Volume 6 Issue 1 April 2012 Welcome to Knowledge Matters Hello everyone and welcome to this special World Shakespeare Festival edition of Knowledge Matters! Since the last edition, the team has been really busy uploading SUS data (from 2006/7 to present) for the whole of the South of England to our data warehouse. Teams in the West and Central have access to this warehouse significantly increasingly our ability to provide benchmarking and analysis for the whole of the SHA cluster. Simon provides more details about this on page 13. We have now agreed a set of indicators to report against each of the five domains of the NHS Outcomes Framework. In some instances, we will be using proxy indicators or alternative indicators to those specified within the framework - in particular we have used this approach where a data set is unavailable for a considerable number of months, or where data is available only annually which will make it difficult to track improvements in patient care over the coming year. Within the next few weeks we will have designed and populated a set of dashboards which cover each domain which will be shared widely across the South. Each dashboard will have an identified ‘owner’ within the Quality Observatory to whom feedback, comments and queries can be directed. In addition, we are keen to develop a set of indicators to benchmark for community services. The Community Data Set became available for local collection from 1st April 2011 and from April 2012 providers should be collecting this data if they have suitable systems. It will be some time until this data becomes available via SUS. Community services play a critical role in the transformation of patient pathways and the delivery of a range of QIPP programmes and because of this we are keen to quickly establish mechanisms to evidence the shift of services to a community setting. If you are interested in getting involved with shaping this work please do contact me! Finally I am very pleased to report that our very own Adam Cook will be one of the 20 Olympic Torchbearers for the NHS nationally! Adam will be carrying the Olympic flame through Redhill on Friday 20th July. Good luck Adam!!
Inside This Issue : The National QOF Tool Goes Live
2
Skills Builder—data warehousing and business intelligence part 2
8
New SUS database
14
COPD Dashboards for the South of Englnad
4
We’re too busy to collect all that data!
10
Ask An Analyst
16
Staff Survey Tool
5
Launch of QiC Diabetes & QiC Excellence in Oncology
12
NHS Patient Feedback Challenge
18
Websites developed by the Observatory
6
Analysis Ancient and Modern
13
News
19
twitter.com/SECSHAQO issuu.com/SECQO http://www.networks.nhs.uk/nhs-networks/sec-qo www.QualityObservatory.nhs.uk
2
The QOF Tool Goes Live! By Nikki Tizzard & Fatai Ogunlayi , Quality Innovation & Productivity Analysts Back in June last year we told you about our new QOF Tool which was in development. We’re very pleased to announce that this has now gone live! Just to refresh your memory, the QOF Tool is an interactive online tool providing comparative analysis of QOF results for all four nations of the UK; England, Scotland, Wales and Northern Ireland. It is flexible enough to allow QOF data to be viewed at any level of any organisation, from country down to practice. You can look at individual indicators, a specific disease area, any of the four domains (Clinical, Organisational, Patient Experience, Additional Services) as a total or your chosen organisation at a summary level. As well as this, a number of different measures are included in the tool; points achieved, underlying achievement, exception rates and also prevalence rates.
At the Start screen, you can select the organisation(s) you want to look at using the drop-down boxes. Then select the QOF domain, disease area and/or indicator and click on the ‘Refresh Graphs’ button. If you then move along the various tabs across the top, you’ll see there are different ways to view your chosen data:
Quality.Observatory@southeastcoast.nhs.uk
•
An Overview across the entire QOF data, or across a particular domain or disease area is available at any level from country down to practice
•
Benchmarking against any level of any organisation. Benchmarks such as minimum, maximum, mean, median and percentiles are also available
•
Trends – a time series analysis is included for monitoring performance over several years.
www.QualityObservatory.nhs.uk
3 There are options to switch between different measures or benchmarks. You can also change your selection criteria at any time by clicking on the Show Options bar at the side. Hit the Refresh Graphs button again and the charts will update accordingly.
In addition to viewing your results in graph format you can also bring up data tables to see the actual numbers.
Depending on which level of organisation is selected, figures for each relevant parent organisation will also be displayed, as well as a peer if required.
You can access the online QOF Tool from the Quality Observatory website:
nww.qualityobservatory.nhs.uk From 15th May, the tool will also be available at www.qualityobservatory.nhs.uk
We will continue to develop and improve the QOF Tool in the future. For example, Clinical Commissioning Groups are included but we will update the tool with any changes as they emerge. Please go take a look and let us know what you think. At the Quality Observatory we are always aiming for our tools to be as useful and user-friendly as possible so we welcome any comments or suggestions you may have. As always, if you would like any further information please do get in touch. For more details or to provide us with any feedback at all, please contact: quality.observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
Quality.Observatory@southeastcoast.nhs.uk
4
