Volume 4 Issue 2 June 2010 Welcome to Knowledge Matters Hello again everyone and welcome to this Super Bumper edition of Knowledge Matters! I am very pleased to announce that the Quality Observatory is now officially published. The May edition of ‘Clinical Risk’ (a Journal of the Royal Society of Medicine) contained an article describing how Quality Observatories can support the local NHS in utilising information to create a culture of measurement for improvement. Further details of how to access the article appear on page 9. Also on page 9, you can find a summary of both the SHA programme leads and Quality Observatory link/s for each QIPP programme. Over recent months the team have busily been working with Clinical Pathway and Programme Leads to develop high level indicators to monitor progress in terms of both quality and productivity. The intention is for each programme to have a high level dashboard containing a range of measures relevant to quality, activity, finance and workforce. These dashboards will of course be regularly updated and available from the Quality Observatory website. We are working with County leads to ensure that our intentions align with and support plans at county level. The Measurement Channel for Cost and Quality that I mentioned last time is now live (see page 17). This provides an opportunity to share examples of excellent practice in terms of measurement. The channel is open until 15th July so please do get your typing fingers on to share examples that you may have. In future editions of Knowledge Matters we are keen to publish cases studies of excellent clinical practice being undertaken across South East Coast which are supported by data. If you would like to be featured in a future edition, please do get in touch. We are keen and willing to support you evidence the great care that you are providing so we can help you with the supporting data, if you can provide us with the case study. See you next time (when I’ll be wearing a different outfit!)
Inside This Issue : The Healthcare Quality Improvement Partnership
2
QIPP Measures and Monitoring
9
Patient Experience Tool Updated
Progress in improving stroke care
4
A3: Ask an Analyst
10 My IC
The National Adult Social Care Intelligence Service
6
Patient Reported Outcome Measures 11 The Measurement Channel
17
Hip replacement comparison tool
7
Skills Builder—Turnover Rates
12 News
18
Delivering Same Sex Accommodation
8
Data.gov.uk
14 Analysis—Ancient and Modern
19
http://nww.sec.nhs.uk/QualiityObservatory
15 16
Page 2
The Healthcare Quality Improvement Partnership The Healthcare Quality Improvement Partnership (HQIP) was established in 2008, with the aim of promoting quality improvement – and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its work includes managing and developing the National Clinical Audit and Patient Outcomes Programme (NCAPOP) which now comprises 30 national audits, a Local Quality Improvement team which provides expert guidance and support at local level, the National Joint Registry – now the largest database of its kind in the world, and finally a Development Team, whose work on the likes of PPE and NHS Boards set the standard in clinical audit. Robin Burgess, Chief Executive, describes how HQIP improves quality :- “HQIP is a consultative and representative body. We listen to and channel the views of professionals, and patients. In our governance we engage the professional representatives of all key disciplines. Building on audit, we are carrying out a wider range of work to promote quality in the NHS linked to our core interest: data driven, professionally led quality improvement. The need for this work is greater than ever.” Robin Burgess
Helen Laing
Helen Laing, National Clinical Audit Lead for HQIP describes more about the objectives and work of her team : - “Our core objectives are: to commission National Clinical Audits and Multisite Audits to meet the required legal requirements, followed by ongoing oversight of the projects, contract management and ongoing review, to ensure projects are able to deliver to time, cost & quality requirements.
In terms of meeting those objectives, firstly we work in close collaboration with HQIP’s main contracting body, the Department of Health (DH). With all projects, we ensure they are procured within the European frameworks and that commercially-focused projects have commercially-focused contracts. Last but not least, we closely follow best practice (NAO and OGC) for contract management and by attending meetings with NCAAG (National Clinical Audit Advisory Group). The national team is now responsible for six new national clinical audits and two rounds of multisite audits. We’ve also worked extremely hard to refocus and improve the contract management we have in place and ensure complete adherence to the OJEC framework. “ The primary aim of the Local Quality Improvement Team is to reinvigorate local audit. Kate Godfrey, National Lead for Local Quality Improvement, explains how HQIP support this aim : - “We do this in a number of ways so as to make our support as comprehensive as possible. Perhaps the most vital part of this is the work we achieve in developing and helping to sustain SHA-wide clinical audit networks, with our team continually on the road, presenting to the networks and driving support for best practice clinical audit at local level.
In support of this we produce relevant written guidance – we recently released no fewer than six new products covering off everything from ‘An Introduction To Statistics For Clinical Audit’ to ‘A Guide For Patients In Understanding Clinical Audit Reports’ – which in turn we promote and support at local level. We also offer support on identified clinical audit issues. Public events are also vital to our work: we hold our own annual two-day national conference, which includes the Clinical Audit Awards, each April and we also speak at local, regional and national conferences.
Page 3 Every single English NHS trust now has a local clinical audit network they can attend and all areas of England are covered. We have developed local guidance such as templates for clinical audit strategies and templates; advice on how to make junior doctor audits more meaningful; how to carry out audits across health and social care sectors. The annual clinical audit conference see around 500 audit leads, managers and clinicians attend and if the space were available I’m sure we could double that. This has become a fixed date in the clinical audit diary, creating a fixed point for those involved in clinical audit to meet and share best practice. I’d like to think that, in its own way, the work we do has helped increase the recognition of clinical audit both as a profession and as a practice.” Finally, Elaine Young, National Development & National Joint Registry (NJR) Lead for HQIP, explains the objectives and role of her team: “From a development point of view, we ensure HQIP programmes are aligned to broader policy direction, and to the development of strategic policy and national projects, including professional validation. To manage stakeholder relationships and the advancement of HQIP key development aims with groups including GPs, NHS Boards, patients and public and clinical audit professionals. With the National Joint Registry (NJR), the primary objectives are to ensure the completeness and quality of the data submitted and that this is measured using three key indicators: compliance, consent and linkability. These objectives are achieved through the development of a robust strategic plan which is developed and monitored within the NJR Steering Committee and associated sub-groups. The development team has completed a number of excellent projects, including the production of the ‘Criteria and indicators of best practice in clinical audit’ guidance and the development of the Patient Network – a 40-strong group which has consulted on documents such as the ‘Criteria...’ and contributed significantly to the development of the highly regarded ‘Patient and Public Engagement (PPE) – PPE in Clinical Audit 2009’) guidance. Elsewhere, the development team has worked with the Good Governance Institute to produce ‘Clinical audit: A simple guide for NHS Boards and partners’, which has been followed with a survey and two workshops to establish a Matrix tool that can be used within trusts. From the NJR perspective, we have seen the development of a strategic process to accurately manage the performance of outlying surgeons and implants. Most recently, we have seen the addition of ankle joint procedures onto the NJR and establishment of links with the NJR’s associated professional associations. Finally, there’s been the development of a research sub-committee to facilitate the research proposals – both internal and external.” Currently, the National Development Team is working with the Royal College of General Practitioners to establish a work plan to facilitate increased clinical audit within primary care, looking at its role within Revalidation. This work has started with a successful workshop. Elsewhere, the work on engagement with Boards and patients will continue as well as looking for opportunities to engage in Leadership programmes. For NJR, re-tendering for the NJR contracts is currently going ahead, which has been undertaken using a two-stage tendering process which will involve a range of stakeholders. We will also be bringing elbows and shoulders procedures onto the NJR by developing links with relevant professional associations to facilitate comprehensive datasets and working with our contractors to facilitate an effective communication process. Finally, we’ll be looking to move forward with approving research proposals through the research sub-committee.” For further details of our work, to access any of the guides referred to in this article or to subscribe to our updates, please visit our website http://www.hqip.org.uk/
Page 4
