Knowledge Matters Vol.9 Issue 1

Volume 9 Issue 1 April 2015 Welcome to Knowledge Matters Come back in time with me, if you will, to the autumn of 1978. The BBC were showing a history of science presented by James Burke—my dad was watching it, as was the 7 year old me (although if I’m honest I probably wasn’t understanding too much of it!) However one thing that James Burke said hit a chord with me, and I had as much of an epiphany as any 7 year old can have.

“The only thing constant is change.”

It may not be particularly revelatory or profound, but it is true—and never more so than within the NHS. Every few years new governments, new policies and new ministers make themselves known and make changes to structure, funding and priorities, and yet the NHS has to carry on making patients lives better. Even during the election time we still carry on doing what we can, and will do so afterwards too. Change is inevitable, and even if exactly the same government came back into power there is bound to be changes so the best that we can do is prepare ourselves for that change, and make our votes count.

This issue of Knowledge Matters, produced in purdah, contains no subliminal political messages or inducements to vote for any specific party. What is contained therein is the usual mixture of knowledgeable articles, geeky guidance and NHS news.

We have an article on how cancer data is being made accessible, and what goes on behind the scenes of the Friends & Family Test dashboard. We look into what goes on in the Mary Seacole programme, and Atlas of Variation for the Patient Safety Collaborative.

All of these things are the result of change, and all will be subjected to change in the future – so get it now while it’s current!

Inside This Issue : Making Cancer Data Accessible

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Behind the Scenes of the FFT Dashboard

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The Mary Seacole Pogramme

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The Kent Surrey & Sussex Patient Safety Collaborative Atlas of Variation

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Ask An Analyst—Finding Hidden Links

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News

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Making Cancer Data Accessible—West Midlands Strategic Clinical Network James Gillies, Project Lead—Cancer Early Diagnosis James.gillies1@nhs.net http://www.wmscnsenate.nhs.uk/ In Volume 8, Issue 1 (April 2014) of Knowledge Matters http://issuu.com/secqo/docs/kmv8i1/6 Rebecca Matthews opened her article by saying “At first glance, cancer data can be tricky to find and access”. I couldn’t agree more. And what’s more, when talking with CCG and NHS England Commissioners, Cancer Clinicians, Cancer Mangers and Area Teams it becomes painfully clear that this is a commonly held view. This has clearly been too big a hurdle for most people to jump and the wealth of cancer data has remained unused, well at least over the last two years. So with the help of Rebecca at the Quality Observatory, I set out to highlight to our wider cancer network what data is available and to make it as accessible as possible to them. I explore a selection of the tools developed below.

CCG Cancer Dashboard The first workbook developed by Rebecca was a cancer dashboard developed for our CCG Cancer Commissioning Colleagues. They stated that having to visit numerous sites for data often prevented them from doing so, and even when they did, they were unsure of how to interpret the data. So inspired by a dashboard developed for the South East Coast Strategic Clinical Network (SCN) we set out to use data extracts from all the sources highlighted by Rebecca in her article last year. In reality, the key source was the National Cancer Intelligence Network Cancer Commissioning Tool www.cancertoolkit.co.uk.

I wanted to place all available CCG relevant data in a single workbook with data items clustered together in themes and searchable by CCG and tumour. To provide some context, data for the selected CCG was presented as a time series plot. In addition, the latest available data item was plotted against the 10 most similar CCG’s, all West Midlands CCG’s and in a funnel plot to visualise variation. Version 1 of the dashboard was shared with CCG’s and following feedback from the end users a much revised version 2 was delivered by Rebecca during March 2015.

I’ve already received very positive feedback on version 2 and we know the dashboard has been used to raise the profile of cancer and cancer data within a number of CCG’s.

Now we have all the data in one place and visualised, our next task is for the cancer network team to support CCG’s to make the most of it when planning services for their population. That is this year’s job.

SPC Analysis of Cancer Waiting Times Data Towards the end of 2014 Strategic Clinical Networks across the country were asked to support efforts to improve cancer waiting time (CWT) performance. Coming from a service improvement background I wanted a way to understand how systems across the West Midlands were performing to deliver the CWT targets. The use of statistical process charts (SPC) would allow the cancer team to identify systems that had always struggled to deliver the targets but also those with a record of strong performance.

