Knowledge Matters volume 8, issue 2

Volume 8 Issue 2 June 2014 Welcome to Knowledge Matters Another tip top, fun packed, super informative and all round marvellous edition of Knowledge Matters is here sports fans, so if you’re still crying into your lager at England’s early exit from the World Cup soothe yourself with the treats we have in store for you.

Simon and I were delighted with the recent publication of the Ambulatory Care Sensitive Admissions Data report for the KSS AHSN recently; find out more about the report and its contents on pages 2 and 3.

If you’ve ever wondered what keeps Adam with his head down all day, read his fascinating review of what analytics for the Strategic Clinical Networks looks like. Never a dull moment, as evidenced by Rebecca’s coverage of the cancer dashboard which she’s developed for the SCN. Aleks gives us a fascinating insight into those all important first steps in designing your website; trust me, she speaks from experience! Check out page 10 for details….

Speaking of non-stop fun, the 2014 NHS Confederation Conference has been and gone and we were pleased to have had a great stand; Amit gives us the highlights on page 12.

There is also a review of the Better Care Fund and what it means for analytics, not to mention some highlights from our postbag. It looks like the QO is running right alongside this fantastic summer of sport!

It only remains to say ‘come on Andy Grigor!’.

Inside This Issue : KSS AHSN ACS admissions

2

Cancer dashboard

9

News

Chi-square– what on earth?!

4

Getting web design right

10 Back page fun!

Working with the SCN

6

NHS Confed 2014

12

Better Care Fund

8

From the postbag

13

14 16

twitter.com/SECSHAQO issuu.com/SECQO

www.QualityObservatory.nhs.uk

http://www.networks.nhs.uk/nhs-networks/sec-qo

2

KSS ACS Emergency Admissions Report Published

By Simon Berry and Kate Cheema The Quality Observatory has recently delivered an in-depth analysis report and suite of tools for Kent, Surrey & Sussex Academic Health Science Network on emergency admissions for Ambulatory Care Sensitive (ACS) Conditions, prompted by last year’s report by The Health Foundation and Nuffield Trust.

The results and publication were presented by the Quality Observatory’s Kate Cheema at a recent KSS AHSN event.

Guy Boersma, Managing Director of Kent Surrey Sussex AHSN said: “I am delighted to have commissioned and published this analysis. The first step towards improvement is to understand what you need to change; this report is a position statement on ambulatory care sensitive admissions for the region and, as with all the best analysis, will prompt you to ask more probing questions and discuss further what action can be taken in your locality. The analysis presented in this report, alongside the associated analytical tool, provides authoritative, detailed information on emergency hospital admissions for ambulatory care sensitive conditions. The report also highlights areas of good practice from which lessons can be learned. I hope to see this spread across the region, shaping strong support and learning networks between peers. I trust that this report will support the spread of existing best practice, and help commissioners and providers to work better to deliver the transformation of health and care services that is needed to ensure that people living in Kent and Medway, Surrey and Sussex receive consistently high quality care when and where they need it.”

Ambulatory care sensitive admission rates are a commonly used indicator of system health and sustainability through the identification of emergency admissions that are generally seen as avoidable.

Such admissions can also be used to identify and monitor efforts to decrease costs and increase productivity. A deeper understanding of ACS conditions across the region will be critical to ensuring that local out-of-hours strategies and QIPP plans can deliver sustainable change across the Kent, Surrey and Sussex region.

The report showed that whilst rates of ACS admissions in Kent, Surrey and Sussex are relatively low, the overall rate is increasing rather than decreasing, at a similar rate to that of England, which increased by 48% over an eleven year period. Less than half of this increase is explained by population growth and demographic change. Of particular concern is the rapid growth of ‘other and vaccine preventable’ ambulatory care sensitive admission rates as well as the steady rise in acute ACS conditions. Interestingly, chronic ACS conditions show limited growth, in stark contrast to the increasing demand in this area from an ageing population that is living longer.

