Knowledge Matters Volume 5 Isuue 6

Volume 5 Issue 6 February 2012 Welcome to Knowledge Matters Hello everyone and welcome to the second (and hopefully not the last) Leap Year edition of Knowledge Matters.

Over the last couple of months good progress has been made in aligning the analytical resource across the South of England and gaining access to South wide data which will enable the production of tools and analyses to be more efficient. A priority for the Quality Observatory will be the replication of key tools such as the Directory of Ambulatory Emergency Care for Adults for the rest of the South. If there are key tools that you would like to see replicated, updated or enhanced please get in touch!

I am pleased to report that the web-based QOF tool developed by the team is now live on the Quality Observatory N3 website for testing. The tool contains QOF data for every GP practice in the UK and enables benchmarking at a range of levels (including against selected peers) and the ability to look at trends over time. The link to the tool appears below. Please have a play and provide us with feedback! http://bit.ly/SEQO-QOF (NWW/N3 ONLY) I am also pleased to report that the problem with our web based catalogue taking a rather long time to load has now been resolved—see the back page for further details of how Kiran worked his magic……..

Finally, in this edition I am particularly pleased to have an article from Paul Levy—one of the most read (if not the most read) health bloggers in the world. Paul is the former CEO of Beth Israel Deaconess Medical Center in Boston. Paul is an advocate for patient-driven care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement—so you can see why we get on! I would encourage you to have a look at Paul’s blog—the link for which can be found at the bottom of page 9.

See you next time!

Inside This Issue : Safety Thermometer Update

2

Skills Builder

6

SHAPE Update

14

Public Health Outcomes Framework

3

Measurement is key—transparency more powerful still

8

Analysis Ancient & Modern

15

Safer Smarter Care On-line Tool

4

Prevalence vs Incidence

10

Ask An Analyst

16

5

National Workforce Sickness Rates Tool

12

News

18

twitter.com/SECSHAQO issuu.com/SECQO

www.QualityObservatory.nhs.uk

2

NHS Safety Thermometer Update

By Katherine Cheema, Specialist Information Analyst Over the course of the past eighteen months or so, the NHS Safety Thermometer has made itself part of the QO family; from the early days of teething problems through to the snazzy tool it is today. We here at QO feel privileged to have watched it develop– a bit like a maiden aunty (we won’t claim parentage, that honour belongs to John Madsen of the HSC Information Centre!). But in the coming few months the NHS Safety Thermometer will properly come of age; this new stage of its life has occurred dizzyingly fast so hopefully what follows will help summarize the latest developments, what to expect in the coming weeks and what support is available to you.

The pilot year, where around 170 organisations from across the healthcare spectrum, including nursing homes, used the NHS Safety Thermometer as part of the Safety Express programme came to an end in December 2011. The data that had been gathered from the NHS Safety Thermometer was aggregated nationally and provided a fascinating picture of key safety issues in the NHS. Here at QO Towers we’ve begun to put the data alongside other data sources to provide a rich picture of safety and harm across the region.

The publication of the NHS Operating Framework for 2012/13 put the Safety Thermometer firmly in its place as a key part of the measurement of harm in the NHS through the introduction of a national CQUIN scheme to incentivise the use of the NHS Safety Thermometer throughout the service. The CQUIN requires provider organisations to collect data monthly using the NHS Safety Thermometer; this data is then submitted to the HSC Information Centre where it will be processed and made available, publicly, via the HSCIC’s website (have a read of page 8-9 to see why this is such a good idea!), publication will be in a way that avoids risk of identification of individual patients.

As the NHS Safety Thermometer is about to hit the big time it’s only right that it looks its best; colleagues at the HSCIC have been busy making the most functional NHS Safety Thermometer yet; the latest version was made available on the 31st of January (version 10.36).

You can download the latest version at http://www.ic.nhs.uk/services/nhs-safety-thermometer . Make sure you download this latest version, the HSCIC won’t be accepting submissions from anything before version 10.

A timetable has been published which sets out proposed dates for doing the surveys and the dates by which the data needs to be submitted back to the HSCIC for it to be included in the national collation and publication. Also available is a paper based version of the tool in either an Excel or PDF format; this is designed for teams to carry with them to record the information, prior to transfer into the electronic tool.

In the short term, a dashboard and funnel plots of using the data submitted from January 2012 onwards will be made available. Regional information teams, including the South of England teams, will be able to interrogate and analyse the data on behalf of their regions according to their requirements and build it into core reporting.

Technical support for the NHS Safety Thermometer will also be made available, and for South of England this will primarily be through me (e-mail address below) with more local support for South of England (Central) provided through Linda Sharpe (Linda.sharpe@southcentral.nhs.uk).

In addition, there are a couple of key resources I recommend that readers access if they are in any way involved with the implementation of the Safety Thermometer:

•

NHS Safety Thermometer user’s guide (which includes the magic Ctrl-SHIFT-E shortcut, a must for easy local analysis!)- http://www.ic.nhs.uk/services/nhs-safety-thermometer

•

NHS Safety Thermometer,:10 Steps to Success- http://www.harmfreecare.org/resources/nhsst-10steps/

Any questions, don’t hesitate to drop me a line at Katherine.cheema@southeastcoast.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

3

Public Health Outcomes Framework

By David Harries, Public Health Analyst Launched on 23 January 2012, the Public Health Outcomes Framework (PHOF) sets out the strategic direction for achieving positive health outcomes for the population and reducing inequalities in health.

