New Look Coming soon… The Quality Observatory, South East Coast Strategic Health Authority quality.observatory@southeastcoast.nhs.uk nww.sec.nhs.uk/knowledge
INSIDE THIS ISSUE 2
Research into practice
3
Paired HRG Tool
3
Stroke dashboard update
4
Safety in numbers
6 7 8
Page from the Patch HPSU Staff survey Skills Builder – the Data Driving the Dashboard
10
From here to maternity…
11
A : Ask an Analyst
12 13
3
Length of stay benchmarking tools Linking post-coded data to a higher geography
14
News
15
Data Quality Update
16
Events & Quick Quiz
Fascinating Fact You would expect there to be more Birth records than Delivery records. So it’s concerning that in the 11 months Apr 08 – Feb 09 that nationally, in SUS, there were 529,083 deliveries, but only 498,209 births.
April 2009 Volume 3 Issue 1
Welcome to Knowledge Matters By Samantha Riley
Welcome to the first issue of volume 3 of Knowledge Matters – it’s hard to believe that’s it’s our 2nd birthday and that our very first edition was published in May 2007! Since the February issue, the results of the recent consultation on clinical quality indicators have been published. The aim of the survey (undertaken by the NHS Information Centre at the end of 2008) was to begin identifying existing quality indicators currently in use within the NHS. The report sets out the results of the survey of around 400 indicators and identifies the 290 indicators that received a very high endorsement score (see page 14 for how to obtain a copy of the full report). The Quality Observatory are now considering the best way in which we can publish benchmarking information for this broad range of indicators and I would be keen to hear views from clinicians with regards to how we can best undertake this function. Along side this, we are working with colleagues across the SHA to consider the implications of the Healthcare Commission’s investigation into Mid Staffordshire Foundation Trust and how we might adapt elements of our analysis and benchmarking to reflect the lessons learnt. Again, I would be keen to hear your ideas and suggestions on this topic. In this issue you will read about a number of new tools that have been developed which benchmark length of stay and differences in the ratio of coding for different HRGs. Over the coming months, we are keen to design a range of additional tools which evidence the variation in efficiency and productivity and makes the critical links to quality of care - quality and efficiency need to be viewed hand in hand. A number of Trusts and PCTs have invited me to meet key staff groups to discuss the Quality Observatory, describe what our function is, the information that is currently available and all importantly the type of information that is required by the local NHS. I am more than happy to come and visit teams across the patch and will also be setting up quarterly Quality Observatory workshops which will provide an opportunity for on-going dialogue, discussion and information sharing. I’d like to finish with some really good news. The CHKS awards took place earlier this week. Six Trusts from South East Coast were in the top 40 hospitals. Medway NHS Foundation Trust also received the ‘Most Improved Hospital’ award. This award rewards continuous improvement in clinical effectiveness, efficiency, health outcomes and quality of care, and is presented to the Trust showing the most significant improvement across all of the 40 Top indicators. I’ll see you in June if not before! Samantha Riley
Knowledge Matters
Page 2
Helping to get research into practice for Quality Improvement Ben Skinner – Evidence-Based / Knowledge Management Librarian, Brighton & Sussex University Hospitals NHS Trust
In around about 1960 the first randomised trial was conducted on the effectiveness of thrombolytic therapy for reducing the risk of death after myocardial infarction (MI). The study seemed to show that thrombolysis reduced your chance of dying by about half, but with only 23 participants the trial was far too small to be conclusive. By the early 1970s nine more studies had been done, encompassing 2,500 participants in all. At this point, if anyone had thought to combine the results of these trials, they would have confirmed that patients on thrombolysis were indeed much less likely to die, and that now, this was conclusive. The likelihood that this association had simply occurred by chance, with so many patients under investigation, was less then 1 in 100. Unfortunately, such a comprehensive search and synthesis of the research literature was not done. At this time, eight out of ten review recommendations did not mention the use of thrombolysis in the treatment of MI, with the other two recommending it only under experimental conditions. What is more, researchers themselves failed to identify this result, and over the next twenty years a further 60 trials were conducted to answer exactly the same question. In 1986 a synthesis of these trials would have shown that the likelihood of thrombolytic therapy not being effective was less than 1 in 100,000, and yet only 5 out of 10 reviews recommended its routine use. This story is not an isolated case. The history of medical advance is littered with examples of demonstrably effective treatments taking years to become routine practice, or, perhaps worse, ineffective and dangerous treatments being adopted too readily. Today, NHS staff wishing to improve the quality of local services should bear this in mind when making decisions. Service development must begin and end, of course, with a look at local evidence from audits, surveys and organisational datasets, to identify those processes that are underperforming, and eventually to determine whether service changes have had a positive effect. But once you know which process needs to be improved, discovering how to do so involves broadening your investigation to the wider research literature. NHS library staff are experts at finding published evidence on the effectiveness of treatments, on different models of service delivery, or on anything else related to patient care. Outcome of BSUH Literature Searches Improved quality of life for patient and /or family Audit or standards of care Revision of treatment plan Minimisation of risks of treatment Identification / evaluation of alternative therapies Confirmation of proposed therapy Differential diagnosis Recognition of abnormal or normal condition Choice of diagnostic test 0%
5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
The library team at Brighton & Sussex University Hospitals carried out over 700 literature searches for local staff in 2008, impacting on guideline and policy development, business planning, and more. In our special care baby unit, evidence we provided on the efficacy of prophylactic antifungals led to a change in practice and rewrite of their guidelines. In A&E we showed that sterile gloves are not necessary in laceration repair, leading to a significant cost saving. Dietary information sourced by our team was used to develop a conference for breast cancer survivors, the first of its kind in the UK, and we also helped to support a business case for a specialist cancer dietician.
Quality improvement requires expertise in information analysis, but it requires expert information retrieval as well, and NHS librarians should be involved in (and funded to support!) service development locally. The impact we can have on safety, effectiveness and cost-savings is vast. To get in touch with your nearest library service, see http://www.hlisd.org/
Do you have something you would like to contribute to Knowledge Matters? Please contact us!
