCTO provider).It offers several points where tobacco
cessation activity could be initiated.
How will it be implemented?
As described in previous Guidance, district alliances need to work with the relevant health and wider sector
partners as appropriate to implement this SLM. Initially the focus should be on the relationship between
DHBs, PHOs, LMCs and WCTO providers and then over time, include secondary, health promotion,
community groups (i.e. marae, sports clubs, churches), Quitline and pharmacists to ensure there is a
continuum of support for the mother and whānau when they decide they wish to stop smoking (either prenatal, during pregnancy or post-natal). As with the other SLMs, alliances are expected to place a priority on
reducing equity gaps through their improvement work.
1
System Level Measure: Youth access to and utilisation of youth appropriate health services.
Outcome: Youth are healthy, safe and supported.
Why is this measure important?
Youth have their own specific health needs as they transition from childhood to adulthood. Most youth in
New Zealand successfully transition to adulthood but some do not, mainly due to a complex interplay of
individual, family and community stressors and circumstances, or ‘risk factors’. Evidence shows that youth
are not in the habit of seeking the services or advice of a registered health practitioner when unwell.
Generally they cope with illness with advice from friends and whanau as they see fit. Attending a health clinic
is often viewed as a last resort instead of a reasonable first choice.
This measure focuses on youth accessing primary and preventive health care services. Research shows that
youth whose healthcare needs are unmet can lead to increased risk for poor health as adults and overall poor
life outcomes through disengagement and isolation from society and riskier behaviours in terms of drug and
alcohol abuse and criminal activities.
Early interventions which target younger populations may potentially be an effective strategy for improving
adult health and reducing future healthcare costs.
What is it? The youth System Level Measure consists of five domains reflecting the complexity and breadth
of issues impacting youth health and wellbeing.
How will it be implemented?
Alliances must select a minimum of one domain and use the national indicator for that domain to set an
improvement milestone, and select quality improvement activities and contributory measures appropriate
to this domain. The selected domain should reflect the domain in greatest need of improvement locally.
As described in previous Guidance, district alliances need to work with the relevant health and wider sector
partners as appropriate to implement this SLM. For this SLM this needs to include the local Youth Service
Level Alliance Teams (SLATs) or equivalent in considering their local data and agreeing an improvement
2
milestone, quality improvement activities and contributory measures for the youth SLM. At a minimum,
besides the DHBs and PHOs, the alliances should engage with those that provide youth health services in
their district.
National Level Indicators
There are five national level indicators, each representing one of the five domains for the youth SLM. A table
identifying the national indicators, data sources and potential improvement activities for each domain is
attached as Appendix One.
Contributory Measures
Contributory measures measure specific health care activities or services that can be influenced by frontline
clinical health care services locally and contribute to the achievement of the System Level Measure
improvement milestone. For the Youth SLM, the contributory measures represent a wide range of clinical,
community and population health measures and activities.
Contributory measures for the youth SLM are available on the Measures Library. The Measures list will
continue to be updated and health providers can suggest new contributory measures for inclusion in the
library (as described in previously issued Guidance).
Engaging Young People
Young people should be meaningfully engaged in the implementation of the youth SLM. Advice and resources
on involving children and young people can be found at the links below. Some DHBs already involve young
people significantly in planning of services. An example is Hawkes Bay DHB which has a Youth Health Strategy
that outlines a shared vision along with youth focussed outcomes and indicators. The DHB has formed a
youth consumer council which is a self-governing body supported by the DHB as well as youth services. The
group has developed their terms of reference that have been signed off by the Consumer Council. For more
information about youth engagement in Hawkes Bay, you can contact Nicky Skerman on 06 878 8109 or
[email protected].
Key links



http://www.occ.org.nz/listening2kids/child-centred/
http://www.youthaffairs.govt.nz/working-with-young-people/youth-participation-in-decisionmaking/index.html
http://www.yacvic.org.au/policy-publications/yacvicother-publications-and-resources/48-youthparticipation/437-taking-young-people-seriously-handbooks
2017/18 SLM Improvement Plan requirements
Based on data available, district alliances will agree and include in their 2017/18 SLM Improvement Plan:




an improvement milestone for the SLM that is a number that improves performance (either for total
population, Maori or other population where equity gaps exist) from the district baseline provided
by the Ministry
brief description of activities to be undertaken by primary, secondary and community providers to
achieve the SLM milestone
suite of contributory measures (number to be decided locally) for the SLM and
district alliance stakeholder agreement with the plan (at a minimum any organisation that is required
to undertake action and who’s performance will be measured by the alliance).
3
Quarterly reporting requirements
The Ministry expects the alliances’ quarters one, two and three reports to include:

Whether the alliance is on or off track to achieve its SLM improvement milestones (this is the number
identified for each System Level Measure in the Ministry-approved Improvement Plan). The report
must reflect the alliance's progress (on or off track) and have the agreement of all parties involved,
not just one party such as the PHO or DHB. If the alliance is off track, a mitigation plan must be
included as part of the report. The mitigation plan must include an assessment by the alliance on the
progress made, reasons for being off track and the specific actions the alliance will take in the next
quarter to get back on track.