Progress in improving stroke care By Karen Taylor, Director of Health Value for Money Audit The National Audit Office’s recent report, Progress in Improving Stroke Care (HC 291 Session 2009-10), sets out the progress that has been made in improving the priority and public awareness of stroke care as well as the improvements in patient outcomes and quality of care thanks to a more urgent response by hospital and ambulance staff. However, variation in hospital services persists and improvements in rehabilitation services and post-hospital support have been less marked. Stroke is one of the top three causes of death and the largest cause of adult disability in England, costing over £3 billion a year in direct healthcare costs. In 2005, we published a value for money report assessing the performance of stroke services in the NHS, Reducing brain damage: faster access to better stroke care, which concluded that as stroke had historically been seen as an inevitable risk of growing old, it had a low priority within the NHS. The report also highlighted that both medical and technological developments used to improve the outcome of stroke were not being implemented widely enough; ultimately leading to considerable variations in the efficiency and effectiveness of patient care. In February 2010, in response to a request from Parliament’s Committee of Public Accounts, we published a follow-up report evaluating the improvement of stroke services over the past five years. Alongside the main report we published a number of separate reports on our website (http://www.nao.org.uk/ publications/0910/stroke.asp) that detail the results of the different strands of our methodology. These include: a detailed methodology; national report based on our survey of ambulance trusts; results of our patients survey; and a good practice guide, which outlines 14 examples of innovative practice across the country. Our conclusion Improvements in the provision and organisation of stroke services, to date, have led to improved value for money. Since the publication of our 2005 report, there have been major changes in the Department’s approach to stroke care, including the publication of the National Stroke Strategy in December 2007. Our modelling of the likely changes in patient outcomes resulting from the changes in service organisation suggests that, since 2006, stroke patients’ chances of dying within ten years had been reduced (by an estimated 4 percentage points, from 71 to 67 per cent) and these improvements have been made cost-effectively.. However, our report warns that if the value-for-money gains achieved so far were to be sustained and further improvements envisaged by the Strategy were to be delivered, a number of significant issues still needed to be addressed across the whole patient-pathway. The report also suggested that for rehabilitation and post-hospital support to match gains made in acute care, the Department and the NHS would have to make a concerted effort to work in partnership with Local Authorities and the third sector. Supporting the strategy with strong levers Implementation of the National Stroke Strategy has been aided by strong leadership at the national level. In order to support the implementation of the Strategy, the Department announced funding of £105 million over a three year period (2008-09 to 2010-11), and have enhanced support given for hospital thrombolysis by modifying the NHS ‘tariff ‘for stroke. Implementation of the National Stroke Strategy was also made a ‘Vital Sign’ Tier 1 indicator, making it a national “must do” requirement in Primary Care Trusts’ operating plans and increasing the priority given to improving services the local level. Furthermore, 28 Stroke Networks have been set-up to improve and coordinate the provision of care at the local level.
Page 5 Improving the acute response to stroke Following the Department’s memorable £11.5 million ‘Stroke – Act F.A.S.T.’ media campaign, which was introduced in 2009, there has been better public awareness of the symptoms of stroke, with the number of calls from stroke patients increasing by 54 per cent in one year. NHS staff awareness of what to do in the case of a suspected stroke has also improved. Our report found that many acute hospital services have been successfully reorganised to deliver the key elements of care that are known to improve outcomes; but that more needed to be done to ensure that all patients get the care they need, when they need it. This is particularly the case as regards access to urgent brain imaging services during evenings and weekends. And importantly, immediate access to and the majority of care delivered on a specialist stroke unit. Despite there having been measurable improvements in the reorganisation of acute stroke care, with all hospital trusts in England now having a stroke unit, only 17 per cent of stroke patients were admitted to a stroke unit within four hours of their arrival in A&E in 2008. Furthermore, there is currently wide variation in the likelihood of achieving the Vital sign target that 80 per cent of patients should spend 90 per cent of their time on a stroke unit by end of 2010-11(Figure 9 in the report). One intervention that has been shown to be cost-effective is the use of Early Supported Discharge teams but only 36 per cent of hospitals have such a team. There is also confusion as to how they should be funded, even though the un-bundling of the stroke tariff was intended for such a purposes. Meeting longer-term care needs Our report found that there is a lack of guidance in terms of research-based evidence on the benefits and costs of clinical and other support for long-term stroke care. While the National Clinical Guidelines for stroke provides clear clinical guidance for the organisation and delivery of acute stroke care, of the 400 recommendations only 16 cover the care given to patients more than six months after their stroke. There are still large barriers to joint working between the health service, social care and other services such as benefits and employment support. Currently, patients and carers lack good information about the services they need and how to access them on discharge from hospital, with only half of stroke survivors saying that they were given advice on further stroke prevention on leaving hospital and only a quarter given information about the benefits system. Moreover, more work needs to be done to ensure that patients get adequate support in the post-hospital setting. Our research indicates that commissioners and providers are unclear of how, and in which setting, the annual review process should be implemented, and what its objectives are. In 2008, 30 per cent of patients were not given a followup appointment within six weeks of discharge from hospital, which is one of the National Stroke Strategy requirements. Recommendations In conclusion, the NHS has made notable improvements in the provision, organisation and strategic oversight of stroke services across the country. However, existing barriers, such as limited access to brain scans out-of-hours, are hindering further progress. Similarly, the historical divide between health and social care presents a large barrier to the continuity of care within the post-hospital setting. Furthermore, in order to sustain and further maximise the progress made in stroke, clear and clinically robust guidelines on rehabilitation and post-hospital support need to be developed. In particular, we made 12 recommendations - covering Primary Care Trusts, Strategic Health Authorities and the Department of Health – to address the remaining challenges in stroke care. On 24 February, our report formed the basis of an Inquiry by the Committee of Public Accounts. The Committee will shortly be publishing their own report based on their questioning of the Department of Health’s Accounting Officer, Sir David Nicholson, and his senior civil servants with responsible for stroke care.
Page 6
The National Adult Social Care Intelligence Service (NASCIS) By Pritpal Rayat, Section Head, Social Care Development Launched in July 2009, The National Adult Social Care Intelligence Service (NASCIS) http://www.nascis.ic.nhs.uk is a free of charge service to local authorities and other public bodies. The service is owned and delivered by the NHS Information Centre for health and social care (IC), and is central to the IC's strategic direction on adult social care. Designed in partnership with the Department of Health, the Association of Directors of Adult Social Services (ADASS) and other national bodies, NASCIS is a single national resource for timely, relevant and useful information relating to the provision and performance of adult social care across England. NASCIS is a dynamic collection of data, tools and resources designed to meet the varied needs of planners, managers, researchers, policy makers and many others. The service is a ‘one stop shop’ for adult social care information and can support a range of service activities such as planning, performance management and service improvement. So, how can NASCIS help you? Whether you want to monitor key activity data, for example, the uptake of direct payments and personal budgets, or know what money is being spent on services in your area, NASCIS has information covering many aspects of social care that can help you make decisions on how to provide the best possible care services. Key features include: An online analytical processing tool: Providing quick, easy and flexible access to a wide range of social care information – enabling you to use an authoritative, common set of data for performance management and benchmarking purposes. Standard reports: Showing the different elements of adult social care data in a range of comparative, thematic and profile reports (see example, below) JSNA indicators: We provide access to a range of Joint Strategic Needs Assessment (JSNA) indicators. These fall into five broad categories: Demography, Social and environmental context, Lifestyle and risk factors, Burden of ill-health and Services (see example, below) An example of a NASCIS Report: National Indicator Set (NIS) for Adult Social Care Report Quick links to additional tools: These include, Projecting Older People Population Information (POPPI); Projecting Adult Needs and Service Information (PANSI); Forecasting Length of Stay and Cost (FLoSC) developed by the DH Care Service Efficiency Delivery (CSED) programme. The NASCIS Library: Easy access to the latest key documents, combined with an intuitive, intelligent search facility that draws upon on around 200 carefully selected social care and health web resources.
