Tasmanian Health Service Performance Framework

Contents

Contents2

Executive Summary3

1Overview4

1.1 Context4

1.2 Purpose of the Performance Framework5

2Performance Requirements under the Act7

2.1 Performance Requirements7

2.2 Unsatisfactory Performance7

3Performance Monitoring Mechanisms9

3.1 Service Agreement9

3.2 Corporate Plan10

3.3 THS Governing Council/THS Functions and Powers10

4Performance Interventions under the Act13

4.1 Under Review13

4.2 Level 1 - Performance Improvement Plan (PIP)13

4.3 Level 2 - Appointment of a Ministerial Representative or a PIT15

4.4 Level 3 - Dissolve the Governing Council, Appoint an Administrator and/or Appoint a New Governing Council17

5Performance Interventions Process for Implementation20

Appendix24

Executive Summary

Under the Tasmanian Health Organisations Act 2011 (the Act) the Tasmanian Health Service (THS) Governing Council is accountable to the Minister for Health and the Treasurer for the performance of its powers and functions. This includes ensuring that the THS performs its functions and exercises its powers in a satisfactory manner and also includes the monitoring of the THS performance against performance measures set out in the THS service agreement.

The Department of Health and Human Services is responsible to the Minister in relation to the Acts administration, and the Minister has delegated a number of performance related functions and powers to the Secretary, Department of Health and Human Services (DHHS) in this context.

This is consistent with the National Health Reform Agreement which recognises the states and territories as system managers of the public hospital system, which includes system-wide public hospital performance. The relationship between the Minister for Health, the Secretary (as the Ministers delegate), the Department, and the THS Governing Council is articulated in the DHHS as System Manager,[footnoteRef:1]document. [1: http://www.dhhs.tas.gov.au/intranet/system/quality/The_DHHS_as_System_Manager_final_endorsed.pdf (only accessible to DHHS/THS staff)]

This Performance Framework (the Framework) provides a single, overarching administrative process through which the THS performance may be monitored. It should be noted that, whilst applying more broadly than section 45 of the Act, this Framework has been developed to meet the requirements of s45 (1)(e). The aim of the Framework is to describe the relevant provisions of the Act as well as outlining how they will be practically implemented. As such, in addition to referencing the relevant provisions and accountabilities of the Act, the Framework details administrative processes that serve to operationalise them. This is particularly the case where the relationship between the Department and the THS CEO, in discussion and review of performance issues and performance interventions, is articulated.

For example, a new under review phase of the performance escalation process is included in the Framework. Once a performance issue has been identified, officers of the Department will commence discussions with the THS to confirm the issue and may require the THS to provide formal advice on the reasons leading to the issue and the actions to be put in place by the THS to remediate it. During this phase, if the view is formed that the THS is unable to remediate the issue, a performance escalation may be recommended.

Whilst its primary focus is on the early identification and remediation of performance issues, equally, strong performance will be highlighted and acknowledged. The Minister and the Secretary are committed to working with the THS Governing Council and the THS to drive high levels of performance whilst at the same time ensuring that performance issues are identified and acted upon in a timely manner.

The Framework expands on the previous 2015-16 Service Agreement Performance Framework. In addition to performance against the requirements of the service agreement, the Frameworks scope now includes:

Performance against the corporate plan (to ensure the requirements of the corporate plan are being met), and

Performance by the Governing Council of its functions to ensure that it performs its functions and exercises its powers in a satisfactory manner.

In addition to the under review phase, three levels of performance escalation are described and high level guidance on the implementation of the performance interventions applicable at each level of escalation, and the requirements for de-escalation, are also provided.

Appendix

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1Overview

The THS Governing Council is accountable to the Minister for Health and the Treasurer for ensuring that the THS provides effective and safe health care and performs its functions, and exercises its powers, in a satisfactory manner.

The Department assists the Governing Council in its obligations to the Minister by providing strategic leadership and direction and through the establishment of a governance framework of processes, procedures and controls. This is consistent with the Departments role as system manager.

In order for the Department to meet its obligations as system manager and Ministerial delegate, it is crucial that performance issues are identified and that the Department can take appropriate action and provide direction to ensure that the THS Governing Council can meet its performance obligations.

1.1 Context

The object of the Act is to assist in the establishment of a public sector health system that delivers safe, high quality health services and health support services so as to improve, promote, protect and maintain the health of Tasmanians (s 3(1)).

This object is achieved through the establishment of Tasmanian Health Organisations for the provision and coordination of health services and health support services (s 3(2)(a)).

In Tasmania there is one Tasmanian Health Organisation the Tasmanian Health Service (THS). As such, for the purposes of this document where the Act is referenced, THS will be used rather than THO.