Knowledge Matters
Page 3
Paired HRG Benchmarking Tool Simon Berry, Specialist Information Analyst
Within HRG3.5 there are a number of codes that are paired, split between simple and complex / elderly, an example being E35 – Chest Pain > 69 years old or with complications E36 – Chest Pain < 70 years old without complications. These HRG codes can have significantly differing tariffs and analysing the proportion coded between the simple and complex forms can highlight data quality issues or changes in coding practice. In order to do this analysis I have created a dashboard that provides a quick an easy overview for all South East Coast Trusts showing the proportion of the spells coded to the complex half of the pairing. In addition, and to put the results in context, the charts show the number of spells and a comparison with all SEC trusts together. A higher level view is also included by HRG chapter to allow a quick overview of areas of interest and to aggregate HRGs where volumes are too small and variability is too high to identify any trends. To use the tool simply select the HRG pair or HRG chapter from the drop down box, when an HRG pair is selected the box at the top left shows the two HRG codes and the latest PbR tariff for those codes. Proportion of Paired HRGs Coded as Complex
HRG
Elec Non Elec
A - Nervous System Sussex BSUH
RSC
RWS
200 100
0%
WASH
08/09 Q3
08/09 Q1
07/08 Q1
0
M&TW
07/08 Q3
0
300
10%
06/07 Q3
100
0%
08/09 Q3
08/09 Q1
07/08 Q1
07/08 Q3
06/07 Q3
06/07 Q1
0
10%
20%
06/07 Q1
0%
200
05/06 Q1
100
20%
05/06 Q3
10%
200
400
30% 300
04/05 Q3
100
08/09 Q3
30%
04/05 Q1
20%
500
40% 400
300
04/05 Q1
08/09 Q1
07/08 Q3
06/07 Q3
07/08 Q1
06/07 Q1
05/06 Q3
SASH
500
40%
30%
600
50%
400
200
0 04/05 Q1
08/09 Q1
0%
08/09 Q3
07/08 Q3
07/08 Q1
06/07 Q1
06/07 Q3
10%
Medway
80%
900
80%
900
80%
900
80%
900
80%
900
80%
900
70%
800
70%
800
70%
800
70%
800
70%
800
70%
800
200 100
0% 08/09 Q3
08/09 Q1
07/08 Q1
07/08 Q3
06/07 Q3
06/07 Q1
0 05/06 Q1
08/09 Q3
08/09 Q1
07/08 Q1
07/08 Q3
06/07 Q3
06/07 Q1
05/06 Q1
05/06 Q3
0
05/06 Q3
0%
300
10%
04/05 Q3
100
20%
04/05 Q1
200
10%
08/09 Q3
08/09 Q1
07/08 Q3
06/07 Q3
0
20%
04/05 Q3
0% 07/08 Q1
08/09 Q3
08/09 Q1
07/08 Q3
0
100
06/07 Q1
0%
10%
05/06 Q1
100
200
05/06 Q3
10%
20%
400
30% 300
300
04/05 Q3
200
06/07 Q3
08/09 Q3
08/09 Q1
07/08 Q3
06/07 Q3
0
20%
07/08 Q1
0% 07/08 Q1
08/09 Q1
08/09 Q3
07/08 Q3
07/08 Q1
06/07 Q1
06/07 Q3
05/06 Q3
05/06 Q1
04/05 Q1
04/05 Q3
0
100
06/07 Q1
0%
10%
05/06 Q3
100
200
04/05 Q3
10%
20%
05/06 Q1
200
04/05 Q1
20%
30%
30%
500
40% 400
400
300
300
500
04/05 Q1
30%
30% 300
06/07 Q1
30%
600
50%
40%
40%
700
60%
600
500
400
400
60% 50%
500
40%
40%
700
600
50%
500
400
60%
600
50%
500
40%
60%
600
50%
700
04/05 Q1
60%
600
50%
700
05/06 Q3
60%
700
04/05 Q3
700
05/06 Q1
This tool is currently set up to look at HRG 3.5 activity, but as 2009/10 data becomes available I will be looking at how this could be applied to HRG 4 and similar coding issues arising in HRG 4.
05/06 Q3
0 04/05 Q1
08/09 Q1
100
0%
08/09 Q3
07/08 Q3
07/08 Q1
06/07 Q1
06/07 Q3
05/06 Q3
05/06 Q1
04/05 Q1
0 04/05 Q3
0%
10%
05/06 Q1
100
04/05 Q3
10%
20%
04/05 Q3
200
200
05/06 Q1
20%
20%
300
700
60%
600
500
40%
300
300
60% 50%
400
30%
30%
700
600
500
400
400 30%
800
700
50%
40%
40%
40%
70%
60%
500
500
800
600
50%
50%
70%
700
60%
600
600 50%
900
800
05/06 Q1
700
60%
EKH 80%
70%
04/05 Q1
800
08/09 Q3
70%
08/09 Q1
800
900
07/08 Q1
70%
80%
07/08 Q3
800
900
06/07 Q3
70%
D&G
80%
06/07 Q1
900
05/06 Q1
80%
05/06 Q3
900
700
Kent
ESHT
80%
04/05 Q3
Frimley 900
60%
A - Nervous System
05/06 Q3
ASPH 80%
04/05 Q1
Currently the dashboard covers up to Q3 2008/09, however, once complete data for Q4 becomes available the tool will be updated. The dashboard is freely available for download from nww.sec.nhs.uk/knowledge, if you have any questions you can contact me on simon.berry@southeastcoast.nhs.uk
Surrey
04/05 Q3
Spells - RH Axis Trust % Complex - LH Axis SHA % Complex - LH Axis
Stroke Dashboard update
The Stroke Provider Dashboard is now on general release. This dashboard was developed in conjunction with the Stroke Clinical Metrics group and the NHS Information Centre. It provides a quick overview of a Trust or Trust site across 12 key metrics selected by the group along with an overview of the site’s performance in the Phase 1 Stroke Sentinel Audit. The dashboard allows users to focus in on patients under 75 years old and whether or not to include diagnosis I60 – Subarachnoid Haemorrhage in the charts using simple check boxes and drop down boxes. Data is sourced from HES and from the Phase 1 Stroke Sentinel Audit and will be updated in a quarterly basis. BSUH - Princess Royal Hospital Stroke Dashboard - All Patients - ICD10 I61-I64 ASU RSU CSU
4 4 5
T
M
Sentinel Overall 08 vs 06
B
Exclude I60 - Subarachnoid Haemorrhage
Admissions
Mortality
40
40%
35
35%
% Patients With CT Scan / MRI Scan
Length of Stay (Days)
% Discharge Destination 40
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
20
40%
40%
15
30%
30%
UPR
CH / NH
Other Hosp
Died
All LoS UPR LoS
35
Other
Nat All LoS Nat All LoS UPR
25%
20
20%
15
15%
10
10%
25
10
20%
0%
7 Day
30 Day
Nat 06/07 7 D
Nat 06/07 30 D
Target
0%
Total Value of Activity 000's
Average Value per Spell 90%
£7,000
£250
10%
CT Scan CT Scan 01
20% 5
10% 0%
04/05 Q1 04/05 Q2 04/05 Q3 04/05 Q4 05/06 Q1 05/06 Q2 05/06 Q3 05/06 Q4 06/07 Q1 06/07 Q2 06/07 Q3 06/07 Q4 07/08 Q1 07/08 Q2 07/08 Q3 07/08 Q4
0
04/05 Q1 04/05 Q2 04/05 Q3 04/05 Q4 05/06 Q1 05/06 Q2 05/06 Q3 05/06 Q4 06/07 Q1 06/07 Q2 06/07 Q3 06/07 Q4 07/08 Q1 07/08 Q2 07/08 Q3 07/08 Q4
5%
04/05 Q1 04/05 Q2 04/05 Q3 04/05 Q4 05/06 Q1 05/06 Q2 05/06 Q3 05/06 Q4 06/07 Q1 06/07 Q2 06/07 Q3 06/07 Q4 07/08 Q1 07/08 Q2 07/08 Q3 07/08 Q4
5
30
0
% Stroke Patients Admitted from UPR & Discharged to UPR
04/05 Q1 04/05 Q2 04/05 Q3 04/05 Q4 05/06 Q1 05/06 Q2 05/06 Q3 05/06 Q4 06/07 Q1 06/07 Q2 06/07 Q3 06/07 Q4 07/08 Q1 07/08 Q2 07/08 Q3 07/08 Q4
30%
25
04/05 Q1 04/05 Q2 04/05 Q3 04/05 Q4 05/06 Q1 05/06 Q2 05/06 Q3 05/06 Q4 06/07 Q1 06/07 Q2 06/07 Q3 06/07 Q4 07/08 Q1 07/08 Q2 07/08 Q3 07/08 Q4
30
Most Recent 100 Patients Run Chart 250 Alive
Died
Unknown
Mean 21.3
UCL 101.0
80% £6,000 £200
200
70% £5,000 60%
£100
£4,000
50%
£3,000
40%
Days
150
£150
100 30%