An example of one of the JSNA indicators in NASCIS: Participation in ‘Stop Smoking’ schemes.
What are the key benefits of NASCIS? • Increased ease of access to and use of management information. • Improves decision making at local and national level by providing consistent data and indicators. • Supports local benchmarking and enables end users to efficiently map time series analyses and trends against similar organisations. • Improved access to a wider range of timely social care information through a single national resource. • Reduced effort and cost of data collection, analysis and dissemination. • A platform for improved integration of health and social care via the inclusion of a range of data and indicators to support JSNA.
For further information about NASCIS, please contact The NHS IC’s Contact Centre on 0845 300 6016 or via email at enquiries@ic.nhs.uk
Page 7
Hip Replacement Comparison Tool By Simon Berry, Specialist Information Analyst, The Quality Observatory Over recent months I have been working with Mr Hugh Apthorp, Consultant Orthopaedic Surgeon at the Conquest Hospital in Hastings (and one of the successful bidders to the regional innovation fund) to develop a suite of analysis to support the spread of his short stay hip replacement programme to other Trusts within the region. Approximately 50% of Mr Apthorp's patients are discharged the day following their surgery and approximately 67% have a two day stay in hospital (this compares to 3% nationally). Mr Apthorp’s re-admission rate is also lower than the SHA average. See the next issue of Knowledge Matters to find out how Mr Apthorp and his team have achieved these amazing results. The hip replacement comparison tool is in final draft currently, however I thought that I would take this opportunity to share with you what will be available within the next couple of weeks. This tool is one of the first that we have developed which provides information to individual Consultant level. The tool consists of four separate tabs as follows: AllConsChart (right) – This graph enables a Trust to be selected and the average length of stay of each individual surgeon identified along with the number of operations that they have undertaken during the period. There is the option to modify the comparator lines (top quartile, median, mean) using the drop down box below the trust selection box. It is possible to compare against national, patch or trust consultants. Consultant Summary (below) – This provides an additional summary at Consultant level of the following: spells, bed days, average length of stay, pre-op length of stay, mortality, complications and readmissions
XXXXXXX Hospitals Trust Consultants Length of Stay Primary Hip Replacement (OPCS W371, W381, W391) Patients Discharged Feb 2009 - Jan 2010 18 XXXX Consultants Other Consultants Trust Upper Quartile
16
Trust Median Trust Mean
14
12
10
8
6
4
2
XXXXXXX Hospitals Trust Consultants 1ry Hip Repl (OPCS W371, W381, W391) Patients Discharged Feb 2009 - Jan 2010
12.7 8.7 7.4 7.0 6.6 6.6 6.5 6.1 6.1 6.1 6.0 5.0 4.7
0.3 0.1 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1
0% 0% 0% 0% 0% 0% 0% 5% 1% 0% 0% 0% 0%
0% 6% 4% 0% 4% 2% 1% 0% 3% 0% 0% 0% 0%
0% 7% 4% 0% 8% 10% 7% 9% 7% 3% 100% 0% 9%
XX XX XX X
XX XX XX X
XX XX XX XX XX X XX XX XX X XX XX XX X XX X
XX XX XX
XX XX XX X
C
38 860 192 7 172 324 661 135 542 570 6 5 273
C
3 99 26 1 26 49 102 22 89 94 1 1 58
C
CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX
CX
28 Day Readmits
C
% Complications
C
Mortality
C
Preop LoS
C
Avg LoS
CX
Bed Days
XX C XX X CXXX XX XXXX XXXX XX C XX XX XX X
0 XX XX XX X
Spells
C
Consultant
Last100Patients (below) – his tab provides a run chart of the most recent 100 patients discharged for a selected consultant (using the drop down box) with mean, median and upper confidence limit (3 standard deviations) for those patients (if they have done less than 100 it will show less data points). Note that the patients in the chart were under that consultant on the admitting episode. Last 100 Primary Hip Replacement Patients Discharged for Consultant CXXXXXXX
Source: Trust SUS extracts, elective admissions, procedure in 1st episode Patients with complications identified from any of first 12 diagnosis fields with T80 - T89 ICD10 code Readmissions are patients with emergency readmission within 28 days of discharge
Source: SUS Extracts, OPCS W371, W381, W391 on admitting episode 60
50
30
20
10
LoS
Median 5 Days
Mean
6.6 Days
22/02/10
20/02/10 21/02/10
11/02/10 17/02/10 19/02/10
01/02/10 02/02/10 04/02/10 05/02/10 06/02/10 08/02/10
19/12/09 21/12/09 22/12/09 25/12/09 08/01/10 15/01/10 18/01/10 26/01/10 27/01/10 28/01/10
18/12/09
15/12/09
04/12/09 13/12/09
19/11/09 20/11/09 21/11/09 23/11/09 27/11/09 30/11/09 03/12/09
11/11/09 13/11/09
08/11/09 09/11/09
27/08/09 31/08/09 16/09/09 22/09/09 24/09/09 25/09/09 30/09/09 03/10/09 07/10/09 10/10/09 17/10/09 19/10/09 20/10/09 23/10/09 05/11/09
26/08/09
19/08/09 24/08/09 25/08/09
18/08/09
12/08/09
18/07/09 23/07/09 27/07/09 29/07/09 06/08/09
14/07/09
08/06/09 14/06/09 17/06/09 03/07/09 04/07/09
0 12/05/09 17/05/09
Days
40
11/05/09
Last100PatientsList (below) – This tab provides a simple bar chart showing the profile of admissions, operations, discharges by day of week of those patients under the selected consultant. In addition, the admission date, operation date and discharge data is provided for each individual patient treated by the Consultant in the period. This will enable Trusts to check that activity has been correctly attributed.