COPD Dashboard for NHS South of England By Katherine Cheema, Specialist Information Analyst I’m sure all our readers are aware of the spectacular suite of dashboards and tools developed by our very own Nikki Tizzard over the last couple of years that relate to COPD (Chronic Obstructive Pulmonary Disorders). Indeed, so successful are they that colleagues in the South West have used the template for their own version! The COPD suite is very detailed and has been developed in tandem with the clinical leads for the Eastern region of NHS South of England. To date, we have not had a consistent set of measures for COPD across the NHS South of England geography; that has now changed. The South of England wide dashboard currently looks at the key indicators that are available from a commissioner perspective, and presents the data by Clinical Commissioning Group (CCG). There are four main areas examined in the dashboard: 1 - The underlying achievement for the COPD QOF indicators : A handy key is provided on the dashboard to enable users to see what each indicator measures. These naturally focus on diagnosis, review and preventative aspects of COPD in the primary care setting. 2 - Estimated vs QOF prevalence: Effective and timely diagnosis is considered a key aspect in the treatment and management of COPD. A gap between the observed COPD prevalence, as defined by practice registers, and the estimated prevalence based on demographic factors in the population, can indicate a population need to be addressed. Equally, a small gap may be an indication of good identification and diagnosis of COPD, as well as potentially, more integrated working with other community health professionals including public health education. 3 - Emergency admissions for COPD: This is presented both as a count of admissions and as a rate per 1,000 to enable simple comparisons, with the option to show a 12 month rolling count as well. 4 - Emergency bed days for COPD: This is presented both as a count of admissions and as a rate per 1,000 to enable simple comparisons, with the option to show a 12 month rolling count as well. It is important to look at both admissions and bed days together; we might expect to see a decrease in admissions as self-management of COPD improves and patients become less dependent on hospital services; at the same time you may see bed days increase as we might expect the patients being admitted to be more serious and thus stay longer. We’ll be undertaking some more work on this dashboard and are looking to includes some additional indicators: •30 and 90 day readmissions •Proportion of last 12 months admissions accounted for by multiple attenders •QOF exception rates on COPD12 •Crude COPD mortality rate As always if you have any comments or question please do get in touch. The dashboard is now available on our website nww.qualityobservatory.nhs.uk
Quality.Observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
5
Staff Survey Tool By Adam Cook, Specialist Information Analyst It’s Staff Survey time again, and once again we’ve taken the national results as published by the Picker Institute and produced some tables and charts based for the whole South of England SHA cluster. There are two sets of tables that are RAG statused. Red = Worst performing quartile Green = Best performing quartile
High Values are:
Yellow = Between best and worst quartiles
National NHS Staff Survey 2011: Key Findings Type of organisation
Good
Good
KF1 % staff feeling KF2 % staff satisfied with the agreeing that their quality of work and role makes a patient care they difference to are able to deliver patients
NHS South of England Results for Key Findings
Code
Good
%
Good
KF3 % staff feeling valued by their work colleagues
%
Bad
KF4 Quality of job design (clear KF5 Work pressure content, feedback felt by staff and staff involvement)
Name
SHA
Acute Specialist Trusts
RPC
Queen Victoria Hospital NHS Foundation Trust
SEC
83.59
90.07
78.04
3.47
2.91
Acute Specialist Trusts
RBB
Royal National Hospital For Rheumatic Diseases NHS Foundation Trust
SW
71.43
90.95
74.22
3.32
3.19
Acute Trusts
RTK
Ashford And St Peter's Hospitals NHS Foundation Trust
SEC
71.03
87.58
69.88
%
Score
3.32
Score
3.16
Acute Trusts
RN5
Basingstoke And North Hampshire NHS Foundation Trust
Acute Trusts
RXH
Brighton And Sussex University Hospitals NHS Trust
Acute Trusts
RXQ
Buckinghamshire Healthcare NHS Trust
Acute Trusts
RN7
Dartford And Gravesham NHS Trust
SEC
76.41
86.78
76.23
3.44
3.18
Acute Trusts
RBD
Dorset County Hospital NHS Foundation Trust
SW
68.19
88.69
74.53
3.37
3.15
Acute Trusts
RVV
East Kent Hospitals University NHS Foundation Trust
SEC
70.36
88.60
72.68
3.38
3.09
Acute Trusts
RXC
East Sussex Healthcare NHS Trust
SEC
67.29
86.48
73.90
3.27
Acute Trusts
RDU
SC
72.14
90.00
78.19
3.42
3.16
SEC
70.80
91.09
78.80
3.41
3.18
SC
69.97
91.56
79.38
3.32
3.29
3.23
Frimley Park Hospital NHS Foundation Trust
SEC
81.76
94.22
78.18
3.51
2.90
Acute Trusts
RTE
Gloucestershire Hospitals NHS Foundation Trust
SW
63.03
87.85
72.88
3.27
3.26
Acute Trusts
RN3
Great Western Hospitals NHS Foundation Trust
SW
72.45
93.70
79.04
3.42
3.16
Acute Trusts
RD7
Heatherwood And Wexham Park Hospitals NHS Foundation Trust
SC
73.55
88.48
73.96
3.37
3.15
Acute Trusts
5QT1
Isle of Wight NHS Primary Care Trust (acute sector)
SC
72.49
89.32
74.19
3.39
3.13
Acute Trusts
RWF
Maidstone And Tunbridge W ells NHS Trust
SEC
75.87
90.99
77.40
3.46
3.01
Acute Trusts
RPA
Medway NHS Foundation Trust
SEC
73.31
86.90
73.77
3.38
3.22
RD8
Milton Keynes Hospital NHS Foundation Trust
SC
71.68
86.07
72.66
3.38
3.17
Acute Trusts Acute Trusts
RVJ
North Bristol NHS Trust
SW
Acute Trusts
RBZ
Northern Devon Healthcare NHS Trust
SW
76.47
94.26
82.06
3.43
3.13
Acute Trusts
RTH
Oxford University Hospitals NHS Trust
SC
78.51
68.54
92.61
91.28
80.82
81.05
3.42
3.41
3.09
Acute Trusts
RK9
Plymouth Hospitals NHS Trust
SW
69.12
87.24
77.85
3.35
3.27
Acute Trusts
RD3
Poole Hospital NHS Foundation Trust
SW
64.95
88.77
75.15
3.32
3.31
Acute Trusts
RHU
Portsmouth Hospitals NHS Trust
SC
67.95
89.77
76.53
3.41
3.26
The first of these shows organisations clustered into peer groups and measured against their national peer group sores. Those who are in the top quartile nationally are coded green, those in the bottom quartile nationally are coded red, and the amber ones fall somewhere between.
3.30
Red = Worst than last year Green = Better than last year
High Values are:
Yellow = Same as last year
The second table is very similar, but compares that organisations score with how they performed last year— red is worse, amber the same and green is better.
