Knowledge Matters V10 I2

Volume 10 Issue 2 March 2016 Welcome to Knowledge Matters Welcome all to another seasonal issue of Knowledge Matters. Easter is a time of rebirth and growth (and also chocolate), and this is no less true for the Quality Observatory. Some of you know that Kate Cheema, one of our long standing stalwarts of team QO, is moving onwards and upwards to new challenges, and as a result the team are taking the opportunity to shuffle around some workloads and give some people new growth opportunities.

Talking of growth we’re keeping ourselves busy at the QO—we’ve been recommissioned by NHS England to carry on with the Friends and Family Test dataset, and our Maternity Dashboard has had a lot of interest, especially in the wake of the recently published National Maternity Review.

You can read about all of this inside this issue.

Other delights in this issue include a review of the Public Health Intelligence training provided by Public Health England, that some of the team went on. Nikki has been working closely with some of the Vanguard CCGs which has informed her article on collecting new data for measurement.

Hope you enjoy this issue of Knowledge Matters. If there’s a burning topic you want to raise, or a piece of work that you want to show off then please let us know and you could contribute to future issues.

Have a relaxing (and chocolate filled) Easter holiday, and we’ll be with you again in the summer.

Inside This Issue : The South East Maternity Dashboard

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Friends and Family Test Contract

Collecting New Data for Measurement

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Patient Insight & Feedback Conference

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Public Health Intelligence Training

10 News and updates

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The South East Maternity Dashboard

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By Adam C. Cook, Specialist Analyst Long term readers may well remember the Maternity dashboard that we used to produce when we were part of the old Strategic Health Authority, it was a big, clunky and colourful beast. It was useful, but was limited, and severely in need of an overhaul.

The South East Strategic Clinical Network (SCN) thought so too, and have decided to revitalise the old dashboard and re-build it with a greater focus on outcomes and how it can be used to show the kind of activity that can be influenced by maternity professionals at a local level.

For many months the SCN went through a process of working through ideas with clinicians and other senior staff across the Kent, Surrey & Sussex patch deciding what metric were needed, how they’re going to be collected and how they are to be presented.

One of the disadvantages of the old collection methodology was that it put the entire onus on the trusts to collect the information every month. Whilst it is true that much of this information was being collected anyway, getting from whatever system it was in then importing it into the dashboard was a labour intensive process, and not everyone was able to provide everything every month. It was posited that actually much data could be obtained by one person doing everything from a central repository of data. Rather helpfully the Royal College of Obstetricians and Gynaecologists (RCOG) have come up with a range of maternity indicators that they have extracted from HES. https://www.rcog.org.uk/en/guidelinesresearch-services/audit-qualityimprovement/clinical-indicators-project/

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We have taken these as the core indicators for our new dashboard, and RCOG have supplied their methodology so that we could recreate their work. This means that not only can we update the majority of the data monthly, but it only takes one person to do it, and every organisation can be updated. It also means that we can also use the national data as a comparator.

The other advantage that the RCOG indicators have is that they have a standard nationally agreed definition, and therefore data is replicable and comparable between organisations. We recognise that local organisations may operate to slightly different definitions on some indicators – however it was decided that coming to a consensus around some of these may well be difficult and time-consuming, so skipping that step and using nationally agreed data has enabled to project to move on at a quicker pace. A detailed definition page is included in the website.

The issue with HES data for maternity is that many people feel that is doesn’t accurately reflect the data that is held within local maternity systems. This is obviously an issue that needs to be addressed if maternity professionals feel that they need to be able to trust the system To this end we have built in a capability whereby they can add in their own data for all metrics and this will generate comparator charts between their data and the centrally extracted data. This will provide hard evidence of what differences there are and what steps need to be taken to address these issues, so that data quality is something that can be relied upon.

Having a separate data collection is also useful because there are a number of indicators that cannot be reproduced by centrally collated information systems, and we have to be reliant upon the trusts to provide this data. We felt that this was important as it gives a more rounded picture of what’s going on at the trust. Currently this data is submitted direct to the QO on a spreadsheet and we upload this to the site.

The site is split into different sections. The homepage provides and introduction to the project and has a maps showing the locations of maternity units across South East Coast – these have clickable icons

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which will provide summary statistics in a pop-out box.

There are two aspects to the site a public facing part with data that is in the public domain, and a site that only people who have registered with a valid NHS e-mail address can see.

The National Maternity review, which has recently been published (more details in the news pages of this newsletter) had an emphasis on mothers being able to access useful information to help decide where they are going to give birth, or to reassure them of the quality of care at their local trusts.