UCL 17.0 Days
Once completed, the intention is that this tool will be updated on a quarterly basis and distributed to Medical Directors of all Trusts and PCTs. The tool will also be available to download from the Quality Observatory website. If for any reason you have any queries or cannot locate the tool, please do not hesitate to contact me (simon.berry@southeastcoast.nhs.uk) If you would like to find out more about Mr Apthorp’s programme, please contact Abigail.Nicol@esht.nhs.uk
Page 8
Delivering Same Sex Accommodation Dashboard By Katherine Cheema, Specialist Information Analyst, The Quality Observatory Protecting patients’ privacy and dignity is an essential part of delivering high-quality care. Providing same-sex accommodation is one powerful sign of the NHS’s commitment to treating all patients with respect, and to making their time in hospital as comfortable as possible. Throughout the South East Coast region, innovative work has been undertaken to improve the experience of patients in this important area of privacy and dignity (for more details see the booklet in the Downloads section of the website (privacy and dignity is within the clinical information Section). Part of ensuring that these innovations delivered what they aimed to do i.e. the virtual elimination of the sharing of sleeping, toilet and washing facilities among DSSA IMPROVEMENT INDICATORSmen and women, was of course to measure the progress Patient experience data - 2009/10 against 2008 inpatient survey Self declaration: organisations were making. This Compliant 100% was done through the collation of a 90% Ward estates return results range of indicators and undertaking 80% Predicted Compliance Dec-09 Non Compliant local surveys of patient experience Actual Compliance for Dec-09 Non Compliant 70% of same-sex accommodation. Predicted Compliance for Mar-10 Non Compliant 1
A low percentage reflects better performance
Worse
0.9
0.8
0.7
60%
The measures included on the dashboard came from a variety of sources and enable the SHA staff responsible for assuring the programme to add contextual commentary. These indicators are:
0.6
Weekly breach reports
Average weekly
2,793
16
50%
0.5
14 Number of breaches
12
40%
0.4
30%
0.3
10 8 6
Better
4
20%
0.2
2 0
10%
22/02/2010 - 28/02/2010
0.1
01/03/2010 - 07/03/2010
08/03/2010 - 14/03/2010
15/03/2010 - 21/03/2010
Period
0% Q1: When you were first admitted to a bed Q5: While staying in hospital, did you ever on a ward, did you share a sleeping area, for use the same bathroom or shower area as patients of the opposite sex? example a room or bay, with patients of the opposite sex?
Local results
England benchmark (IPS 2008)
Other
SHA commentary
0
Baseline (IPS 2008)
Clinical need
•
Contextual commentary here!
organisations’ selfassessment of compliance with DSSA policy,;
Top decile (IPS 2008)
• the number of patients actually reporting sharing accommodation or bathroom facilities with members of the opposite sex (benchmarked against national benchmarks and the 2008 inpatient survey baseline);
Ward estates return results
100% 90%
A low percentage reflects better performance
80%
Washing facilities that are not designated same-sex* (exclude those with specialist bathing equipment)
None recorded
Toilet facilities that are not designated same-sex* (exclude those with specialist toileting equipment)
None recorded
Pass through opposite sex areas to reach their own sleeping or toilet facilities
None recorded
70% 60% 50% 40%
Weekly breach reports
30%
16
20%
14
10%
12
0% April
May
June
July
August
September
October
November
December
January
Ward results
February
March
Trust baseline
10 8
Taken together, these measures can provide an interesting picture. In the example above, whilst the estates return shows non-compliance, the Commentary patient perspective has improved beyond the national top decile and weekly DSSA breaches have improved significantly. The weight added to each indicator rather depends on the individual organisation, but it serves to underline the importance of not attempting to describe improvement through a single measure or indicator. Patient experience data: Q5 While staying in hospital, did you ever use the same bathroom or shower area as patients of the opposite sex? 90%
6 4
A low percentage reflects better performance
2
80%
Clinical need
Week 31
Week 30
Week 29
Week 28
Week 27
Week 26
Week 25
Week 24
Week 23
Week 21
Week 20
Week 19
Period
Week 18
Week 17
Week 16
Week 15
Week 14
Week 13
Week 9
Week 12
Week 11
Week 8
Week 10
Week 7
Week 6
Week 5
Week 4
60%
Week 3
70%
Week 2
0
Week 1
Worse
100%
Week 22
results from a short term weekly data collection, show the number of DSSA breaches per week with an indication of whether breaches were for clinical reasons (for example the use of special equipment) or otherwise.
Select ward:
Patient experience data: Q1 When you were first admitted to a bed on a ward, did you share a sleeping area, for example a room or bay, with patients of the opposite sex?
Number of breaches
•
DSSA IMPROVEMENT INDICATORS- Babylon 5 ward
Worse
results from estates surveys;
Better
•
Other
50% 40%
Better
30% 20% 10%
0%
April
May
June
July
August
September
October
November December
January
Ward results
February
March
Trust baseline
This dashboard was designed to reflect data from a very specific period of time; patient experience information on DSSA is not collated by the SHA on a regular basis (or the weekly breech information!). However, if individual organisations wish to utilise a similar tool to keep any eye on DSSA issues at a ward level, the dashboard has been adapted into a generic tool that organisations can enter their information into; all the charts and calculations are then generated automatically. The tool can be downloaded from the website and includes simple instructions for use. It currently has enough space for 25 wards (in the download all of them are named after famous sci-fi spaceships!). As ever, if you have any queries or comment, please contact me (Katherine.cheema@southeastcoast.nhs.uk)
Page 9
QIPP Measures and Monitoring Samantha Riley, Head of the Quality Observatory The Quality Observatory now has named links for each regional QIPP programme to link with the SHA Programme Leads (a summary table appears below). For some of the programmes, a significant amount of work has already been undertaken with regards to the specification of indicators, the development of dashboards and associated tools. Numerous indicators which are relevant to QIPP are already reported on existing dashboards (such as the Performance Improvement Dashboard and Quality Dashboard). For each programme, we are planning to develop a high level dashboard, which is some cases may then be supplemented by a series of dashboards and tools providing further details for specific areas. A good example of this is long term conditions. A high level dashboard has been developed for some time, this is already supplemented by a long term conditions cost explorer tool, two dementia dashboards and a draft COPD dashboard. For each programme, we hope to have high level dashboards available in draft and populated with data within the next month or so. QIPP PROGRAMME
SHA LEAD
QUALITY OBSERVATORY LINK/S
Maternity and Newborn Children and Young People Staying Healthy Acute Care Planned Care Mental Health Long Term Conditions End of Life Rationalisation of Pathology Productivity through Medicine Management Safe Care Contracting & procurement efficiencies - CSU Primary Care contracting efficiencies Back Office/Supply Chain Rationalisation Estates Optimisation Digital Vision - Informatics Workforce Productivity
Helen O’Dell Trish Dabrowski Seamus Watson Rachel Harrington Kate Slaven Katrina Lake Amanda Grindall Karen Devanny Stephen Day Gail Fleming Debbie Stubberfield Stephen Day Oliver Phillips David Price John Herbert Andrew Brownless Philippa Spicer
Adam Cook & Katherine Cheema David Harries David Harries Simon Berry Simon Berry & Rebecca Matthews Adam Cook Katherine Cheema & Nikki Tizzard Adam Cook Adam Cook Rebecca Matthews Adam Cook & Katherine Cheema Simon Berry Katherine Cheema & Nikki Tizzard Simon Berry Charlene Atcherley-Steers & Adam Cook Nia Naibheman & Kiran Cheema Kiran Cheema
If you would like to know about any of the above programmes in more detail from an information perspective i.e. which indicators are currently reported on, which tools are already developed and planned, then please contact the named Quality Observatory lead. For general queries regarding any of the programmes, please contact the relevant SHA Programme Lead.
