Knowledge Matters Volume 10 Issue 1

Volume 10 Issue 1 December 2015 Welcome to Knowledge Matters Welcome to this very festive edition of Knowledge Matters. As you can see from my picture below the 2015 diet has really paid off, and I’m delighted to say that after a 6 month hiatus Knowledge Matters is back with a bang, showcasing some of the best work the Quality Observatory has ever undertaken and celebrating our continuing success in all things analysis. Take a look at page 2 to see what we’ve been up to all this time (phew, exhausting just thinking about it!).

It’s been a cracking year for the Quality Observatory and we’re immensely proud of what we have achieved. Once again we’ve kept a clear line of sight on patient care being at the heart of everything we do. We’ve been as much a part of clinical quality programmes (see pages 3 and 4) as we have more strategic work (see page 7) and absolutely believe that good data can make the difference in quality, safety and efficiency in healthcare. All this within the (by now fairly normal) context of change and development within the health service; watch out in future editions of Knowledge Matters for more news on our work with the New Models of Care sites.

In the meantime it only remains for me to wish all our readers a very happy Christmas, prosperous New Year and to encourage you all to try the Christmas crossword (page 10), vote for the best worst chart of 2015 (page 11) and exercise your festive lungs with our traditional carol! It’s good for the lungs don’t you know! Signing off for 2015……. Kate

Inside This Issue : QO Catchup

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Insights

7

Christmas Crossword

10

Maternity Dashboard

3

Cancer Routes to Diagnosis

8

Christmas Poem

12

BAPEN

4

SCW Staff Conference

9

News

12

Safety Thermometer

6

Staff Christmas Party

9 twitter.com/SECSHAQO issuu.com/SECQO

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Where did the QO go? What on earth have you been doing all this time?

“People assume that time is a strict progression of cause to affect, but actually, from a non-linear, non-subjective point of view it is more like a big ball of wibbly wobbly timey wimey...stuff” - The Doctor It’s been a whopping six months since our last issue of Knowledge Matters; a bit like The Doctor, we got a bit caught up in the wibbly wobbly timey wimey stuff. Okay, okay, we did consider a team field trip examining the finer points of healthcare systems in the Bahamas but actually we just got a bit side-tracked with producing some of our most exciting work yet! Loyal readers, you all know how incredibly excited we get about all things data and we want to showcase in this, our festive issue, just a few of our latest pieces of work for our increasingly diverse portfolio of customers.

Our range of web-based tools is expanding and this month sees the launch of the South East Strategic Clinical Network maternity dashboard, using local and nationally available data to help organisations develop their understanding of key clinical metrics, as well a presenting useful measures in a way that can help women make informed decisions about their care. Find out more on page 3.

November saw the QO go truly international for the first time, when we co-presented our work on the BAPEN nutritional care tool at a pan-European conference in Berlin. Attended by delegates attending from thirteen countries, the nutritional care tool caused a bit of stir as the first attempt by any of the participating nations to systematically and regularly measure the quality of nutritional care across multiple settings. This project has been a great example of co-design between nutritional care professionals and our technical know-how; read all about it and see some preliminary results on page 4.

Since our last edition in June, those of you who keep your eyes peeled in the safety world, will have spotted an ever increasing array of Safety Thermometer apps; we are incredibly proud to now have five apps supporting the ‘Classic’ Safety Thermometer and each of the four ‘Next Generation’ apps available across multiple mobile platforms. If your organisation is looking for a way to get your Safety Thermometer data collections closer to the patient (and reduce the time you need to sit in front of a PC!) then do let us know. See page 6 for more details.

Perhaps our most exciting development in the past 6 months has been the launch and ongoing development of the Insights Network. Initially developed to provide a platform to explore qualitative patient feedback, it has developed to include more than 20 dashboards and visualisations to provide CCG customers with real insight into a wide range of quality, safety and experience metrics. Insights Network is a subscriber led network of CCG customers who define the future direction of the Insights data platform; in a world of ever increasing volumes of data, it is critical that we work closely with customers to ensure that our information products meet their needs. Read more on page 7, and get in touch if you think you know a CCG who could benefit from this amazing suite of tools.

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The South East Maternity Dashboard Launch

By Adam Cook ...and lo it came to pass in the back room of a humble (Holiday) Inn in the little town of Horley a miracle was born!

This was the event launching the South East Maternity Dashboard. On the 11th of December the great and the good in the local maternity world flocked to Gatwick to hear about how the dashboard came to be and how it will help bring light into maternity services across the patch.

There will be future articles about he utility and functionality of the dashboard, but sufficed to say that this has been a long journey. There has been much effort put into the selection of the metrics, the design of the dashboard and the piloting phase of the programme.