The quarter reports are due to the Ministry on 20th of the month following the quarter. It should be
reported through the DHB quarterly reporting database via the PP22 System Integration A3 reporting
template as a separate line activity or as a separate word document attached to the PP22 quarterly
reporting data base. A reporting template has been developed and can be found on the Nationwide
Service Framework Library for those who choose to use this format. Questions about reporting can
be emailed to Alison Randall ([email protected]).
Quarter 4 reporting and payments
DHBs, on behalf of their alliances, are required to report performance against the System Level Measure
improvement milestone that was agreed and approved by the Ministry in their Improvement Plan.
If the district alliance(s) has not achieved any improvement milestones in quarter 4 they must submit an
explanation for the non-performance.
If district alliance(s) do not achieve their improvement milestone in quarter 4, the PHO will still be paid if the
explanation submitted with the quarter 4 report satisfies the Ministry that the:





district alliance had an Improvement Plan that was approved by the Ministry
the Improvement Plan was fully implemented
district alliance(s) took all reasonable steps to ensure the milestone was achieved
district alliance(s) reasons given as to why the milestone was not achieved adequately explain the
reasons for non-performance and the actions taken to mitigate the non-performance; and
the milestone was closer to being achieved in quarter 4 than it was on the first day of quarter 1.
The quarter 4 report is due to the Ministry via the DHB quarterly reporting database on the 20 July following
the previous financial year. It should be submitted via the PP22 System Integration A3 reporting template as
a separate line item or as a separate word document attached to the PP22 quarterly reporting data base. A
reporting template will be available on the Nationwide Service Framework Library later in May for those who
wish to use it. Questions about reporting can be emailed to Alison Randall ([email protected]).
4
PHO financial incentives for 2017/18
The following table shows the payment process for the approach to financial incentives in 2017/18.
Size of Payment
Purpose
Paid When
25%
‘Up front’ capacity/capability payment to PHOs
15 July 2017
50%
Capacity/capability payment to PHOs on Ministry
approval of Improvement Plan
15 September 2017
25%
‘At risk’ and paid to PHOs on achievement of
incentivised measures (see below) based on Q4
performance.
15 September 2018
The last 25% ‘at risk’ payment will be used to incentivise the following three SLMs and the two primary care
National Health Targets:
o
o
o
o
o
Acute hospital bed days per capita,
ASH rates for 0-4 year olds,
Patient experience of care;
National Health Target Better help for smokers to quit; and
National Health Target of Increased immunisation for eight-month olds.
The 25% PHO incentive funding is equally weighted across all five incentivised measures.
There is no ‘at risk’ funding attached to the following three SLMs in 2017/18:
o
o
o
Amenable mortality rates
Proportion of babies who live in a smoke-free household at six weeks post natal
Youth access to and utilisation of youth appropriate health services.
5
Appendix One
Domain
Youth Experience of
Health System
Outcome
Young people feel safe and supported
by health services
National Indicator
Child and Adolescent Mental Health
Services – Mārama real-time survey
results (10 – 24 year olds)
Sexual and
Reproductive Health
Young people manage their sexual and
reproductive health safely and receive
youth friendly care
Chlamydia Testing Coverage for 15 –
24 year olds
Mental Health and
Wellbeing
Young people experience less mental
distress and disorder and are
supported in times of need
Young people experience less alcohol
and drug related harm and receive
appropriate support
Self-Harm Hospitalisations and short
stay ED presentations for under 24
year olds
Alcohol-related Emergency
Department (ED) Presentations for 10
– 24 year olds
Alcohol and Other
Drugs
Access to Preventive
Services
Young people receive the services
they need to keep healthy
Adolescent Oral Health Utilisation
(school year 9 to 17 years of age)
Potential Local Quality Improvement Activities
 Improve uptake of survey both by youth
and DHBs
 Improved use of the survey results
 Expand use of survey to other services
young people use
 Could identify specific service gap and
access issues to be addressed in year two
 Improve data quality (labs reporting NHIs)
 Improve locations of clinics to increase
uptake
 Social marketing and education in schools
and community locations (maraes,
churches, sports clubs)


Improve data quality
Develop referral pathways


All EDs recording the data
Improve data quality e.g reduced
percentage of ‘unknowns’
Improve response to weekend referrals
Identify referral pathways
Actively monitor and follow-up adolescent
utilisation of CDA dental services with
providers and families
Compare Community Oral Health Service
data at school year 8 with adolescent
utilisation of Combined Dental Agreement
(CDA) providers at school year 9




6