The Framework has been published in three parts. Part 1 introduces the overarching vision for public health, the outcomes we want to achieve and the indicators that will help us understand how well we are improving and protecting health. Part 2 specifies all the technical details we can currently supply for each public health indicator and indicates where we will conduct further work to fully specify all indicators. Part 3 consists of the impact assessment and equalities impact assessment.

The framework concentrates on two high-level outcomes to be achieved across the public health system: • increased healthy life expectancy • reduced differences in life expectancy and healthy life expectancy between communities The outcomes reflect a focus not only on how long people live but on how well they live at all stages of life. The second outcome focuses attention on reducing health inequalities between people, communities and areas.

Using a measure of both life expectancy and healthy life expectancy will enable the use of the most reliable information available to understand the nature of health inequalities both within areas and between areas.

The two high-level outcomes are underpinned by a set of supporting public health indicators covering the full spectrum of public health and what can be currently realistically measured. These 66 supporting indicators re grouped into four ‘domains’: 1.

2.

3.

4.

Improving the wider determinants of health Health improvement Health protection Healthcare public health and preventing premature mortality

The intention is for data for PHOF indicators to be published in one place by Public Health England at England and upper tier LA level - and at lower geographical levels, and by various inequalities and equalities breakdowns where feasible. Currently 29 of the 66 PHOF indicators (and indicators corresponding to the two overarching outcomes) are already ready in terms of having a confirmed definition and data source, which will provide data at national and upper tier local authority level. Development work is ongoing to fully define and identify/improve data sources for those indicators that are not yet ready with the aim of publishing an updated technical specification in Autumn 2012. In addition Public Health Observatories will be working on producing a set of baseline figures for the indicators to be published also in Autumn 2012 to support local planning.

Primary alignment with the NHS Outcomes Framework (published in December 2011) is a set of shared indicators on premature mortality from specific disease areas (in domain 4 of the PHOF): Under 75 mortality rate from all cardiovascular diseases; Under 75 mortality rate from cancer; Under 75 mortality rate from liver disease; Under 75 mortality rate from respiratory diseases ;and Excess under 75 mortality in adults with serious mental illness. Other indicators shared between PHOF and NHS OF include: Infant mortality; Emergency readmissions within 30 days of discharge from hospital; Employment of people with long-term conditions.

There are also complementary indicators shared with the Adult Social Care Outcomes Framework (published in March 2011), relating to improving outcomes for specific client groups, e.g. those with mental illness, learning disabilities or long term conditions. Whilst, a complementary indicator around Employment of people with mental illness are shared across all three (Public Health, NHS, and Adult Social Care) Outcomes Frameworks.

For further information and to download and view the PHOF: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132358

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

4

Safer Smarter Care Online Tool

By Adam Cook, Specialist Information Analyst I’m sure that many of you are aware of our Safer, Smarter Nursing Metrics programme that has been running for several years now. This involved the local South East Coast area trusts sending in a spreadsheet of largely risk related nursing measures to the SHA once a month with a dashboard of those results to follow.

The initial big six metrics (MRSA. CDiff, Falls, Pressure Damage, Drug Administration Errors, and Patient Complaints) have changed.

The HCAIs have been dropped because they are reported extensively elsewhere.

The Pressure Damage has been split into all and new, and broken down into grades of severity. Falls also has been split into five grades of severity. There are a number of new indicators too around CAUTI, VTE and nutrition all to fall into national thinking along safety.

The evolution hasn’t just been applied to the measures, the whole tool and data capture and reporting system has grown. Safer Smarter Care metrics are available as a fully formed web tool.

Data can be entered directly into the on screen data capture page.

Access to this is through a secure login linked to a registered person’s e-mail account.

Once logged in they can add new data, and also edit and revise existing data, should the need arise.

Once the data is saved the table is viewable to all on the web and can be printed off as a PDF.

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

5

This, however, is not the end of the end of the process. Instead of the data having to be collated by the SHA, and pushed out in an excel spreadsheet there is an online reporting component to the tool which automatically updates a suite of charts, as soon as the data is saved. This means no waiting around for the dashboard to be uploaded or sent out, because there is a tab that will navigate directly to the online charts.

There are three separate strands of data:

•

Acute Inpatients

•

Community Inpatients

•

Community base care

There is a drop down menu to select which organisation, plus an overall South East Coast total for each of these types of organisation.

This means that whenever someone wants to look at the dashboard they know it will be as up-to-date as it can be.

Also, in the near future, this dashboard should be available to download as a PDF document too.

There is still some work to be undertaken on the online tool, a few polishing of rough edges, and adding in some extra functionality, but this work can all go on in the background, as the tool is now functionally live. The transition from spreadsheets to online will be happening over the next few months.