The first bit of the public data comes from the popout box accessed from the front page map. This shows data for the most recent 12 months for the chosen trust and displays an infographic of how women may expect to deliver should they go to that trust. From this page more a detailed service overview can be accessed in depth with further infographic. This includes things like induction, assisted labour, Friends and Family test and complaints. Detailed definitions of clinical terms are linked to from NHS Choices, so that the public can understand the nuances of the terminology.

This data is also available to NHS personnel, however when they login the main dashboard page becomes visible.

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The main view of this shows all the indicators with a run chart and funnel plot for each one. Trusts can be selected from a drop down menu at the top of the page.

The HES data is shown by default on the line chart, but other lines can be added.

This includes the National average, the Kent Surrey and Sussex average and the equivalent data from the trusts own maternity systems. One of the advantages in this is that trusts can compare their own data against HES and use it to check data quality. This could be used as the first step on the road to get greater alignment between HES maternity data and local maternity system data.

Users can see the individual charts in greater detail by clicking on them. This will show a larger view of the chart, along with three others that are related to that measure. This is to ensure that people looking at the data are not just looking at activity in isolation, but are thinking of the bigger picture.

Improvement in one area may have a corresponding worsening in another area, so it is always important to look at these things together. This view is available for both run charts and funnel plots.

Elsewhere on the site there is section for help and support. This includes things like how to interpret the funnel plots, bug fixes, and user forums so that experiences can be shared easily.

If you are interested in hearing more about the maternity dashboard please contact Adam Cook adam.cook@qualityobservatory.nhs.uk or you can take a look at public facing side yourself by going to: http://maternitydashboard.secscn.nhs.uk/

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6 Collecting New Data for Measurement: a few basic rules and suggestions

By Nikki Lawford, Specialist Analyst

Although it can sometimes feel as though we are awash with data in the NHS, there will always be occasions when you need to measure something new, possibly activity or cost related or maybe a qualitative area such as patient experience. Whether you are an analyst, part of a service re-design team, a project manager or just someone trying to evidence how effective your work is, there are a few things to bear in mind before you get started.

Focus your data needs • Think carefully at the outset what you need to know and the message or story you hope to convey at the end. Careful thought at this stage can save a lot of frustration and additional time later on!

• Consider the eventual reporting of your data and who the audience will be. For example, are you just hoping to broadly demonstrate that you have achieved what you set out to do, or will you want to provide regular feedback along the way to various stakeholders, staff or maybe patients?

• Wherever possible, try to collect exactly and only the data you will need. You need to be sure that all the essential elements have been covered, however your data is much more likely to be consistent and accurate, the less you try to collect.

What exactly do you need and not need to know?!

• •

• •

A ‘right first time’ approach • Identify clearly who should, and should not, be included in your data collection - think about age groups, diagnoses, providers, type of patient contact, day/time of activity etc.

• Although it may change over time, there is likely to be a core set of metrics that will be needed in order to demonstrate success. Think about short, medium and long term aims.

How often will data be collected and reported?

Who will record your data? Will it be best recorded by front line staff at the point of contact with the patient, or would it be better to assign someone to collect the information later on? Get agreement early on from those who will undertake the data collection.

Once data has been collected ‘on the ground’, agree what will happen to it next - will it be sent on to a manager, administrator or Business Intelligence contact? If so, how and how often?

Ensure the complete process is in place prior to starting data collection, otherwise information could get lost!

Simple categories • Narrow these down to the really important ones and use ‘other’ for the rest • Don’t try and capture data for every disease/condition/diagnosis individually - just the ones where your project aims to show improvement • For example, if your workstream is focused on respiratory diseases but not particularly on pneumonia, maybe just give options for Asthma, COPD and Other

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• This limits potential differing interpretations of responses and ultimately increases the likelihood of getting meaningful analysis from your data • Simplicity is particularly important if you are collecting patient experience data, or if it will be collected manually and entered electronically later on • Devise a separate way to handle any comments or anomalies Test your new data collection procedure!

• Wherever possible, involve a staff member who might typically be asked to record the information and test it on someone who might be asked to respond • Make sure everyone involved fully understands what is required • Check that the broader data collection process works efficiently - in other words, that all your data ends up where it ultimately needs to be • Ask a friendly local analyst to check that they can produce something meaningful from the test data • And then check it will definitely answer the question you are trying to answer!