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Impressed by version 1 of the CCG Cancer Dashboard, I approached Rebecca to deliver such a dashboard. Analysis is presented across two tabs; the first provides a performance dashboard view across all targets. The data can be queried by tumour and provider.

The second tab contains the SPC analysis and again is searchable by tumour and provider.

This workbook has been shared with NHS England colleagues to inform discussion around recovery plans, and the use of SPC was greatly welcomed. We have also shared the workbook with CCG’s. However, what became clear is that we need to undertake much more work to highlight the value of using SPC as a way to understand system performance and improve quality, both within trusts and CCG’s. For the cancer network team, this dashboard has already proven invaluable with planning the coming year’s work programme. We have not only been able to confidently identify particular systems that are and have always struggled to deliver the targets but the tool will also enable us to monitor improvement progress.

Cancer Service Profiles A third tool in development is tumour specific service profiles. The West Midlands SCN, has a network of tumour specific ‘Expert Advisory Groups’ (EAG). Membership on each EAG is drawn from clinical teams, ideally with representatives from each of the tumour specific MDT’s around the region as well as patient representation. These groups have an overview of issues related to their particular tumour and use their clinical expertise to support commissioners. Based on the NCIN service profiles and the London Cancer Alliance Pathway Metrics, our service profiles are being developed to provide EAG’s with the latest available service level data. We have been particularly keen to include data available on the Cancer Outcomes Services Dataset (COSD) www.ncin.org.uk/collecting_and_using_data/ data_collection/cosd. I am also working with the EAG’s to explore possibilities to define data items drawn from Hospital Episode Statistics (HES) and the Diagnostics Imaging Dataset (DiD) that could provide additional markers of quality outcomes.

The service profiles differ from the tumour specific data available in the CCG Cancer Dashboard as they describe different populations and illustrate variation in treatment quality and access between providers in the region. Of course EAG’s can use any of the dashboards developed by Rebecca to highlight and address variation by working within their employing trusts and collectively by supporting commissioning decision making.

To date only the Head and Neck cancer service profile has been developed and that was shared with the EAG shortly before Easter. I am awaiting feedback so Rebecca can make amendments to the data items included. Several more profiles are currently in development. As the service profiles draw heavily on COSD, I have arranged for the Public Health England Cancer Registration Team to present at EAG meetings to raise awareness of COSD, the importance of clinicians owning their own COSD data and data completeness.

Over the last few months Rebecca has delivered a number of extremely valuable tools that have allowed me to highlight the wealth of cancer data available. And through the clever design of interactive workbooks, she has made that data more accessible to the wider cancer network. The next step is to ensure that data is being used to its full potential to improve cancer services and outcomes for patients across the West Midlands.

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The Kent Surrey & Sussex Patient Safety Collaborative Atlas of Variation by Kate Cheema Here at QO Towers we have a bit of a bee in our collective bonnet about measuring stuff effectively and meaningfully.

This is critical if we as a wider system are going to prove that we have made a sustainable improvement to patient outcomes, experience and safety.

The Quality Observatory is therefore delighted to be working closely with Kent, Surrey & Sussex AHSN to help measure the impacts (among other things!) of their Patient Safety Collaboratives. Patient Safety Collaboratives have been developed in response to The Francis Enquiry into patient deaths at Mid Staffordshire NHS Foundation Trust and the Berwick review into patient safety, two major reports that highlight how basic safeguards breaking down or being ignored can lead to tragedy.

Measurement has been identified as a workstream that underpins every successful Patient Safety Collaborative and we’re keen to make sure that each and every clinical priority area has support in measuring and evidencing their improvement work.

We also want to raise the awareness of measurement as an important and integrated workstream in its own right and one of our first steps on the road to this is to develop an ‘Atlas of Variation’ (yes, we stole the name shamelessly, why reinvent wheels!).

The idea of the atlas is to make high level measures for all the PSC priority workstreams available to view so that everyone can understand how we are currently measuring progress. The atlas supports inquiry into two key questions; “Have we made an improvement?” and “What is the variation across Kent, Surrey & Sussex?”.