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3

Clear variations between areas are apparent at both a national and regional level. Most areas show increased rates of ambulatory care sensitive admissions over time, but there is variation evident in the degree of change and the extent to which this is evident in different ACS conditions. Levels of deprivation, which are strongly linked to rates of ACS admission, can explain some of this variation but there are still significant differences between areas even after deprivation is taken into account. The impact of deprivation is lesser in the Kent, Surrey and Sussex region than in England as a whole. A number of scenarios were applied to the data in an effort to provide a high level estimate of the scale of resource redistribution opportunity from hospital to out of hospital settings. The high level estimates from these scenarios ranged from ÂŁ6.7m to ÂŁ27.3m and showed that despite the relatively good rates of ACS admission rates in the region, opportunities remain to redistribute resources from hospital to out of hospital settings.

The report sets out some highlights from analysis of specific ACS conditions. Pneumonia (shown on the left) is a significant driver of growth and disproportionately affects older people. There is significant variation in emergency hospital admission rates between clinical commissioning group areas and the majority of emergency hospital pneumonia admissions are shown to be primarily for pneumonia and not pneumonia as a co-morbidity.

Urinary tract infection and pyelonephritis is the most common ACS admission reason across the Kent, Surrey and Sussex region. These admissions are not purely the domain of older people but also have an impact on younger females which may have implications for public health.

Epilepsy and convulsions is an ACS condition where admissions are evident in all age groups but especially younger children; it is highlighted as an example of where a condition can disproportionately impact a younger group, and highlights the fact that ACS admissions are not just a concern for the older population.

Copies of the report are available on http://issuu.com/secqo/docs If you are interested in similar pieces of analysis in your area, please contact the Quality Observatory at: info@qualityobservatory.nhs.uk

www.QualityObservatory.nhs.uk

info@qualityobservatory.nhs.uk

4

Chi-square– what on earth is that?!

I recently had a question which took me straight back to my school days (and incidentally brought me out in a cold sweat). It was ‘what on earth is a chi-square test and when should I use it?’. The first time I came across the chi-square test was in biology lessons, associated with dim remembrances of marking grasshoppers with tippex before recapture. Hard times for grasshoppers.

Whilst the concept was, quite literally, greek to me then, the chi-square test has served me well since. I will attempt to explain here why we use it, when to use and how to interpret the results.

Let’s imagine we want to know whether there is a difference between men and women’s tastes in sci-fi, as illustrated by whether they prefer Star Wars or Star Trek. First of all, have a think about your hypothesis, what do you expect to see? In this instance let’s assume that our hypothesis states that there is no difference between men and women when it comes to a love of Kirk or Han Solo.

Right, time to collect some data. You ask 100 men, and 100 women which of Star Trek and Star Wars they prefer and the results are shown in the table to the left. So, do these results suggest a difference between the ACTUAL genders? Well first we need to decide which test we might use to decide this. Chi-square is a test that we can use with categorical data. This is data that is, as the name suggests, put into categories rather than measured on a continuous Men 85 15 scale such as height and weight. As we have very simple categorical data here (shown in a 2x2 contingency table) Women 64 36 the Chi-square test is a good one to use.

Clearly we have different numbers for men and women in each category of sci-fi, but are our results far enough away from what we would expect to see if there was no difference at all, so far far away in fact that we could call it significantly ‘different’?

Therefore we have to think about what we would expect to see if our ‘null hypothesis’ was true; thus we need to calculate what numbers of Trekkies and Star Wars lovers we EXPECTED would expect in each category if men and women’s sci-fi tastes didn’t differ from each other. Unless you have a specific theory to apply, in this case we might expect to see a 50/50 split in both genders and as we’ve got 100 men and Men 50 50 100 women in the sample (how convenient) we would therefore expect to see 50 people in each cell of our 2x2 Women 50 50 table, like that to the right.

So, we now want to calculate a statistic which compares our actual (or observed) and expected data to see whether the reality is significantly different from our theory which is, remember, that there is no difference between the two genders.

For the purists amongst you, the formula to be applied can be seen on the next page. Basically, the Chi-square value is a single number that adds up all the differences between our actual data and the data expected if there is no difference. If the actual data and expected data are identical, the Chi-square value is 0. Greater

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5 differences between expected and actual data produce a larger Chisquare value. The larger the Chi-square value, the greater the probability that there really is a significant difference. That phrase ‘greater the probability’ is an important one because we aren’t talking about absolutes here. A high Chi-square statistic value means that it is very unlikely that the difference isn’t down to pure chance, but there always remains a slight probability that it is. This probability reduces as the Chi-square statistic gets higher.