The THS primary purpose is to promote and maintain the health of Tasmanians and to provide care and treatment to, and ease the suffering of, people with health problems (s 10).

The THSs functions include:

To improve, promote, protect and maintain the health of Tasmanians

To provide effective and safe care

To conduct and manage public hospitals, health institutions, health services, and health support services that are under the THS control

To provide training and education and to undertake research and development that is relevant to the provision of health services and health support services

To manage the organisations budget and its other funds to ensure the efficient and economic operation of public hospitals, health institutions, health services and health support services, and delivery of health services, and health support services that are under the THS control, and the efficient and economic use of its resources (s 11).

The Act provides that the Governing Council of the THS is responsible to the Minister for Health and the Treasurer for the performance of functions and the exercise of powers under the Act (s 14).

The Governing Councils functions include:

To ensure that the THS:

Delivers the services that it has agreed, under the THS service agreement, to provide, and

Delivers those services in accordance with the performance standards set out in the service agreement,

Delivers those services in accordance with the budget set out in the THS annual business plan, and

Delivers those services in accordance with the THS corporate plan, and

To monitor the THS performance against the performance measures set out in the service agreement, and

To ensure that the objectives specified in the THS ministerial charter and corporate plan are achieved (s 22).

The THS must act in accordance with its corporate plan (s 48) and business plan (s 51); and the THS may be considered to be performing unsatisfactorily if the Minister is of the opinion that the THS has failed to meet the requirements of its service agreement or corporate plan, or if the organisation, or the Governing Council of the organisation, has not been performing its functions, or exercising its powers, in a satisfactory manner (s 59).

The Minister, or the Secretary as delegate, may authorise a person or persons to conduct a review or audit of any aspect of the THS operations or performance (s 58) and may require a governing council to produce a performance improvement plan and appoint a performance improvement team if the THS is performing unsatisfactorily (ss 60 and 67 respectively).

1.2 Purpose of the Performance Framework

The Act establishes the accountability relationship between the responsible Ministers and the THS Governing Council. It also outlines the performance requirements of the Governing Council and identifies the interventions available to the Minister for Health and delegate when a performance issue is identified.

The Framework provides a single, overarching administrative process through which the legislative framework established by the Act is translated into a consistent and transparent approach for the identification, monitoring and management of the THS performance. It provides the THS with certainty regarding responses to identified performance issues, establishes a structure around the legislative performance interventions available and describes processes through which the escalation and de-escalation of identified performance issues occurs.

While all efforts will be made to ensure the Framework is consistently applied, it is not in itself a legislative requirement. The Act provides the responsible Ministers with all required powers in relation to the performance management of the THS: they can at any time act in accordance with those powers, outside of the processes described in the Framework.

The Framework includes the following sections:

1. Performance Requirements under the Act

2. Performance Monitoring Mechanisms

3. Performance Interventions under the Act

4. Performance Interventions Process for Implementation

Diagram 1 on the following page summarises the four sections described above.

Appendix

Diagram 1: System Manager Performance Management Component

2Performance Requirements under the Act2.1 Performance Requirements

Parts 5 and 6 of Act establish the accountability relationship between the responsible Ministers and the THS. These Parts also identify the performance requirements that the THS is expected to meet.

Part 5 of the Act provides for Ministerial Charters, Ministerial Policies and Directions and Service Agreements.

Part 6 of the Act provides for Corporate Plans, Business Plans and Reporting.

Under Part 5 of the Act:

The Minister for Health and the Treasurer must issue a Ministerial Charter for the THS (s 39). The Ministerial Charter is to specify the Ministers broad policy expectations for the THS (s 40). The Governing Council must ensure that the business and affairs of the organisation are conducted in a manner that is consistent with the Charter (s 41).

The Minister for Health may require the THS to implement a policy (s 42) and may give the Governing Council directions in relation to the functions and powers of the THS and its Governing Council (s 43).

The Minister for Health and the THS will enter into a Service Agreement (s 44). The Agreement must include a schedule of services to be provided by the THS and the funding to be provided in respect of those services. The Agreement must also include performance standards, targets and measures and a performance management process for the THS (s 45).

Under Part 6 of the Act:

The THS Governing Council must give the Minister for Health and the Treasurer a Corporate Plan. The Plan must contain actual and estimated information for a minimum six year period, in accordance with Treasurers Instruction THO 04-46-01, and be consistent with the THS Ministerial Charter (s 46). The THS is required to act in accordance with the Corporate Plan, unless the Minister approves otherwise (s 48).

