Stichting Regionale Instelling voor Beschermde Woonvormen in Zaanstreek, Waterland en West-Friesland

Transcription

1 Benchmark report: Stichting Regionale Instelling voor Beschermde Woonvormen in Zaanstreek, Waterland en West-Friesland 1

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3 1. General information General information Name Town/City Number of locations Number of organisational units Number of members of Board of Directors Number of members of Supervisory Board Stichting Regionale Instelling voor Beschermde Woonvormen in Zaanstreek, Waterland en West-Friesland Purmerend

4 Information for mental health care institutions Number of clients at the institution on January 1st Number of new clients in the reporting year Total number of clients in the reporting year Number of leaving clients in the reporting year Number of clients at the institution on December 31st Clients with a care intensity package (ZZP) Number of available beds/places with residential care Beds in a small scale setting Number of DRG's (DBC's) started in reporting year Number of DRG's (DBC's) closed in reporting year Number of emergency care contacts Number of days of residential care, incuding small scale settings Number of days of residential care with a care intensity package, incuding small scale settings Number of days of residential care with a care intensity package in a small scale setting Number of half-day sessions of daytime activities Number of patient-bound, mental care related permanent employees Number of FTEs of patient-bound, mental care related permanent staff Number of non-patient-bound, mental care related permanent employees Number of FTEs of non-patient-bound, mental care related permanent staff Number of mental care related permanent employees Number of FTEs of mental care related permanent staff , , , , , ,553 10,607 9,238 15,

5 Income information Aggregate operating income 18,469,574 Operating income from mental health care Statutory budget for care under the ZVW 20,037,780 21,650,302 Statutory budget for care under the AWBZ 18,006,583 60,202 Statutory budget for care under the AWBZ/ZVW 92, ,714 Statutory budget for care under the PGB 59,849 84,189 Municipal budget for care Other operating income Other non-sector income 5

6 2. Key financial figures benchmark The table below shows the values for some commonly used key financial figures. Annex 1 contains an overview of the meaning and interpretation of each figure. The table also shows the relative scores vis-à-vis all institutions that provide mental healthcare ( Z scores). The average score for the sector has been set at 0, so a positive value means the institution scores above average for the aspect concerned, and a negative value means it scores below average. The values do not indicate actual performance, only whether an institution performs above or below par. A Z score of -2 means the institution scores two standard deviations below the average value. The colour scale slides from dark pink (<-3) to dark yellow (>3). A strong yellow score for increase in turnover for example indicates the institution has shown strong growth compared to the average. Key financial figures value z-score value z score value z score Increase in turnover 4.3% % % 0.2 Operating income 4.5% % % 1.0 Solvency 66.0% % % 1.8 Buffer capital 33.5% % % 1.5 Capital intensity Liquidity 407.4% % % 2.3 Return on Assets 7.5% % % 0.7 Return on Equity 13.5% % % 0.1 EBITDA 5.1% % % 0.3 DSCR DSCR Budget per client 16, , , Number of FTEs per client Absenteeism 5.4% % % -1.2 Average wage (corrected) 52, , , Rate of labour costs for hired staff 5.0% % % -0.3 Part-time ratio

7 3. Spending categories The table and graph below show the spending of the institution per category. Institutions are free to divide the budget between the different spending categories, in part depending on the type of patients. No appraisal can be made on the relative values, as a high value on one category is not necessarily better than a low value. Again, the Z-scores represent the deviations from the average. Spending categories value z-score value z score value z score Labour costs 42.4% % % -0.8 Social security premiums 14.5% % % 0.2 Percentage of hired staff 3.0% % % -0.4 Food costs 7.3% % % 2.1 General costs 9.8% % % 0.6 Client-related costs 1.4% % % -0.3 Accommodation costs 10.7% % % 0.7 Depreciation costs 5.8% % % -0.5 Build-up of capital reserves 1.3% % % -0.9 Gross revenu 3.8% % % 0.6 7