Future developments for this tool include adding in the recent Phase 2 Stroke Sentinel Audit results and developing an entirely new Commissioner based view, these will be released in the coming month. The dashboard is readily available on nww.sec.nhs.uk/knowledge. If you would like to speak to me about the dashboard and future developments please do not hesitate to contact me simon.berry@southeastcoast.nhs.uk
£2,000 20%
£50 £1,000
10%
50 Site National
0%
19/02/08 08/03/08 17/03/08 28/03/08
21/12/07 08/01/08 14/01/08 22/01/08 29/01/08 09/02/08
27/11/07 01/12/07 09/12/07
23/09/07 27/09/07 11/10/07 17/10/07 22/10/07 25/10/07 01/11/07 04/11/07
17/07/07 27/07/07 02/08/07 07/08/07 13/08/07 22/08/07 24/08/07 04/09/07 07/09/07 13/09/07
26/06/07 29/06/07 07/07/07
13/06/07 15/06/07
0 09/05/07 18/05/07 22/05/07
04/05 Q1 04/05 Q2 04/05 Q3 04/05 Q4 05/06 Q1 05/06 Q2 05/06 Q3 05/06 Q4 06/07 Q1 06/07 Q2 06/07 Q3 06/07 Q4 07/08 Q1 07/08 Q2 07/08 Q3 07/08 Q4
04/05 Q1 04/05 Q2 04/05 Q3 04/05 Q4 05/06 Q1 05/06 Q2 05/06 Q3 05/06 Q4 06/07 Q1 06/07 Q2 06/07 Q3 06/07 Q4 07/08 Q1 07/08 Q2 07/08 Q3 07/08 Q4
£0
04/05 Q1 04/05 Q2 04/05 Q3 04/05 Q4 05/06 Q1 05/06 Q2 05/06 Q3 05/06 Q4 06/07 Q1 06/07 Q2 06/07 Q3 06/07 Q4 07/08 Q1 07/08 Q2 07/08 Q3 07/08 Q4
£0
Is there something that you wish you knew more about? To suggest future topics for knowledge matters contact the team
Knowledge Matters
Page 4
Safety in Numbers Martin Fletcher, Chief Executive, National Patient Safety Agency The National Patient Safety Agency (NPSA) was established in 2002 as a special health authority with a core function to collect, analyse and learn from information on patient safety incidents in England and Wales. We were joined in 2004 by the National Research Ethics Service and the National Clinical Assessment Service. For the purpose of this piece Iâ&#x20AC;&#x2122;m going to concentrate on the work of our national Reporting and Learning System. What is the national Reporting and Learning System? The national Reporting and Learning System (RLS) aims to help the NHS improve the safety of patient care. Our major focus is on using the information provided by NHS organisations to identify risks to patients across the NHS and opportunities to improve patient safety. In short, information from reported incidents helps the NHS understand why things go wrong and how to prevent them from happening again. The RLS is the first national-level patient safety incident reporting system of its kind in the world. It is something of which the NHS should be very proud. All healthcare staff in England and Wales providing NHS funded care can report patient safety incidents to the RLS. It provides comprehensive coverage of healthcare settings (acute, ambulance, combined, learning disability, mental health and primary care organisations) and supports direct reporting from patients. It is internationally unique. The first incident reports were submitted to the RLS in November 2003. By January 2005 all NHS organisations were linked to the national system. The NRLS database contains over three million incidents and around 80,000 incidents are reported by NHS staff each month. Ninety-nine per cent of the incidents reported to the RLS come through Local Risk Management Systems (LRMS) of NHS organisations. Electronic transfer of the incident reports mean that incidents reported once serve both local and national needs. We donâ&#x20AC;&#x2122;t collect information about patient or staff names. Regular feedback is provided on data collected by the RLS through data summaries and feedback reports to trusts. How do we learn from reporting? Every year, around 10,000 patient safety incidents resulting in death or severe harm to patients are reported by NHS organisations. Each of these incident reports are reviewed by expert clinical reviewers at the NPSA. Free text within the report is used to better understand the patient story and its clinical significance. This helps identify the contributing factors leading to the incident and wider system failures. If further information about the incident or underlying safety issues is required, the NPSA contacts the reporting organisation. Key reports are prioritised according to their importance for national learning and action, using robust criteria and decision processes. This happens at a weekly multidisciplinary meeting at the NPSA with a range of clinical inputs. Other potential safety issues are also considered from sources such as coronersâ&#x20AC;&#x2122; data and serious untoward incidents. We work with experts and NHS bodies to develop safety recommendations from providers of NHS-funded care to raise awareness of risks and inform local priorities and action to improve patient safety. These are issued as Rapid Response Reports (RRRs): one-page guidance with deadlines for action. They are issued through the Central Alerting System (CAS) in England. Sixteen RRRs have been issued to date, ranging from problems with insertion of chest drains to medication overdoses. Care setting of incident reports in England October 2007 to September 2008 Do you have something you would like to contribute to Knowledge Matters? Please contact us!
Knowledge Matters
Page 5
Hereâ&#x20AC;&#x2122;s an example of a Rapid Response report: Reducing risk of overdose with midazolam injection in adults Midazolam is a drug used to sedate patients undergoing procedures like endoscopy or minor surgery. Between November 2004 and November 2008, the NPSA received reports of 498 incidents of adult patients being given the wrong dose of midazolam injection when used for conscious sedation. This includes the death of three patients. 48 incidents resulted in moderate harm to patients and the other 447 were of low or no harm to the patients involved. The reported incidents found that in some cases staff gave the wrong dose in error or experienced difficulty in determining the appropriate dose for individual patients. On occasion staff lacked the necessary skills and training in sedation procedures. On 9 December 2008, the NRLS alerted staff in the NHS and independent sector to the risks of overdosing patients with midazolam. The alert sets out action for all organisations in the NHS and independent sector where midazolam is used for adult conscious sedation.
