Qld politics: Ruthless KPIs could make Qld’s worst hospitals even worse

A major overhaul in the way public hospitals are funded has been quietly pushed through by the state government, with the move branded a “blunt instrument”.

Health Minister Tim Nicholls this week. Picture: Liam Kidston

• Editor’s view: Model worth a try
• ‘All talk’: Psych’s savage spray

Public hospitals that consistently have patients ramped for more than 2.5 hours are at risk of losing crucial government funding under strict new performance targets.

A major overhaul in the way public hospitals are funded has been quietly pushed through by the state government — moving from funds based on how many people are treated, to how well they do as they move through the system.

The changes — active as of July 1 — are part of the 2025-26 service level agreements for hospital services which outline strict hospital spending positions.

Agreements are negotiated and signed by each Hospital and Health Service (HHS), following consultation with chief executives and Department of Health Divisions.

The move to place KPIs on ambulance ramping and emergency departments has been branded a “blunt instrument” by a health services expert, while the peak medical body has warned the government needed to clearly communicate with clinicians.

Any hospital wanting to move funds from one area to another within their system must seek permission from the director-general — but must also meet all “key performance indicators”.

THE NEW FUNDING MODEL COULD BE WORTH A TRY, WE WRITE IN TODAY’S EDITORIAL – READ IT NOW

This includes ensuring patients aren’t ramped when they arrive by ambulance for more than 2.5 hours, moving emergency department patients into wards within 24 hours and clearing elective surgery waitlists.

There are also incentives, where hospitals can get extra funding for meeting the government’s priorities, like child health checks and reducing preventable admissions.

Health Minister Tim Nicholls, whose office declined to comment, earlier this week launched a full-throated defence of KPIs in emergency departments.

Griffith University health services management expert Professor Reece Hinchcliff said tighter KPIs and penalties for emergency departments breaching the 24-hour transfer rule was a naive approach.

“It’s an approach that a business owner or a finance accounting would take, it’s a blunt instrument,” he said.

Ambulances ramped at Royal Brisbane and Women’s Hospital

“It’s good for the optics because it looks like we’re attempting to fix an issue, but we need large scale health reform.”

Mr Hinchcliff said the concept of tying funding to patient outcomes was sensible only if under pressure hospitals were provided support.

AMA Queensland President Dr Nick Yim warned that clear communications with clinicians was essential to ensure they didn’t feel pressured to meet KPIs at the expense of patient needs.

Hospital and Health Services will now also be subject to broader performance measures that are harder to control like birthing healthy weight babies and achieving a “sustained reduction in suicide counts and rates of First Nations people”.

All jurisdictions, including Queensland, has consistently recorded an increase in the First Nations suicide rate since it became a Closing the Gap measure in 2018.

Every HHS will now face quarterly performance reviews to assess if they’re meeting their KPIs.

Underperformance could result in the hospital slapped with a “not performing” tag, with director-general David Rosengren then given final say on downgrades and funding adjustments.

The Queensland Health Performance and Accountability Framework described the new model as a “shift towards a health system that incentivises patient outcomes over activity.”

A Queensland Health spokeswoman said the move would help the state create a more “sustainable and high-performing health system”.

“The purpose of the Queensland Health Performance and Accountability Framework introduced in 2011, is to outline how Queensland Health oversees service performance,” she said.

“By taking an outcome focused approach to healthcare ensures services are measured by their real-world impact on people’s lives.

“This includes patient experience, clinical effectiveness and long-term health improvements.”

Originally published as Qld politics: Ruthless KPIs could make Qld’s worst hospitals even worse