Quality Observatory published The Quality Observatory are delighted to have been published in the May 2010 edition of Clinical Risk. Clinical Risk is a journal of the Royal Society of Medicine and publishes authoritative articles and news on risk management, patients safety and medicolegal issues. The journal is primarily aimed at senior clinicians and managers in NHS Trusts and independent hospitals, and at Claimant and Defendant lawyers specialising in clinical negligence. The paper (jointly written by Samantha and Kate), describes the role that a Quality Observatory can play in utilising information to create a culture of measurement for improvement. The paper describes a number of areas on which the Quality Observatory has focused to improve the quality and safety of services provided to patients within South East Coast. Here’s the full reference for the paper : Riley, S. and Cheema, K. (2010), Quality Observatories: using information to create a culture of measurement for improvement, Clinical Risk, 16 (3), 93-97 If you would like a copy of the paper, please e-mail quality.observatory@southeastcoast.nhs.uk
Page 10
Q : How many acute beds are there across South East Coast? A- This is one of the most simple and fundamental questions that any analyst could ever be asked, and yet the answer is far from easy. Leaving aside the often contentious issue of “How do you define a bed?”, (a whole other minefield for another time), then we would expect this number to be readily available at a moments notice, at least to anyone working in a secondary care environment. However the day-to-day reality is that beds, bays and whole wards can be opened and closed at quite short notice depending on a variety of pressures. Reconfiguration and system reform also means that more long term wards are shut or re-assigned usage, and this information isn’t always passed down the chain of command. Having said all this, there will be at least a rough idea of numbers of beds within the Trust – even if it means the analyst having to ring round ward managers and ask them. For a PCT, or an SHA, asking how many beds are in our patch gets a bit more complicated. The weekly SITREP can be used to collect information on beds – numbers of acute beds, numbers of occupied acute beds, numbers of medical beds, and numbers of medical outliers. The problem with using this data source is that these fields are not mandatory, and as a consequence the data is not always complete or accurate. To be fair to Trusts, many are still making great efforts to complete this information week-on-week, and provide a useful pool of data. So, if we can’t use the weekly SITREP, then what can we do? The most commonly used resource is the annual KH03 collection – this does show the average number of available and occupied beds per day by Trust, sector and ward type. This is the standard data source that would be used nationally for any calculations based around numbers of beds. This data is available from the Department of Health website to download: http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/Beds/DH_083781 As a something that provides a general overview, and gets a good feel for the number of beds it’s a great data source, but it does have the disadvantage of only being annual. So if a Trust undergoes reconfiguration after their original submission, which substantially alters their bed stock, then the numbers will be wrong. Especially worrying would be using the bed numbers as a denominator in a calculation, this could severely skew results. So going back to the original question – how many beds do we have (particularly from a PCT or SHA viewpoint). The answer is we don’t know exactly – we can have a good idea for previous years, but right here, right now the best way to find out is to pick up the phone and call your local Trusts.
Q : I need an automatic process to list items in number order to compare performance/achievements and do not have an obvious solution on my PC. Help! A– Excel can of course help! I have produced a tool that simply creates a Report (League Table) consisting of a list of Items ranked in number order / significance. By entering basic reporting data (See example right with name "Service Team 1 etc. and associated number (10.0 etc. - i.e: Yellow Cells) into the “Data Input” tab the League Table spreadsheet will automatically create a League Table on the “Results” tab and associated graph on the “Dashboard” Tab, with respect to report month / week. I have created two different League Tables to cover Numbers and Percentages with easy to understand guidance notes on the “League Table Notes” tab. I am always happy to help if you have any further questions. The League Tables for Numbers and Percentages are available to download from the Quality Observatory website or you can contact me on 01403 227000, ext 7612 or email me : robert.leiper@westsussexpct.nhs.uk Thanks to Robert Leiper, Project Manager, West Sussex Health (Community Services)
Page 11
Patient Reported Outcome Measures By Professor David Parkin, Chief Economist, NHS South East Coast A completely new type of routine NHS data is now available, with the release of the first results from the national Patient Reported Outcome Measures (PROMs) initiative. This article explains what PROMs are and gives some headlines from analysis of the data. What are PROMs? PROMs are indicators of the impact of health care interventions on patients’ health, derived directly from information given by patients themselves. They have been widely used both in the UK and elsewhere for many years, but the NHS is now leading the world in its requirement that PROMs are routinely collected. Since April 2009, providers of four surgical procedures - hernia repair, hip and knee replacement and varicose vein surgery - must collect specific health status measures for all NHS patients before and after treatment. This initiative, which was one of the outcomes of the Next Stage Review, will be extended to other NHS services and might even be linked to payments for care. PROMs are likely to be included in Quality Accounts and will be an important part of the South East Coast’s Enhancing Quality programme. What do the first data show? Pre-operative EQ-5D index score for groin hernia patients in PCTs
The first data to be released are not strictly outcome measures, but they are nevertheless very informative. They measure patients’ pre-operative health, giving a view of case mix that has not been routinely available before.
0.8
0.7
0.6 EQ-5D score
For each procedure, patients complete a questionnaire called the EQ-5D, which is a simple measure of overall health. It produces two index numbers: one derived from a scoring system applied to a description of the patient’s health and the other from a visual analogue scale. Hip, knee and varicose veins patients also complete a questionnaire that is focussed on their condition, which also generates an index number.
0.9
0.5
0.4
0.3
0.2
0.1
0 1
6
11
16
21
26
31
36
41
46
51
56
61
66
71
76
81
86
91
96 101 106 111 116 121 126 131 136 141 146 151
PCT
Nationally, the data show large variations across both commissioners and providers in case mix, especially for hip and knee operations. There will be a number of reasons for this, but an association that is noticeable is between PROMs scores and levels of deprivation, which is also reported. The more deprived the area where the patient lives, the worse their self-rated health is, particularly for knee replacements but less so for varicose veins operations. An additional factor is the type of facility, where it seems that independent sector treatment centres treat patients who on average have better health states. It is therefore not surprising that patients in the South East Coast overall have the best pre-operative self-reported health of any SHA region in England for all of the procedures. For most PCTs in the region, patients’ average health is at or above the English average for every procedure. The chart shown is an example of this, with SEC PCTs highlighted. However, there is no consistent ranking between our PCTs. Most, but not all, providers in the region are also above the English average, but there is a considerable variation between them. What is the future? The next stage will be the release of data on post-operative health (due in September), which will give information both on the health states that result, adjusted for factors that might have an effect on that, and at the gain in health from pre- to post-operative condition. These data will provide much valuable information for patients, clinicians and others in the NHS. If you are interested in reading more about PROMs, the King’s Fund and the Office of Health Economics have produced a useful report on PROMs which is available for free download at http://www.kingsfund.org.uk/publications/proms.html. Details of the DH PROMS initiative , including the data, can be found at http://www.ic.nhs.uk/services/patient-reportedoutcomes-measures-proms. A more detailed report on PROMs and the results for South East Coast will shortly be available to download from the Quality Observatory website. In the meantime, if you have any queries please do not hesitate to contact me directly david.parkin@southeastcoast.nhs.uk
Page 12
An Introduction to Turnover Rates By Aleksandra Bujnicka, Workforce Support Analyst
Web Search on ….. Turnover “Labour shortages in nursing have been forecast for several years by human resource planners in health care”
“(…) recruitment will only be effective to the extent that these students complete their training programmes and do not leave their jobs or the profession early in their careers”
“…report showed that many new graduates are leaving their jobs within 2 years of graduation”
“(…) in the United Kingdom 10% of newly qualified nurses leave the NHS within 12 months of qualifying and one-third of nurses of working-age are no longer working as nurses” These are some examples of statements to be found in the research literature drawing our attention towards the ongoing issue of nursing shortages and the importance of managing turnover, in particular nursing turnover, within appropriate levels as critical to delivering high-quality patient care. Staff Turnover is Included in the NHS Better Care Better Value Indicators , together with Sickness Absence Rates and Agency Costs, as some of the high-level indicators of organisational efficiency and performance. These Workforce Metrics can be indicative of: trends , possible problem areas, retention issues, costs Consequently, they can support informed planning, show possible improvement areas and generate saving ideas. NHS Better Care Better Value Indicators guidance suggests that “each 1% reduction in turnover is estimated to save 1% on paybill in cash and efficiency costs”.