Why is reporting and learning important? Open and fair reporting should be the goal for all. Our experience is that Trusts with higher levels of reporting often have a stronger culture of safety in which staff are more likely to raise concerns. A commitment to reporting and learning demonstrates a commitment to patients and their safety. In March, following consultation with the NHS, we opened up RLS data for scrutiny through publishing organisational level data summaries on our website. This attracted a lot of interest from the media, Trusts and the public. Whilst drawing attention to the issue of patient safety, we recognise the need to be careful in how data from different organisations are compared. Our main focus must be on learning from our mistakes and sharing best practice to make patient care even safer. Making services safe for patients is essential in the provision of high-quality health services for all NHS organisations. Key to this is learning from staff who report when patients have, or could have, been harmed.
Reported incident types in England October 2007 to September 2008
Staff need to see that the effort they make to report incidents is worthwhile and results in safer services. Actionable learning and feedback are vital. The response system is always more important than the reporting system. For further information about the Reporting and Learning Service at the NPSA see: http://www.npsa.nhs.uk/nrls
Coming soon to South East Coast â&#x20AC;Ś. Work is currently underway to develop a Serious Untoward Incident (SUI) dashboard. The dashboard will use information as reported on STEIS and provide a range of graphical views for selected indicators. For further information on this development, (david.harries@southeastcoast.nhs.uk or 01293 778844)
please
contact
David
Harries,
Is there something that you wish you knew more about? To suggest future topics for knowledge matters contact the team
Health
Analyst
Page 6
Knowledge Matters
Page from the Patch - Health Policy Support Unit Madeleine St Clair, Director World Class Commissioning (WCC) requires each PCT to be able to identify priorities for its population and decide how healthcare resources are to be allocated. Health care resources are finite. PCTs will always be faced with difficult and sensitive decisions about apportioning healthcare resources. They have to draw the line between what will be funded and what will not. The South East Coast (SEC) Health Policy Support Unit (HPSU) was established on 1 April 2008. It provides rational, prioritised, evidence-based policy recommendations on health and healthcare investments to the eight SEC Primary Care Trusts (PCTs). HPSU manages the SEC Policy Review and Recommendation Process (PRRP). This Process has been established by SEC PCTs to provide commissioning advice where an area-wide approach is needed. HPSU receives topics for policy review which are normally proposed by SEC wide groups, such as the Directors of Commissioning, Chief Pharmacists Group or the Public Health Leadership Group, but can also suggested by individual PCTs. All topics are screened to ensure that applications fall within the remit of the PRRP and are not adequately covered by an existing SEC-wide policy or national guidance which has been reviewed recently. Topics may include: • New drugs, technologies or therapies; • New indications for existing drugs, technologies or therapies; • Drugs, technologies or therapies thought to be of little or no clinical value; • Interpretation of NICE Clinical Guidelines; • Managing the intervening period between the launch of a new product and issue of NICE Technology Appraisal Guidance. For each review, a Topic Working Group (TWG) is convened consisting of representatives from relevant and interested parties. These generally include PCT, clinician and patient/public representatives. Initially TWG activities involve: • establishing the current position (e.g. existing policies, activity, and costs); • assembling and interpreting the evidence base; and • undertaking a stakeholder consultation Following consideration of the preliminary results of the review, the TWG propose one or more intervention options defining the provision of a healthcare intervention across SEC. The next stage of the review is the Local Impact Assessment where an assessment of the likely effects of the intervention options on the local heath economy is undertaken. After considering the results of the Local Impact Assessment, the TWG agree a preferred option which is reviewed by the SEC Policy Recommendation Committee (PRC) at their next meeting. HPSU maintains the work of the SEC PRC membership of which covers a wide professional and geographic representation and includes members from SEC PCTs, SEC NHS Trusts and the SEC Specialised Commissioning Group. Once formally agreed through the PRC, policy recommendations are issued to SEC PCTs and they decide whether, and in what time frame, they will adopt the policy recommendations. After an appropriate interval the text of a policy recommendation will be communicated to the wider group of stakeholders and placed in the public domain. Recently issued policy recommendations include: • The use of probiotics in the prevention and treatment of Clostridium difficile associated diarrhea; • Co-careldopa intestinal gel (Duodopa ®) for the treatment of advanced Parkinson’s disease; • Assisted conception; HPSU also undertake overview reports; reviewing issues which are wider, and more general, than the kind of questions which can be addressed through the PRRP. These tend to involve issues of national or European policy, therapeutic advances and service development. Recent overview reports issued by HPSU include orphan drugs and percutaneous aortic valve replacement (PAVR). The Health Policy Support Unit is hosted by NHS West Sussex and based at NHS Brighton and Hove’s headquarters in Brighton. There are four members of the HPSU: the Director of HPSU, a Principal Information Analyst, a Clinical Review and Effectiveness Specialist and a Business Administrator. Currently, there is a vacancy for an Information Analyst: Health Policy Development to be a part the team. For further information, please visit our website http://nww.sechealthpolicysupportunit.nhs.uk. Do you have something you would like to contribute to Knowledge Matters? Please contact us!
Knowledge Matters
Page 7
Staff survey
By Adam Cook, Specialist Information Analyst It’s that time if year again when the annual staff survey has been released. Letting us know how happy or not we all with our jobs. This year’s staff survey has 36 key indicators based on the questions asked in the survey. This is significantly more than in previous years, and gives us a greater insight into the feeling of staff. As in previous years, here at South East Coast SHA we have produced a RAG status table showing where our organisations lie in relation to the best and worst national results of their peers, along with a comparison of the 2007 and 2008 surveys. As we now have several years of survey data, I have been able to design a staff survey dashboard. At first glance the results against national average are rather disappointing with quite a number of indicators showing ‘red’. More detailed analysis, however, has shown that when looking at best and worst performing quartiles rather than just national average, many of those reds (and some greens) turned amber. So the end results probably won’t surprise too many people – the reality is that there is significant variation across the three counties. There are some areas of significant poor performance, some of very good, and a whole lot somewhere in the middle.
Generally speaking the acute Trusts fare better than other organisations. It is important to understand that in some cases, an apparent poor performance can be explained by shifting of goal posts. One of the hazards of looking at data within quartile ranges as that as organisations improve then the quartile ranges change, and what was green one year becomes amber the next. This can be frustrating for organisations who have made a year-on-year improvement, but have failed to move themselves from red to amber or amber to green. The other problem with staff and patient survey data is that it is annual. So much of what we do is seen in trends and patterns, and when there are only three or four points on a chart, it is not only difficult, but sometimes dangerous to conclude that there is a trend in activity (as there are of course statistical rules about trends – we will cover more on this in a future article). One of the key learning issues that we can all take away from the staff survey is around the interpretation of this type of qualitative survey data. Surveys are a specialised data collection tools form which we can gain lots of useful information, but understanding the context of the survey, the response rate, and the interpretation of the questions is something that we’re not all used to. It’s something that we’re going to have to get more acquainted with in the future though – Patient Related Outcome Measures are often going to take the form of patient surveys and questionnaires. If you would like a copy of the staff survey dashboard and analysis that I have developed, or if you would like to talk about survey data in general, please do not hesitate to contact me adam.cook@southeastcoast.nhs.uk
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Knowledge Matters
Skills Builder – the Data Driving the Dashboard Charlene Atcherley-Steers and Nia Naibheman Performance Analysts, South East Coast SHA In the previous edition of Knowledge Matters we went through the first part of creating a dashboard the design stage. In this edition we will guide you through the data sheet that supports the dashboard. Datasheet organisation The data sheet consists of three main sections; chart data, lookup data and raw data. 1) Chart data. This is the area in which you will put the data that will be shown on your graph. It is important that you label the rows appropriately so you know which graph it relates to. You need to ensure that you have decided on a timescale for the column titles for each graph. If you have drop down boxes this data will need to be updated dynamically using Vlookups (this will be discussed in further detail in later sections of this article). It is best to place the chart data at the top of the data sheet to keep it separate from the raw data.