100
National NHS Staff Survey 2011: Key Findings Comparison to 2010
NHS South of England Results for Key Findings (organisations with no RAG Status did not complete the 2010 Survey)
Type of organisation
Code
Good
Good
Good
KF1 % staff feeling satisfied with the quality of work and patient care they are able to deliver
KF2 % staff agreeing that their role makes a difference to patients
KF3 % staff feeling valued by their work colleagues
Name
SHA
RPC
Queen Victoria Hospital NHS Foundation Trust
SEC
83.59
90.07
78.04
3.47
2.91
RBB
Royal National Hospital For Rheumatic Diseases NHS Foundation Trust
SW
71.43
90.95
74.22
3.32
3.19
Acute Trusts
RTK
Ashford And St Peter's Hospitals NHS Foundation Trust
SEC
71.03
87.58
69.88
3.32
3.16
RN5
Basingstoke And North Hampshire NHS Foundation Trust
72.14
90.00
%
KF4 Quality of job design (clear KF5 Work pressure content, feedback felt by staff and staff involvem ent)
Acute Specialist Trusts
SC
%
Bad
Acute Specialist Trusts
Acute Trusts
%
Good
78.19
Score
3.42
Score
3.16
Acute Trusts
RXH
Brighton And Sussex University Hospitals NHS Trust
Acute Trusts
RXQ
Buckinghamshire Healthcare NHS Trust
SEC
70.80
91.09
78.80
3.41
3.18
SC
69.97
91.56
79.38
3.32
3.29
Acute Trusts
RN7
Dartford And Gravesham NHS Trust
SEC
76.41
86.78
76.23
3.44
3.18
Acute Trusts
RBD
Dorset County Hospital NHS Foundation Trust
Acute Trusts
RVV
East Kent Hospitals University NHS Foundation Trust
SEC
70.36
88.60
72.68
3.38
3.09
Acute Trusts
RXC
East Sussex Healthcare NHS Trust
SEC
SW
68.19 67.29
86.48
88.69
74.53 73.90
3.37 3.27
3.23
Acute Trusts
RDU
Frimley Park Hospital N HS Foundation Trust
SEC
81.76
94.22
78.18
3.51
2.90 3.26
3.15
Acute Trusts
RTE
Gloucestershire Hospitals NHS Foundation Trust
SW
63.03
87.85
72.88
3.27
Acute Trusts
RN3
Great Western Hospitals NHS Foundation Trust
SW
72.45
93.70
79.04
3.42
3.16
Acute Trusts
RD7
Heatherwood And Wexham Park Hospitals NHS Foundation Trust
SC
73.55
88.48
73.96
3.37
3.15
KF1 % staff feeling satisfied with the quality of work and patient care they are able to deliver
High Values
Good
90 80 70 60 50 40 30 20 10
SW SEC
SW Acute Trusts
2011
2010
SC
Royal Berkshire
University Hospital Southampton
Winchester & Eastleigh Healthcare
Portsmouth Hospitals
Milton Keynes Hospital
Oxford University Hospitals
Isle of Wight PCT (acute sector)
Heatherwood & Wexham Park Hospitals
Western Sussex Hospitals
Buckinghamshire Healthcare
Surrey & Sussex Healthcare
Basingstoke & North Hampshire
Medway
Royal Surrey County Hospital
Frimley Park Hospital SEC
Acute Specialist Trusts
Maidstone & Tunbridge Wells
Dartford & Gravesham
East Sussex Healthcare
East Kent Hospitals University
Ashford & St Peter's Hospitals
Brighton & Sussex University Hospitals
Weston Area Health
Yeovil District Hospital
University Hospitals Bristol
The Royal Bournemouth & Christchurch Hospitals
Salisbury
Taunton & Somerset
South Devon Healthcare
Royal Devon & Exeter
Royal United Hospital Bath
Poole Hospital
Royal Cornwall Hospitals
Plymouth Hospitals
North Bristol
Great Western Hospitals
Northern Devon Healthcare
Dorset County Hospital
Gloucestershire Hospitals
Queen Victoria Hospital
Royal National Hospital For Rheumatic Diseases
0
Finally there is a suite of charts, that again show organisations against their peers. Each Key Finding is available from a dropdown menu, and the results plotted on the chart show each organisations score with the national average and also their own score for the previous year.
For further details on this work please contact adam.cook@southeastcoast.nhs.uk
England 2011
www.QualityObservatory.nhs.uk
Quality.Observatory@southeastcoast.nhs.uk
6
Websites developed by the Quality Observatory By Fatai Ogunlayi , Quality Innovation & Productivity Analysts Many of our readers will already be familiar with the range of tools and dashboards created by the team here at The Quality Observatory which by the way are available through the searchable catalogue on our website http:// nww.qualityobservatory.nhs.uk. This site has been developed in house and as our web skills have grown so have the requests to develop online tools and websites for other people. We thought we would give a quick update on some of the web projects that we have been involved with recently.
The Quality Observatory Team were recently asked by the South East Coast Informatics team on behalf of the Medical Directors Forum to create the recently launched 'Clinical Technology Matters' website. http://nww.ctm.southeastcoast.nhs.uk/
The website is only available on the N3 network (nww) and is aimed at sharing local and national case studies showing where technology has benefited clinical operations.
One of the features of the site is a South East 'Treasure Map' pinpointing local case studies with summary information. You can also get updates from the Chief Clinical Information Officer campaign, which share the latest steps to encourage clinicians to lead technology enabled improvements to clinical operations.
There is a forum for browsers to comment on developments they have read about or seek help with their own areas of improvement.
The QO team have also integrated data capture capability into some of the sites we have developed. One example is the Safer Smarter Care online tool which was mentioned in the last edition of KM (Volume 5 issue 6).
As part of our winning bid to support The Improving Quality Programme (IQP) at South Central, we have also developed a similar data capture and dashboarding tool which has allowed organisations to enter data directly (via this tool) which in turn provides a rapid visualisation of the data which is benchmarked against other organisations.
Quality.Observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
7 The IQP site has been developed with security and anonymity in mind, so that only authorised persons can view/edit data for their own trust.
Until the user logs in, the trusts’ data are anonymised, users can view the data but not able to edit or see the corresponding organisation’s name.
Access to the data is via a secure login and once logged in, each user can then edit the data for their own trust for the selected period. (Users can also decide whom to grant access to on the site and the level of access ranging from viewer only, editor and administrator. Only an administrator can grant access privileges to other users.)
The data can then be saved and once saved there is a rapid visualisation of the data via the dashboard.
The dashboard aspect provides a variety of views, from Provider view seen here above to the Measure Trends where a particular measure is shown overtime for all organisations.
We have already started developmental work around an advanced patient level collection system with skip logic algorithm implemented. We will be sure to keep you updated as time goes on.