To use the tool go to the Quality Observatory Catalogue http://nww.qualityobservatory.nhs.uk/ Navigate to the Safer Smarter Care page, and click on the Online tool icon.

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

6

Low Impact Data Warehousing and Business Intelligence,- part 1 Store It Once Use It Many Times !

How many times have you sat in front of your PC cutting and pasting data into different excel workbooks, creating a myriad of reports that use the same data but are ever so slightly different? Ever wondered if there was an easier way to manage it?

Do you have a massive dataset, it won’t fit in Excel 2003, and you don’t want to be e-mailing out an enormous Excel document to all your contacts, eagerly awaiting a beautiful dashboard.

Tired of filling up mailboxes with and updated copy of the same workbook every day, week or month?

Well this article is here to help! We aim to introduce you to a few methods that should make your life easier and it won’t cost you anything!

The basic principles of Data Warehousing and Business Intelligence systems are fairly straight forward: Have a single updateable data store that can feed into may different report automatically

Update data store:

Multiple reports linked to Database and updated automatically

Database

The data store this example will use Access as the database but it could be any database MS SQL, MySQL , Oracle etc.

We will look at using Excel to create reports that are updated from our database, but again this could be a variety of formats.

Linking data stored in Access to Excel is, thankfully, very easy. Two methods are covered in this article which will probably cover most day to day requirements.

For example the Normalising Birth data set holds over 90,000 records and feeds into 3 different Excel tools. It wouldn’t be practical to have the same data set copied into three Excel spreadsheets, so instead all the data is saved in an Access database, with all the relevant queries required for the different tool written and ready to go.

Step 1 : Set Up The Database!

In this example I have created a small simple table for demo purposes, it has three fields Org, value1 and value2 The database is saved as db6.mdb

Step 2 : Getting the data into excel Data menu, go to Import External Data and then select the New Database Query option

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

7

To link to an Access Database select the MS Access Database option. If you are using another database (e.g. MS SQL you may need to use the <New Data Source> option)

Navigate to the database you want to link to (in this example db6.mdb)

Once you’ve selected your database the wizard will prompt you to select the columns of data you want to include in your query. Select the ones you need and then click on the arrow to add or remove them.

There then follow options to filter and order your data.

Last up you’ll be asked what you want to do next- return the data to Excel, view or edit the query or create and OLAP cube. Go for the first option (we will look at the others later). Then decide where you want to put the data

cAnd that’s it really, your data will be returned post haste.

To change the filters and sorts: right click the table > Edit Query To automatically refresh when excel opens: To refresh your data:

right click the table > Data Range Properties

right click the table > refresh Next Issue... …. we will look at some of the other things you can do like linking to Queries, creating Dynamic Queries with Parameters and linking to Pivot Tables …...

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

8

Measurement is Key, but Transparency is more Powerful Still

By Paul Levy, Former CEO of a Large Boston Hospital and Advocate for Patient-Driven Care It is risky to give cross-cultural advice on hospital management issues. So let me instead relate a story from my former hospital, Beth Israel Deaconess Medical Center (BIDMC), and leave it to the readers of Knowledge Matters to decide whether or not it is applicable to your settings.

Our vision at BIDMC was to make an explicit commitment to improving the quality and safety of care delivered to our patients, to measure our progress in doing so, and to be utterly transparent with regard to those matters to our own staff and to the world at large. You might think that it would go without saying that a hospital should be concerned about quality and safety, but it is the sad truth that these items are not usually given the strategic attention that they deserve.

Our faculty and administrative leaders, and members of our Board, decided that we should adopt a vision that would set a high standard on these matters. While we felt that improving our record on this front might help distinguish us from other hospitals in Boston, the main impetus was simply to provide better care to our patients. We had always had the view that our purpose was to “deliver the kind of care we would want for members of our own family” but we realized that we were failing to do that in a systemic and quantifiable manner.

We concluded early on that being transparent about our quality and safety metrics was an important component of achieving success. This was risky business, in that we would be posting our infection rates and other rates of preventable harm for the world to see. What if patients responded by getting nervous about these problems at our hospital?

What if referring physicians in the community decided to send their patients to our competitors instead?

We were convinced that any possible risks inherent in transparency would be overshadowed by its efficacy in fulfilling our vision. We knew that transparency’s major value as a strategic imperative is to provide creative tension within a hospital so that staff members hold themselves accountable to the standard of care to which they have jointly agreed.

How does this work?

First you, as leader, help the people in your team establish an audacious goal for the organization. The goal has to be clear, measurable, and non-debatable. In our hospital, the goal was to eliminate preventable harm. Not to reduce it by 10% per year, but to send it to zero.

Paul O’Neill, the former CEO of Alcoa, explains this concept when he describes what any organization interested in achieving habitual excellence must have: A leader who articulates and establishes aspirational goals for the institution. By aspiration, we mean goals that are set at the theoretical limit of what is possible. For example, zero nosocomial infections, zero medication errors, zero patient falls, zero work place injuries for all employees, zero wasted time spent hunting and fetching, zero duplicative or repair work for things not done correctly the first time, i.e., lab work or imaging studies. [1]

Quality.Observatory@southeastcoast.nhs.uk

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9 He expands: Setting goals at theoretical limits sharpens the understanding of the size of the opportunity relative to current performance. Benchmarking against national averages or even better performers can create the illusion of success or satisfaction with “good enough.”