The THS Governing Council is required to produce an annual Business Plan within 30 days of entering into a Service Agreement under section 44 of the Act. The Plan is to set out how the THS intends to meet the requirements of the Service Agreement and a budget specifying how the THS funds are to be expended to meet the requirements of the Agreement during the year (s 50). The THS is required to act in accordance with the Business Plan (s 51).

The Minister for Health, or the Treasurer, may require the THS to provide progress reports (s 52) and specified reports (s 56). An Annual Report is also required (s 53).

2.2 Unsatisfactory Performance

Part 7 of the Act defines unsatisfactory performance and sets out the performance interventions available to the Minister for Health when unsatisfactory performance is identified.

Section 59 of the Act provides that a THS is performing unsatisfactorily if the Minister is of the opinion that:

The THS has failed to meet the requirements of its Service Agreement or its Corporate Plan, or

The THS, or the THS Governing Council, has not been performing its functions, or exercising its powers, in a satisfactory manner.

The Minister may authorise a review or audit of any aspect of the THS operations or performance to identify whether the THS performance is satisfactory, or unsatisfactory within the meaning of section 59 of the Act (s 58).

If the Minister is of the opinion that the THS is performing unsatisfactorily there are a range of actions that can be taken, as follows:

The Minister may require the Governing Council to produce a Performance Improvement Plan (PIP) (s 60).

The Minister may appoint ministerial representatives to the Governing Council (s 63).

The Minister may declare that a Performance Improvement Team (PIT) has been appointed (s 67).

The Minister may dissolve the Governing Council (s 69).

Importantly, most of the actions are designed to provide temporary assistance and/or resources to the Governing Council and/or the THS rather than being punitive. They are designed so that there are graduated interventions that can be applied, rather than the responsible Minister having the sole option of dissolving the Governing Council.

The process for implementation of these performance interventions is outlined in section 4 of this document.

3Performance Monitoring Mechanisms

The routine monitoring of THS performance by the Department is critical in ensuring that the THS is meeting its performance requirements and that the Department is meeting its obligations as system manager. The timely identification of performance issues on an emerging basis is important in ensuring that a sound understanding of the cause and contributing factors can be established and the most appropriate action required to remediate the issue can be implemented.

The monitoring mechanisms in place are briefly outlined below. Importantly, beyond those mechanisms, the Governing Council has an important responsibility to monitor the organisations performance against the performance measures set out in the service agreement.

3.1 Service Agreement

The Act specifies that by 30 June each year, there must be in place a service agreement between the Minister and the Governing Council for the following financial year (s 44).

The service agreement must include:

A schedule of services and the funding to be provided in relation to the provision of those services.

Performance standards, performance targets and performance measures for the THS.

Standards of patient care and service delivery.

Requirements for the THS to report on its performance.

A continuous performance management process (s 45).

The service agreement may include other provisions in respect of a matter relating to the THS functions or powers that the Minister thinks fit (s 45(2)).

The THS Governing Council is required to ensure that the THS delivers the services that it has agreed to deliver under the organisations Service Agreement and to provide those services in accordance with the performance standards set out in the Agreement and in accordance with the budget set out in the Business Plan (s 22). In addition, the THS is required to deliver services in accordance with the performance standards set out in the Service Agreement, within the funding provided, and specifically:

To ensure that appropriate corporate and clinical governance procedures are in place in relation to the organisation (s 22)

To implement policies in respect of the THS operation (s 22)

Meet performance standards and targets for the organisation (Key Performance Indicators (KPIs)) set out in the THS Service Agreement (s 45). KPIs are grouped under the performance domains as outlined below (see Table 1).

Table 1: Service Agreement KPI Performance Domains

Performance Domain

Example

Acceptability

Services are respectful and responsive to user needs, preferences and expectations.

Accessibility

Services are obtained in the most suitable setting in a reasonable time and distance.

Appropriateness

Services are relevant to consumer needs and are based on accepted or evidence-based practice.

Effectiveness

Services are provided based on scientific knowledge to achieve desired outcomes.

Efficiency

Resources are optimally used in achieving desired outcomes.

Safety

Mitigate risks to avoid unintended or harmful results.

The Department monitors performance against the requirements of the Service Agreement on a routine basis. To ensure performance issues are addressed in a timely fashion, discussions with the THS are commenced as soon as a performance issue is identified.

3.2 Corporate Plan

The Act also specifies that the Governing Council of the THS must provide the Minister for Health and the Treasurer a draft of a corporate plan for the THS not later than 90 days before the day on which it is intended that it will take effect. The Corporate Plan must:

Relate to the period and be in the form specified in the Treasurer's Instructions THO 06-46-01.