In the meantime, if you have any questions or would like to discuss ways that The Quality Observatory could be of help to your organisation, drop us an e-mail at our usual address:
quality.observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
Quality.Observatory@southeastcoast.nhs.uk
8
Low Impact Data Warehousing and Business Intelligence,- part 2 Store It Once Use It Many Times ! In the last issue of Knowledge Matters back in February we started to look at low impact data warehousing and looked at how you can connect your reports in Excel to your data in access. We looked at how you might grab data from a database table and get it into Excel. In the example in last issue the major benefit was the updating automatically from the database which means that if you have several different reports using the same tables you can update the source database and the data will flow to the spreadsheets. However this does pull through the entire dataset into your spreadsheet. This can still cause problems when you have big datasets, especially when you actually only want a small subset of the data. Wouldn’t it be nice to leverage the power of databases and utilize queries and functions to process the data and control the flow? Well keep reading to find out how!
Linking to database queries: In our example we have three originations: A, B and C if we want to just look at organisation A we could setup a simple query in access to do this, however when we go through the linking process the query doesn't appear as an option to select? By default excel will only show the database tables that are available. We need to set the Query Wizard options to show “Views”
Once you have selected the “Views” option the queries that you have saved in the database should now be available to select.
In this example we have set up Query1 to bring back only records relating to Organisation A.
This means that we can set up different queries in our database and link to these queries to only bring back the data that we need in our spreadsheet, reducing file sizes and refresh time. But does this mean that you have to create a query for each organisation if you want to set up the same report for each? Surely there must be a way to dynamically query the database? Maybe pass through some parameters?
Quality.Observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
9
Dynamic Data: We can also set up the spreadsheet to dynamically update from the parameters that we pass in. This way we can re-create the same analysis for different subsets of data (e.g. different orgainiations) all in a single spreadsheet! But how do we do this? Can we create a parameterised query in access by using [“param”] in the access Query Wizard Criteria field? … Well nice thought but no not quite, if you try to access a parameterised query via the query wizard you will get a “Too few parameters” Error ! The best way to do this is to run through the query wizard and link to the table or query view that you want to get your data from. When you get to the finish screen select the “View data or edit query in Microsoft Query” option and then hit the Finish button.
This will bring up the Microsoft Query Screen. You can use this screen to create query functions like joins, modify SQL, add in formulas like sum & count and add in custom Query Criteria. The feature that we will use is the Criteria pane. Click the view criteria button in the toolbar to bring up the Criteria pane.
In the Criteria field select the field that you want to use with parameters. In the Value field type in a name for your parameter e.g. [‘org’] .. Don’t forget the quotes! Repeat for all the fields required. Then hit the exit button back to excel
You will notice that the “Parameters” button is now available in the import data screen. This will bring up the Parameter screen. The parameter screen will give you 3 option, you can set it up to give you a pop up box asking for the value when the data is refreshed, give it a fixed value or set it to get the value from a cell in the workbook! This last option gives you the ability to make your spreadsheet dynamic and interactive!
If you right click into the table of data you will see “parameters” in the list of options, use this to change the settings later if required.
Visit the website to find out how to use the database link to drive pivot tables .
www.QualityObservatory.nhs.uk
Quality.Observatory@southeastcoast.nhs.uk
10
“We’re too busy to collect all that data” By Mike Davidge, Senior Improvement Advisor, 1000 Lives Plus “We’re too busy to collect all that data”, that’s what staff told Kylie, the stroke lead from the Royal Gwent Hospital. It’s early in 2009 and she had been trying to co-ordinate the data collection for a national programme which was aiming to improve stroke care in Wales. The Royal Gwent is a district general hospital serving the population of Newport and the surrounding areas and admits 45-50 stroke patients per month. So admittedly data collection was no trivial task. The task to Kylie had seemed simple enough - to data collect on the parameters of care for stroke patients and to identify from these data specific areas for improvement. So what had she found? It was difficult to get people on board because they did not understand the importance of the project. As a consequence they did not commit fully to ‘doing their bit’ to collect the relevant data. When she was away, data collection did not happen. The fact that task group was not fully representative of patient pathway i.e. no representation from A&E / MAU, probably didn’t help either. Figure 1 It is worth at this stage explaining why the programme was so important. Every 2 years there is an audit carried out in all stroke units in England, Wales and Northern Ireland. The 2006 Sentinel Audit results provided sobering reading for those in Wales. The audit contained a wealth of detail on the care provided to stroke patients and can be summed up in a composite indicator that comprises 12 key factors. Figure 1 shows that Wales appeared bottom of the league for this composite indicator. The maximum score possible is 100 so Wales barely reaches halfway toward that goal. The publication of the report plus comments from one of the reviewers Dr Tony Rudd, who said services in Wales were "scandalously bad”, stimulated a reaction in Wales. But effective action was a long time in coming. Eventually in late 2008, around the time that the 2008 audit results showed no change in the Welsh position, a national improvement programme was launched covering Figure 2: The care bundles all 14 acute stroke units in Wales, of which the Royal Gwent was one. The focus of the programme was to improve the consistency of care given in the first 7 days after a stroke. From the evidence, a set of 4 care bundles was derived Figure 3: The 7 Steps to (depicted in Figure 2) and Measurement the aim of the programme was to achieve 95% compliance with all four bundles. The bundles consisted of 16 separate measures and 43 data items. The stroke unit teams all agreed that these represented excellent care and needed to happen. Despite this, reliable data collection was slow in occurring. You have seen the difficulties that the Kylie was having and the Royal Gwent were one of the better units! It was clear that if they were going to succeed, Kylie and her colleagues in the other units needed help. That help was to come in two forms: a measurement method and hands-on support. Good measurement doesn’t happen by chance, it needs a good process. The ‘7 steps to Measurement’ is used now in Wales to provide a structure to those like Kylie struggling to measure progress (Figure 3). The first three steps cover setting up measures. This had been done by the national programme and teams were clear what they had to collect and why. Their difficulty came in applying steps 4 to 6 – the Collect-Analyse- Review cycle.