To work out whether your Chi-square statistic is big enough, we need to look up the value in a table (you can find these online, or usually your software package of choice will do the work for you!). The reference tables will provide you with a ‘critical value’ for the Chi-square test for each level of significance. So, for example, if you wanted to see if your statistic indicated a probable difference at the 99% level, you’d look up a critical value for that level, which would be higher than that for the 95% level and so on. The higher the level, the smaller the probability that any difference identified is down to chance alone.

If the Chi-square value is greater than or equal to the critical value then there is a significant difference between the groups we are studying. That is, the difference between actual data and the expected data (that assumes the groups aren’t different) is probably too great to be attributed to chance. So we conclude that our sample supports the hypothesis of a difference, in this case that men and women have different sci-fi preferences.

If the Chi-square value is less than the critical value then there is no significant difference. The amount of difference between expected and actual data is likely just due to chance. Thus, we conclude that our sample does not support the hypothesis of a difference.

In this example, the critical value at the 99% level is 6.6. The Chi-square value was 11.6 which is larger than 6.6. Thus, there is a significant difference in sci-fi preferences between men and women in our sample. We conclude that based on this sample, men generally strongly prefer Star Trek (85% of men responded in this category) whilst women were more equal in their preferences with a near 60/40 split. You can see this is the original raw data.

Generally speaking, your chosen software package will give you a ‘p-value’; this is the probability that the Chistatistic is down to chance alone. If your ‘p-value’ is less than 0.05 then the Chi-square statistic is significant at the 95% level, if it’s less than 0.01 then it’s significant at the 99% level and so on.

WARNING!!

We have not proven anything!!! These first samples might be atypical. Repeated sampling

may show a significant difference, or eliminate the difference we thought we saw. Because of this uncertainty, we can only say that the hypothesis was supported or not supported, not that we have incontrovertible proof.

If you want to test your knowledge try this little nugget (which hopefully helps point to more healthcare related applications). Answers on a postcard to the usual address!

Survival figures for RMS Titanic by gender

Died

Survived

Men

680

168

Women

126

317

www.QualityObservatory.nhs.uk

If you’d like to develop your statistical skills further, drop us a line to see what the QO can do for you at info@qualityobservatory.nhs.uk

info@qualityobservatory.nhs.uk

6

Working with the Strategic Clinical Network

By Adam C. Cook A few issues ago I mentioned the importance of Strategic Clinical Networks and their various work streams. We at the Quality Observatory have been working closely with the South East Coast SCN on a whole range of projects. Elsewhere in this issue Rebecca has already detailed some of the interesting cancer work she has done, and here are a few more extracts from some of the other pathways that highlight the current thinking coming from this highly pro-active and engaged SCN. Paediatrics There has been much talk in paediatric circles around activity in 6 high volume conditions – Abdominal Pain, Asthma & Wheeze, Bronchiolitis, Fever & Minor Infections, Gastroenteritis/Diarrhoea & Vomiting, and Head Injury.

These 6 plus Urinary Tract Infections (UTI) have been shown to make up the bulk of activity for some of the younger age groups. Some of these conditions may well be very serious, however often they can be relatively minor, and therefore if admitted unnecessarily can be a drain on secondary care resources, and divert clinicians from where they are needed more. To look at this in more detail we have produced a dashboard and some maps showing admissions to secondary care for the 6 conditions plus UTI for patients under 5, who had a zero length of stay; this being the cohort that is most likely to have unnecessary admissions. In conjunction with this we looked at A&E data—looking at patients in the same age band who have been to A&E but have been discharged without either investigation or treatment. This provides a larger picture of where, in the system, these things are happening. This is the start of the work. Now that the SCN has this information they need to examine it and discuss with local clinical stakeholders how best to use the data in implementing changes to pathways, so that these children get the appropriate level of care, which is not at the expense of children with greater need.