From distant lands there came three wise men, Matthew Jolly (National Clinical Director for the National Maternity Review and Women’s Health) chaired the event, Tony Kelly (Consultant Obstetrician & Gynaecologist, Brighton & Sussex University Hospitals) talked about the history and development of the dashboard, about how we got to where we are now, and the importance of measurement in maternity services. Finally Adam Cook (that’s me, folks) was relieved to have a working WiFi so that a live demonstration of the online tool could be given. Even wiser than these three was Mary Darking (Senior Lecturer in Social Policy and Innovation, University of Brighton) - Mary has been out and about running an intensive evaluation of the project. She talked about people’s perceptions of the dashboard and how everyone engaged with the project.

After that there was an opportunity for networking over lunch and also for people to have a look at the tool itself in the wild on one of the stands we had set up. A number of people eagerly signed up there and then for access.

The postprandial session was a number of interactive discussions on and around the dashboard, and how to move forward locally. There was a high level of engagement and enthusiasm in the room—people seemed to like the tool and wanted to be more involved. I feel that the event as a whole was a successful day, and that real progress has been made in the understanding of providing quality measurement to maternity services in the South East area.

Finally I have to mention Laura Ansboro, who is the project lead for this programme at the clinical network—without her neither the dashboard, or the launch event could ever have happened. She’s going off on maternity leave in January, and all of the team at the Quality Observatory would like to wish her the best of luck, and we can only hope that the data she’s seen on the dashboard has helped reassure her of the quality of local maternity services!

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BAPEN Nutritional Care Tool

By Kate Cheema and Alisa Brotherton (Chair of BAPEN Quality Group) Here at QO Towers we often reflect that the best bit of the job is the variety of customers that come across our respective desks. One such customer is BAPEN, the British Association of Parenteral and Enteral Nutrition.

The QO has been working with BAPEN over the past 18 months to realise its first ever online Nutritional Care Tool. The tool was launched back in June 2015 and has been put through its paces in the first data collection week. Between the 21 st and 27th September, organisations were asked to use the tool to survey patients on four wards (or more!). Questions within the tool focus on the effective screening of patients using ‘MUST’, a malnutrition risk assessment tool, and, uniquely, also ask patients for their views of the nutritional support they have received.

We are absolutely delighted to report an incredibly encouraging first data collection period, with more than 1,000 patients surveyed across 17 organisations (with more coming in!). Although it is early days, the results indicate a high level of quality of nutritional care in participating organisations, but 1.

Proportion of surveyed patients able to at the same time highlights variation and answer who have received all the food opportunities for learning and improvement.

2.

3.

4.

5.

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and drink and/or nutritional care they have needed (Patient experience question 1) Proportion of surveyed patients able to answer who have received all assistance to eat and drink they have needed (Patient experience question 2) Proportion of surveyed patients screened on entry to the care setting (MUST on admission) Proportion of surveyed patients rescreened at an appropriate interval (MUST rescreening) Proportion of surveyed patients identified as being at risk of malnutrition on entry to the care setting (Patients at risk of malnutrition) Proportion of surveyed patients who have lost more than 5% of admission weight whilst in care (Patients with >5% weight loss)

It’s becoming clear, even at this early stage, that the use of the tool differs between organisations; some are surveying ‘little and often’ to build up a long term view of their data. Others are surveying at scale on a less frequent basis. Either approach is perfectly OK. The whole purpose of the tool is as an enabler for organisations, so that data can be used to promote the best nutritional care in a way that best suits the organisations using it. We’re focussed on improvement, not performance management.

Comparisons between organisations are for learning purposes and we hope that this approach supports you in your ongoing work.

Initially we’ve looked at six key measures, the results of which can be seen in the box to the left, and published a summary table for users registered on the website.

In addition to the summary table, the Nutritional Care Tool site presents results to registered users using a number of visualisations. At this early stage, key measures have been presented as funnel plots, to help better understand the degree of variation between organisations submitting.

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We’ve also looked at simple bar charts to breakdown the key demographics. Of the 1,163 patients surveyed at the time of writing, 96% were surveyed in an acute setting and were generally older people (70% 65+ years) and had a wide range of primary diagnoses, the most common of which were ‘neurological including stroke’ (12.7%), ‘gastroenterology & liver disease’ (17.2%) and ‘respiratory disease’ (14.4%). The vast majority (70%) received nutrition through food and drink alone.

All plots have been developed to be interactive, allowing hover functionality to identify individual organisations and help users find the best learning.

But we’re not stopping there; further indicators are in the pipeline, specifically around how ‘MUST’ assessments are carried out and the issues that organisations find in relation to accurately and regularly weighing patients.

In any measurement instrument where the focus is improvement, we look for change over time and as the volume of data builds up, time series charts will be added to the tool to help organisations identify where they have made a change and link this back to their improvement work.