Quality.Observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
11 Collect Kylie and the other unit leads were coached by the national team in creating a data collection plan. This meant involving everyone along the acute stroke pathway or in Kylie’s words “[you need an] Initial introduction to [the programme] for all relevant trust members” and “Get committed team with representation from all relevant areas”. In terms of the process they ended up with, she says “Look towards what you have to use for data collection before reinventing the wheel.” Figure 4: Example run chart
Analyse
Whereas setting up a reliable data collection process is well within the gift of a dedicated project manager, converting raw data into something more useful requires more specialist skills. This is why an Excel database tool was developed. Users entered the data on each patient into the data entry sheet and run charts showing weekly and monthly progress were automatically displayed on separate sheets. Figure 4 shows achievement for one of the care bundles in the early stages of the programme. Teams were able easily to drill down into each bundle to see where they were falling down. A score of zero for a bundle, as here, could be the result of failing on only one of the measures with the others at 100%.
Review The final step in the cycle is to meet regularly to understand what the data is telling you. This review step had two aspects for Kylie. She regularly reviewed the completeness of the data collection sheets to indentify uncompleted data and liaise with the appropriate member of the Multi-Disciplinary Team (MDT). She also used the twice weekly MDT meetings to review the run charts. Figure 5
The effect for the Royal Gwent team was that for the first time they provided hard evidence of where the gaps in the service lay. And they could work at closing those gaps. But it was not just the Royal Gwent that did this, they all did. Over the succeeding 2 years, they worked away at getting their care bundles reliable. Figure 5 shows what all 14 units combined have achieved for one of the care bundles.
Initial compliance was zero in early 2010 when the first national data was produced. It steadily increased during 2010 and by October it first reached 95%. It has been maintained at that level of performance ever since. Oh and by the way, 2 of the remaining 3 bundles show a similar performance with the fourth hovering at around 80% compliance. How have they done this? There are naturally many factors at play but one of these was the change in attitudes toward using data. Remember the initial reaction from staff at the Royal Gwent? They didn’t have time to get the data. This response was not unique to them; the other units experienced exactly the same problem. Contrast this with what Kylie says now; ““Data collection can be easily incorporated into daily roles with commitment from a team and quickly starts to provide a basis for change.” There is a fascinating post script to this story. Recently at an all-Wales stroke meeting a suggestion was made that the current bundle based data set was dropped in favour of one a based on a national audit. There was uproar. Noone in the room wanted to lose a dataset that “tells us how we are doing”. Now that is success.
www.QualityObservatory.nhs.uk
Quality.Observatory@southeastcoast.nhs.uk
12
Launch of QiC Diabetes & QiC Excellence in Oncology By Thomas Meek, Web Editor, PMGroup Last year I wrote in Knowledge Matters about the importance of recognising what is quality healthcare in the UK during a time of huge uncertainty for the NHS. This spring, with the passing of Andrew Lansley’s heavily amended Health and Social Care Bill things may be slightly more foreseeable, although the path is both a long and precarious one. One thing that still shouldn’t be forgotten on the journey though is that recognition of good practice, especially in priority therapy areas, such as diabetes and cancer, is still necessary to ensure all parts of the UK healthcare system know what it takes to provide the best service for patients. This is what the Quality in Care (QiC) Programme is aiming to achieve with the second year of QiC Diabetes, and the launch of QiC Excellence in Oncology. Both programmes come from publishing company PMGroup, and comprise an awards event and subsequent opportunities for finalists to explain why their efforts were successful to a wider healthcare audience. QiC Diabetes, which is supported by Diabetes UK, NHS Diabetes and Sanofi, had a very successful first year during 2011, with over 60 entries and the chance for winners to share their work at Diabetes UK’s Annual Professional Conference in Glasgow. Case studies from finalists were also compiled as QiC Connect – an online ‘knowledge hub’ for healthcare professionals to learn from good practice that has had positive real-life benefits and make contact with the people behind these projects. Even more examples will be added to QiC Connect following QiC Diabetes 2012, with entry open now for its 15 award categories covering all essential aspects of diabetes care, including ‘Best initiative supporting self-care’, ‘Best improvement programme for children and young people’ and ‘Best in-patient care initiative’. Entries are invited from groups working in the NHS, industry and for patient organisations, with joint working and collaboration key to the QiC Programmes. The deadline is May 25, 2012. An awards ceremony celebrating the winners and finalists in each category will be held at Sanofi’s Guildford headquarters in October 2012. Entry is also open for QiC Excellence in Oncology, which aims to recognise and share good practice in cancer care – a constant priority in NHS plans. An evolution of Pfizer’s Excellence in Oncology Awards, Pfizer remains a key partner in QiC EiO along with the NHS’s National Cancer Action Team (NCAT), Macmillan Cancer Support, Bristol-Myers Squibb and Novartis Oncology.
"The National Cancer Action Team believes that QiC Excellence in Oncology provides an effective means of both celebrating and learning from new ways of working which will help to drive up the quality of care,” said Stephen Parsons, director of the NCAT.
NHS Team of the Year Working in Diabetes
Entry is open until July 20, 2012, with categories relating to the NHS outcomes framework as well as individuals and teams who have made a difference in cancer care.
More details on how to enter both programmes are available at www.qualityincare.org/entry
QiC Connect can be accessed at www.qualityincare.org/qicconnect
Quality.Observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
13
Anaylsis Ancient and Modern By Katherine Cheema, Specialist Information Analyst Numbers, numbers, numbers. Here at QO Towers we just can’t get enough of them. The ancient Egyptians were also quite keen on numbers; after all you can’t just build a pyramid without a few calculations to underpin it. You need to know how many stone blocks you need, numbers of slaves required and amount of beer required to keep them quiet. The Egyptians were also a bit keen on pictures and married their love of the two in a very convenient number system.
•1 is shown by a single stroke. •10 is shown by a drawing of a hobble for cattle. •100 is represented by a coil of rope. •1,000 is a drawing of a lotus plant. •10,000 is represented by a finger. •100,000 by a tadpole or frog •1,000,000 is the figure of a god with arms raised above his head. (Obviously 1,000,000 is an important number.) The conventions for reading and writing numbers is quite simple; the higher number is always written in front of the lower number and where there is more than one row of numbers the reader should start at the top. We quite like the idea of expressing key pieces of NHS information in this way; it would certainly add a splash of colour to board reports! Have go at the question below and see what you think.