This is not the only piece of paediatric work that is going on. There is a strand that is looking at the management of paediatric long-term conditions—asthma, diabetes and epilepsy. This work is looking at the cost and management of these conditions in secondary care with specific thought about transitioning these out into community settings and making sure that the best and most appropriate care for those with longterm conditions is available in the paediatric setting, so that the continued management of the condition into adulthood is not only appropriate but also resource effective.

Maternity There are many ongoing discussions around the building about a new online and interactive maternity

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7 dashboard. There have been many meetings now that have hammered out what metrics are to be used, how they are to be used and how we need best to present them. Agreement is being reached on this, and soon work will begin on that in earnest over the next few months. Watch this space—as this is a major piece of work, and we will be coming back to detail it in future editions of Knowledge Matters.

Cardiovascular There has been a lot of work going on around the Cardiovascular pathway. We have been working on the heart attack pathway focussing upon STEMI (ST segment elevation myocardial infarction) and Non-STEMI conditions. Particular interest here lies in the numbers of patients undergoing

these events and especially the subsequent management of this. So we have been looking at readmissions within 30, 60 and 90 days, and also if patients were transferred from one trust to another, some local trusts being specialised centres for STEMI. We looked at how quickly patients were transferred to a more appropriate setting. Expansion upon this detail was added around pacemakers, ablations and other intrinsic parts of the cardiovascular pathway.

Stroke

Ischaemic Stroke Activity - Percentage with Atrial Fribrillation

Source: Secondary Uses Service (SUS)

NHS Eastbourne Hailsham & Seaford CCG 30-Day Readmissions

Bed days

Admissions

Stroke has always been a pathway that has had a lot of focus upon it. This is unsurprising; it is a high volume, high cost, with high mortality pathway.

Clinical improvements and recommendations are numerous and varied and so the SCN are very interested in looking at all the available data to see where best practice is already happening, and where it needs improvement. This means looking at data across a number of sources. There are stroke relevant indicators in QOF and obviously the secondary care inpatient data is of huge value. More detail though is to be found in the Sentinel Stroke National Audit Programme (SSNAP) which has a huge range of indicators. We’re currently working on building a dashboard based on this using selected KPIs. Elsewhere on the stroke pathway we’ve looked at the influence of atrial fibrillation on stroke and how that has an impact upon the incidence and management of Ischaemic activity.

In-hospital Deaths

120%

Deaths with AF

Eastbourne, Hailsham, Seaford

12

KSS

80% 70%

100%

10

80%

8

50%

60%

6

40%

40%

4

20%

2

0%

0

60%

30% 20% 10% 0%

13/14 Q3

12/13 Q4

12/13 Q1

11/12 Q2

06/07 Q1 06/07 Q3 07/08 Q1 07/08 Q3 08/09 Q1 08/09 Q3 09/10 Q1 09/10 Q3 10/11 Q1 10/11 Q3 11/12 Q1 11/12 Q3 12/13 Q1 12/13 Q3 13/14 Q1 13/14 Q3

0%

10/11 Q3

10%

09/10 Q4

20%

09/10 Q1

30%

08/09 Q2

40%

Beddays with AF

07/08 Q3

50%

40 100% 35 90% 80% 30 70% 25 60% 20 50% 15 40% 30% 10 20% 5 10% 0% 0

06/07 Q4

Admissions with AF

60%

06/07 Q1

70%

1400 100% 90% 1200 80% 1000 70% 60% 800 50% 600 40% 400 30% 20% 200 10% 0 0%

Readmissions with AF Eastbourne, Hailsham, Seaford

6 5 4 3 2 1 0

PbR Tariff

Tariff with Af

7

Eastbourne, Hailsham, Seaford

KSS

£180,000 £160,000 £140,000 £120,000 £100,000 £80,000 £60,000 £40,000 £20,000 £-

There are many others areas of work that the SCN is covering—I’ve been working up some projections on adult obesity recently, and there are projects around diabetes, renal disease and mental health in the pipeline. As new thoughts and ideas and ways of viewing data come out of these, we will be sure to feed back on this.

www.QualityObservatory.nhs.uk

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8

Better Care Fund

By Nikki Tizzard, Information Analyst In June 2013 the government announced the £3.8 billion Better Care Fund, designed to integrate spending between the NHS and council social care. The intention is to build on existing work being done by CCGs and councils to significantly expand the care provided in community settings. It is hoped that the funding will help drive better integrated care and support for the ageing population, not only helping to manage existing pressures but also improve long term sustainability. CCGs and councils have been tasked with developing a joint plan for supporting adult social care services, where there will also be a health benefit. Taking into account existing commissioning plans, they must agree where the funding will be best spent and what outcomes are expected. The effective use of data from both healthcare and local government is essential for establishing baselines at the outset and evidencing achievement in the future.