As I write, the second data collection period is well underway and has already had another amazing response.

We would like to wholeheartedly thank all those who have taken the time to enter data and provide us with feedback on the Nutritional Care Tool. In the coming months we will be focussing on spread and developing the analytics and functionality of the site in response to user feedback.

If you’d like more information, get in touch with the QO at the usual address!

www.QualityObservatory.nhs.uk

info@quailtyobservatory.nhs.uk

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Safety Thermometer An app a day keeps the doctor away…. Well, we’re good for the whole working week, coz we got five…

The NHS Safety Thermometer and the Next Generation of safety thermometers have been a cornerstone of safety measurement across the country for a number of years, but as more and more organisations move into using tablets and other mobile devices for key data entry tasks and review of critical information, we need to move with the times and ensure that this point of care survey can truly be undertaken directly at the point of care.

With this in mind, we (well, Matt, our superb app developer in residence) set about designing and building a suite of apps, now available for both iOS and Android platforms, and are delighted to say that all have now launched and are being used regularly by a range of participants in each of the Safety Thermometer communities: 

‘Classic’

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Medications

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Maternity

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Mental Health

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Children & Young People

We’ve had some great feedback from users about the quick and clean interface and the real advantage of being able to enter data offline and then sync records later on.

This not only means you don’t need to worry about a reliable internet connection but also that you’ll save time re-entering data from paper records. If the system is slow due to high volume, that doesn’t matter; just leave your device to chug through the uploading of the records whilst you make a nice cup of tea and relax (or get on with other things!).

All the apps have been driven by the App User Groups who have advised on the features and functions that would be useful to them, and of course we continue to develop them in line with user comments and requests.

It’s super easy to get started; just drop us an e-mail at: info.safetythermometer@nhs.net and we can set you up as a user and get you all set up with those pretty little icons. There are lots of guides for how to use the apps as well as more technical guidance for setting depending on your operating systems. We’d recommend getting your IT folk involved as well, just to make sure local settings and security protocols don’t create any unexpected gremlins.

Here at QO Towers we’re really proud of this foray into the world of mobile apps and we have a couple more up our sleeve relating to sample size calculations for surveys and an NHS jargon buster. Watch this space!

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Insights It’s now more important than ever that commissioners and providers stay informed about the experience and opinions of their patients, so the QO have recently developed a new Insights tool to make this task much easier! Working in collaboration with several London CCGs, the aim has been to eliminate the need to search countless different data sources in the quest for valuable insight into the best ways to provide services to the local population.

What is Insights?

Insights is a business intelligence tool that pulls data from national sources of patient opinion, alongside some performance and activity information, making them available in a single place. In addition to the tool itself, member organisations form a network that informs the work programme and its future direction.  Visualisations of datasets are provided in a variety of different formats, using both qualitative and quantitative measures  Positive and negative feedback can be displayed separately, by filtering on key words, and both acute and primary care service providers are covered  The Insights tool currently includes 23 individual interactive dashboards... and counting!  Each dashboard covers a different area of measurement and includes a number of metrics  Sources of data include, but are not restricted to; GP Patient Survey, Inpatient Survey, Friends & Family Test, PROMS and the NHS Safety Thermometer. Below are just a couple of examples of what’s included:

NHS Choices & Patient Opinion  Here the visualisations are based on comments selected by ‘tag’ for chosen providers, with the ability to filter for positive/negative/neutral comments  Visualisations include word clouds and bubble charts, plus interactive maps of your geographical area and beyond  The original comments are also available in full, allowing for context and further detail  The user can also filter comments for more than 20 different aspects of acute care or 6 key areas of primary care

QOF Data Explorer  View QOF results at any organisational level for all countries in the UK  Display from total level down to individual QOF indicator, for measures including points achieved, underlying ratio, prevalence and exception rates  As well as seeing trends over several years, users can benchmark against peers at different organisational levels plus quartiles, averages, minimum and maximum

Key Features Your own login will provide the ability to view only the providers you are interested in, with the option to view everything that’s available nationally if you wish! There is even an online forum and suggestions box so that users can continue to help drive what goes into the Insights tool and the future direction it takes.

If you would like to know how to join the Insights network please do get in touch at info@qualityobservatory.nhs.uk

www.QualityObservatory.nhs.uk

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Routes to Diagnosis (for Cancer) - Updated Analysis

By Rebecca Matthews Last month saw the release of the new Routes to Diagnosis data by the National Cancer Intelligence Network (NCIN). Analysis is now available for 2006-2013, previously the latest available was 2010.

This work combines a wide range of data sources: HES data, Cancer Waiting Times data, screening programmes data and cancer registration data and categorises every case of cancer diagnosed into one of eight Routes to Diagnosis (GP referral, Two Week Wait, Emergency Presentation, Other Outpatient, Screen Detected, Inpatient Elective, Death Certificate and Unknown).