For our hospital, I used to say, with regard to preventable harm, “The target is zero, zilch, nada. No other target is intellectually or morally defensible.”

Second, you make the goal public, and you also make public the data indicating your progress toward meeting the goal. The gap between where you are now and your desired end-state is what establishes a creative tension for your organization that drives people to achieve the vision.

For our hospital, I used to say: “Our data are here (on our company website) for the world to see, mainly to help us hold ourselves accountable to the standard of care to which we aspire.”

The MIT Sloan School of Management’s Peter Senge explains: The gap between vision and current reality is . . . a source of energy. If there was no gap, there would be no need for any action to move toward the vision. Indeed, the gap is the source of creative energy. We call this gap creative tension.

Imagine a rubber band, stretched between your vision and current reality. When stretched, the rubber band creates tension, representing the tension between vision and current reality. What does tension seek? Resolution or release. There are only two possible ways for the tension to resolve itself: pull reality towards the vision or pull the vision towards reality. Which occurs will depend on whether we hold steady to the vision.[2] And holding ourselves accountable in this manner did work. Our hospital made clear and continued progress in reducing infections, falls, medical errors, and other types of harm to patients. We documented our progress quarterly on our corporate website, for the world to see. Our open approach on these matters brought us a mention from the Massachusetts Senate in 2008, citing our “unparalleled leadership in health care quality and patient safety.” We were the subject of numerous articles and case studies around the world,[3] and were used as an example in conference talks by international experts in process improvement. Instead of raising concerns among patients and referring physicians, our approach generated increased trust in our hospital and our physicians.

Perhaps a similar approach can work in your institution? ________________________________ [1] O’Neill, Paul, “The Key Leadership Behaviors in a Lean Organization” Thedacare Center for Healthcare Value, http://networkedblogs.com/ol8i9.

[2] Peter Senge, The Fifth Discipline: The Art and Practice of the Learning Organization, p. 150 [3] For example, The Health Foundation in the United Kingdom produced a case study entitled, “Beth Israel Deaconess Medical Center, How leadership and a focus on quality rescued Beth Israel Deaconess Medical Center.” November 2010. http://www.health.org.uk/publications/bethisrael-deaconess-medical-center/

Interested in what you have read…? You may want to have a look at Paul’s blog………..

http://runningahospital.blogspot.com/

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

10

Prevalence vs Incidence—what’s the difference?

By Katherine Cheema, Specialist Information Analyst I’m often asked what the difference between prevalence and incidence actually is; we tend to use the terms fairly interchangeably and once you add ‘incidents’ into the mix it can all get rather confusing. So, here’s a quick guide to the difference: Prevalence Prevalence is defined as the total number of cases of a particular disease, harm, smoking (or anything else for that matter) in a given population at a specific time. For example, the prevalence of pressure ulcers for a hospital would be the number of pressure ulcers, no matter when or where they occurred, in a hospital population on a particular day. Alternatively you might look at smoking prevalence in a CCG population at a particular time. Prevalence is typically expressed as a proportion of the population (i.e. a percentage).

There are additional sub-types of prevalence: • Lifetime prevalence– the proportion of the population who have experienced an event or case (i.e. disease etc.) at any time in their lives, up to the point of data collection.

• Period prevalence– in a similar way to lifetime prevalence, this looks at the proportion of the population having experienced an event or case at any point in a defined time period, for example, the most recent 12 months.

• Point prevalence– this type of prevalence has an even more specific time period, a particular day or month for example.

Let’s look at an example of these three types of prevalence in the context of smoking prevalence. A quick poll showed the following prevalence for smoking amongst members of the Quality Observatory (no names mentioned!): • Point prevalence– 0% smoking prevalence • 5 year period prevalence– 0% smoking prevalence (so everyone had given up smoking at least 5 years ago!)

• Lifetime prevalence– 22% smoking prevalence Incidence Incidence is different to prevalence because it focuses on the measurement of the number of new individuals who contract a disease, harm etc. during a particular period of time. In the case of pressure ulcers, we would be interested in the number of pressure ulcers occurring within a particular organisation; this could be said to be the pressure ulcer incidence for that organisation. Equally, smoking incidence, would be the proportion of new smokers in a population. You can express incidence in the same way as prevalence, as a percentage, and looking at incidence over different time frames.

For both prevalence and incidence, bear in mind that you can have virtually any kind of denominator you choose; for example you could look at the prevalence of obesity in under 15’s, or only women, or pressure ulcer incidence in over 75s and so on. As ever, it is really important to make sure you understand what you are measuring before you interpret it!

As ever, if you have any queries please do get in touch!! Katherine.cheema@southeastcoast.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

11

Meet the Observatory— Dr Quality interviews Nikki Tizzard So Nikki, how long have you been working at the Quality Observatory?