2) Lookup data. This is necessary if you have drop down boxes as it will be used to populate them. The lookup data will be a list(s) of options you would like the user to choose from e.g. Trust name, admitted or nonadmitted. When an option is selected the drop down box outputs a number to a cell you have selected. This number corresponds to the list order i.e. if you select the 5th option in the list then it will output 5. If you only have one drop down box then it would be ok to use this number as the reference for looking up in the actual data, for more than one drop down boxes you will need to assign a unique reference i.e. letters, symbols to your list(s). Furthermore, a Vlookup will be needed to create the unique reference which combines the choices from the drop down boxes i.e. South East Coast may be 1 and non-admitted may be £ so the unique reference would be 1£. If you do not have any drop downs then your chart data will be directly linked to your raw data. In a future article, we will describe how to create a drop down box and link this to the output cell. A detailed description on how Vlookups work and how to create them can be found in the Vlookup section opposite.
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3) Raw data. This can be on the same sheet as the chart data or can be on several different sheets. The format of this data could be a direct download or collection or even results from a database query. Pivot tables are useful when dealing with large datasets as they can organise your data and make calculations easier to create and maintain. Once your data is in a format that can be used for the charts (i.e. all calculations completed) you may need to assign a unique reference to each row as per your lookup options. You can repeat the ‘unique’ reference for different sections of the raw data.
Line charts are good for showing change over time. They enable you to see a trend emerging and give a good overview of what has happened in the past. They are also good if the target or average changes frequently and you wish to plot this on the chart. Vlookup The Vlookup will sit in the chart data section and will be unique for each chart. It is a standard Excel function which allows you to use the unique reference you have created to look up the corresponding data in the raw data section. The formula for Vlookup is: =Vlookup(Cell,Range,Column,Boolean) The description of the above arguments are: • • •
•
Cell is the cell where the unique reference is listed and is usually found in the lookup data section. Range is the range of raw data which is linked to the chart. Column is the column number which contains the data you wish to look up in the range. This could be a number (i.e 2) or a cell reference (i.e B2). For example if the column is set to 2 then the output will be data from the second column. It is best practice to align the column headings all the way through the datasheet so you can number the columns at the top of the datasheet and use this as your column value for your Vlookup. This proves to be more efficient when more dates are added to the chart data. Boolean, this can either be TRUE or FALSE. Use TRUE if you are trying to find the closest match to the unique output and the data is sorted into ascending order. Use FALSE if you require an exact match to the unique reference, this is the most commonly used argument.
The layout of your datasheet is important in ensuring that your dashboard is easy and efficient to update and maintain. Having a well laid out datasheet will allow other users to take ownership of the dashboard with ease. A well planned out front end should enable you to achieve this. The next edition will deal with bringing the front end and datasheet together. As ever, if you have any queries related to the development of dashboards, please contact one of the team!
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From here to maternity… Adam Cook, Specialist Information Analyst Adam Cook
Practically every one in this country aged 60 or under has used NHS maternity services at some point, even if they were too young to remember it! This makes maternity services more used per head of population than acute inpatient or outpatient services, mental health services or the majority of community services. Recently the Heads of Midwifery in South East Coast have come together to decide on a full set of metrics that they can use and share to drive forward quality, service improvement and share best practice.
“Maternity”, 1963, © 2003 Estate of Pablo Picasso/Artists Rights Society (ARS), New York
One advantage of having agreement from the Heads of Midwifery is that it helps to get clarity around the definitions of data, and pinpoints what is seen as globally important, so that everyone is working to the same ends using the same methodology.
There is a long list of over 40 metrics covering a number of different areas – organisation, workforce, activity and clinical indicators Examples of the ‘organisation’ indicators are diverts and unit closures recorded. Activity indicators will be more familiar to people outside of maternity services – total numbers of births, elective and emergency c-sections, inductions, use of instruments in delivery all fall into this category. Workforce numbers are very important in delivering (pun not intended!) a successful maternity service so midwife to woman ratio, consultant cover, and vacancy rates are covered in this section. The clinical indicators make up nearly half of the total numbers and contains such things as several indicators around both neonatal and maternal morbidity, infection control and homebirths. SEC Average Green Flag
Sussex
0.5
ASPH
0.5
Frimley 0.45
0.4
0.4
0.35
0.35
0.3
0.3
0.25
0.25
Kent 0.5
0.5
0.5
BSUH
ESHT
D&G
EKHT
0.45
0.45
0.45
0.4
0.4
0.4
0.4
0.35
0.35
0.35
0.35
0.3
0.3
0.3
0.3
0.25
0.25
0.25
0.25
0.45
0.2
0.2
0.2
0.2
0.2
0.2
0.15
0.15
0.15
0.15
0.15
0.15
0.1
0.1
0.1
0.05
0.05
0.05
0
0
0
0
0
0
0.5
0.5
RSC
RWS
SASH
Apr Ma Jun Jul Aug Sep O ct Nov Dec Jan Feb M ar
Apr Ma Jun Jul A ug Sep Oct No D ec Jan Feb M ar
0.5
0.5
0.5
WASH
Apr Ma Jun Jul A ug S ep O ct N ov D ec Jan Feb M ar
0.1 0.05
Apr Ma Jun Jul A ug S ep O ct N ov D ec Jan Feb M ar
0.1 0.05
Apr Ma Jun Jul Aug Sep O ct Nov Dec Jan Feb M ar
0.1 0.05
0.5
M&TW
Medway
0.45
0.45
0.45
0.45
0.45
0.45
0.4
0.4
0.4
0.4
0.4
0.4
0.35
0.35
0.35
0.35
0.35
0.35
0.3
0.3
0.3
0.3
0.3
0.3
0.25
0.25
0.25
0.25
0.25
0.25
0.2
0.2
0.2
0.2
0.2
0.2
0.15
0.15
0.15
0.15
0.15
0.15
0.1
0.1
0.1
0.05
0.05
0.05
0
0
0
0
0
0 A pr Ma Jun Jul Aug Sep O ct Nov Dec Jan Feb M ar
0.1 0.05
A pr Ma Jun Jul Aug Sep O ct Nov Dec Jan Feb M ar
0.1 0.05
A pr Ma Jun Jul Aug Sep O ct Nov Dec Jan Feb M ar
0.1 0.05
A pr Ma Jun Jul Aug Sep O ct Nov Dec Jan Feb M ar
Surrey 0.5 0.45
A pr Ma Jun Jul Aug Sep O ct Nov Dec Jan Feb M ar
One of the key challenges with this project is data quality. Most maternity units have been used to using their own data to manage their systems for a long time, and it is known that they have ways of coping with known data inaccuracies. I don’t think it will be a shock to anyone to state that most hospital maternity systems do not give the same numbers as the Trust PAS. Obviously one of the key areas of work that will come out of this is increasing accuracy and consistency of reporting.