The QO have become involved as part of our ongoing support to Surrey Heath CCG and have started working closely with Surrey County Council to build and implement the required plans. A specific BCF Metrics Group has been formed with representatives from across the county to focus on establishing and delivering measureable outcomes.

Several nationally agreed metrics have been identified which must be incorporated into the joint plan: 

Permanent admissions of older people to residential and nursing care homes



Proportion of older people who were still at home 91 days after discharge from hospital into reablement/rehabilitation services



Delayed transfers of care from hospital



Avoidable emergency admissions



Patient/service user experience (a national measure specific to integrated care is currently being developed, so for now this can be an existing metric or BCF groups can develop a new one).

An additional, locally chosen measure is included as well, perhaps an existing one from any of the Outcomes Frameworks or another suitable metric that meets the given criteria.

Data sharing across organisations will be done via use of NHS numbers to allow safe sharing across systems.

There are obviously challenges, such as the availability and timeliness of data or dividing the county into measurable geographic areas. BCF plans are submitted at a county-wide level, but data is also needed at a lower level so CCGs can be clear on their commitments. This is an issue where geographical footprints of county council districts and boroughs differ from those of the CCGs. Also, where a BCF metric is also included in other workstreams, we have needed to avoid a situation where an organisation ends up with two different targets for the same measure while still making sure the BCF target is appropriate.

A significant chunk of the BCF funding is directly linked to achievement of the desired outcomes, so all of the organisations involved are keen to make sure joint plans are robust from the outset. This means joint use of data and a collaborative approach towards determining where we are now, and jointly evidencing our progress.

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9

Strategic Clinical Network Cancer Dashboard

By Rebecca Matthews, Information Analyst The Quality Observatory have been working with the SEC Cancer Strategic Clinical Network to create a set of dashboards around the cancer care pathway. The first dashboard, which focuses on measures around cancer awareness and early diagnosis has been developed and sent out to CCGs and key groups for comments.

The first view on the dashboard has a number of CCG level measures. All of the indicators are shown on one page with a drop down box to select the CCG you are interested in. There is a second drop-down box which allows you to select a second CCG as a comparator, with the England figure also being shown on all charts.

The measures on this page include 2 week wait referrals, emergency admissions with cancer, conversion rate, routes to diagnosis data, uptake for national screening programmes and diagnostic imaging data. There is also a providerbased chart which looks at the latest National Cancer Patient Experience Survey data around the number of times a patient had to see their GP before being referred.

The second view of the dashboard is a subset of the CCG measures, but drilling down to GP Practice level for those measures where data is availa-

ble. The practice level charts also include the relevant CCG figure as an additional benchmark.

The final sheet of charts in the dashboard looks at the measures relating to cancer from the CCG Outcomes Indicator Set including mortality and survival rates.

The dashboard is still draft and plans for future development include the addition of staging data once this is available, also a set of charts allowing the user to compare all the CCGs for a selected measure.

Please get in touch if you have any questions or comments! Rebecca.matthews@qualityobservatory.nhs.uk

www.QualityObservatory.nhs.uk

info@qualityobservatory.nhs.uk

10

Getting web design right– things to consider!

By Aleksandra Bujnicka

“I’m really keen to get a website up to help support the new programme but really not sure where to start? Can you help me?”

Solution: Complexity 2/5 When considering a new website, at some point of the process of getting one, most people find themselves talking to a firm or a person specialising in designing web pages… As getting the design of your website just right is important - this is the very conversation that is worth preparing for.

Just like building a new house, building a new website requires some careful thought, planning and designing. As it is your website, the role of designer is to implement your idea. For this reason, the aim of the conversation you are about to have, is to give the designer a sense of what you are really looking for in your website, what you want to accomplish with it and how you want to accomplish it.