I’ve been at QO Towers since June 2010 having previously worked at East Sussex PCTs. I have learnt absolutely loads since I’ve been here – it’s been challenging but definitely in a good way! The team are all great and never seem to tire of me asking silly questions. Maybe they just hide it well.

And which specific areas of work have you had responsibility for?

I lead on COPD and my main area of work for some time was supporting the South East Coast Respiratory Programme. Among other things I developed a COPD dashboard to act as a single tool covering both primary and secondary care providers. It’s gained a lot of interest nationally and I’ve since developed similar dashboards at different organisational levels and for other parts of the country. I’ve also worked on the new online QOF tool with Fats and for the past six months or so I’ve been providing commissioning analysis and support to two CCGs in Surrey. It’s been really interesting and good to be involved at the start of something new. I’ve developed practice-level dashboards and worked with each of the practices to tackle things like GP referrals, emergency admissions, nursing home admissions, prescribing and to help answer any number of queries. The feedback from GPs has been really good so far.

What do you do when you’re not crunching data sets at Quality Observatory HQ? I’m a big music fan and I love basketball (watching, not playing, I hasten to add). I enjoy spending time with my family at weekends and also try (!) to keep fit. I love zumba and usually go four times a week. I also like running and I am a member of my local gym, although I usually find any reason in the world not to actually go there!

And finally Nikki, I hear that the team consume a fairly large quantity of biscuits, what’s your personal favourite?

Well I am quite partial to a custard cream but really nothing beats a chocolate digestive. And yes, I do approve of dunking.

Demand and Capacity Model for Endoscopy Services In order to give wider access to its demand and capacity models, The Elective Care Intensive Support Team (IST) has started to publish these on the NHS IMAS web site. The first model to be made available via this route is the Endoscopy model. The model, a populated example and guidance notes can be accessed via the link to the IMAS web site below. www.nhsimas.nhs.uk/what-we-can-offer/intensive-support-team/ You may wish to bring this to the attention of colleagues in those organisations that are struggling with waiting times and/or pressures on Endoscopy services.

For your information the IST demand and capacity models for: · · ·

1st Outpatients; Cancer Two-Week Waits; Admitted Patients.

Will also be made available on the same web site within the next few weeks. If you wish to discuss these please contact either Doug.Barnes@Southwest.nhs.uk or your IST lead for your SHA regional area. The generic email address for IST enquiries is

nhsimas.ist@southwest.nhs.uk

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

12

Sickness absence tool

By Aleksandra Bujnicka, Workforce Support Analyst Sickness absence management is one of the priorities as well as legal duties placed on employers.

There are number of reasons for it. First of all employee absence is a significant cost to businesses, secondly, in a healthcare organisation setting the issue has the potential to negatively influence patient care as well as staff health and morale. As all these three areas are interlinked it explains even further how one activity, like sickness absence, might have a considerable effect on overall organisational productivity.

The Quality Observatory have a number of tools looking at sickness rates at summary and detail levels:

Summary Level Tools: There are 2 Summary Level tools available : IC Published Data Tool: • Updated from the data published by the IC • Contains National Data • Available as XLS download and Online tool • SHA and Organisational level rates • Local and National Benchmark • Online tool is Embeddable—Use it in your own websites!

Available from the QO Resource Catalogue http://bit.ly/SEQO-SICK-IC

ESR Data: • Updated from the ESR data warehouse • Available only to users on the N3 Network • Contains National data • Available as an XLS download(online tool coming soon!)

• SHA and Organisational level rates • Local and National Benchmarks Available from the QO Resource Catalogue http://bit.ly/SEQO-SICK-ESR (N3 users Only!)

Detail level Tool: • • • • • • • • •

Updated from the ESR data warehouse Available only to users on the N3 Network Contains Local (South East Coast) Data Available as an XLS download Drill down to organisational and staff group levels Benchmark across patch % days lost by reason / orgainsation Average episode length by reason / orgaisation Frequency analysis of episode length

Available from the QO Resource Catalogue

http://bit.ly/SEQO-SICKDETAIL-ESR (N3 users Only!)

Any queries please get in contact: Aleksandra.Bujnicka@SouthEastCoast.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

13

Christmas Crossword Answers In the last issue we devised a fiendish Christmas Crossword!

Here are the solutions!

1.

Unwanted side effects of a medical or surgical intervention

—complications

2.

(Discharge destination= 4)/admissions

—Mortality Rate

3.

Ratio of leavers to staff in post

—turnover rate

4.

All the returns are brought there together on this Department of Health website —unify

5.

The county with the biggest population in NHS South of England

—kent

6.

Visualization of data

—graph

7.

Which former South Central PCT did not merge into South of England, but instead became part of NHS Midlands and East —Milton Keynes

8.

Relationship between 2 sets of variables

9.

National dashboard including data on pressure ulcers, falls, catheters and VTE

—trend

—safety thermometer 10.

Number of Specialist Analysts in the Quality Observatory Team

—three

11.

The ‘V’ in BCBV indicators

—value

12.

Director of Information for Service Improvement

—samantha riley

13.