Contain the information specified in the Treasurers Instruction including any information specified in the Instructions as to the THS objectives, policies and programs.

Be consistent with the organisations Ministerial Charter (s 46).

The THS Governing Council is responsible for ensuring that the THS delivers services in accordance with the Corporate Plan and that the objectives specified in the Corporate Plan are achieved (s 22).

Once approved by the Minister, the Department conducts routine monitoring of the requirements of the plan to ensure the THS is complying with those requirements.

3.3 THS Governing Council/THS Functions and Powers

The functions and powers of the Governing Council are outlined in sections 22 and 23 of the Act. This includes ensuring that the THS performs its functions, and exercises its powers, in a satisfactory manner.

Responsibility for determining whether the THS is performing satisfactorily rests with the Minister under section 58 of the Act.

As the Department that is responsible to the Minister for administration of the Act, the Department undertakes many responsibilities, roles and functions acting for and on behalf of the Minister for Health. The document DHHS as System Manger outlines in detail the various components of this role. In summary, those components are:

Describing and enacting the strategic direction of the Health System

Government relations

The planning and purchasing of services

Performance management of service providers

Regulation of service providers

Monitoring and oversight of the system

System reporting

Continuous improvement in the quality of care

Industrial relations.

There are a range of instruments available to the Department to enable it to identify whether, and provide assurance to the Minister for Health, about, the extent to which the THS is meeting its obligations under the Act. For example, the Quality Governance Framework aims to ensure that structures, systems and processes are in place which provide at least the minimum acceptable level of quality and safety and service delivery whilst focussing on excellence and ongoing improvement.

In addition, there are a range of legislative obligations which the Governing Council of the THS must comply with. These include:

Implementing Ministerial policies and directions issued under sections 42 and 43 of the Act respectively.

Complying with the Ministerial Charter, which sets out the Minister for Health and Treasurers broad policy expectations for the THS.

Producing an annual business plan, describing how the THS intends to meet its service agreement requirements during the financial year and how it will spend its funds. The THS must act in accordance with its business plan (s 50).

In relation to the Framework, while it is not possible to describe one single process that will be applied in determining if the Governing Council or the THS is performing its functions, or exercising its powers, in a satisfactory manner, that determination will be made through application of the broader set of instruments available under the Act. In doing so, where unsatisfactory performance is identified, the processes described in the Framework for the monitoring and management of performance are applicable.

3.4 Performance Review Meetings

THS performance is routinely monitored by the Department through the range of mechanisms outlined above to ensure performance requirements are being met and performance issues can be identified and discussed with the THS on an emerging basis and in a timely fashion.

At a minimum, performance review meetings are held at the end of each quarter to review THS performance over the preceding quarter. Where a performance escalation is in place, more frequent meetings may be required to monitor progress against agreed actions.

Meetings are characterised by:

Interactive two-way discussions between the Department and the THS about performance.

Review of previous agreed action items.

Discussion and analysis of performance issues, THS plans to address such issues and timeframes for improvement.

Flagging of any potential or emerging performance issues.

Identifying risks affecting future performance.

Clear recording and communication of actions and requirements of the THS and the Department.

Performance is reported at a number of levels with high level performance reporting provided to the responsible Ministers at the end of each quarter. A briefing and a quarterly performance report is provided outlining the key issues in relation to THS performance over the preceding quarter and, where necessary, recommended performance interventions. The report is compiled following discussion at quarterly performance review meetings.

Other more focused reports and Ministerial summaries are produced where required for example, if there is an escalation in place or at the Ministers request. These reports go into more detail on specific performance issues and allow for more focused discussion and analysis.

4Performance Interventions under the Act

Part 7 of the Act sets out the performance interventions available to the responsible Ministers when unsatisfactory performance is identified. Those interventions, and guidelines for their implementation, are outlined below.

4.1 Under Review

Once a performance issue has been identified, the Department will commence discussions with the THS to confirm the issue and may request the THS to provide formal advice on the reasons leading to the issue and what actions are or will be put in place by the THS to remediate the issue.

During this phase, if the Department forms the view that the THS is unable to remediate the issue, a performance escalation may be recommended.

The processes involved in this phase will depend on the particular performance issue concerned and will be conducted on a case-by-case basis.

Generally, a performance escalation will only be recommended in circumstances where the THS is unable to demonstrate that:

the performance issue is being actively managed and monitored by the THS, and/or

the THS possesses the necessary skills to achieve sustainable performance improvement in the area of concern.

An issue may be escalated or de-escalated in a non-sequential fashion (see Table 2 in section 5).

Relevant Legislation

Section 58 of the Act enables for a review and audit should this be required.