So, what are the things to consider before you talk to your designer?

You need to contemplate your approach to all of the required components of your “online hub”. Build the function first and let the design follow.

First of all, it might be reasonable to establish a few essential objectives for the website. The key information would be:



what type of website it is going to be – showcase for your organisation, information page, blog, shop etc.



who is the target audience – age, gender, socio-economic group



what’s the purpose of the site – to let others know what you do, to provide information, to get someone to do something, to impress the visitor, to sell services or goods



what is the user experience that you want people to have – professional, trendy-hip, socially engaged, animated etc.

Then, you need to consider your website or web page architecture:



Content Management System (CMS) – will your site need maintaining; who will manage and maintain the site, and how; do you need CMS that is easy to use and keep up to date



data collection – do you need a database-driven website (important when planning to collect information) or a “static” one – without database



site structure – try putting together a list of pages and sub-pages required for the website

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11 It is also necessary to reflect upon the style of the web page:



content design – are you able to supply text and photos for the website - knowing in advance how much text there is going to be on each page will help to decide on the amount of visual content needed to get the balance right



use of colour – what colours do you like or would rather avoid; what colour scheme would you want for your website – dark, light, bright, colourful…



logo/branding – will the website need to complement the existing branding and comply with related guidelines



page layout – do you have any preferences regarding where different elements on the page should go

Finally, to round up the whole process you might like to present examples of your favourite or least favourite websites. Try to find 3 websites similar to yours in terms of content and think what you like or dislike about them, then find an additional 3 sites which you like or dislike in terms of design, the look or the feel of them… or maybe with certain elements or aspects of them that are to your liking.

To sum up, the simple rules that might be worth keeping in mind while planning your website, which might help to get it just right, if followed, could be:



focus on user needs,



focus on quality content,



make it easy to navigate,



put the focus only on the essential elements of your website and get rid of the unnecessary



keep it simple and elegant

If, at some point in the future, you find yourself keen and ready to start an adventure with your own webpage and don’t know where to begin, need someone to give you advice or a hand with it – you could try the benefits of having the Quality Observatory Development Team working for you – it might be just the one you needed.

Have fun! ;-)

www.QualityObservatory.nhs.uk

info@qualityobservatory.nhs.uk

12

QO goes to Confed - Liverpool 2014

By Amit Chavda, Information Analyst The NHS Confederation Conference was an opportunity to network with other Commissioning Support Units, Commissioning Care Groups and other NHS and non-NHS bodies and companies. There are a vast number of opportunities available within the new NHS structure and it is evident that individuals are using innovative methods to solve problems within the NHS whilst working together.

NHS Confederation Conference is branded as one of the biggest NHS shows of the year and this was the first for the new CEO of NHS England, Simon Stevens. An inspiring speech was given about how we need to sustain the care patients deserve over the future years whilst battling the most sustained budget crunch since the Second World War. He indicated that too much time has been spent on analysing the challenges and there needs to be more focus on getting on with the job and developing the solutions for future healthcare.

Simon Stevens’ speech concentrated on the following 3 topics: 

Improving the sophistication of commissioning a focus on outcomes for patients and taxpayers



Accelerating the design of care delivery with greater local flexibility to meet the social care needs for the people we serve



Actively exploiting and embracing the fundamental transformations that are believed to sweep modern medicine

The three topics are presented in more detail on: http://www.england.nhs.uk/2014/06/04/simon-stevens-speech -confed/ NHS Confederation for the QO Tim Kelsey, 2014: BIG DATA REVOLUTION “we should think of data, not as some dry technocratic scientific clinical record base entity. We should think of data as a pooling of our collective wisdom and our collective experience of health care.”

Tim Kelsey indicates that there are pockets of health care which we just do not have any data on. For example, we are unaware of the number of patients that underwent chemotherapy and whether the chemotherapy had any benefit to the patient. This is something we do not have data on. In addition there is very little information about general practice, mental health services and there is next to nothing on social care.

This speech outlined the fundamentals of the importance of data as historically data has been used to judge instead of improve. It is the power of data that will allow us to improve, grow and energise the NHS system.