Normal distribution

—bell curve

14.

One of two basic data categories/types used in analysis

—qualitative

15.

The number of acute trusts in the new South of England cluster (not counting Mental Health, Community or Ambulance trusts) —thirty nine

And the hidden jumble was : Christmas Tree Tool - Which can be downloaded from our catalogue!

Escaping the snow ……..

In early February, not having had a break or any sunshine for far too many months, Samantha headed off to sunny Gambia for a 7 day relaxing Gambia break……… Well that was the idea….. The idea certainly wasn’t to Conakry be diverted to Conakry (where’s that I hear you say!!) in the Guinea Republic for 6 hours due to a sand storm!! But hey, it’s all part of the adventure!!!!

The rest of the week was more restful and included much laying by the pool, a visit to a snake farm, an afternoon watching wrestlers from Senegal and the occasional happy hour cocktail. There was also the occasional night of boogying……

Where to go for my next trip….?? —ideas on a postcard please!!!!

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

14

An Update on SHAPE Strategic Health Asset Planning and Evaluation (SHAPE) is a web enabled, evidence-based application which informs and supports the strategic planning of services and physical assets across a whole health economy.

SHAPE is free to NHS professionals and Local Authority professionals with a role in Public Health or Social Care. Access to the application is by formal registration and licence agreement.

It is possible to sign up to e-bulletins which are designed to inform users about recent and upcoming developments to the SHAPE application. To sign up for bulletins e-mail shape@nepho.org.uk In response to the increased number of users the SHAPE team are creating more training opportunities to make sure users get the best experience of using SHAPE. Attending training sessions can be expensive and time consuming for participants so the team has decided to use webinars to deliver the training which is free and means that users don’t need to leave their desks.

The SHAPE team will be hosting an hour long session once a month that anyone can join in. They will be held on the first Wednesday of every month at 10am. Details on how to login will be posted on the SHAPE home page. The team are also happy to also host free bespoke webinars to teams on request. The first webinar will be on Wednesday 7th March at 10am.

Benefits of webinars:

• • •

Free Live and interactive, you can ask questions directly to the presenter Can be recorded so you can watch and listen back at your convenience

What you will need to join the webinar:

• • • •

A computer Internet access A phone line or speaker/headset For the first time you use the webinar, you may be asked to download some software

For more details contact the helpdesk at shape@nepho.org.uk or call 0191 334 0368.

Data updates Some new data and functionality has been uploaded to SHAPE, these include:

• • • • • •

HRGv4 data is currently undergoing validation and will go live soon CCGs organisations across the country have been implemented Data on percentage of households that can access a GP practice or hospital by walking Data on percentage of households that can access a GP practice or hospital by car Indicator for providers on Standardised Hospital Mortality Indicator (SHMI) Data for providers on patient experience of the hospital

For further information on SHAPE, visit the website http://shape.dh.gov.uk/

Quality.Observatory@southeastcoast.nhs.uk

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15

Analysis Ancient, Modern and Future : Walter Shewhart

By Samantha Riley, Director of Information for Service Improvement Walter Andrew Shewhart (March 18, 1891 - March 11, 1967) was an American physicist, engineer and statistician and is sometimes known as the father of statistical quality control.

Dr. Shewhart joined the Western Electric Company Inspection Engineering Department in 1918 supporting the engineers who had been working to improve the reliability of their transmission systems. At the request of his boss, "Dr. Shewhart prepared a little memorandum only about a page in length. About a third of that page was given over to a simple diagram which we would all recognise today as a schematic control chart. That diagram, and the short text which preceded and followed it, set forth all of the essential principles and considerations which are involved in what we know today as process quality control."[1] Dr Shewhart's work was key in pointing out the importance of reducing variation in a process and the understanding that continual process-adjustment without understanding the causes of variation actually increased variation and was detrimental to quality. Dr. Shewhart concluded that while every process displays variation, some processes display controlled variation that is natural to the process, while others display uncontrolled variation that is not present in the process causal system at all times. [2] Many of you will (I hope) be familiar with control charts as there are very many examples of where control charts have been applied to a health care setting to evidence common and special cause variation and inform action plans to reduce uncontrolled (and un wanted) variation.

A sample control chart

A good example of where a control chart can help improve a healthcare system is using data from attendances at A&E. Some years ago the Quality Observatory developed a suite of tools using control charts to evidence patterns in variation which were successfully used with a number of Trusts to improve flow and waiting times. If any of you are still struggling to maintain optimal waits in A&E please get in touch with Simon Berry simon.berry@southeastcoast.nhs.uk who will be happy to help.

So, from our perspective here at the Quality Observatory, the work undertaken by Dr Shewhart all those years ago plays a critical part in ensuring that changes that are undertaken to improve our healthcare system are the correct changes, which tackle the real problems and that the impact of changes can be evidenced—ie uncontrolled variation is reduced. In the current context, with the health needs of the population forever increasing and resources being limited, it is becoming even more important that evidence based approaches such as this are employed in the NHS. If you would like further information on how to create and interpret control charts, please get in touch!