St Anywhere’s hospital
has admissions each month
This results
in bed days
Roughly, what is St Anywhere’s average length of stay?
A.
B.
days
days
C.
days
Have a go at more problems, including working out how many buckets of food you’ll need for your camels at http://www.eyelid.co.uk/numbers.htm
www.QualityObservatory.nhs.uk
Quality.Observatory@southeastcoast.nhs.uk
14
New SUS database for NHS South of England By Simon Berry, Specialist Information Analyst
Over the past couple of months Adam Cook and I have been busy beavering away downloading the SUS data extracts for the whole of the South of England patch from April 2006 and uploading them into our new SQL server database. This includes the inpatient, critical care, maternity / births, outpatient and accident and emergency datasets, not only for all activity for providers in the patch but also for the entire resident population regardless of where they have been treated, including activity at ISTCs. That’s nearly 25 million inpatient episodes, 112 million outpatient appointment records and 20 million A&E attendances. This database will be updated monthly to ensure the most up to date data is available. What does this mean to you? We in the South East Coast Quality Observatory as well as the analysts in South Central and South West now have access now to nearly 1/3 of the entire country’s activity data in a single source that we can carry out sophisticated benchmarking and analysis on for anybody who wants it. In addition, over the coming months we will be updating the range of tools we already provide, where appropriate, to cover the whole of the South of England, these will be available on the nww.qualityobservatory.nhs.uk website. If you’ve got any questions you can contact the QO at quality.observatory@southeastcoasst.nhs.uk
Cuppa anyone? Here at the Quality Observatory HQ we love nothing more than a good cuppa and a slice of cake. So to help with the distribution of one of our favourite treats Sam kindly purchased a vintage tea trolley for our use. Here is Sam modelling the trolley, since posting the picture on our Facebook page (http://www.facebook.com/ quality.observatory) the requests have come flooding in………...
Champion in the team…. In early March the SHA table tennis tournament final was played. Our very own Fatai Ogunlayi was one of the finalist and after several gruelling rounds was crowned champion. Here he is pictured with the other finalist Hilary Hodgson. Well done Fats!
Quality.Observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
15
Meet the Observatory— Sister Safety interviews Fatai Ogunlayi Hello Fatai. Why so formal Sister Safety, everyone round here calls me Fats OK. So Fats, how long have you been working at the Quality Observatory? I started working here in July 2010...wow, that’s almost 2 years now, how time flies. My first day was a bit unusual as I had met most of the team on Saturday prior at Sam’s beach-themed birthday party. What did you do prior to working at The QO? I worked in the Pharmaceutical Industry providing Statistical Forecasting into Clinical Trials.
And which specific areas of work have you had responsibility for at The QO? I am the lead on Enhancing Quality Programme - a quality improvement programme aimed at improving patient outcomes by reducing variation in care. This involves working with the Programme team to develop CQUIN measures, tracking and monitoring variation in outcomes, reporting on financial contribution to QIPP. I am also the lead for EQ sister programme, The Improving Quality Programme at South Central and I’m also leading for our new online QOF tool which is now going live.
So Fats where do you stand on the iPhone vs Android debate….. I think iPhones are overhyped - style over substance, give me an Android any day however some of the team are doing a good job in trying to convert me.
Welcome to Naz……... Hi I’m Nazir Zarnosh and I joined the Quality Observatory in March as a Performance Analyst and work for the Performance and Planning Analyst; Rebecca Matthews. I began my career in the NHS as a Junior Project Manager for 18 Weeks programme and then moved on to become an Outpatient Manager at Epsom Hospital. I then moved on to work as a Performance Analyst at Havering PCT. My move into data was easy as being an Aeronautical Graduate I feel that data drives everything. If we don’t have data we can’t make change. My main responsibilities have been creating and populating weekly scorecards to monitor the performance in Primary Care Trusts and Acute Hospitals. My role also entails ad- hoc analysis of performance and creating dashboards. Joining the team at South East Coast was daunting at first because of the excellent reputation of the Quality Observatory however as soon as I soon realised they were as mad as me I eased right in.
www.QualityObservatory.nhs.uk
Quality.Observatory@southeastcoast.nhs.uk
16
Flattening a crosstab in Excel Application: Microsoft Excel Whilst working on the staff survey I found that the data came in an unusable format for using when creating charts. The data came as a table with organisations down one side and various questions along the top (see Example 1). What I really needed was the file to be a long format with a column for the organisation, a column for the variable (e.g. the question) and a column for the value (e.g. the result). So I said to myself Adam what’s the best way to get this?
Solution: Complexity 3/5 — Intermediate Excel knowledge
Well Adam, the obvious way of doing this is to drag and drop or cut and paste the columns – this method is time consuming and error prone – there is sneaky trick using pivot table to get the desired result. Example 1
Example 2
The first thing we need to is decide which “variables” or columns we want repeated on each line. As can see in Example 1 above we have organisation name, code, SHA and year, all of which aren’t really variables like the questions, as they will need to be on each new row. Therefore we need to create a key for them. To do this we need to stick in an extra column between the organisation details and the start of the questions. In this field concatenate the fields required using an & statement and appropriate delimiters (e.g. =A2&"|"&B2&"|"&C2&"|"&D2&"|"&E2). ). This will now be the basis of the pivot table. Start the pivot table as normal from the data menu and in the first dialog box choose the third option “Multiple consolidation ranges”, on the next dialog box stay with the default option which is “Create a single page field for me”. The next step is to specify the range this will be from the top of the new concatenated field down to the bottom row of the data set and all the way across to the final data column, and click next.
Quality.Observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
17
The next dialog box should be familiar to everyone who uses pivot tables regularly – and the next step is to click the “Layout…” button on this. In the layout box get rid of anything, by dragging and dropping everything except the “Count of value” which should be in the middle of table, then click OK, and finish. The resulting table will look something like the table on the this:
Double click in value cell of the table, this will export the data into a new worksheet with four columns labelled Row, Column, Value and Page1. This is the now flattened dataset. The column labelled row will have the previously concatenated data in it. To deconcatenate this insert some columns to the right of this column and then choose “Text to columns…” from the data menu and follow the wizard, putting in the appropriate delimiter that was originally used. Once this is done then the resulting dataset can be pivoted, labelled and referenced is whatever way is necessary for analysis. Contact adam.cook@southeastcoast.nhs.uk for further details on this.