4.2 Level 1 - Performance Improvement Plan (PIP)Overview

The Secretary, as the Ministers delegate, has the power to request the THS to prepare a PIP if it is deemed that the THS is performing unsatisfactorily. A PIP is generally requested from the THS when the Under Review phase does not result in the adequate resolution of the performance issue.

Relevant Legislation

Sections 60 to 62 of the Act.

Process

The Department will draft a PIP Notice.

The Notice will specify the following:

the requirements of the THS service agreement or the corporate plan that are not being met or the functions or powers of the THS or THS Governing Council that are not being performed or exercised in a satisfactory manner

the requirement for the Governing Council to prepare a PIP

any matters that the Secretary (as the Ministers delegate) requires the PIP to contain (this will vary depending on the performance issue)

reports to be submitted to the Secretary (as the Ministers delegate) in relation to the carrying out of the PIP if the PIP is approved, and the dates by which the reports are to be submitted, and

the date by which the PIP needs to be submitted to the Minister for approval.

The PIP will specify:

The steps that the Governing Council intends to take to ensure that the requirements of the THS Service Agreement or Corporate Plan, or the functions or powers of the THS or Governing Council, that are specified in the Notice are to be met or performed or exercised in a satisfactory manner, and

The date by which the steps are to be implemented, and

The performance measures that are to be set and achieved so that the Secretary (as the Ministers delegate) can determine whether the requirements of the THS Service Agreement or Corporate Plan, or the functions or powers of the THS or Governing Council, that are specified in the Notice are to be met or performed or exercised in a satisfactory manner.

Requirements

The focus of the PIP will depend on the nature of the performance issue. For a financial performance issue, the plan will generally focus on a financial and operational strategy to align expenditure to budget over an agreed timeframe. For non-financial performance issue, the plan will generally outline an agreed strategy and timeline to address a specific issue.

The PIP needs to be very clear on what and how the THS is going to deliver in terms of improved performance. Generally, the THS will be required to undertake an in-depth assessment of the problem and identify options to address the problem as well as a timetable for resolution. As a minimum, PIPs should outline:

the reason(s) for unsatisfactory performance

the remedial action that is or will be put in place to address the specified matters in the Notice, and the dates by which those actions will be implemented, and

clear improvement targets and timeframes for their achievement (established by the THS in consultation with the Department) against which future progress can be monitored.

Assessing the PIP

The Department will assess the PIP and advise the Minister for Health accordingly.

When assessing the PIP, the Department will ensure that all requirements listed in the Notice have been adequately addressed.

The Department will assess whether the plan is realistic, achievable and likely to result in performance improvement. For example:

Are the strategies evidenced and well structured?

Are the timeframes achievable?

Are there any financial implications? How will they be managed?

Are there any service implications? How will they be managed?

How does it comply with evidence based practice/contemporary practice requirements?

Have risks been identified and are there strategies in place to mitigate these risks?

Advice from specialist areas within the Department will be sought when assessing the PIP.

The Secretary may either approve the PIP, or advise the THS that amendments need to be made.

Monitoring the PIP

Once the PIP is approved, the Department will establish a formal monitoring process in accordance with the Notice.

Completion of the PIP

A PIP will be seen as completed when the requirements of the PIP are determined as having been met.

4.3 Level 2 - Appointment of a Ministerial Representative or a PIT4.3.1Appointment of a Ministerial Representative Overview

The option to appoint a Ministerial Representative(s) is most appropriately used where there is an issue relating to how the Governing Council is functioning in managing the THS.

A Ministerial Representative will only be appointed if:

the organisation is performing unsatisfactorily, and

the Minister is of the opinion that the appointment will assist the Governing Council to improve the performance of the organisation.

The Minister must have regard to the following in determining whether to appoint a Ministerial Representative:

the financial performance of the organisation

the safety and quality of the health service and other services provided by or on behalf of the THS

whether the organisation is complying with its service agreement or corporate plan, and

whether the Governing Council has requested the appointment.

Relevant Legislation

Sections 63 to 66 of the Act.

Function

In essence, the Ministerial Representative can act as a mentor to the Governing Council and provide assurance to the Minister that activities are progressing and risks are being effectively managed.

The function of a Ministerial Representative is:

to attend meetings of the Governing Council and observe its decision making processes

to provide advice or information to the Governing Council to help it to understand its obligations under the Act, or any other Act

to advise the Minister and the Secretary on any matters relating to the THS or the Governing Council, and

to assist the Governing Council to meet the requirements of the organisations PIP, if any.

General Points to Consider on Appointing a Ministerial Representative

No more than two Ministerial Representatives can be appointed to a Governing Council.