8 Budget spending % 0% 6% 1% 10% 40% Labour costs Social security premiums Percentage of hired staff Food costs General costs 15% Client-related costs Accommodation costs Depreciation costs Build-up of capital reserves 9% Gross revenu 1% 16% 8

9 4. Quality The benchmark for quality is based on the score for the quality indicators at the level of the institution. This is not the same as the quality of care, which is much harder to measure. See Annex 2 for an explanation of the method used. Also in this respect, the average quality score has been set at 0, so a positive value means the institution scores above average for the quality indicator concerned. In addition to overall quality, a distinction is made between the regular process and outcome indicators ( ZI measurements), the process and outcome indicators for psychoforensic care ( FP measurements) and the quality experienced by clients ( CQ measurements). It is quite possible an institution has a 0 score or no score for quality in a certain year (see Annex 2). Institution: quality Quality Number of indicators Client experienced quality Number of indicators Care related quality Number of indicators Forensic psychology quality Number of indicators z-score z score z score The tables below give a breakdown for each indicator for 2013, including the Z scores. In the CQ Index, a higher Z score indicates a relatively higher level of satisfaction. In the ZI measurements, a higher Z score for most indicators indicates a lower value. The set of indicators can differ from one year to another, complicating direct comparison of single indicators over the years. Again, Z-scores only measure relative performance, so low scores on indicators not necessarily translate to low quality. 9

10 Institution: quality indicators 2013 (CQ set) Adequate attitude towards the client Adequate information provision by caregiver Personal contact The way clients experience the living environment within a clinical setting or RIBW-setting The way clients feel about the change in severity of care-related problems Care continuity Drop-out: drug-related disorders Drop-out: anxiety disorders Drop-out: delirium, dementia, amnetia and other cognitive disorders Drop-out: other, specifically: Drop-out: personality disorders Drop-out: schizofrenia and other psychotic disorders Drop-out: mood disorders Drop-out: childhood related disorders Evaluation of care plans Sense of safety during treatment or stay Information on complications Provision of information Informed consent 1 Informed consent 2 Freedom of choice 1 Freedom of choice 2 Changes in health and disabilties Fulfilment of care related wishes Fulfilment of care related wishes: experiences with treatment/councelling process Residential and living circumstances value mean z-score

11 Institution: quality indicators 2013: core set (1) Systematic measurement: daily client functioning- Children and adolescents Systematic measurement: daily client functioning- Elderly Gerontopsychiatry Systematic measurement: daily client functioning- Addiction long term care Systematic measurement: daily client functioning- Addiction curative care Systematic measurement: daily client functioning- Adults short-term Systematic measurement: daily client functioning- Adults long-term Systematic measurement: experienced quality of life- Children and adolescents Systematic measurement: experienced quality of life- Addiction long term care Systematic measurement: experienced quality of life- Addiction curative care Systematic measurement: experienced quality of life- Adults short-term Systematic measurement: experienced quality of life- Adults long-term Systematic measurement: changes in severity of care related problems- Elderly Gerontopsychiatry Systematic measurement: changes in severity of care related problems- Addiction long term care Systematic measurement: changes in severity of care related problems- Addiction curative care Systematic measurement: changes in severity of care related problems- Adults short-term Systematic measurement: changes in severity of care related problems- Adults long-term Changes in severity of care related problems (delta t score)- Children and adolescents Changes in severity of care related problems (delta t score)- Children and adolescents Changes in severity of care related problems (delta t score)- Elderly Gerontopsychiatry Changes in severity of care related problems (delta t score)- Addiction long term care Changes in severity of care related problems (delta t score)- Addiction long term care Changes in severity of care related problems (delta t score)- Addiction curative care Changes in severity of care related problems (delta t score)- Addiction curative care Changes in severity of care related problems (delta t score)- Adults short-term Changes in severity of care related problems (delta t score)- Adults short-term Changes in severity of care related problems (delta t score)- Adults long-term value mean z-score