Information Governance Before launching your new data collection process, be sure that it passes all necessary IG scrutiny! You may need to undertake a Privacy Impact Assessment in advance, or new data sharing agreements may be needed before data can be shared across organisations.

A note about proxy measures It may be that you are unable to collect exactly the data needed to tell the story you wish to. If so, consider using a proxy measure. In other words.... when you can’t measure exactly what you need, measure what you can. For example, instead of reporting on a specific group of patients, maybe you could use available data for a pre-defined age group and/or geographical area, with a specified set of co-morbidities, and so on.

It may not give you absolute certainty of the outcome of your project but it might give a reasonable degree of confidence that you achieved your aims and also evidence any wider ‘knock-on’ effects. It may also be helpful to use a proxy measure until you have enough of your new data, just to show you are on the right track.

In summary • Aim to get it right first time as much as you can • Keep it focused • Keep it simple • Check IG requirements • Test the process, and..... ... check you are definitely measuring what you need! Re-visit your original aims and double-check. And, if you can’t measure what you need, measure what you can.

If you would like any further information please do get in touch at info@qualityobservatory.nhs.uk

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Friends and Family Test Contract

By Rebecca Matthews, Specialist Analyst

The Quality Observatory are delighted to have retained our contract with NHS England for our work around the Friends and Family Test, following a frantic festive season of filling in tender documents and an interview for Rebecca and Kate in Leeds in January.

What do we do?

Our work falls into 2 main areas: firstly we manage the data processing for all of the collections, dealing with any issues uploading the returns, chasing up missing returns, validating the data and checking out any oddities in the data with providers and finally producing the outputs that get published on the NHS England website and the data that gets sent to other people for their use e.g NHS Choices.

Secondly we also run the national FFT help desk, dealing with any questions around anything to do with FFT so if you have an FTT related query and email england.friendsandfamilytest@nhs.net or call 0113 824 9494 you'll be speaking to one of our lovely FFT team.

Who are the FFT team?

There are 5 of us in the Quality Observatory's FFT team: Rebecca (me) I nominally manage the team but everyone else knows far more about FFT than me!

Feel free to contact me though for any FFT related issues or questions or if you want to learn more about what we do: Rebecca.matthews@qualityobservatory.nhs.uk Dani, Becki, Liam and Trishna are the experts in all things FFT related and know all of the many guidance documents inside out.

So if you have an FFT question, do contact us on the details above!

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9 Patient Insight and Feedback conference Rebecca and Kiran spent a day in Leeds on 17th March exhibiting at the Patient Insight and Feedback Conference. The conference was aimed at NHS staff leading patient insight and experience work in both provider and commissioning services and provided an opportunity to look at what has been learned so far from the Friends and Family Test and other sources of patient insight. Speakers at the event included Anu Singh, Director of Patient and Public Participation and Dan Wellings, Head of Insight and Feedback at NHS England and also included a session with four patient panel members.

The winners of the FFT awards were also announced at the conference - the full list of winners is available here: https:// www.england.nhs.uk/2016/03/fftawards-patient-feedback/ The Quality Observatory were one of 12 exhibitors at the conference and we took the opportunity to demo our Insights platform and Friends and Family Test Analysis website, as well as running an FFT data drop-in surgery throughout the day, giving advice on how (and how not) to use your FFT data. We also had time for a quick photo with Monkey from Monkey Wellbeing!

Goobye from Kate...

‘It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.’- Sherlock Holmes As with so many things, Sherlock understands what the QO is all about; evidence based decision making, based on reliable, and incidentally beautiful, data. It’s a message I’m going to be taking out even wider in my new role as Head of Transformation Analytics for South, Central and West CSU. It’s going to be wrench leaving the QO not least because the very lovely people in it, past and present, have all helped me learn so much. I’ll still be based at QO Towers though, so at least I’ll still get to see everyone’s smiling faces occasionally! The new role will be a challenge, not least with the current expectation of the NHS delivering huge savings, but there is no question that my time at the QO will have given me the very best possible preparation for it. I look forward to being merely a contributor to Knowledge Matters and seeing the QO team continue to go from strength to strength.

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10 Public Health Intelligence Training

by Becki Ehren A couple of us at the Quality Observatory were invited to attend a pilot course put on by Public Health England to provide training on public health intelligence. The course ran over 5 days, each covering a different topic ranging from the background of public health and the role of PHE, Epidemiology, health inequalities, health patterns and displaying the information (to name a few).