While the period of appointment is up to 12 months, a person can be re-appointed.

Appointment is to be by instrument in writing. The instrument is to specify the terms and conditions of the appointment and may specify the remuneration, if any, to which the representative is entitled.

A ministerial representative who is a State Service officer or State Service employee is not entitled to remuneration unless the Premier approves it.

Selecting a Ministerial Representative

The selection of an appropriate Ministerial Representative will depend on the nature of the performance issue.

If the person is external to the State Service, consideration will need to be made on matters such as remuneration.

4.3.2Appointment of a PITOverview

The Secretary, as the Ministers delegate, may declare that a PIT has been appointed in respect of the THS if the organisation is performing unsatisfactorily. The declaration is to be by notice in writing to the Governing Council of the THS.

The members of a PIT have the functions and powers of the THS, or of the THS Governing Council, that are specified in the Secretarys notice declaring the PIT established.

The team is likely to consist of specialists in a particular field, for example emergency medicine, elective surgery or finance.

Relevant Legislation

Sections 67 to 68 of the Act.

Scope of Work and Terms of Reference for the PIT

The Department will recommend the scope of work to be completed and terms of reference for the PIT. This will be used for selecting appropriate PIT members.

The functions or powers of the THS, or THS Governing Council, that the PIT is to perform or exercise to ensure that the requirements of the Service Agreement or Corporate Plan that are not being met will be met, or the functions or powers of the THS or THS Governing Council that are not being performed or exercised satisfactorily will be performed or exercised satisfactorily, will be specified in the Ministers notice declaring the PIT established. This may include activities such as developing and implementing a PIP or taking over implementation of an existing PIP. As a minimum the scope of work should include:

the key outcomes that are to be achieved

governance i.e. who will the team will report to? is there a team leader? what is the team structure?

reporting obligations

resourcing requirements, and

the functions/powers of the PIT.

Selecting PIT members

The skills required of PIT members will vary depending on the performance issue that needs to be addressed and the scope of work.

Under the Act, only a State Service Officer or State Service employee can be appointed to the team.

While a person who is not a State Service employee cannot form part of the PIT, they can advise the team.

Notice of PIT

The Department will develop a Notice Declaring the Appointment of a PIT.

The Notice should include:

the requirements of the service agreement or corporate plan that are not being met or the functions or powers of the THS, or of the Governing Council of the THS, that are not being performed or exercised in a satisfactory manner

why the appointment of the PIT is necessary

the period for which the PIT is to be in existence

the functions or powers of the THS, or THS Governing Council, that the PIT is to perform or exercise in order to ensure that the requirements of the THS Service Agreement or Corporate Plan that are not being met will be met, or the functions or powers of the THS or THS Governing Council that are not being performed or exercised satisfactorily will be performed or exercised satisfactorily.

The Notice may also refer to the requirement under section 68(1) for the THS Governing Council to provide a member of the PIT with assistance necessary to enable the PIT to perform its functions, and exercise its powers, under the Act.

Governance and Reporting of the PIT

Formal monitoring of the PIT will be established by the Department to oversee the work and a schedule of meetings set to monitor progress.

4.4 Level 3 - Dissolve the Governing Council, Appoint an Administrator and/or Appoint a New Governing Council

This course of action is considered a last resort option likely only to occur when the organisation is considered unsustainable on a clinical, performance and/or financial basis, and under exceptional circumstances (such as patient safety is at risk).

Overview

There may be circumstances where the Minister is of the opinion that the Governing Council has ceased to perform its responsibilities satisfactorily and no other action will enable the Governing Council to perform its functions, or exercise its powers, in a satisfactory manner.

The Minister may only dissolve the THS Governing Council if the Minister is of the opinion that:

the Governing Council has ceased to be able to perform its responsibilities or functions, or exercise its powers, in a satisfactory manner, and

no other action that the Minister may take under Part 7 of the Act in relation to the THS will enable the Governing Council to perform its functions, or exercise its powers, in a satisfactory manner.

There are three steps involved:

1. Minister dissolves the Governing Council by notice in writing.

2. If required, the Minister may appoint an administrator of the THS (optional).

3. Appointment of a new Governing council.

Relevant Legislation

Sections 69 to 73 of the Act.

Advising Parliament

If the Minister dissolves the Governing Council he or she must lay in front of both Houses of Parliament within 21 sitting days of the dissolution, a document outlining the reasons for the Governing Council being dissolved.

The Department will prepare on the Ministers behalf a document outlining the reason for dissolving the Governing Council.