Measuring Turnover : Turnover is usually measured as a rate - the number of leavers in a period of time given as a percentage of the average number employed (during the same period). Number of Leavers x 100
= Turnover Rate
Average Number Employed If there is 81 leavers and the number of staff employed at the beginning of a given period was 350 and at the end 366 – the turnover rate would be: 81 x 100
= 5.7 %
(350 + 366) / 2 The NHS Better Care Better Value Indicators, defines the number of “Leavers” as including: Redundancies, Death in service, Dismissal, End of contract, Retirements, Staff who moved to other NHS organisation And, it should not include: Staff who left one role but stayed within the organisation, Bank staff ,Agency staff
Page 13 To facilitate the measurement and analysis of turnover, control charts are worth using. It is possible to look at turnover rates from different angles. Chart 1 For the purpose of comparing or monitoring trends, the indicator can be approached from higher - organisational level as in Chart 1.
Turnover Rate by SHA SHA Turnover Rate 2009/10 Cumulative National Avg 2009/10 Cumulative National Avg 2008/09
SHA Turnover Rate 2008/09 Monthly National Avg 2009/10
Monthly National Avg 2009/10
4.00
Cumulative National Avg 2008/09
3.75 3.50 Cumulative National Avg 2009/10
3.25
Chart1 shows :
3.00 National Avg 2008/09
2.75
indicative monthly trend data for the region, (yellow bars)
2.50 2.25 2.00
alongside national and local trends (green and pink lines)
1.75 1.50 1.25
and gives and indication of historical seasonal national and local variation (brown line and green bars)
1.00 0.75 0.50 Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Source: ESR DW
Chart 2 SEC SHA Turnover Rate (April-June 2009 Avg)
% FTE - National Average Turnover Rate 0.20
SEC SHA Average
Students
Nursing and Midwifery Registered
Medical and Dental
0.00 Healthcare Scientists
and local average for all staff ( purple bar)
0.40
Estates and Ancillary
the national average for all staff (yellow line)
% FTE - National Average Turnover by Staff Group
0.60
Allied Health Professionals
alongside national average for each major staff group (pink line),
0.80
Administrative and Clerical
indicative average data for each major staff group in the region (blue bars),
% FTE - SEC SHA Average Turnover by Staff Group (Note: Group "No Staff Group Specified" Omitted)
1.00
Additional Clinical Services
Chart 2 shows :
1.20
Add Prof Scientific and Technic
The indicator could also be approached from a more specific department or staff group level as in Chart 2.
As there is no set, acceptable level of turnover, it is possible, while using control charts, to gauge the turnover values against other similar organisations or workforce groups. This can help to highlight any related problem areas and to address the issues as early as possible. With the use of ESR DW and NHS I-View these data sets can be prepared to compare whole SHA regions, or individual organisations of similar types.
Summary: Turnover rate is an interesting and important indicator able to illustrate the trends within the workforce including possible problem areas. However, it is worth noting that for quality monitoring purposes and to evaluate the true impact of turnover, it helps to take into account additional related information and measures that tie in with turnover metric and when combined can give a fuller, multi-dimensional picture of workforce. Additional information that could be used in analysis, on top of the number of leavers, would be: Number of starters, Length of service, Department, Staff group, Time of year And related measures could include: Stability Rate, Vacancy Rate, Sickness Absence Rate, Agency Costs. If you are interested in this topic and would like further information or a reading list please contact : Aleksandra.Bujincka@SouthEastCoast.nhs.uk
Page 14
Data.gov.uk—A new source of information Charlene Atcherley-Steers, Performance Analyst, South East Coast Quality Observatory Data.gov.uk was launched on the 21st January 2010 and was set up by the government with help from Sir Tim Berners-Lee (inventor of the World Wide Web) and Professor Nigel Shadbolt (Deputy Head of the School of Electronics and Computer Science and the University of Southampton). Its goal is simple: to share government data by making sure it is easy to find, licence and re-use. The website allows people to search for data for their own use or for applications that they will share with others. The site also allows public bodies to upload data that they are happy to share or that is already publically available. The layout of the site has been designed to be simple to make it easy to navigate. The data tab is easy to spot and takes you to a page where you can search for datasets. There are several search options including a simple keyword search like you would find on most sites, an option to choose popular tags, the ability to filter by Public Body, view all the datasets and even choose a random dataset. Using the keyword search brings up all datasets that are relevant, you can then filter by Nation, Public Body and Tags. This means you can quickly cut down large result sets and get to what you want. Several government departments as well as councils have contributed datasets. The biggest contributor is the Department of Health which, at the time of writing had contributed 599 datasets. Therefore there are lots of health related datasets available for people to create wonderful and useful applications and dashboards. As well as being able to upload details of and links to applications, users of the website can suggest further applications that could me made. This enables those with the ideas to reach those with the skills to bring them to life. There are already lots of applications on the site and they are very varied with many different uses. For example UK Pharmacy which allows iPhone users to find a pharmacy based on their location or through a place name or postcode search. There are other health related applications including a GP search and Obesity data by PCT and local authority. Others have more of a fun side such as the ASBOrometer that allows you to see how many ASBOs have been issued in a area and how that area compares to others. So next time your looking for some data check out www.data.gov.uk. For those of you who want to get more involved and be kept up to date with the project there are forums, blogs and you can even follow them on Twitter!
Page 15
Patient Experience Tool Updated Katherine Cheema, Specialist Information Analyst, South East Coast Quality Observatory We are pleased to announce that the Inpatient Survey Benchmarker developed by the Quality Observatory last year, has been updated to include the INPATIENT SURVEY 2006-2008 BENCHMARKER- QUEEN VICTORIA HOSPITAL NHS FOUNDATION most recently published data from TRUST Select organisation (a-z) QUEEN VICTORIA HOSPITAL NHS FOUNDATION TRUST the annual inpatient survey. Save & print
BENCHMARKER
The tool utilises that national survey data—thereby allowing any English Trust to make comparisons with regions and different Trust types on all of the questions included in the survey. Questions are also grouped into key themes to give a broader overview of key areas such as privacy and dignity and hygiene.
KEY THEMES
Notes: None
Select questionnaire domain
Notes: 80%
Select question
60%
Q26. How would you rate the hospital food?
Elective waits & choice
Q6 not included in 2006 or 2009; shown as 0%. Definition change in Q8 in 2007
100%
Hospital and ward
QUESTION KEY Q6. Were you offered a choice of hospital for your first hospital appointment? Q10. Were you given a choice of admission dates?
40% Q11
Select first benchmark (trust category)
Select second benchmark (regional)
MEDIUM ACUTE OUTSIDE LONDON
ENGLAND
Q10 20%
Q8. From GP referral, how long did you wait to be admitted to hospital?
0% Q9. How do you feel about length of time on the waiting list before your admission to hospital?
Series display options
100%
90%
Q11. Was your admission date changed by the hospital?