What does this all mean for the QO team? It means data will no longer be treated as Kryptonite for trusts and local health care bodies. It means that data will be used for what it was fundamentally designed for - to share good practice and aid evidence-based working.

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13

Letters to the editor(s) The virtual postbag is heaving with feedback after the last edition of Knowledge Matters. We’d like to thank our readers and encourage you all to feed back your comments and any ideas for future issues (and if you ever fancy contributing do drop us a line!). Here are a selection of comments and thoughts: Have just been enjoying the latest edition of KM which was full of useful material as ever. I have a couple of pieces of feedback for you.

The first relates to the article on rare events SPC. Right at the end, you mention Don Wheeler and his views on rare events charts. I haven’t read the article you quote but Don’s view about specialist SPC charts in general are that you should only use them if the assumptions used to create the control limits are valid for your data. This is why he advocates using XmR charts because they make the least assumptions about the data. I have successfully used XmR to plot both time between and cases between data.

The second relates to the super article on bar charts in Ask an Analyst. As well as the method described (which works just fine), there is an alternative. Place the values of interest in a separate column (as described) but replace them in the main column with a zero. Then use a stacked bar chart format (the only time a stacked bar chart is useful in my view, but that’s quite another story) which avoids the need to fiddle around with overlapping columns.

-Mike Davidge, Director, NHS Elect and Head of Improvement Methodology, 1000 Lives Improvement Service (NHS Wales)

Thanks very much for your letter Mike; we’d be really keen to hear from anyone else who has used XmR charts in this way. The assumptions and techniques behind many of the specialist SPC charts can sometimes prove hard to grasp so being able to use the XmR as an SPC ‘swiss army knife’ would be great!

I think the appropriate usage of stacked bar charts could be the subject of a whole future edition of Knowledge Matters! - Ed.

Just wanted to say, I am very impressed with the elearning you’ve put together (http://www.seqo.nhs.uk/ elearning/NHSST_Analytics/story.html), it is excellent and I’m sure will be of help to a lot of people. Well done!

- Jackie Smith, Informatics Development Manager, Developing Informatics Skills and Capability (DISC), HSCIC

www.QualityObservatory.nhs.uk

Thanks very much for your kind words Jackie.

We’re currently working on a whole suite of elearning tools to help bring the fundamentals of measurement for improvement to an easily accessible and, hopefully, fun platform! Watch this space! - Ed

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14

NEWS Latest CCG outcomes indicators published The latest Clinical Commissioning Group Outcomes Indicators were recently released by the Health & Social Care Information Centre. The indicators aim to provide information about the quality of health services commissioned and associated health outcomes. New indicators include: 

One-year survival from all cancers



Breast feeding prevalence at 6-8 weeks



Access to psychological therapies services by people from black and minority ethnic groups

For more information see: http://www.hscic.gov.uk/catalogue/PUB14298 Federation for the Health Informatics Profession BCS The Chartered Institute for IT, the UK Council of Health Informatics Professionals (UKCHIP) and the Institute of Health Records and Information Management are working to create a new Federation for the Health Informatics profession. Consultation on this proposal continues until October 2014. Three specific questions are being posed about the priorities for the Federation:



What is important to you?



Why is it important?



What are the best ways of involving you and your professional colleagues to make sure we get this right?

For more information see: http://www.ukchip.org/? page_id=5404 Moving….

The QO is pleased to (very quietly on the back pages, because we’re not ones to tempt fate) announce that we will shortly be on the move to our new premises– we’ll still be based in sunny Horley but our address and telephone numbers will change, hopefully by September. Make sure you keep in touch via e-mail and keep up with Knowledge Matters to see how the move is progressing!

info@qualityobservatory.nhs.uk

Sign up to Safety Sign up to Safety is a new national patient safety campaign that was announced in March by the Secretary of State for Health. It launched on 24 June 2014 with the mission to strengthen patient safety in the NHS and make it the safest healthcare system in the world.

The Secretary of State for Health set out the ambition of halving avoidable harm in the NHS over the next three years, and saving 6,000 lives as a result. This is supported by a campaign that aims to listen to patients, carers and staff, learn from what they say when things go wrong and take action to improve patient’s safety, helping to ensure patients get harm free care every time, everywhere.

