Patients - Quality - Productivity programme -

helping deliver PAHT2030

Putting our patients at heart – make it count

By

Dr

Bob Ghosh,

Divisional Director For Medicine And Urgent And Emergency Care

You may have heard of, or been a part of, our PatientsQuality - Productivity (PQP) programme, which is helping to deliver our PAHT2030 strategy. If you haven’t been involved yet, it is very likely you will be. The aim of the programme is to ensure the highest outcomes for our patients through effective ways of working, and spending money as if it were our own.

Background

You will be aware that postCOVID, we are experiencing challenges in meeting demand from our community, both in waiting times for urgent and emergency care and for planned care, such as outpatient appointments and surgery. We are also in a financially challenging position, anticipating approximately a £24m underlying deficit for 2022/23. We have seen a decrease in productivity of 20% since the end of 2019/20, meaning we are seeing and treating less patients, which impacts on waiting lists.

Some of the reasons for our overall operational and financial position include the impact of COVID-19, increased demand for our services, and changes in the income we receive.

Research

I would like to share two very good articles which embrace the PQP way of thinking.

y Engagement Value Outcome case study, Gloucestershire Health and Care NHS Foundation Trust > y Correlation between hospital finances and quality and safety of patient care >

I would encourage you all to take a look at these, with a key abstract of an important piece from academics in the United States detailed overleaf. We particularly need to focus on the below findings: y Hospitals which deliver good care usually deliver good finances; it is not a question of choosing to provide quality or choosing to spend wisely – it will be both y Spending wisely leads to good, effective care y Good, effective care leads to wise, effective spending

Your involvement

We all need to be a part of this. We would like ideas on effectiveness, productivity and spending to come from those of us who deliver clinical care.

Please contact your line manager if you would like to be involved. If you are approached by a colleague, please be part of the conversation, and consider being part of the PQP team - thank you. The Project Management Office (PMO) team will work with you to support you to develop and implement your ideas – they can be contacted at paht.pmo@nhs.net. You can read more about the PQP programme on AlexNet Please look out for more updates on the Patients

– Quality – Productivity programme coming soon.

Correlation between hospital finances and quality and safety of patient care,

by Dean D. Akinleye, Louise-Anne McNutt, and Victoria Lazariu (from the United States)

Background

Hospitals under financial pressure may struggle to maintain quality and patient safety and have worse patient outcomes relative to well-resourced hospitals. Poor predictive validity may explain why previous studies on the association between finances and quality/safety have been equivocal. This manuscript employs principal component analysis to produce robust measures of both financial status and quality/safety of care, to assess our a priori hypothesis: hospital financial performance is associated with the provision of quality care, as measured by quality and safety processes, patient outcomes, and patient-centred care.

Methods

This 2014 cross-sectional study investigated hospital financial condition and hospital quality and safety at acute care hospitals. The hospital financial data from the Centers for Medicare and Medicaid Services (CMS) cost report were used to develop a composite financial performance score using principal component analysis. Hospital quality and patient safety were measured with a composite quality/safety performance score derived from principal component analysis, utilising a range of established quality and safety indicators including: risk-standardised inpatient mortality, 30-day mortality, 30-day readmissions for select conditions, patient safety indicators from inpatient admissions, process of care chart reviews, CMS value-based purchasing total performance score and patient experience of care surveys. The correlation between the composite financial performance score and the composite quality/safety performance score was calculated using linear regression adjusting for hospital characteristics.

Results

Among the 108 New York State acute care facilities for which data were available, there is a clear relationship between hospital financial performance and hospital quality/ safety performance score (standardised correlation coefficient 0.34, p<0.001). The composite financial performance score is also positively associated with the CMS Value Based Purchasing Total Performance Score (standardised correlation coefficient 0.277, p = 0.002); while it is negatively associated with 30 day readmission for all outcomes (standardised correlation coefficient -0.236, p = 0.013), 30-day readmission for congestive heart failure (standardised correlation coefficient -0.23, p = 0.018), 30 day readmission for pneumonia (standardised correlation coefficient -0.209, p = 0.033), and a decrease in 30-day mortality for acute myocardial infarction (standardised correlation coefficient -0.211, p = 0.027). Used alone, operating margin and total margin are poor predictors of quality and safety outcomes.

Conclusions

Strong financial performance is associated with improved patient reported experience of care, the strongest component distinguishing quality and safety. These findings suggest that financially stable hospitals are better able to maintain highly reliable systems and provide ongoing resources for quality improvement. Read more here >