Trust Red Flag
Activity: C- Section: Elective caesarean section
Apr Ma Jun Jul Aug Sep O ct Nov Dec Jan Feb M ar
Initially we are looking at a comparative view for each metric across organisations, however we will also be developing an organization based dashboard.
South East Coast Core Maternity Dashboard
A pr Ma Jun Jul Aug Sep O ct Nov Dec Jan Feb M ar
At South East Coast we have started to pilot collecting this information and have built a prototype dashboard.
Kate and I are working on building this together, so if you would like further information please contact either one of us: adam.cook@southeastcoast.nhs.uk katherine.cheema@southeastcoast.nhs.uk
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A3: ASK AN ANALYST – If you have a question for the team please e-mail: Knowledge.management@southeastcoast.nhs.uk Kate Cheema
Q How can I make my spreadsheets more interactive? I want users to be able to make changes without having to understand the cell references. One way you can use to make your spreadsheets a bit more interactive for users is to investigate the ActiveX controls in the toolbox and how they can be used to make life a bit easier for users if they need to input into a spreadsheet based model, for example defining percentage reductions, setting a starting point, or needing to test multiple scenarios without wanting a separate worksheet for each. One example is the scroll bar control. 1) Make sure you have the toolbox toolbar available by selecting ‘Control Toolbox’ on the Toolbars selection under the View menu 2) Click on the icon for the scrollbar 3) Use the cursor to draw on the spreadsheet where you want your scrollbar to be 4) Once you have positioned your scrollbar make sure that the design view is on 5) Right click on the scrollbar you have placed on the sheet and click on ‘properties’ 6) Most of the properties for this control are quite self explanatory but the really important ones are where you define a linked cell (just enter a normal cell reference) and where you can set the minimum and maximum value for the control. For this example, put in 100 as the maximum and 0 as the minimum. By selecting a linked cell, the value of the control will be output to that cell, which can then be used in calculations 7) Once you have set all the properties, deselect the design view button on the control toolbox. A user can now use the scrollbar to define input into a spreadsheet model. Less reduction
More reduction
Output:
30
Modelling and Simulation Resources ……. The RIGHT (research into global healthcare tools) project, a collaborative of seven UK universities, has published a number of tools that are now available online. The first, 'Modelling and Simulation Techniques for Supporting Healthcare Decision Making: A Selection Framework' is now available for purchase from http://wwwedc.eng.cam.ac.uk/books/right/. Another tool, the RIGHT Methods Selection Tool (Version 5.0 Beta) is a webbased visual interactive application tool that is built as part of the RIGHT toolkit. Its purpose is to help the stakeholders faced with service-related problems to select an appropriate tool or method that would support their decision-making in terms of modifying organisational processes or policies. The tool addresses seven issues (seven questions), having gradations and ranges on a minimum to maximum scale. The users’ answers (choices) are taken as input and recorded for further analysis of data. The is also a World Class Commissioning version available that sets out possible modelling techniques appropriate to each competency. This is available, free, at http://www.right-toolkit.org.uk/.
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Length of Stay Tools Simon Berry, Specialist Information Analyst One of the most common requests that we have received over recent months relate to benchmarking length of stay. As a result of this, I have recently developed 2 new tools to enable Trusts to monitor the impact of improvement programmes to reduce length of stay/benchmark their performance locally and nationally. The first tool is designed to provide an easy comparison of length of stay across South East . Coast Trusts for grouped specialties. Grouping specialties allows comparison between Trusts that allocate their admissions differently. The charts show volume of admissions, Trust quarterly LoS, SHA quarterly LoS, national 07/08 top quartile, decile and median LoS.
All Specialties
Elective Length of Stay
Spells - RH Axis Trust % Complex - LH Axis SHA % Complex - LH Axis
All Specialties - Trimmed
Nat Untrimmed Top Quartile 0708 Nat Untrimmed Top Decile 0708
Trimmed
Elective
Nat Untrimmed Median 0708
2000
08/09 Q1
08/09 Q3
07/08 Q3
07/08 Q1
06/07 Q3
06/07 Q1
05/06 Q3
04/05 Q3
2000
1500
1000
1000
2.5 500
500
2.0 08/09 Q1
08/09 Q3
07/08 Q3
07/08 Q1
06/07 Q3
06/07 Q1
05/06 Q3
0 04/05 Q3
08/09 Q3
08/09 Q1
07/08 Q3
06/07 Q3
07/08 Q1
05/06 Q1
04/05 Q3
0
05/06 Q1
2.0 04/05 Q1
08/09 Q3
08/09 Q1
2500
3.0
2.5
07/08 Q3
3000
3.5
1500
500
07/08 Q1
05/06 Q1
04/05 Q1
08/09 Q3
08/09 Q1
07/08 Q3
06/07 Q3
07/08 Q1
06/07 Q1
05/06 Q3
05/06 Q1
3.5
1000
0
3500
4.0 2500
3.0
2.0
4000
3000
1500
05/06 Q1
08/09 Q3
07/08 Q3
08/09 Q1
07/08 Q1
05/06 Q3
Medway
04/05 Q1
2000
2.5
05/06 Q1
04/05 Q3
04/05 Q1
08/09 Q3
08/09 Q1
07/08 Q3
07/08 Q1
06/07 Q3
05/06 Q3
3.5
500
0
5.0
4.0
1000
2.0
4000
0
4.5
2500
3.0
04/05 Q3
08/09 Q3
08/09 Q1
07/08 Q3
06/07 Q3
07/08 Q1
06/07 Q1
05/06 Q3
05/06 Q1
04/05 Q3
0
2.0
3500
3000
1500
2.5
2.0
06/07 Q1
04/05 Q1
08/09 Q3
07/08 Q3
08/09 Q1
07/08 Q1
06/07 Q3
06/07 Q1
2000
500
04/05 Q1
08/09 Q1
08/09 Q3
07/08 Q3
07/08 Q1
06/07 Q3
06/07 Q1
05/06 Q1
0 05/06 Q3
04/05 Q3
2.0
3.5
1000
2.5
5.0
4.0 2500
3.0
500
4000
500
0
M&TW
3000
1500
1000
2.0
4.5
04/05 Q3
2000
1000
2.5
3500
04/05 Q1
3.5
3.0
2.5
5.0
4.0 2500
1500
3.0
4000
1500
500
0
4.5
04/05 Q1
2000
2.5
3500
3000
4.0 2500
3.5
2.0
2000
3.0 1000
500
0
4.5
3000
4.0
2.5
2500
3.5
1500
WASH
5.0
3500
4.5
2000
3.0
RWS 4000
3500
4.5
04/05 Q1
05/06 Q3
04/05 Q1
SASH
5.0
Finally, it is possible to view trimmed length of stay where all stays in excess of the national 07/08 trim points are reduced to the trim point. You can do this by selecting the “Trimmed” check box.
