Volume 10 Issue 6 February 2017 Welcome to Knowledge Matters One of my personal heroes is Douglas Adams, who once said “I love deadlines. I love the whooshing noise they make as they go by.” - Bearing that in mind welcome to the February edition of Knowledge Matters! It’s all change here at QO Towers—Simon has headed off to pastures new (see page 14), and we have a plethora (a plethora can be three, can’t it?) of new team members to introduce (see page 15). Reassuringly Knowledge Matters is still the same old mixture of idiosyncratic articles on how to do tech stuff, interesting things going on in the world of NHS analysis, what the QO have been up to lately, and dodgy poetry. This issue we see the welcome return of Samantha Riley, this time in her new role in NHS Improvement, championing the role of quality analysis in improvement services, this time she’s looking at the difference between measurement for improvement and measurement for judgement. There’s a couple of articles focussed on cancer; one is a case study about analysing data for the Cancer Vanguard, and the other from South East Coast Clinical Network about the Fourth Biennial Early Diagnosis Research Conference. We’re also looking at population analytics in terms of STP footprints with the exciting new CareMap tool. Becki and Dani have been on voyages of discovery down the murky tributaries of Excel and have come back eager to share their knowledge on Power Pivots and dependant dropdown menus. That’s probably about enough for now—see you next time!
Inside This Issue : Measurement for improvement vs measurement for judgement
2
Skills Builder—Power Pivot
8
News
13
CareMap Population Analytics
4
Ask An Analyst—C reating Dependent Drop
10
Team News
14
Cancer Vanguard Project – automating charts to highlight outliers Part 1
6
Fourth Biennial Early Diagnosis Research Conference
13
The Back Page
15
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2 Measurement for improvement vs measurement for judgement By Samantha Riley, Head of Improvement Analytics, NHS Improvement Hello Knowledge Matters readers. Those of you who are regular readers will know how big a fan I am of statistical process control (SPC) charts. And how much I dislike comparisons between 2 data points which are then identified as red, amber or green. I do wonder why, despite the wealth of publications over the years evidencing the benefits of using SPC, there are still so few examples of this approach being used in healthcare. Here are a couple of papers that I would draw your attention to. The first was published in 2004 and is written by M Mohammed. This paper describes the role that SPC has in improving the quality of healthcare http://qualitysafety.bmj.com/content/13/4/243. This is only one of quite a number of papers published on this topic. The second was published much more recently and looks at the content of board papers from a sample of Trusts in England. This makes depressing reading for fans of SPC - http:// qualitysafety.bmj.com/content/26/1/61 with only a very small percentage of boards using control charts. This paper does identify a number of potential barriers to the use of SPC and also talks about actions that could be taken to remove these barriers. More about this later. I am pleased to say that East London Foundation NHS Trust is one of the few Trusts to do understand the benefits of using SPC to look at their data. Their board paper is a thing of beauty! This screenshot gives you a flavour – but I would strongly encourage you to have a look at the full report https://www.elft.nhs.uk/uploads/files/1/About/Trust%20Board%20Meetings/2017/8.%20TBD2017-02-23%20Quality%20Report.pdf
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3 Measurement for improvement vs measurement for judgement The last thing that I want to draw your attention to today, is the strategic framework for improvement and leadership which was published in December : Developing People, Improving Care. https:// improvement.nhs.uk/resources/developing-people-improving-care This is an evidence based national framework to guide action on improvement skill-building, leadership development and talent management. The framework was co-developed by a number of national organisations including NHS Improvement, NHS England, the Care Quality Commission and the Department of Health. Each of the 13 national organisations who were involved in the development of the framework have committed to adhere to three pledges which are described in the document. One of these relates to reshaping the regulatory and oversight environment and giving organisations and systems the time and space to establish continuous improvement cultures. A key element of this involves taking a much more balanced approach to measurement – focussing on measurement for improvement much more than we do currently. The strategic framework is a framework for action – details of proposed actions appear below. I really do believe that this is a great opportunity for us to seriously consider how we remove the barriers to people understanding variation and utilising techniques such as SPC – approaches which have a strong evidence base in their ability to support better decision making. I would be interested to hear views from Knowledge Matters readers – what are the actions that NHS Improvement and others could take which would make the biggest impact? How could we best equip analysts with the skills and tools that they will need? What can we do to encourage boards to leave behind their RAG status reports and move to using control charts? I would be really pleased to hear from Knowledge Matters readers if they have good examples of SPC being used or thoughts and ideas about how we can start the measurement for improvement revolution! Samantha.riley1@nhs.net