There are some key principles that go along with these, namely: • Measurement will be undertaken with a true ‘measurement for improvement’ ethos. On this basis we use statistical process control plots to visualise the data, alongside elements of RAG which is

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We must ensure that any measurement approach clearly harnesses the power of our existing data sets as well as opening up possibilities for the development of new collections. In other words, use what we have now, don’t wait for new data to come along. ‘Perfect’ is often the enemy of ‘Good’ and that is nearly always true when it comes to ideal data sets.

With these questions and principles in mind we have created three views of measures for each workstream. These are:

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Maps: a series of maps that show the variation between providers or CCG geographies across the KSS PSC footprint.

Time series: Helping us to answer the question ‘are we making an improvement?’, time series analysis, generally in SPC or run chart format, helps us to understand how measures have changed over time Variation: Alongside the maps, this part uses funnel plots to help us answer the question ‘what is the variation across Kent, Surrey & Sussex?’

This is very much a first step; we want the atlas to be organic and grow with PSC rather than be a static resource. As each clinical workstream of the PSC develops measures, their sources are likely to change and the atlas will be updated accordingly to reflect latest thinking. We hope that over time the atlas will become a one stop shop for people wanting a high level view of where and how measurement is used in the PSC and gain a broad understanding of progress and variation.

As always we’re keen to hear your views and ideas for improvement.

Have a look at the atlas at atlas.kssahsn.net and drop your comments to the usual address.

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Behind the Scenes of FFT—Maintaining a Data Collection Rebecca Matthews—Specialist Analyst What could be simpler than collecting a bit of data? Decide what you want to collect and by when, put a bit of technical guidance together and wait for your data to roll in! Well here at the Quality Observatory we’ve become very familiar with how much more to it there can be, through our involvement with the Friends and Family Test collection.

As well as the monthly data collection and reporting, one of our tasks is managing the national helpline and inbox for the FFT, so we get to see first hand all of the issues and challenges that organisations face when collecting their data and have been able to illustrate that in our weekly dashboard that we use to monitor the queries that come in.

The dashboard looks at the number of queries received in that week and cumulatively monitors: • Total queries by category • Totals by organisation type • Percentage closed within the week • Numbers in each category to date, in latest month and that week • Numbers by organisation type to date, in latest month and that week • Totals by organisation type, showing the split between emails and phone calls.

From the dashboard it’s easy to highlight key times in the data collection, which are reflected in the type and numbers of questions sent in.

The small bump in the totals in July shows when the new guidance was released—with the majority of the ‘huge’ (as we thought at the time) number of queries coming in from NHS Trusts. No surprises there as these were

the only organisations submitting data at the time.

Moving on a few months and queries to the inbox and phone line have been dominated by GPs and dental practices—look at the chart on the right and spot the week that dental practices were asked to complete an FFT readiness questionnaire then the week that the FFT starter packs for dentists were being sent out.

The 64 queries we received for the week of 25th July last year now seem somewhat insignificant compared to the volume we are receiving at the moment (the record is currently 424, received in one week in March 2015.

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Looking at the same chart, this time filtered for GP practices, and again it is easy to spot when the first data from these organisations was being looked at: Of course, a lot of this can be attributed to the number of new organisations starting to undertake the Friends and Family Test: thousands of GP practices and dental practices compared to mere 100s of NHS trusts, but monitoring the questions coming in to us does illustrate that rolling out the Friends and Family Test to primary care presented very different challenges to those faced by NHS Trusts, maybe because NHS Trusts are already very familiar with having to submit monthly data returns? E.g. when completing their FFT readiness questionnaire dental practices were asked to submit their location ID—a number of practices needed advice on how to find this and instructions on how to do this have been made available on the BSA website.

Where we have questions that come up repeatedly, or which raise points not already included in the guidance, we make sure that these are fed back to NHS England with a view to be being included in the Friends and Family Test FAQs. One question that has been raised by our analysis of the FFT queries, and which we haven’t found an answer for yet is why dental practices are so much more likely to make a phone call than other organisations?

The chart on the dashboard which shows the split between phone and email queries shows that in general, dental practices seem to prefer to make a phone call than send an email. For all other organisations, email is definitely the preferred option.