Weekly A&E and Emergency Admissions dashboard By Rebecca Matthews, Planning and Performance Analyst South East Coast Performance Dashboards: Weekly A&E and Emergency Admissions South East Coast Acute Trust Total
Type 1 A&E attendances
Total A&E attendances
Type 2 A&E attendances
Type 3 A&E attendances
1400
25000
30000
3500
15000
10000
20000
15000
10000
5000
5000
3000 Number of attendances
Number of attendances
1000 800 600 400
2500 2000 1500 1000 500
200
0
10_11 actvity
10/04/2011 01/05/2011 22/05/2011 12/06/2011 03/07/2011 24/07/2011 14/08/2011 04/09/2011 25/09/2011 16/10/2011 06/11/2011 27/11/2011 18/12/2011 08/01/2012 29/01/2012 19/02/2012 11/03/2012 01/04/2012
11_12 activity
10_11 activity
Total emergency admissions
11_12 activity
10_11 activity
Ratio of admissions via type 1 A&E to type 1 A&E attendances
9000
10_11 activity
11_12 activity
11_12 activity
All types A&E performance YTD
Type 1 A&E performance YTD 120%
4000 3000 2000 1000 0
0.25 0.20 0.15 0.10
60% 40%
10_11 activity
11_12 activity
60%
40%
0%
10_11 performance
11_12 performance
Each week providers in England submit the Weekly SitReps return with information on A&E attendances and emergency admissions. We have developed a dashboard for South East Coast organisations which provides information on A&E performance by provider, total SHA position and cluster. (Note, however, that the cluster positions are made up of the total provider views grouped into clusters, rather than being commissioner views of the data.)
80%
20%
0% 10/04/2011 01/05/2011 22/05/2011 12/06/2011 03/07/2011 24/07/2011 14/08/2011 04/09/2011 25/09/2011 16/10/2011 06/11/2011 27/11/2011 18/12/2011 08/01/2012 29/01/2012 19/02/2012 11/03/2012 01/04/2012
10/04/2011 01/05/2011 22/05/2011 12/06/2011 03/07/2011 24/07/2011 14/08/2011 04/09/2011 25/09/2011 16/10/2011 06/11/2011 27/11/2011 18/12/2011 08/01/2012 29/01/2012 19/02/2012 11/03/2012 01/04/2012 11_12 activity
80%
20%
0.05 0.00
10_11 activity
100%
100%
0.30
Number of attendances
6000 5000
% treated within 4hrs
7000
0.35
10/04/2011 01/05/2011 22/05/2011 12/06/2011 03/07/2011 24/07/2011 14/08/2011 04/09/2011 25/09/2011 16/10/2011 06/11/2011 27/11/2011 18/12/2011 08/01/2012 29/01/2012 19/02/2012 11/03/2012 01/04/2012
Type 1admissions/ type 1 attends
120%
8000 Number of admissions
10/04/2011 01/05/2011 22/05/2011 12/06/2011 03/07/2011 24/07/2011 14/08/2011 04/09/2011 25/09/2011 16/10/2011 06/11/2011 27/11/2011 18/12/2011 08/01/2012 29/01/2012 19/02/2012 11/03/2012 01/04/2012
0 10/04/2011 01/05/2011 22/05/2011 12/06/2011 03/07/2011 24/07/2011 14/08/2011 04/09/2011 25/09/2011 16/10/2011 06/11/2011 27/11/2011 18/12/2011 08/01/2012 29/01/2012 19/02/2012 11/03/2012 01/04/2012
0
10/04/2011 01/05/2011 22/05/2011 12/06/2011 03/07/2011 24/07/2011 14/08/2011 04/09/2011 25/09/2011 16/10/2011 06/11/2011 27/11/2011 18/12/2011 08/01/2012 29/01/2012 19/02/2012 11/03/2012 01/04/2012
0
10/04/2011 01/05/2011 22/05/2011 12/06/2011 03/07/2011 24/07/2011 14/08/2011 04/09/2011 25/09/2011 16/10/2011 06/11/2011 27/11/2011 18/12/2011 08/01/2012 29/01/2012 19/02/2012 11/03/2012 01/04/2012
Number of attendances
20000
Number of attendances
1200 25000
10_11 performance
11_12 performance
The dashboard has eight charts – the first four show numbers of A&E attendances – total attendances and split by type of A&E department. The charts show the number of attendances reported each week along with a comparison to attendances in the previous year.