Quality.observatory@southeastcoast.nhs.uk

[1]

“Western Electric—A Brief History”. The Porticus Centre. Retrieved 2009-04-10.

[2]

Neave, Henry R.; British Deming Association (1992). Why SPC?. Knoxville, Tennessee: SPC Press. ISBN 978-0945320173.

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

16

Word Templates being Weird Application: Microsoft Word Dear Quality Observatory I wonder if you can offer any assistance. our "templates" which are basically word documents with stripped in headers and footers bearing our branding that have been saved as templates. The problem is that when we have tables where rows extended across a page break the complete cell will drop to the next page and where a row is longer than a page (which can happen in Board notes etc.) then the formatting goes completely haywire. ?

Paul Carter Comms and Engagement Manager Enhancing Quality and Recovery Kent, Surrey and Sussex

Solution: Complexity 2/5 — Intermediate Word knowledge To be Completely honest this one had us stumped for a few moments !

So the first thing to do was to have a look at the problem!

So we copied the template table into a Blank document to see what should be happening

So in the new document the Tables and rows were behaving normally the rows were breaking across the pages

But in template file this wasn’t happening!

There were 2 issues : 1.

The rows were not breaking across the pages 2.

Rows with text longer than the page width were going “haywire”

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

17

Our first thought was to check the table properties and make sure that the “Allow to break across pages” option was checked..

And yes it was checked !

This was curious? …. So we investigated further … we decided to remove the table and see what happened to text on the page …

This is when we spotted something strange….

The text was moving to the next page before it reached the margin ….?

We expected at least another line or two of text?

This is where we would expect the text to move to the next page

This is where the text was actually moving to the next page

This was our Eureka moment!

We realised the issue you are having is due to your footer image.

When you look at the footer image it would appear that the Image is contained Inside the Footer Block.

However there is a lot of white space above the image.

This is causing the Image to overlap the page margins that have been set for the template.

Once this happens the image attempts to force the page content to wrap around it causing the layout issues that you are having.

There are 2 things that I would recommend: 1 - Use the image crop tool to crop the image white space. This should make the image Height fit in the footer area 2 – Set the Image wrapping properties to either “Behind Text” or “Through” – This Should mean that any adjustments to the margins/ accidental overlap should not affect the template.

As always if you have any queries or need further help please contact us at: quality.observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

18

NEWS Quality Observatory celebrations Since the last edition of Knowledge Matters, there have been a number of c e l e br a t i o n s within the team. In January, Kate, David and Adam celebrated their birthdays.

In February it was the turn of Aleksandra……

Although in this edition we had hoped to name the member of the team who will be an Olympic torch bearer, restrictions are still in place which mean that you will need to wait until next time…...

Recruitment to the Quality Standard Topic Expert Group for Self Harm

The course has been developed by senior technical staff within the Data Quality and Support Services team at the Health and Social Care Information Centre (HSCIC). As a consequence of the time taken to develop the course, as well as the staff time required to deliver it, it is necessary to charge a minimal fee to delegates. This fee purely covers cost recovery.

If you would like to book a place on the course please contact the HSCIC SUS team at:susmeetings@ic.nhs.uk. Please indicate which date you would like to attend on your email.

Current confirmed course dates are as follows:

•

Tuesday 13th March

•

Tuesday 17th April

•

Wednesday 30th May

Recruitment to the NICE self harm quality standard topic expert group (TEG) has begun. NICE are seeking applications for the role of chair. Information on the post is available on the NICE website, please follow this link for details: http://bit.ly/yYhyUu

Please note that courses are limited to 12 delegates and places will be allocated wherever possible on a first come, first served basis. However, where demand exceeds the number of places available, the HSCIC reserves the right to allocate places as may be required to ensure coverage across regions and organisations.

The deadline for receipt of applications is 5pm on Wednesday 14th March

For those in the South of England, local South of England SUS training is being provided by John Wilshaw at Oxfordshire PCT on 19th March. Places are on a first come first served basis. For details or to book a place please contact

An Introduction to SUS Training Courses In response to user feedback, the NHS Information Centre has developed a one day introductory course to assist those new to SUS and SUS data.

The course will be delivered six times over the next six months, with the first course scheduled to take place on Tuesday 13th March in Leeds. Following delivery of the six sessions, there will be a review to consider the future need for the course, both in terms of content and location / method of delivery.

A course overview providing more information can be accessed at the following web address : - http://bit.ly/ wwR8Bh

Quality.Observatory@southeastcoast.nhs.uk

Lavinia.Tuckfield@southcentral.nhs.uk Additional Member Recruitment to the Quality Standard Topic Expert Groups for Hypertension and Management of VTE Diseases NICE are currently seeking to recruit commissioners for the topic expert groups for two quality standards: Hypertension and Management of VTE Diseases. Information on the posts is available on the NICE website, http://bit.ly/yYhyUu.

The deadline for applications to these posts is 5pm on 7th March 2012.

www.QualityObservatory.nhs.uk

19

NEWS NHS Classification Service Update

New Unify2 Collection

The NHS Classification Service wants to hear your views on the OPCS-4.6 eVersion, irrespective of whether you are a regular user or have never used it at all.