Interim Arrangements for the THS

Options for how the THS will be managed during the period between when the Governing Council is dissolved and the new council is appointed will be presented to the Minister for consideration, prior to the dissolution.

Once the council has been has been dissolved, and until an administrator is appointed (if this occurs), all the functions and powers of the organisation fall to the Minister.

An assessment should be made as to:

whether an administrator should be appointed (refer to section below), or

if an administrator will not be appointed, what processes/systems will be put in place to support the Minister in taking on the responsibility of the powers and functions of the organisation.

Appointment of an Administrator

It is likely an Administrator will need to be appointed within a short timeframe. Therefore, as much preparatory work should be done in identifying the requirements of an Administrator, selecting potential candidates and being clear on what their role will be. This is so the appointment of an Administrator is not delayed by process.

An administrator is usually someone with extensive senior leadership and management experience within the health systems at the board level.

Requirements of the Administrator

The conditions will be specified in the Administrators Instrument of Appointment and the Administrator will have all the functions and powers of the THS Governing Council.

The role of the Administrator in exercising the functions and powers of the organisation will include matters such as:

restoring the THS to adequate performance

overseeing the THS while a new Governing Council is formed

managing the THS on a day-to-day basis, and

developing actions for the future of the organisation for the Minister such as alternative service provision, to ensure that all patients have access to high-quality, sustainable services.

Other considerations may include the Administrators requirements for support.

The Administrator will be accountable to the Minister.

End of the Administrator Appointment

An Administrator is appointed for a finite period. In advance of the conclusion of their terms of appointment, consideration will be needed as to who will exercise the powers/functions of the organisation either:

by the appointment of the new Governing Council, or

the Minister (if a new Governing Council has yet to be formed).

Appointment of a New Governing Council

Prior to commencing the selection process for new council members, consideration should be given as to whether any changes are required to the selection process or council members terms of appointment in light of the dissolution of the former Governing Council. The changes to the selection process may be as a result of:

lessons learnt from undertaking a review as to why the Governing Council needed to be dissolved, and

Recommendations from the Administrator.

Responsibility for appointment of a new Governing Council sits with the responsible Ministers.

5Performance Interventions Process for Implementation

This section translates the legislative performance interventions available to the responsible Ministers into a single, overarching administrative process through which the monitoring and management of identified performance issues occurs.

The performance intervention process includes an initial under review phase and three subsequent levels of escalation. Generally, a level 1, 2 or 3 escalation will only be considered when the Department forms the view that an identified performance issue is not being remediated satisfactorily by the THS during the under review phase. Where that occurs, the Department will undertake a formal risk assessment process (see below) to determine the most appropriate level of escalation in the prevailing circumstances.

Table 2 outlines the Departments responses at the under review phase and the three subsequent levels of escalation. It provides the requirements for de-escalation and the reference to the performance interventions available to the responsible Ministers under the Act.

Table 2: Performance Escalation Table

Level of Response

Response

THO Act reference

Authority (or delegated authority)

Under Review

Once a performance issue has been identified, the Department will commence discussions with the THS to confirm the issue and may request the THS to provide formal advice on the reasons leading to the issue and what actions are or will be put in place by the THS to remediate the issue.

During this phase, if the Department forms the view that the THS is unable to remediate the issue, a performance escalation may be recommended.

The processes involved in this phase will depend on the particular performance issue concerned and will be conducted on a case-by-case basis.

Section 58

Secretary

Level of Response

Response

THO Act reference

Authority (or delegated authority)

Level 1

Request a PIP (PIP)

The Secretary formally requests the Governing Council to:

provide a PIP for approval

comply with the requirements of the PIP, and

meet with the Department to formally monitor the PIP.

The Department will prepare an Escalation Notice for the THS.

De-escalation will occur when the requirements of the PIP are met.

Sections 60-62

Secretary

Level 2

Appoint a Performance Improvement Team OR

Appoint a Ministerial Representative to the Governing Council

The Secretary will:

formally notify the Governing Council that a Performance Improvement Team is to be appointed in respect of the THS. The THS will provide all reasonable assistance to the Performance Improvement Team, OR

recommend that the Minister give notice to the Governing Council of the appointment of a representative to the Governing Council. The instrument of appointment of the Ministerial Representative will specify the terms and conditions of the appointment.

De-escalation will occur when the period for which the Performance Improvement Team was formed expires

OR

The terms and conditions of the ministerial representatives appointment have been met.

Sections 63-68

Secretary (PIT), Minister (Appointment of a Ministerial Representative to the Governing Council)

Level 3

Dissolve the Governing Council

The Minister will dissolve the Governing Council if they are of the view that the THS or the Governing Council are not performing its functions or exercising its powers in a satisfactory manner and a level 1 or 2 escalation is not sufficient to enable the THS or the Governing Council to rectify the situation.