The data is publically available and the published Excel workbook contains a huge amount of cancer data and shows tumour level data for each diagnosis route broken down by sex, age and deprivation. Both incidence and survival metrics are shown within the workbook. Data can be viewed for the full time period or for each individual year from 2006 onwards.

The data can be viewed on the NCIN website here: http://www.ncin.org.uk/publications/ routes_to_diagnosis The analysis is currently only available at an all England level, but should be available broken down to SCN and (for some of the data) CCG level in early 2016 and ready to use in all of the Quality Observatory Cancer dashboards and analysis.

info@quailtyobservatory.nhs.uk

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SCWCSU Conference and Staff Christmas Party

Staff Conference We recently attended one of the 5 South, Central and West CSU Staff Conferences ‘Taking Flight, Soaring High’ in Brighton. This was a great opportunity for us all to get together with some of our colleagues who we have not met before (because SCWCSU is so big!), or don’t often get a chance to work with.

The day started off with lots of praise for the whole CSU for how well we have performed this year, especially during the merging period. It was wonderful to hear so much positivity about what we have achieved so far, and what we can expect to achieve in the coming months and years.

In ‘Back the Bid’ we worked in teams to create a business case complete with costings and customer benefits! My team chose the ‘Nighty Night Nursery’, a 24 hour nursery for NHS staff. Sadly our bid did not win, but some of our very own Quality Observatory team won with their ‘Social Petwork’ bid. They were all rewarded with an additional day’s holiday next year on their birthdays!

We were also able to meet most of the Executives from the SCWCSU who answered all of our queries during the Q&A session. This was really useful to get some clarification and an idea of where the CSU is aiming to expand/develop within the next few years.

I think I can speak for most of us when I say it was worth going (not just for the free lunch!) as sometimes you can forget just how big an organisation we work for, and how much effort is put in by everyone contributing to improve the quality and value of health and care services.

Staff Christmas Party We don’t usually need an excuse to go out on a ‘Team Do’ and Christmas has been no exception of this. We started off with some drinks in a pub in Clapham Junction and then moved on to Bodeans BBQ restaurant to get our Christmas meat fix. I think it’s safe to say we were all extremely full and ready to enjoy a few more cocktails.

In Christmas tradition, most of us wore our ‘classy’ Christmas jumpers and I think our Programme Support Assistant Liam won the competition for the most fabulous.

His jumper not only had everything to do with Christmas you could possibly think of, but it also lit up (see the picture to the left of Liam in his light-up jumper drinking his festive cocktail!).

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Christmas Crossword!

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Best Worst Chart of 2015 In our relentless search across the globe for truly terrible charts, we have three real beauties (all in actual publications!), each a prime example of how not to chart stuff, on our shortlist this year. Drop us a line to vote for your favourite, or show us something even better (worse!).

Pick between our exploded two piece doughnut chart, a spaghetti junction of a time series plot where no-one has a clue what each series represents, and my personal favourite the ‘it’s only two numbers’ bar chart.

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Christmas Poem To the tune of We Three Kings To ensure you get quality care, We team of geeks from Horley are

We run the numbers and compare,

Gathering data from near and far,

Rates and means and the in-betweens,

Analysing, Quantifying,

To set a benchmark fair

And plotting it in a chart.

Chorus Chorus: Oh chart of wonder, chart of light,

From many sources we get the data,

Chart that gives us deep insight,

Making use of denominator,

Into the movement that shows improvement,

Demographics on geriatrics,

Guiding us to make things right.

Sorting the smaller from greater.

Dashboards built to monitor trends,

Chorus

Compare yourself against all your friends, Horizon scanning, resilience planning,

Evidence base - the golden rule,

Making it pay dividends

For every spreadsheet and online tool, Decision making, it's groundbreaking,

Chorus

Making analysis cool.

Chorus

Meet Rajima!

Hello everyone. My name is Rajima Chandrika, I am the latest addition to the Quality Observatory Team and I started in October. This is my first job with the NHS, having worked in customer service industries before. My role here involves administration work for the whole team within the Quality Observatory. Still in my early days, settling in well with this wonderful team!!

Simon says…….

Dreaming of a geek Christmas? Get toasty in front of a virtual fire with a Star Wars twist, and put this on your telly:

https://youtu.be/PVJzibVS2YM You too can enjoy five hours of a warm, gently crackling Darth Vader ...go on, roast your chestnuts on an open pyre…..

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.

Hosted by: South, Central and West Commissioning Support Unit E-mail: info@qualityobservatory.nhs.uk To contact a team member: firstname.surname@qualityobservatory.nhs.uk