Our analysis of the FFT queries we’ve had to deal with only looks at some of the issues that have arisen around the monthly data collection and can’t begin to touch on the huge amount of work that went on beforehand to get the data collections finalised, tested and in place for a huge variety of organisations, but has definitely helped to give an idea of what sort of things need to be thought about when setting up a data collection and rolling it out to NHS organisations.

Please get in touch with any comments or queries! rebecca.matthews@qualityobservatory.nhs.uk

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Finding Hidden Links Application:: MS Excel 2010 Dear Ask an Analyst I am creating a number of Excel workbooks (in Excel 2010) with the same format but covering different data. As each has the same format I am using the previous workbook as a template for the next one. These are being sent to external people so need to be standalone files, i.e without any links to other sources or files.

Each of the files has a number of tables and charts on different tabs and I have been deleting all of the data from the previous tables and charts before populating with the new data. However in the latest workbook there still seems to be something that is linking back to a previous file. I’ve been through all of the formulas and chart series and can’t see anything that has an external link. Any ideas on how to find this?

Solution: Complexity 1/5 — searching in Excel, named ranges and add-ins Thanks for asking us—this is one of those annoying little things that should be very simple, but can be elusive!

If you are sure that none of your data should be linked to an external source you could just break the link by going to Data—Edit Links then clicking on the ‘Break Link button. This will ensure that any links that are in your spreadsheet will be converted to values. This removes the problem of having a link to an external source, but won’t show you where the links are and won’t highlight if you’ve still got something linked that shouldn’t be.

You say you’ve already looked through all of your formulas for any external links, but the first thing to do would be to double check if there are any obvious ones still in your file. You can do this by clicking on the ‘Find and Select’ button on the Home tab. Under ‘Find’ if you click on the ‘Options’ button you will be able to choose to search the whole of the workbook and not just within the selected sheet. You can also choose to search formulas within the workbook. As the link will be to another Excel file, you can just type ‘.xls’ (without any quotation marks) into the ‘Find what’ box and this should pick up your links. You can of course search for the whole filename if you know this and what to search for a specific link.

If this picks it up, you can choose the best way to deal with it—paste the data as values, link to data within the same workbook or whatever you want!

However if you’ve already had a good look through your workbook then it’s quite possible that this won’t pick up anything. There are a couple of other things you can try though.

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One other possibility is that the link is contained within a defined name within the workbook. You can check if you have any defined names and also see the ranges they referred to by going into ‘Formulas’ then clicking on the ‘Name Manager’ button.

If you see any references to external sources in the Name Manager list here, or any references that have errors, then you can delete these here. This will ensure that you no longer get a prompt to update external links when opening the workbook.

If this too fails to pick up your link in your workbook then the final thing to try would be to download an add-in for Excel which will pick up all hidden links. One example is the ‘FINDLINK’ add-in which can be downloaded here http:// www.manville.org.uk/software/ findlink.htm (although others will also be available). The web page gives instructions on downloading and installing this in a number of different versions of Excel from 2003 onwards.

Once installed you can click on the addin name (on the Add-Ins’ tab), choose what link to search for and how you want to deal with it if you find it (e.g. prompt for each individual link or just delete the links as they are found).

Using an add-in such as this should ensure that all external links are removed from your workbook and you will be able to send the file to anyone outside of your organisation and they will be able to open it without getting messages to update the links or errors within the workbook.

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The Mary Seacole Programme

By Kate Cheema Back in the mists of time (well, 2013) the NHS Leadership Academy published details of their new programmes for leadership development. The idea was to provide a programme for every level of responsibility, and bring some of the elements of the recommendations made by the Francis and Berwick reports (among others) into structured learning and development for all NHS staff. So I looked down the list and alighted on the ‘Mary Seacole Programme’ just one of a dazzling array of options which promised to provide world class content and supported learning. The programme itself was to take one year and lead to a postgraduate certificate in healthcare leadership, with a tutor group as the main supporting unit in terms of learning and exchange of ideas. All content was delivered online, with the exception of three day-long workshops which would enable participants to explore ideas and concepts through practical exercises and group work.