The Secretary may recommend that the Minister appoint an administrator who has the functions and powers of the Governing Council.

A new Governing Council may then be appointed.

De-escalation will occur when the period and conditions specified in the administrators instrument of appointment are complete.

Sections 69-73

Minister

Risk Assessment

When the Department forms the view that an identified performance issue is not being remediated satisfactorily by the THS during the under review phase, a formal risk assessment process will be undertaken as a guide to determine the most appropriate level of escalation in the prevailing circumstances.

The process will include an assessment of the consequence of a performance issue not being remediated and the likelihood of that consequence occurring. The relationship between consequence and likelihood, and the resultant risk rating, is demonstrated in Table 3 below.

Table 3: Risk Matrix

Likelihood

Consequence

Negligible

Minor

Moderate

Major

Extreme

Almost certain

Level 1

Level 2

Level 2

Level 3

Level 3

Likely

Level 1

Level 2

Level 2

Level 2

Level 3

Possible

Level 1

Level 2

Level 2

Level 2

Unlikely

Level 1

Level 1

Level 2

Level 2

Rare

Level 1

Level 1

The risk matrix is a guide only and the Department will ultimately at its discretion determine the most appropriate level of performance escalation.

The risk consequence and likelihood tables are provided in the Appendix.

AppendixRisk Assessment - Likelihood Table

Likelihood Rating

Scale

Almost certain

Is expected to occur in most circumstances

Likely

Will probably occur in most circumstances

Possible

Aware of instances that have occurred at some time

Unlikely

Could occur at some time

Rare

May occur only in exceptional circumstances

Risk Assessment Consequence Table

Consequence Gravity

Negligible

Minor

Moderate

Major

Extreme

Consequence Category

Acceptability Health Services are responsive and Respectful to user needs, preferences and expectations.

Isolated failure in patient satisfaction with incidental impact

Isolated failure in patient satisfaction which is simply resolved.

Failure in patient satisfaction which requires moderate input to rectify.

Patient dissatisfaction resulting in disciplinary action or process reengineering. Includes damage to the reputation of service provider.

Significant / Systemic patient dissatisfaction requiring a high level of disciplinary action or significant process reengineering. Includes damage to the reputation of service provider.

Accessibility Health services are obtained in the most suitable setting in a reasonable time and distance.

Delay in treatment with no discernible patient impact.

Delay in treatment resulting in minor patient inconvenience.

Delay in treatment resulting in patient impact requiring remedial care.

Delays in treatment resulting in significant patient impact requiring remedial inpatient care.

Individual or systemic delays in treatment resulting in catastrophic patient harm.

Appropriateness Health Services are relevant to user needs and are based on accepted or evidence based practice.

Failure to support strategic purchasing directions of the purchaser with little to no impact on patient safety or outcomes.

Failure to support strategic purchasing directions of the purchaser with some isolated impact on patient safety or outcomes.

Failure to support strategic purchasing directions or ceiling delineation roles of the purchaser with impact on patient safety, outcomes or access to care.

Failure to support strategic purchasing directions or exceeding ceiling delineation roles of the purchaser with major impact on patient safety, outcomes or access to care.

Systemic failure to support strategic purchasing directions or exceeding ceiling delineation roles of the purchaser with catastrophic impact on patient safety, outcomes or access to care.

Effectiveness Health Services are provided based on scientific knowledge to achieve desired outcomes.

Minor policy breaches or insignificant negative outcomes for Tasmanians.

Failure to deliver on key health policy or results in negative health outcomes with minor negative impacts on the health of Tasmanians.

Failure to deliver on key health policy or results in negative health outcomes with discernible negative impacts on the health of Tasmanians.

Failure to deliver on key health policy or results in negative health outcomes with significant negative impacts on the health of Tasmanians.

Systemic failure to deliver on key health policy or results in negative health outcomes with catastrophic negative impacts on the health of Tasmanians.

Efficiency Resources are optimally used in achieving desired outcomes.

10% over service agreement funding allocation

Safety Mitigate risks avoiding unintended or harmful results.

Small safety breaches that are easily remedied internally by the provider.

Safety breaches that have little impact on patients and are easily remedied.

Breach(es) of patient safety that have a minor impact on patient wellbeing.

Significant patient safety failure resulting in considerable patient harm or leading to significant and ongoing (shorter-term) adverse media coverage/ damage.

Systemic failures leading to one or more sentinel events resulting in significant patient harm or an event leading to significant and sustained (longer-term) adverse media coverage/ damage