Acting on intelligence

Informed decision-making and continuous improvement through data and performance agreements

Informed decision-making and continuous improvement in healthcare

02 April 2025

8 min read

In the ever-evolving landscape of health and social care, the HSE Health Regions, along with their Regional Executive Officers (REOs) and Executives, play a pivotal role in ensuring that services are coordinated, delivered, and managed effectively to meet both local needs and national standards.

Our healthcare team outlines below the structural components necessary for these regions to act on intelligence, highlighting the significance of data availability and performance agreements in driving informed decision-making and continuous improvement.

The HSE Health Regions, their REOs and their Executives, are responsible for:

coordinating and delivering health and social care services
managing and organising care for people and communities in their area
ensuring care is of high quality and meets both local needs and national standards

This will be done on a continuously improving, cyclical way.

Two key structural components required for this to happen effectively are:

That data about health and care services, and the populations the serve, are available as intelligence that allows informed decision-making regarding the performance (incl. quality, quantity/access, and costs) and landscape (incl. providers, workforce, estate and equipment) of need and care for which the Health Regions are responsible.
That the mechanisms for acting on those decisions, and improving the performance and/or landscape, are available and are used.

Kelan Daly

Head of Healthcare Consulting

KPMG in Ireland

Performance Agreements

Performance Agreements are a key mechanism for improvement. And can impact improvement in any or all aspects of services internally or externally commissioned: such as safety, quality, quantity (including access), costs, staff factors, or structural change such as incentivising integrated care, data sharing or enabling other policy intentions.

A Performance Agreement may take many forms, but between organisations may take the form of a contract, a service level agreement, or a more informal arrangement.

For example, the HSE and NTPF, when work is outsourced as part of targeting commissioning, use private provider frameworks or surgical services tenders, the continuing use of which was indicated in the National Service Plan 2025.

However, there are some key components of Performance Agreements, which have much wider application than is currently employed in the Irish health and care system.

Key components

These key components include:

The Agreement needs to be written down, clearly, coherently and purposefully. This does not mean that it should be lengthy.

any Agreement needs to be managed, with regular review of its effectiveness in achieving its objectives. The consequences of performance (positive, negative and informative) against the Agreement should be clear and applied, including through the use of:

Performance indicators – of which there are a number of types – should be meaningful, and consistent with e.g. HSE dashboards.
The use of payment mechanisms which incentivise, including for populations, capitation

Integration into the commissioning cycles of the health region – as there is a commissioning cycle nationally and within each Health Region, Performance Agreements need to align with decisions made in those population health management cycles and, through their reporting schedules, feed into the next iteration of decisions about Regional performance and landscape.

Consistency and concordance with the longer-term intention of the Region, the HSE and policy – this may be within individual Agreements, including their duration, or with the use of incremental specifications (and performance indicators)

Compliance with legal and other regulatory requirements (including regarding procurement, data, sharing of information, etc.)

These should be explicit as part of the high level definitions and specification.

Specification at the correct level of granularity to avoid over-specification and/or operational provider management (expect where required), but equally to ensure that it is beyond doubt what is to be provided. This includes:

outcomes
key inputs (e.g. regarding qualifications of practitioners)
key required outputs, and any key process points (such as interfaces), if necessary

The requirements for reporting should be explicit. This may provide data for performance management of the Agreement, but may serve a wider or longer-term function, including for analysis with regard to population health.

Importance of expert stakeholders

In developing Performance Agreements for clinical services, the expertise engaged is critical: the involvement of service users and service providers (such as health and care professionals) early in the development of specifications is critical. But this should be done in a facilitated way to focus valuable input to where it has the most impact.

Also important is the engagement of the organisations who are going to provide the services. Performance Agreements are just that, they are Agreements and work best when transparent and developed from a perspective of development and aligned objectives.

A united view of commercial/ financial, clinical (including workforce) and legal expertise, not siloed but working together, is very powerful in the development of effective Performance Agreements, which are sustainable and drive HSE and policy objectives. Specialist legal and other inputs are required because of the specialist nature of clinical service commissioning and contracting, including in the context of the changing regulatory environment for AI, sustainability, procurement, digital, etc.

Taking performance agreements nationwide

In order that the wider application of Performance Agreements to health and care services in Ireland does not become onerous, there are several activities that could be undertaken centrally, using individuals and teams who have this experience, but drawing on local knowledge and leadership for regional application.

This approach not only enhances the quality and efficiency of care but also ensures that services remain responsive to the evolving needs of the population, paving the way for a sustainable and effective health care system.