2006 Q9
80%
2006
70%
2007 2008 2009
Q8
2007
2008
2009
CQUIN questions and composite score
60%
Notes:
50%
Composite CQUIN score for trust and selected benchmarks: 2008 and 2009
Selected trust results for individual CQUIN questions: 2008 and 2009
40%
100%
ENGLAND
30% 80%
MEDIUM ACUTE OUTSIDE LONDON
20% 60%
New this year is the inclusion of a section enabling trusts to assess their performance on the 5 CQUIN questions against benchmarks (see below).
10% QUEEN VICTORIA HOSPITAL NHS FOUNDATION TRUST
40%
0%
2006
2007
2008
2009
QUEEN VICTORIA HOSPITAL NHS FOUNDATION TRUST
61.26%
65.53%
71.54%
67.40%
MEDIUM ACUTE OUTSIDE LONDON
52.10%
51.65%
54.04%
52.64%
ENGLAND
52.24%
52.96%
54.66%
53.63%
20%
0%
2009 0% Q41
Chart Type Bar chart
Line chart
Series display options B'mark 1 Trust
Q44
Q45
2008
B'mark 2
Q64 2009
Q69
10%
20%
30%
40%
50%
60%
70%
80%
90%
2008
Q41. W ere you involved as much as you wanted to be in decisions about your care and treatment? Q44. Did you find someone on the hospital staff to talk to about your worries and fears? Q45. W ere you given enough privacy when discussing your condition or treatment? Q64. Did a member of staff tell you about medication side effects to watch for when you went home? Q69. Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital?
The tool has a notes tab which each element of the tool in more detail. The tool can be downloaded by registered users of the Quality Observatory website. Look in the Clinical Information section of ‘Downloads’ and select patient experience.
If you have any questions (or find any bugs!) please e-mail katherine.cheema@southeastcoast.nhs.uk.
New Quality Observatory website coming soon……. The Quality Observatory is currently finalising a catalogue of products, tools and dashboards developed by the Quality Observatory, South East Public Health Observatory and other regional bodies. The catalogue will underpin the new Quality Observatory website (coming soon) and will enable users of the website to search by QIPP programme or clinical pathway. In addition to the catalogue, our indicator library will provide details of the construction of each indicator with definitions and data sources. Users of the current website will not need to re-register and will automatically be directed to the new site once it is launched. If you would like to be a test user of the new website, please e-mail quality.observatory@southeastcoast.nhs.uk
Page 16
My IC—Get faster, easier access to information By Caroline Cowen, Senior Marketing Manager My IC is a new feature on The NHS Information Centre’s website that allows users to create their own information homepage. My IC gives users free access to a library of more than 359 useful data, statistical resources and analytical tools from The NHS Information Centre and other public sources. It saves users time and effort accessing the information they need to do their job and allows them to have their most used resources in one place. Who is it for? This new feature has been designed for informatics professionals working across health and social care, who use data and statistical information for planning and management decision making. My IC allows users to create a page completely from scratch or choose a prepopulated theme page. Users can select their theme based on their area of interest. We currently have profiles in commissioning, public health, finance, clinical, workforce, social care and specialist areas such as mental health to get users started. ‘The most useful feature is being able to personalise the page to get easy access to the information that’s relevant to my role, and it’s quick and simple to do’ Greg Chambers, Head of Workforce Systems, NHS Nottinghamshire County.
So, what are the benefits of My IC for users? Authoritative health and social care information in one place Bookmark and store content from preferred sources, quickly and easily. • Save links to essential data analytical tools from The NHS IC and external sources. • Add content from a library of over 359 useful data and statistical resources selected by The NHS IC for their relevance, credibility and usefulness.
•
Easier access to useful data and statistical resources • Customise and broaden the search. Users can access 200 carefully selected health and social care website sources and save their searches to their My IC page. • Get news feeds to latest information updates. • Store essential analytical tools from The NHS IC.
Information presented in a way that makes sense to users • Save data, documents and website links in panels. • Add own links to favourite resources. • Personalise the page with information from The NHS IC and external sources. • Add, remove, resize, rename and change panels to suit own needs. • Add external Google widgets e.g. BBC News, NHS Evidence search and National Rail Enquiries to My IC.
Get started To use My IC, users need to register http://www.ic.nhs.uk/myic If you already use one of our web applications, such as NHS iView or NASCIS, you can log into My IC using your existing username and password.
Page 17
Measurement Channel for Cost and Quality By Dr Annette Neath, Associate, NHS Institute for Innovation and Improvement Jim Easton, NHS national director of efficiency and improvement, is calling on the NHS to work together to find solutions to local healthcare challenges by sharing examples of best practice in effective measurement. Jim Easton recently said: “Delivering improved quality care against a difficult cost backdrop is not going to be easy so it is vital that we know whether we are being successful or not. To do this we need to be able to measure our work at every level to show that we are making quality improvements and cost savings at every step of the way. “ Measurement at local level is going to be key if we are to determine early on whether something is working or not and change tack if need be rather than find out afterwards that a service is not delivering quality care or is not viable cost wise. Our experience, however, is that many people are unsure about what to measure, how to measure it and whether they are going about it in the right way. This is why the NHS Institute for Innovation and Improvement has recently established a new web-based Ideas Channel to showcase examples of good practice based on skills, knowledge and effective metric models. The aim is to develop a central database where people can access these best practice examples and implement them across their organisations. But first we need to obtain them, hence our call to arms to all those working with measurement systems in the NHS. We want to hear about all the good work that is being done out there and, instead of re-inventing the wheel, we want to be able to harness this learning and put it in one place so that we can all draw from it. If you or your team have any shortcuts to collect and collate data that shows variability, demonstrates good knowledge and learning and includes easy-to-use and accessible metric models, we want to hear from you. The NHS Institute is encouraging all NHS organisations to submit examples including effective ways of measuring patient and staff experience and satisfaction, safety, clinical outcomes, prevention, population health and staff productivity. NHS staff can log onto http://www.institute.nhs.uk/cost_and_quality/ qipp/measurement_for_quality_and_cost.html to submit their measurement examples and to review and comment on other people’s submissions. The website will be live until 15 July 2010 after which a panel of specialists from a variety of NHS organisations will help determine which examples have the biggest potential to make a difference across the whole of the service. These will be published on the Ideas Channel website. In line with other successful calls to NHS staff for sharing of best practice, we look forward to thousands of you submitting and viewing examples, reviews and comments from across the country. So, please do make a submission and tell us where and how you have applied effective measurement to your work and find out what other people have posted.
Don’t delay! The channel will remain open until 15th July 2010. So either, log on to http://www.institute.nhs.uk/cost_and_quality/qipp/ measurement_for_quality_and_cost.html or e-mail Annette.neath@institute.nhs.uk for further details.
Page 18
NEWS Revision to 2010/11 Operating Framework and changes to targets A revision to the 2010/11 Operating Framework has been published on the Department of Health website: http:// www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_110107 This has made a few immediate changes to national targets:
•
•
18 weeks will no longer be performance managed by the Department of Health although data will still be published and patients’ rights under the NHS constitution will continue. In the future there is likely to be an increased focus on median waiting times; The operational standard for A&E four hour waits has now reduced from 98% to 95%. Again there will be a focus on median waiting times;
•
The Vital Signs primary care access indicator will no longer be a performance target. All other Vital Signs and Existing Commitments remain the same for this year.