2.0
08/09 Q3
08/09 Q1
07/08 Q3
07/08 Q1
06/07 Q3
05/06 Q3
RSC
06/07 Q1
5.0
05/06 Q1
4000
0 04/05 Q3
2.0 04/05 Q1
08/09 Q1
0 08/09 Q3
07/08 Q3
07/08 Q1
06/07 Q3
06/07 Q1
05/06 Q3
04/05 Q3
Specialty groupings are selected using the main drop down box and it is also possible to selective elective or non-elective admissions by using the ‘radio’ select buttons.
05/06 Q1
04/05 Q1
2.0
500
3.5
1000
05/06 Q1
500
2500
1500
1000
2.5
500
2000
3.0
1000 2.5
3.5
3000
4.0
2500
1500
3.0
3.0 1000
2.5
2000
1500
1500 3.0
3.5
3500
3000
4.0
04/05 Q3
2000
4000
4.5
3000
4.0
5.0
3500
4.5
06/07 Q3
3.5
05/06 Q1
2000
06/07 Q3
3.5
2500
4000
05/06 Q3
2500
EKH
5.0
3500
3000
4.0
4.0 2500
4000
4.5
3000
3000
Kent
D&G
5.0
3500
4.5
4.5
4.0
4000
3500
3500 4.5
5.0
05/06 Q3
4000
ESHT
06/07 Q1
5.0
04/05 Q3
4000
06/07 Q1
5.0
Non Elective
Sussex BSUH
Frimley
06/07 Q1
Surrey ASPH
Data is sourced from HES for the national benchmarks with a combination of SUS and Trust extracts used for the quarterly data. The specialty groupings used for the dashboard are detailed within the tool. Length of Stay Grouped Benchmarking Tool This is a tool which I hope you are already familiar with as it was developed and circulated several months ago. I have updated this benchmarking tool with 2007/8 data and also incorporated the speciality groupings described above. Length of Stay Benchmarking by Specialty 2007/08 Non-elective - All Specialties 11
10
Top Decile Top Quartile Median
9
8
7 6.4 6.1
6
5.7
Drop down menus allow selection of which specialty is of interest, the type of averaging required (median or mean) and whether elective or non elective admissions are to be looked at. All South East Coast Trusts are highlighted in red and labelled. All data is sourced from HES.
5
If there are other benchmarking tools that you would find useful, I’d be really keen to hear from you – we are after all here to help to local NHS improve services for patients.
4
3
2
1
WAS ESHT
D&G
Fpark RSC
M&T
Medw EKH
RWS
SAS
BSU
ASP
0
Both of these tools are available to download from the ‘Tools’ section on our website nww.sec.nhs.uk/knowledge If you have any queries on the tool or would like to suggest enhancements for future versions, please do get in touch simon.berry@southeastcoast.nhs.uk Do you have something you would like to contribute to Knowledge Matters? Please contact us!
Knowledge Matters
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Linking post-coded data to a higher geography David Harries, Health Analyst Analysts will frequently need to match post coded data to a higher level of geography, for example, when carrying out spatial analysis, linking neighbourhood statistics to the data or to ONS population denominators. The NHS Postcode Directory (NHSPD) can be used as a ready means of matching post coded data to a range of geographic areas. The NHSPD is a comprehensive postcode lookup table covering the whole of the UK and is available to download to anyone with NHS connection via the Connecting for Health site (select the file ‘gridall.zip’) http://nww.connectingforhealth.nhs.uk/ods/downloads/officenatstats The NHSPD relates both current and terminated postcodes to a range of current statutory administrative, electoral, health and other area geographies. It also links postcodes to pre-2002 health areas, to the 1991 Census enumeration districts and to 2001 Census Output Areas. The NHSPD is produced and updated quarterly (latest version Feb-09) by ONS Geography, which provides geographic support to the Office for National Statistics (ONS) and geographic services used by other organisations. Postcodes are the most commonly used geographical reference and provide a mechanism for linking together several datasets. For example by using the NHSPD to link the post coded data to Lower Super Output Area (LSOA), it is then possible to link the LSOA to the deprivation score (IMD 2004 and 2007 are produced at LSOA). Aside: What are super output areas? Output Areas (OAs) were built from clusters of adjacent unit postcodes and were used across the UK as the base unit of census output in 2001. Super Output Areas (SOAs) are built from groups of OAs and were designed to improve the reporting of small area statistics. Within England and Wales there is a Lower Layer (minimum population 1000) and a Middle Layer (minimum population 5000). Unlike electoral wards, these SOA layers are of consistent size across the country and are not subjected to regular boundary change.
Geographic hierarchies available in the NHSPD include: • Government Office Region (GOR) • County • Unitary Authority/Local Authority District • Ward • SHA • PCT • Census Output Area (OA) code • IT Cluster • Lower Super Output Area (LSOA) • Urban/Rural Indicator • Parliamentary Constituency • Cancer Registry • Cancer Network
Other useful links: A useful guide to geographic areas is available from ONS http://www.statistics.gov.uk/geography/beginners_guide.asp . ONS Lookups: These may be used to aggregate results for Output Areas to higher areas or to link non-census data coded to postcodes to the 'denominators' provided by Census statistics. http://www.ons.gov.uk/about-statistics/geography/products/geog-products-area/lookups/index.html I’m the mapping lead for the team so if you have any queries on this article or mapping in general, please do contact me (david.harries@southeastcoast.nhs.uk or 01293 778844) Is there something that you wish you knew more about? To suggest future topics for knowledge matters contact the team
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Page 14
News Deadline for Revising Data for Annual Health check
New NHS Improvement System launched
Requests for revisions to 2008/09 data submitted to Unify2 will need to made before the Unify2 team pass the data onto the Care Quality Commission for use in scoring the Annual Health Check. The dates for this vary for each return:
The new system is now live with enhanced functionality and screen layouts. A link to the new user guides is contained on the home page of the NHS Improvement website http://www.improvement.nhs.uk/
18 Weeks RTT Audiology RTT MMR GUMM VSMR Delayed Transfers QMAE Cancelled Operations MAR DM01
Refer to Knowledge Matters Volume 2 Issue 4 for a detailed article on the NHS Improvement System.