The training provided a great insight into where the information comes from, how it is analysed and what it is used for. One of my particular favourite parts was the section on Epidemiology and how Field Epidemiologists are vital in helping counties and organisations to minimise the negative impact on people’s lives during an event.

This part of the course also covered how it is so important to consider the wording and imagery that is used when data is published because everyone interprets things differently. For instance, the media will often use the term ‘epidemic’ to get a better reaction and to create better headlines, however this is the same as referring to something as a cluster or an outbreak, which I think we can agree doesn’t sound half as dramatic as an epidemic! The course also covered how it is really important to remember that how you use infographics is very important due to the sensitivity of some subjects, and also to remember that whilst we may view an image one way, a member of the public who does not have an analytical background may see it completely differently.

It was great to meet people who work in various roles that use public health data – some of who worked in completely different backgrounds, so I found it really useful to hear their view on some of the data that is published. Attendees varied from analysts, council workers, NHS staff, insurance advisers and many others. Some of the training that we covered involved looking at different types of graphs and thinking about how even the smallest change such as the colour of a line can have a huge impact on how the target audience receives the information.

One of the most useful tools that we were shown is ‘Fingertips’ by PHE. It’s great for looking through specific data in order to compare local areas against the England average. You can change the way the data is displayed through various charts and graphs, and the tool allows you to select additional comparatives to look deeper into the data. If you are interested, the link to the site is http://fingertips.phe.org.uk/

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QO Latest Projects CAS

NEWS This review by Baroness Julia Cumberlege was releasesd in February of 2016. It says that:

The Central Alerting System (CAS) is a webbased cascading system for issuing patient ”Maternity services in England must safety alerts, important public health messages become safer, more personalised, kinder, and other safety critical information and professional and more family-friendly. “ guidance to the NHS and others, including independent providers of health and social care. Hopefully the South East Maternity dashboard goes Alerts currently available include safety alerts, CMO messages, drug alerts, missing patient alerts and medical device alerts.

some way to helping these ideals become reality. To read more about the report go to: https://www.england.nhs.uk/2016/02/maternityreview-2/ Or you can download it from:

We currently provide the service for the South https://www.england.nhs.uk/wp-content/ and South West regions, with Devon and uploads/2016/02/national-maternity-review-report.pdf Cornwall being our most served areas. Alerts are sent to a number of service providers including GP practices, pharmacies, dental practices, Birthdays substance abuse clinics and more.

Further information can be found here: https://www.cas.dh.gov.uk/Home.aspx

Showing the kind of remarkable efficiency for which the QO is known Aleksandra and Charlene had their birthday on the same day in February. Here there are enjoying traditional QO Birthday goodies!

CAMHS Modelling Tool The CAMHS Strategic Modelling Tool has been created to help plan and improve the commissioning and delivery of Children and Adolescent Mental Health Services.

The scope for the model is across health, education, third sector and local authority services.

The tool is designed to enable a ‘whole system’ view of CAMHS in an area, regardless of the commissioning / funding route and the setting and provider of the service. Providers can enter a variety of figures into the tool and be provided with information such as how to optimise patient appointments based on waiting time, staffing cost estimates, yearly commission activity estimates and more.

Further information can be found here - http:// www.scwcsu.nhs.uk/about-camhs National Maternity Review

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For Kate

An Easter Puzzle

We're here to say goodbye to Kate, and wish her well in her endeavour, We'll miss her when she is gone, and collectively be less clever.

She's Wrestled with performance, and sent returns away, And she's made up targets for C-Diff and MRSA. She's been the leading light of the Safety Thermometer, The spreadsheets and the website they just could not beat her.

Her advice has been relied upon in matters quite statistical, Always true, and thoughtful, and never egotistical.

Thanks to Kate for her good humour and her sense of fun, And her sense of perspective in getting the job done.

We'll see her round the office, she's not going far away, So will still enjoy her company, just not every day.

Good luck to her in your her job, we know that she'll be great,

In above grid-shading puzzle, each square is either black or white. One of the black squares has already been filled.

Each row or column is labelled with a string of numbers. The numbers indicate the length of all consecutive runs of black squares, and are displayed in the order that the runs appear in that line. For example, a label "1 2 3" indicates sets of one, two and three black squares, each of which will have at least one white square separating them.

The final image, when scanned will reveal a hidden message. Good luck!

We send her off with all our love, goodbye, and good luck to Kate.

Knowledge matters is the newsletter of the NHS Quality Observatory. To discuss any items raised in this publication, for further information or to be added to our distribution list, please contact us.

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