Withdrawal of 18 weeks and audiology PTLs Following the publication of the revision to the Operating Framework, the 18 weeks and audiology weekly PTLs will no longer be collected. The returns for the week ending 20th June will be the final returns. The monthly returns will still be collected and published as normal. CQC Ratification The first phase of data to be used by the CQC in their annual assessment for 2009/10 has now been made available to organisations on the ratification website. A password is required to access this and organisational passwords have been emailed to PCT and Trust Chief Executives. Any queries should be emailed to performance.indicators@cqc.org,uk This is an opportunity for organisations to review the data and raise any enquiries on the data. The deadline for phase 1 enquiries is 8th July 2010. A second phase of data will be uploaded on 14th July with the final data being released on 2nd August. VTE Risk Assessment Collection The VTE risk assessment collection is now available on Unify along with all guidance and information. April and May will be voluntary returns with this being mandated for June 2010 data.
PbR Benchmarker update A number of updates have recently been made to the Benchmarker. Accident & Emergency (A&E) indicators have been added to the existing inpatient and outpatient data available in the National Benchmarker. Users can select from a number of indicators covering attendance duration, referrals and coding measures. The A&E data is accessible from both the Data Explorer and the Scorecard Viewer. A full list of indicators is available from the ‘help’ pages which can be accessed from the National Benchmarker home page. Users from outside the NHS can now access the National Benchmarker providing they obtain a sponsor from an NHS organisation. This is aimed at users from private organisations who are working with NHS organisations. Non-NHS users can request access via the user request form which is available by pasting the following link into your web browser: www.audit-commission.gov.uk/pbrbenchmarking A list of terms and conditions have also been added to the National Benchmarker. By registering and using the National Benchmarker, users agree to acceptance of these. We recommend all users make themselves familiar with the terms and conditions that are accessible from the National Benchmarker homepage. Please provide feedback to pbr-benchmarking@auditcommission.gov.uk Fellowships in Clinical Leadership Applications for the above SHA programme are now open. There are 15 places available for this exciting initiative which offers a unique opportunity for clinicians working within Kent, Surrey and Sussex to develop practical leadership skills whilst also gaining an MSc in Clinical Leadership. The programme is very strongly workplace based with participants undertaking approximately 20 days of academic study per year in 5 day blocks at the University of Brighton. The programme is part time for 2 years. Assignments will be based around participant’s engagement in projects such as change management and partnership working. All applicants will need to obtain a supportive statement from their line manager. Applications can be made until 17:00hrs on Friday 9 July 2010. Application forms and further details can be accessed from laurainne.copnall@southeastcoast.nhs.uk. Interviews will take place on 27th July 2010
Page 19 SHA Innovation Report Published
NEWS Quality Accounts All healthcare providers or sub-contractors of NHS services have been required to produce a Quality Account by 30th June 2010 (with the exception of primary care and community care for this first year). Quality Accounts should have been submitted directly to the Secretary of State and also uploaded to the NHS Choices website (where that will be available to view). In July, the Quality Observatory will be undertaking an assessment of the indicators and areas of focus for Trusts within South east Coast. Further details on this piece of work will appear in the next edition of Knowledge Matters.
From 1 April 2009 SHAs were given the legal duty to promote Innovation. The first Innovation Report has recently been published. This report describes the work that NHS South East Coast has undertaken to fulfil this duty in the year 2009-10. The report will be available to download from the SHA website shortly www.southeastcoast.nhs.uk
New team member to join the Quality Observatory We are pleased to announce that the Quality Observatory will be gaining a new team member for the next two years to support analysis on quality, productivity and innovation. Fatai Ogunlayi (Fats as he likes to be called) will be joining the team on Monday 19th July. Fats will be reporting to Kate Cheema and working alongside Nikki Tizzard (who recently joined the team.
Did you know?????? That the South East Coast Quality Observatory website now has 978 registered users? Who will be the lucky 1,000th user? There will be a reward so get registering!
Analysis, Ancient and Modern If you thought that the need for proper measurement and analysis is a new phenomenon to the public sector think again; throughout history there are numerous examples of how good quality analysis has been the corner stone of civilisation! In this (possibly) regular spot, we’ll be looking at where analysis and the effective visualisation of information has been used to great effect in healthcare and beyond. We’ll start with the very ancient. The ‘Rhind Mathematical Papyrus’ dates from around 1550BC and contains 84 mathematical problems, including how to calculate the hypotenuse of a pyramid and how to distribute 100 loaves of bread among a workforce in different ratios. It was likely designed to be a guide for scribes, the administrators in Egyptian Society, to enable them to carry out routine tasks effectively. These kind of analytical and mathematical skills were crucial in ancient societies to ensure everything ran smoothly; create buildings, manage food supplies and compute the flood levels of the Nile for example. The title of the papyrus gives some indication of the importance placed on its contents: “The correct method of reckoning for grasping the meaning of things and knowing everything, obscurities and all secrets”. Perhaps a little ambitious! If you would like to find out more about the papyrus click on http://www.britishmuseum.org/explore/highlights/ highlight_objects/aes/r/rhind_mathematical_papyrus.aspx
Page 20
Introducing Nikki Tizzard Hi, I’m Nikki Tizzard and I’ve just joined the team on a two year secondment from East Sussex PCTs. I’m working with Kate Cheema as a Quality Innovation & Productivity Analyst where, among other things, I’ll be leading on COPD and also working on a new project for East Sussex with some of my old team. I started working for the NHS in January 2009 as a Health Planning Analyst, focusing on Practice Based Commissioning. Prior to that I worked briefly in the world of investment management (the market crash of 2008 saw the end of that!) and also spent nine years working in the wines and spirits industry – hard work but great perks of the job! I’m now learning lots in my new role and enjoying the challenge. I commute to Horley from Eastbourne where I live right by the sea - not so good in the winter but just great in the summer. I look forward to meeting you all!
90 Minutes Referee to Tea Time Disappointed your team didn't score? Missed a penalty, lost the ball? Do not worry, don't let dreams shatter, In the long run, it doesn't matter. When it's over and the game's done, The aftermath is where you find the fun. Analyse the goals and chances, Opportunities and advances Replay the tackles and the passes, Looks like the ref may need glasses. The team, on paper, couldn't lose,
Exciting day….
At least that was the pundits views.
On the 28th May Nia Naibheman and Charlene Atcherley-Steers visited the Radio 1 Studio for Greg James’ show Feet Up Friday. They met various DJ’s including Fern Cotton, Chris Moyles and Vernon Kay, as well as spotting stars such as Slash and Noel Clarke. Nia and Charlene also enjoyed a tour of the studio. Here’s a photo of the girls with Greg James who is now a proud owner of the Quality Observatory mug.
In the end if you can't win on pitch or with statistics, Then lie back and think of England in 1966.
WORD SEARCH
Many Happy Returns…. …. To Kiran (Workforce Analyst within the Quality Observatory) who recently celebrated his birthday. Here Kiran can be pictured with one of his favourite presents—Shrek wrestling head gear. Could start a new trend…….
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:
ANALYST CHART DASHBOARDS DATA DATABASE EXCEL
FORMULA QUALITY QUERIES SAMANTHA SQL UNIFY
NHS South East Coast York House 18-20 Massetts Road Horley,Surrey, RH6 7DE Phone:
01293 778899
E-mail: Quality.Observatory@southeastcoast.nhs.uk To contact a team member: firstname.surname@southeastcoast.nhs.uk