30/04/2009 22/05/2009 29/05/2009 29/05/2009 15/05/2009 22/05/2009 11/05/2009 03/06/2009 29/05/2009 22/05/2009
Any revisions made after this point will be subject to ratification by the CQC. Queries on this should be emailed to the Unify2 mailbox: unify2@dh.gsi.gov.uk or directed to the relevant contact for that return (see contacts list on Unify2) According to the Unify2 revisions policy, they do reserve the right to turn down requests for revisions. Full details of the revisions policy can be found on the Unify2 website. New DM01 Template
Clinical Quality Indicators Survey published The results of the consultation on clinical indicators (undertaken by the Information Centre in November and December) are now available to download from the Information Centre’s website. http://www.ic.nhs.uk/services/indevelopment/clinical-quality-indicators The aim of the survey was to begin identifying existing quality indicators, focusing primarily on secondary care indicators, to complement existing activities in other health settings. Better Care, Better Value Indicators – new data published Quarter 3 data has now been published for the Better Care Better Value indicators http://www.productivity.nhs.uk/
For April 2009 data onwards, there is a new template for the DM01 monthly diagnostic returns. This will collect the same information but the number of time-bands to be completed has been reduced. It will not be possible to submit returns using the current template.
The South East Coast BCBV dashboard has been updated with this data and is available to download from our website nww.sec.nhs.uk/knowledge
The new template is available to download from Unify2.
World Class Commissioning – Turning Data into Information for Improvement
PbR Benchmarker – new inpatient data added Q3 0809 inpatient data has just been added to the PbR National Benchmarker. Unfortunately there has been a delay with the national extract of outpatient data; however this is likely to be available within the next month. http://www.audit-commission.gov.uk/pbr Refer to Knowledge Matters Volume 2 Issue 4 for a detailed article on the PbR benchmarker. For further information contact Howard Davis, PbR Benchmarking Manager, at h-davis@audit-commission.gov.uk.
The presentations and templates presented at the recent local workshops (22nd and 29th April) have now been made available on the Knowledge Management website at nww.sec.nhs.uk/knowledge, under the World Class Commissioning section which can be access via the Work Programmes heading on the homepage main menu. A forum has also been set up to encourage discussion and sharing of best practice. For further information on this programme of work, please contact Katherine.Cheema@southeastcoast.nhs.uk
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Knowledge Matters
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Data Quality Programme update The NHS Information Centre has recently launched their Data Quality Programme. Good quality data is instrumental in ensuring that patients receive high quality, safe care. Good quality data is also essential in calculating funding. The 2008 Informatics Review reconfirmed that the quality of data used to support policy, service planning, commissioning and performance management decisions remains inadequate in some organisations. The Audit Commission’s PbR Data Assurance Framework 2007/08 Report identified a Trust where coding was 76% inaccurate. Earlier this year, the Information Centre National Back Office reported that over 90% of the NHS Number allocations made by one Trust were duplicates. The Data Quality Programme has been established to improve data quality by: Raising awareness about the impact of data quality; Helping data suppliers to improve data quality; Providing data suppliers and data users with a data quality grading scheme The programme embraces data quality from data definition, through data capture, aggregation, analysis and use. It is engaging with all Health and Social Care organisations – data providers, regulators and users. The Programme, led by The NHS Information Centre, brings together a wide range of organisations. including the NHS, Department of Health, Audit Commission, Healthcare Commission, PCTs, SHAs, Mental Health and Acute Trusts, NHS Connecting for Health and the Independent Sector. Further information on the programme and details on how to get involved with shaping what happens (well over 300 people across the country have already registered interest) can be obtained from the NHS Information Centre website: http://www.ic.nhs.uk/services/in-development/the-data-quality-programme Alternatively, please contact the Programme Manager, John Madsen (john.madsen@ic.nhs.uk) who will be able to let you know the name and contact information for your SHA Data Quality lead.
South East Coast Update The second data quality workshop was held on 29th April at York House with over 20 individuals from Trusts and PCTs with an interest in data quality. We were lucky to again be joined by Lorraine Gray from the NHS Information Centre, (Programme Manager for SUS/HES Data Quality) who led an interactive morning debating data quality issues and sharing local and national experience. Presentations from the session are available to download from the Data Quality section of our website (nww.sec.nhs.uk/knowledge) There was even a lunchtime quiz with prizes for all participants not just the winners (congratulations to Adrian Billington from Dartford and Gravesham NHS Trust and Andy Banks and Jenny Garvey from Western Sussex Hospitals Trust who were joint winners on this occasion). The next workshop will be taking place on 28th July 10am – 1.30pm. Lorraine will again be joining us. Topics that we will specifically be focusing on at this session include: • • •
Reviewing EDQRS benchmarking information for our local Trusts; Sharing local experience around improving data quality at the point of data entry; Discussing differences between SUS and PDS.
If you’re wondering what all of this is about, you may like to think about joining us next time or contacting Adam Cook who leads on Data Quality for South East Coast (adam.cook@southeastcoast.nhs.uk) Lunch will be provided and there will be another data quality quiz so start preparing now!
Is there something that you wish you knew more about? To suggest future topics for knowledge matters contact the team
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Quality …
Can we help??? Do you have a specific query on an Excel problem? How about Access, PowerPoint or even Word? The Quality Observatory team will be holding 1-2-1 drop-in sessions on 20th May which will be purely driven by requests. Individuals will be allocated one hour slots with one of our analysts who will go through the topic area with you. You are able to book more than one slot and we encourage you to bring any work you may need help on with you.
[...to the tune of "Daisy Daisy"] Lord Darzi, Lord Darzi, Give me your answer do, From clinic to kharzi, Quality must shine through, PROMs and CQUIN metrics, In acute, mental health and obstetrics, Will be complete In each spreadsheet, as part of the Next Stage Review!
The sessions will take place here at the SHA, to book your slot please contact nia.naibheman@southeastcoast.nhs.uk
Interested in Mental Health Data Quality ?? A meeting to focus on mental health data quality has been arranged for 19th May 2pm – 4pm at York House, Horley (Kent and Medway Room). Netta Hollings from the NHS Information Centre Programme Manager for Mental Health and Community) will be joining the meeting and will be able to provide an overview of work that is underway at a national level to improve the data quality for mental health services. This will also provide an opportunity to raise local issues directly with Netta. For further details and to register your attendance at this session, please contact Adam Cook (adam.cook@southeastcoast.nhs.uk)
Knowledge Management event A South East Coast Knowledge Management event is being on:Tuesday 19th May in Tunbridge Wells
Knowledge matters is the newsletter of NHS South East Coast’s Quality Observatory. To discuss any items raised in this publication, for further information or to be added to our distribution list, please contact: Knowledge Matters C/O The Quality Observatory NHS South East Coast York House 18-20 Massetts Road Horley,Surrey, RH6 7DE
The one day event will provide an overview of Knowledge Management and the people, tools and technologies that are available to make it work. The day will be highly interactive. The course is free and open to all NHS staff working within Kent, Surrey and Sussex. Further details can be downloaded from the SEPHO website: http://www.sepho.org.uk/viewResource.aspx?id=12370& cvbu=false
Phone: 01293 778899
Quick Quiz
E-mail: quality.observatory@southeastcoast.nhs.uk
Data Quality for items in CDSs can be measured according to VODIM. What does VODIM stand for?
To contact a team member: firstname.surname@southeastcoast.nhs.uk
The answer will appear in the next issue.
Do you have something you would like to contribute to Knowledge Matters? Please contact us!