There is now a new Unify2 collection to collect information on the numbers of available and occupied non-consultant led beds. Data from the Unify2 DToC collection and the existing KH03 beds collection are used to create DToC indicators in various places (e.g. NHS Performance Framework, CQC’s Quality and Risk Profiles, Monitor’s compliance framework). However there is a discrepancy between the 2 collections as the KH03 only covers NHS consultant-led beds. This new collection addresses the gap between the 2 collections. The deadline for the first collection (Quarter 3 data) is Wednesday February 29th. Guidance and template are now available on Unify2.

Your input into the short online survey which takes less than 10 minutes to complete will help them to understand how the eVersion is performing in Trusts. More importantly it will provide valuable information on what can be done to improve the next release based on user feedback. Here’s the link to the survey http://bit.ly/ wMgbdC ICD-10 4th Edition The updated ICD-10 clinical coding instruction manual is expected to be with coding managers next month ready for implementation of ICD-10 4th edition from 1 April 2012.

The manuals has been updated in both content and format and will no longer be a ring binder but published as a book. The change in content has also seen a change in name to reflect its purpose as a reference manual and it is now called the National Clinical Coding Standards ICD-10 4th Edition.

PIP Implant data Data collected on PIP implants via Unify2 is now being published each week on the Department of Health website. It is therefore important that the Tuesday deadline for this collection is met each week. We are asking that data is uploaded to Unify2 by 2pm on Tuesday afternoon which will leave the SHA time to chase up any late returns.

Updated Coding Clinic available January 2012 [V1.1]

Local Tobacco Control Profiles for England

The Coding Clinic has been revised to create Issue January 2012 [V1.1] which is available for download from the NHS Classification Service website. The Coding Clinic provides essential updates to the coding standards in use in the NHS. Please ensure that previous versions of the Coding Clinic are deleted as this is now out-of-date.

The final version of the Local Tobacco Control Profiles for England were published in January. The work has been led by the London Health Observatory (LHO) on behalf of the Public Health Observatories in England.

The NHS Classification Service is the definitive source for clinical coding guidance and sets the national classifications standards in use in the NHS www.connectingforhealth.nhs.uk/clinicalcoding For clinical coding and coding training queries: Tel: 01392 206 248 or e-mail datastandards@nhs.net

The pr of i l es ca n be a c ce s s e d at www.tobaccoprofiles.info. If you have any queries, please contact lho.enquiries@lho.nhs.uk Drop In session Dates : The drop in session dates for the next few months are: 21-March 2012 18 April 2012 Sessions Are available to all NHS Staff Across the patch who want to improve their skills or need help with a development.

E-mail us to book your session (quality.observatory@southeastcoast.nhs.uk)

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

Super Fast Quality Observatory Catalogue Load Time…...

One of the things that had been bothering us (and you) was the time that the catalogue was taking to load, we timed it as running around 30+ seconds! So we pulled on our overalls got out tool box and had a poke around to tune the engine. After many cups of tea, much stroking of beards and lots of exclaiming we have managed to bring the Catalogue Load Time down to a lightning fast 3 seconds!

We hope that you will love the new speedy catalogue which has a multitude of useful products and handy links!

Happy Browsing!

http://nww.qualityobservatory.nhs.uk/ Leap Year Poem Hooray! It is a leap year - we've got an extra day, Lots of things to see and do, let's go out and play.

What are all the things you can do with 24 more hours?

Ramble in the countryside and appreciate the flowers, Go into a darkened room and watch lots and lots of telly, Throw a kiddies party with ice cream and with jelly, Hook up to the internet to fight with goblins and with trolls, Be creative in the kitchen making cakes and sausage rolls, Sashay around the office singing Broadway tunes, Accompanied by colleagues playing on the spoons, Going down on one knee proposing to your fella, Try reading people's minds just like Uri Gellar, Go and paint the town red with a gang of friends, Maybe watch "The Mousetrap" - don't tell me how it ends, Putting on the wireless tuned in to Radio 4, Have a nice long sleep, to prove that you don't snore, Listen to your favourite band (tho' the newer stuff's not as good), Take up playing Pooh Sticks in Hundred Acre Wood, Get your pilot's license and learn to fly a blimp, Pop into your local zoo for a conversation with a chimp, Pretend that you're a cowboy by riding on a horse, Re-arrange your sandpaper into fine, medium and coarse, You could run a marathon for fitness and for fun, Even write a silly poem, not unlike this one, Grab a leotard and tutu and do a jeté in the ballet, Millions of things to do this extra February day, Of course there is just one thing if you want to go berserk, You could always spend the day doing lots and lots of work.

Fascinating Facts According to statisticbrain.com : The percentage of the population born on leap day is 0.274% The number of people born worldwide on leap day is 4,791,239 The actual number of days that it takes the earth to revolve around the sun is 365.242199

Simon says…….

Is your small child losing their milk teeth and annoyingly constantly wobbling the loose ones? If so, simply give them a Cowans toffee bar, one good bite and hey presto the annoying tooth will remain stuck in the bar!

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: 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