12 Institution: quality indicators 2013: core set (2) Changes in experienced quality of life (delta t score)- Children and adolescents Changes in experienced quality of life (delta t score)- Children and adolescents Changes in experienced quality of life (delta t score)- Addiction long term care Changes in experienced quality of life (delta t score)- Addiction curative care Changes in experienced quality of life (delta t score)- Adults short-term Changes in experienced quality of life (delta t score)-adults short-term Changes in experienced quality of life (delta t score)-adults long-term Changes in experienced quality of life (delta t score)-adults long-term Changes in daily functioning of clients- Children and adolescents Changes in daily functioning of clients- Children and adolescents Changes in daily functioning of clients- Elderly Gerontopsychiatry Changes in daily functioning of clients- Elderly Gerontopsychiatry Changes in daily functioning of clients- Addiction long term care Changes in daily functioning of clients- Addiction long term care Changes in daily functioning of clients- Addiction curative care Changes in daily functioning of clients- Adults short-term Changes in daily functioning of clients- Adults short-term Changes in daily functioning of clients- Adults long-term Changes in daily functioning of clients- Adults long-term value mean z-score Institution: quality indicators 2013: FP set Reduction in crime ratio Drop out Systematic measurement of severity of care related problems of clients Systematic measurement of change of crime risk of clients value mean z-score

13 Annex 1: Key financial figures description - Increase in turnover indicates the degree turnover has increased compared to the previous year. - Operating income indicates the percentage of receipts not used for expenditures. It may be considered an institution's profit and may be used in the future. Due to the not-for-profit nature of the institutions, operating income supplements an institution's equity position. - Solvency is the part of an institution's total assets that is its equity capital. A healthy institution will have a 15-20% solvency rate. - Buffer capital indicates the extent an institution can accommodate losses with its own equity capital, usually 15%. - Capital intensity indicates the capital required to generate 1 euro in earnings. The average ratio for the sector is approx Liquidity measures whether the institution has sufficient disposable equity to meet its current liabilities. A liquidity rate of 150% is generally recommended. If the liquidity rate is too high, money is left in the bank unused. - EBITDA is an institution's earnings before interests, taxes, depreciation and amortisation. This indicator might be less useful for the sector concerned (especially intramural mental health care) as it is strongly dependent on whether an institution owns or rents its buildings. As rent is considered regular expenditure and depreciation of real estate is not, an institution renting its buildings has a much lower EBITDA. Apart from that, depreciation of assets outside of real estate is usually quite small, and care institutions generally do not pay taxes. - Debt Service Coverage Ratio (DSCR) can be measured in two ways: in the narrow sense (DSCR1: [operating income + interest income] / interest expenditure) and in the broad sense (DSCR2: EBITDA / interest expenditure). DSCR measures the extent to which an institution's earnings suffice to meet its financial liabilities. If the DSCR is smaller than 1, an institution cannot meet its financial liabilities, and if it exceeds 1, the institution can theoretically take out new loans. The figure for DSCR shows a large variation and may differ greatly from year to year. - Fixed assets ratio indicates the relation between fixed assets and turnover. Institutions owning a large share of fixed assets such as real estate compared to their turnover are potentially less flexible in their strategy. - Rent ratio indicates what proportion of capital expenses consists of rent. A large value indicates the institution rents a large part of its buildings, for example from housing corporations. As this often concerns long-term lease contracts, it decreases an institution's flexibility. - Budget per client indicates the average budget available for each client. This figure reflects an institution's possibilities to provide care, and is closely interrelated with an institution's average level of care intensity. - Number of FTEs per client is the average number of full time staff per client, and strongly depends on the balance between intramural and extramural clients. As extramural clients require significantly less contact hours, the number of FTEs per client for extramural institutions is much lower than for intramural institutions. 13