Brilliant, sounds like a plan.

FAST FORWARD 14 MONTHS “It seemed like a good idea at the time!” a member of my tutor group opined in the group forum at somewhere around midnight, two days before the final deadline for submission of our ‘examinable component’.

It had been quite a journey. There had been no lack of challenge and for me, a jobbing information analyst, considerable insight into how other parts of the NHS operate and the commonalities we have in driving forward change and improvement. The programme undoubtedly provided us with tools, ideas, concepts and techniques that we could apply both in practical leadership situations and use to reflect on our own personal style and development.

The benefits were manifest. But, as my tutor group colleague alluded to, the commitment to development had to be on both sides of the equation.

The Academy had committed to us, and we had to commit to the programme which meant (in practical terms) late nights, discipline and a dusting off of ‘how to structure an essay’ guidance.

But it was worth it, and we felt an enormous sense of achievement as we graduated in April 2015.

Personally, I have taken a lot away from the programme, even without realising it, and am grateful to have had the opportunity to dip my toe into such a huge pool of knowledge and learning. But by far the greatest benefit has been to meet people in a similar place to me and be part of a community that will continue to support and learn from each other, long after the final certificate was awarded!

If you think you’d benefit from the Mary Seacole or other Leadership Academy programmes check out http:// www.leadershipacademy.nhs.uk/programmes/

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NEWS Bye, Bye Choose and Book In keeping with our theme of change Choose and Book is changing to a new e-referral system which aims to make referrals smoother and easy for both clinicians and patients. For more information follow this link:

New Office!

After two years, many false starts, and a series of setbacks and mishaps, the Quality

http://systems.hscic.gov.uk/ers

QO Birthday!

Rebecca recently celebrated her birthday—and here she is celebrating with traditional QO gifts. All much needed as Rebecca and her team have had a very busy couple of months as the Dental Friends and Family Test went live in April. The team have had a very active time fielding calls and requests.

Observatory has finally moved into their new offices*. We’re still in Horley, but we’ve moved across the road to The Gables, where we have

++++STOP PRESS+++++ New Government Some things take us by surprise, and whilst preparing this issue we were expecting there to be days of wrangling of how a coalition would be made up—but instead there’s been an outright majority and we now have a Conservative government. At the moment we’re still not sure how this will affect us—but I’m sure it won’t be long until we find out what’s in store.

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taken up residence in the back half of the ground floor. As well as space for the whole team we’ve got two bespoke meeting rooms (named Enterprise and Voyager!) There’s still a few bits of unpacking to do—but we’re settling into our new spacious accommodation quite comfortably.

*Nearly all—there’s still a couple of souls hanging on in at York House whilst we make the final move of data and software.

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New Starter at the QO! Welcome to Liam Blaney Hello there! I’m Liam, and I am the Quality Observatory’s latest newbie, having joined in March 2015. This is my first job with the NHS, having previously worked as a Stock Controller for a Tax Refunding company.

My primary role here will be assisting the team with the Friends and Family Test service. What have I let myself in for?!

Election Poem It has been brought to my attention, That there is a general election.

Time again to mark the paper with a cross, Time again to appoint the next big boss.

Got to look at policies, start comparing manifestos, Just Like choosing between Sainsburys, Asda and Tescos.

We've listened to the promises, and what they'll do for us, See them on the campaign trail, in a battle bus.

The future of the government is resting in our hands.

Go and cast your vote as your conscience demands.

The polls are on a knife-edge, the swingometer has swung, Will there be a majority or will parliament be hung?

The votes are cast, ballots posted, results in dispatch, And we all wait and hope the next lot are up to scratch.

Fascinating Facts The UK has had 13 Prime Ministers who took office without winning a General Election.

These include such luminaries as Winston Churchill, John Major and Gordon Brown.

Call for articles Are you using information in exciting and innovative ways? Is information core to your new project transforming patient care? Do you know any neat tips and tricks that can help with data presentation and analysis? Or maybe you just want to let the world know that you’re there and shout out about your good work. If so then you could write an article for Knowledge Matters—just contact us at the e-mail address below. We’d love to hear from you!

Knowledge Matters is the newsletter of 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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