The five Sign up to Safety pledges

1. Put safety first. Commit to reducing avoidable harm in the NHS by half and make public the goals and plans developed locally.

2. Continually learn. Make their organisations more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe their services are.

3. Honesty. Be transparent with people about their progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.

4. Collaborate. Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use.

5. Support. Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the progress.

The QO will be making a pledge very soon, will you?!

www.QualityObservatory.nhs.uk

15

NEWS Feedback sought on Code of Practice for Confidential Information The HSCIC is draft Code of Information2.

inviting feedback on its Practice on Confidential

Under the Health and Social Care Act 2012, the HSCIC is required to publish a Code of Practice.

Organisations that handle confidential information about the provision of health and adult social care in England are required to have regard to it, from GP practices and hospital trusts, to commissioners and research organisations.

BCS ASSIST mentorship programme Regular readers of Knowledge Matters will know how passionate we are here at the QO about professional development for folk in our line of work. In light of this, we are pleased to announce that BCS Assist (The Association for Informatics Professionals in Health and Social Care) will be launching a mentoring programme. The key aims of this programme are to help and advise ASSIST members with their continued professional development by developing specific skills and knowledge that will enhance their professional and personal growth. Mentoring will:

The HSCIC released a Guide to Confidentiality in Health and Social Care in September 2013 which provided citizens and health and care staff with clear, accessible guidance on the handling of confidential information3.

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The Code of Practice aims to complete the picture by providing good practice guidance to those responsible for setting and meeting organisational policies in this arena. It will help organisations to ensure that the right structures and procedures are in place to help all staff follow the confidentiality rules in the previously published guide.

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The HSCIC is inviting a wide range of stakeholders to read the draft Code available at www.hscic.gov.uk/cop and provide their feedback by 18 August 2014.

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Results of the feedback gathering will be published on our website and used to develop the final Code before its publication at the end of September 2014.

Help develop the next generation in health informatics

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Facilitate growth by sharing resources and networks Focus on the individual’s development as a whole

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Focus on professional development that may be outside an individual’s area of work/knowledge

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Enhance the skill set and knowledge about a specific issue Facilitate the sharing of expertise with others.

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Help the individual learn more about other areas within health informatics.

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Help the individual gain from the mentor’s expertise

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Help the individual develop a sharper focus on what is needed to grow professionally within health informatics

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Help the individual learn specific skills and knowledge that are relevant to personal goals ASSIST will aim to help members find a mentor/ trusted advisor. 9 members of the National Council will be able to provide one on one mentoring for an hour each month. Our National Council mentors have a wealth of knowledge and experience to share with you. If you’re interested in getting mentored, please get in touch with the BCS Secretary (c.l.sidile@bham.ac.uk").

www.QualityObservatory.nhs.uk

info@qualityobservatory.nhs.uk

SUZANNE – A farewell ode

Au revoir!

I know we all hate to say goodbye, But sometimes we really must, So we bid a fond adieu To someone in whom we trust.

Suzanne has kept us running smoothly, For more years than I can mention, But now she is retiring, I'll ask you to pay attention,

As Adam’s poem may have suggested, our long time team administrator Suzanne is leaving us for a life of leisure and a well deserved retirement.

The whole team, along with some old faces, gathered to send Suzanne off in style in the traditional way!

Because we come to praise her, And to thank her for her work, She's coped with all our craziness, But never gone berserk.

She's sorted out our diaries, Ensured we've been on time, Made sure we've filled the forms out, And kept us all in line She's gone beyond the call of duty, In screening out unwanted callers, And when we buy up extra tech, She's sorted out the orders.

Suzanne will now be leaving us, For a life of leisure, Extra time to spend with Fred, I'm sure that she will treasure.

We all thank you Suzanne,

Simon says…….

“It requires a very unusual mind to undertake analysis of the obvious” - Alfred North Whitehead

for being our administrator, We will all miss you so, You couldn't have been greater!

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: Central Southern Commissioning Support Unit E-mail: info@qualityobservatory.nhs.uk To contact a team member: firstname.surname@qualityobservatory.nhs.uk