14 - Absenteeism might be a related to quality, as a high rate of absenteeism is usually indicative of lower quality. The average rate of absenteeism is around 5%. - Average wage is calculated by dividing the total labour costs by the total number of full time equivalent jobs: the lower the average wage, the more FTEs are available for each client for the same share of labour costs. The average wage is corrected for any other activities an institution might engage in, so the corrected average wage will better reflect the mental health care related wage. - Ideally, the Rate of labour costs for hired staff should be kept low. Hired staff is more expensive than permanent staff, as VAT is charged on hired services. A high percentage of hired staff might be indicative of lower quality. - Part-time ratio is the number of FTEs divided by the number of employees. If the figure is low, many employees work on a part-time contract. - Expenditure for 2012 is subdivided into a number of categories. Labour costs are usually by far the greatest item of expenditure. On average, an institution will spend 50% on Labour costs, 15% on social security premiums and other costs, 15% on subsistence costs ( Food costs ; General costs ; Client-related costs ), 15% on Accommodation costs, and 5% on General operational costs. - General operational costs include interest on loans as well as any allocations to be made. Interest received, extraordinary receipts or allocations released are not added to general operational costs. Therefore, the general operational income may differ from the (total) operating income. 14

15 Annex 2: Description and explanation of aggregation method for quality Description of variables The quality is measured using a publicly available set of indicators. The set of indicators has been adjusted each year by the responsible agencies. In 2011 the set consisted of 93 indicators, while in indicators were measured, and 74 in For the aggregated quality indicator the full set for each year is used. Three different types of indicators are measured: core quality indicators, forensic psychology indicators and consumer quality indicators, measured on the level of an organizational unit. For each institution an average score per indicator is calculated. The within-variation for each indicator at the concern level can be substantial, but is disregarded for the aggregate benchmark score. The variation between institutions is used to calculate benchmark scores. The method used here measures the extent to which institutions score above or below average. An institution with an average score is assigned the value 0. An institution that scores above average has a positive value, and an institution that scores below average has a negative one. The level of the score depends on how much better (or worse) the institution scores compared to the population. The values are then transformed from a quality score to a benchmark score. Hence, the benchmark score does not say anything about the level of quality at the institution, but only says something about the position of the institution compared to the other institutions. The benchmark scores do not provide an absolute measure of quality, but a relative measure. If overall quality is good, a negative benchmark score not necessarily reflects poor quality. The benchmark score is the Z score (standard normal score) and is calculated as follows: Whereby i indicates the quality variable per institution, is the average of the population i, and is the standard deviation. This formula results in an average value of 0 for each variable and a standard deviation of 1 ( Z value). This formula has been used for each quality indicator for each institution. These benchmark scores have the same scale, so they may be accumulated or averaged. Hence, the average benchmark score indicates the average score on all quality indicator compared to the other institutions. In addition to a single aggregate quality variable, three variables are created for each type of indicator. The quality indicators that were surveyed are clustered into an aggregate CQ variable. The quality indicators that were measured for the core quality set are clustered into an aggregate core quality variable and the indicators measured for the forensic psychology are clustered into an aggregate FP variable. The aggregate quality indicator is a weighted average of the three sub-indicators. Questions about methodology can be directed towards niek.stadhouders@radboudumc.nl. 15

16 5. Disclaimer This report was compiled by Celsus, academy for sustainable healthcare, (which is part of the Radboud University Nijmegen Medical Centre) and commissioned by the Ministry of Health, Welfare and Sport in the context of the Caretool developed by TNO. The report was produced on the basis of publicly available data. No rights may be derived from this report. Celsus is not responsible for the way the report is interpreted, nor for any consequences for the parties involved. The report has been compiled using data from 2011 through 2013, which may be out-of-date. The key figures show only a part of the entire picture, and must be interpreted in combination with additional information supplied by the institution concerned. Rather than drawing conclusions on the basis of key figures alone, the figures may serve as a basis for engaging in a dialogue with an institution. 16