The remaining four charts show total emergency admissions, the ratio of admissions via type 1 A&E , and year-to-date performance (both type 1 and all types). Again, all charts show the current position and a comparison to the same week last year. The second sheet in the dashboard shows ‘Performance highlights’ and is a snapshot of which trusts haven’t met the A&E waiting times operational standard in the latest week and also highlights where performance has worsened by more than 5% or activity has increased by more than 5% compared to the previous year. The 5% figure can be changed – e.g. to look at trusts where activity is up 10% on last year. Currently, the dashboard covers Trusts within South East Coast, however the tool could easily be expanded to the whole of the South if this would be useful to Trusts in South Central and South West. As always, the dashboard is available to download from the Quality Observatory website nww.qualityobservatory.nhs.uk If you have any queries or suggestions please feel free to contact me: rebecca.matthews@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
Quality.Observatory@southeastcoast.nhs.uk
18
NHS Patient Feedback Challenge By Samantha Riley, Director of Information for Service Improvement Last week, I attended a really interesting event run by the NHS Institute for Innovation and Improvement which focussed on the challenge of gaining experience data from patients. The recently launched NHS Patient Feedback Challenge will provide an opportunity to radically transform patient experience, to spread this learning widely across healthcare systems, and reward those who are making this happen. The NHS Patient Feedback Challenge is backed by a £1m challenge fund which will support the development of ambitious demonstration sites that::
• • • •
Develop a fully integrated patient experience measurement system that leads to continuous improvement cycles; Create wholly patient focussed organisations; Encourage spread and adoption of positive patient experience practice within and across organisations; Develop sustainable approaches that live beyond the initial programme
The NHS Patient Feedback Challenge has been established to provide financial reward for the spread and implementation of great experience improvements made by teams within the NHS. It is designed to reward the development of a culture which rapidly identifies areas for improvement in experience and implements the best ideas. The NHS Institute aims to support the development of partnerships with other NHS organisations, social care, local government, commercial, voluntary and third sector organisations to create innovative approaches to spread and implementation of proven approaches to improving patient experience. A web portal (which is now live) will collect the ideas and will support the development of projects. Teams will be able to bid for staged funding/ reward. The programme will include development support which will have been identified through the application process. The funding will be based on the team’s ability to demonstrate spread of the approach to improving experience to new settings, and that the partners who have adopted the new approach can demonstrate the impact on patient experience. Challenge sites will move through the programme only when they can demonstrate that they have achieved their outcomes. It is really easy to get involved in the NHS Patient Feedback Challenge. Everyone can get involved, either by sharing work you are doing, becoming a spread partner in areas you are interested, providing your expertise or to comment on the work others have done and help them to be built into great projects that can be spread across the NHS to really impact on the service we deliver to our patients. I’ve already signed up…… Here’s where you can find out more! http://www.institute.nhs.uk/innovation/spread_and_adoption/nhs_patient_feedback_challenge.html
Quality.Observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
19
NEWS Enhanced Health Informatics Career Framework
Drop In session Dates :
The enhanced version of the Health Informatics Career Framework (HICF) can currently be accessed by NHS colleagues via:http://10.56.157.66/HICF. A short introductory video to the HICF (featuring the voice talents of one of the QO team!) has also been developed which provides an introduction and overview of the enhanced Health Informatics Career Framework (HICF). This is available via YouTube:
Need some help with Excel, Access or SQL databases? Not quite sure what do to with that data? Then why not come along to one of our drop in sessions. The next sessions are on the: 16th May 2012 20th June 2012
http://www.youtube.com/watch?v=1s7vnvE2Mx0.
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 today to book your session: quality.observatory@southeastcoast.nhs.uk
Speed dating at the Health Informatics Congress Secondary Uses Service (SUS) Kate Cheema and Kiran Cheema will be among the health informatics professionals taking part in the ‘speed dating’ section of the Skills Zone at this year’s Health Informatics congress (HC2012). They’ll be discussing their careers in health informatics, promoting our profession and highlighting the skills needed to do what they do! So do come along and say hello if you’re at the event on 2nd-3rd May 2012 at the Business Design Centre in London.
The Operating Framework identifies SUS as the standard repository for performance, monitoring, reconciliation and payments by April 2012. The NHS Information Centre has made available a Payment by Results (PbR) Key Performance Indicator Summary Report that aims to highlight key measures in relation to data quality. The report includes the percentage of invalid HRG codes which will be key to PbR Leads and Finance Directors. See: www.ic.nhs.uk/services/secondary-uses-servicesus/updates-and-guidance.
Inpatient survey results The results for the national survey of inpatients has now been published; you can find results for individual organisations at http://www.nhssurveys.org/ and the Quality Observatory’s Inpatient survey benchmarker (now with 6 year’s worth of data!) will be made available in the first week of May. Keep an eye on the website for a couple of little tools to help legacy SHA regions explore their outpatient survey data as well; these will be published over the next few weeks.
National PbR Benchmarker – April 2012 update DATA UPDATE - 2011/12 Q3 The National Benchmarker has recently been updated to include 2011/12 Q3 data for inpatients, outpatients and accident and emergency. The data is available in the Classic Benchmarker and Volume Analysis Scorecard. Data for 2011/12 Q4 is expected towards the end of June 2012. New Injury Profiles available
National Sickness Rates Tool Updated The SEQO online sickness rates tool has been updated with the latest data published by the IC. Data is now available to Dec 11: http://bit.ly/SEQO-SICK-IC
New Injury Profiles have recently been updated. They provide an easy-to-use online tool that brings together over 40 intentional and unintentional injury indicators for each local authority in England. www.injuryprofiles.org.uk
Quality Observatory Olympic Torchbearer
Kate swims 5km
Our resident poet Adam Cook is in training as he prepares to be one of the Olympic torch bearers. Adam will be carrying the torch through Redhill on 20th July. His time slot is yet to be announced so watch this space!
In April, Kate Cheema, swam 5km in an impressive two hours and five minutes to raise money for Maria Curie nurses. If you would like to sponsor her there is still time: http://bit.ly/KmjG5Z
www.QualityObservatory.nhs.uk
Quality.Observatory@southeastcoast.nhs.uk
Happy Birthday Suzanne…...
Welcome back to Charlene Hello, I’m Charlene Atcherley-Steers and I have re-joined the Quality Observatory in my old role as a Performance Analyst, after taking six months off to travel. I will be working for Rebecca on performance and planning products as well as with Kiran on website projects.
This month Suzanne Gregg (Sam’s PA) celebrated her birthday.
I spent the last six months travelling in South America and South East Asia and had a great time. Even though coming back to the UK was a bit strange, I am glad to be working for the Quality Observatory again as they are a great team!
Suzanne received some lovely flowers and a nice balloon crown from the team, which she is modelling in this picture. Hope you had a great day Suzanne!
Fascinating Facts
Sonnet XVIII (version 1.02) Shall I compare thee to the average length of stay? Thou art more reliable and more accurate:
During his life, Shakespeare wrote 37 plays and 154 sonnets! This means an average of 1.5 plays a year since he first started writing in 1589.
Increased efficiency means it can last but a day, Tho' events untoward affect the discharge date: Sometime too weary under hospital confines, And often linger longer when abed unlimbed, And every intervention changes vital signs, Then PbR shows to us length of stay untrimmed: But thy steadfast constancy shall not fade, Nor depend upon the accuracy of clinical codes, Nor shall death in hospital need to be surveyed, When in proper time all is fully diagnosed, So long as length of stay is counted properly, So long lives spells and episodes as IP currency.
Simon says……. Quality is not just ensuring that what you are producing is the highest quality, it is trusting those who supply you are doing the same.
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