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4 CareMap Population Analytics By Trevor Foster, Head of Geographic Intelligence and Mapping , SCWCSU CareMap has been developed by the SCW CSU HealthGIS Team, to provide a rich analysis of population data, to inform the Five Year Forward View and delivery of Sustainability and Transformation Plans (STPs). This analytical tool makes the complex simple, providing a unique platform for Clinical Commissioning Groups (CCGs) and STP footprints to view the activity flows of their population. Designed in collaboration with CCGs and NHS England, this powerful web accessible mapping tool shows visualisation of services, travel accessibility, and activity/patient flows and population demographics, on the map of the CCG/STP footprint area. One size doesn’t fit all, so this dynamic tool, has levels of sophistication and flexibility to allow you to tailor your visuals to sort your needs. How CareMap can help you! Our HealthGIS team are experts at making the complex simple. Layers of data, from various sources are analysed and presented in a unique visual format. The interactive maps consist of; ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦
Backdrop mapping (Ordnance Survey), content changes depending on zoom scale CCG boundaries with high level statistics; Number of GP practices, population size Hospitals (acute and community hospitals) Deprivation indicator at Census Lower Super Output Area (LSOA) level Ethnicity indicator STP (Sustainability and Transformation Plan) footprint Postcode areas Electoral wards Primary Care providers; GP surgeries, Pharmacies, Dentists, Opticians, Care Homes Hospital travel access zones (catchment areas for acute and community hospitals) Travel access isochrones (private vehicle, public transport, walking) to GP surgeries Population numbers and percentage within travel times CCG level Admitted Patient Care (APC) shown as pie symbols representing volume of activity and split by provider ♦ GP practice level Admitted Patient Care (APC) shown as pie symbols representing volume of activity and split by provider ♦ GP practice level GP referred outpatients shown as pie symbols representing volume of activity and split by provider ♦ Activity spidergraphs at GP practice level, APC and GP referred outpatients ♦ Output Area Classification (OAC), ONS population segmentation/classification information
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5 CareMap Population Analytics
Key Features of CareMap: ♦ ♦ ♦ ♦ ♦ ♦
Provides powerful visualisation of information Is Web accessible Offers Flexible graphics options Easy to use Easy to share Technical support is available at the end of the phone
CareMap is a powerful tool for Clinical Commissioning Groups and Health and Care systems as they develop their Sustainability and Transformation Plans. Imagine you were embarking on a public consultation regarding a service configuration in your CCG. Visual maps tell a thousand words, they are simple to understand and based on fact. CareMap and the suite of other map based visualisation tools from HealthGIS provide a valuable source of information, to inform discussions and improve decision-making. With many years of experience of working with NHS information combined with GIS software and data the HealthGIS team provides Geographic Information (GIS and maps) services to NHS organisations in England and Wales. They are experts in their field and at developing innovative solutions to support health commissioners in their day-to-day business, such as CareMap. Key Benefits
♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦
Activity can be viewed for all or part of your CCG/STP footprint Visualisation of activity on a map instantly shows flows and behaviours Scheduled data re-fresh ensures accurate information Services can be visualised in a flexible way Mapped layers of analysis can be switched off or on Search functionality available right down to address and postcode level Provides essential analysis to inform and influence transformation debates and decisions Visuals can be annotated and printed to suit your specific needs Truly flexible visual tool to support business cases and public consultations
For more details about CareMap please contact: Trevor Foster, Head of Geographical Intelligence and Mapping, Email: Trevor.Foster@nhs.net
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6 Cancer Vanguard Project – automating charts to highlight outliers Part 1 by Daniel White – Senior Information Analyst As part of our ongoing working partnership with the London Cancer Vanguard, South, Central and West CSU were asked to assist with a piece of work to extract incidence and mortality data from the CancerStats portal and produce a meaningful set of analyses on this, highlighting outlying values as compared to the England value. Data consisted of: Age standardised Incidence and Mortality rates for 33 cancer types across 46 CCGs in 4 regions. Data was further cut by Male/Female/Persons, meaning three Incidence/Mortality charts were produced per cancer type. Prevalence data by CCG and cancer type (ICD10 coded) Data sets for each cancer type required a column chart of Age-standardised Incidence and Mortality rates. However, the following additional requirements presented a challenge: Overall Incidence and Mortality rates for England to be shown as lines on the column chart Data to be grouped by region Regional incidence and mortality figures to be displayed on the chart as four captions National Incidence and Mortality rates to be displayed as flat trend lines Additionally: If the Upper CI (Column H) is less than the England Rate, the charted rate will feature a border shaded GREEN If the Lower CI (Column G) is less than the England Rate, the charted rate will feature a border shaded RED
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7 Incidence Rates
Male Age standardised rate per 100,000 (2012-2014)
MC
00T
NHS Bolton
Number of tumours - 3 years (2012-2014) 24
4.4
11.0
-3.9
Age standardised rate per 100,000 (2009-2011) 10.9
RM
08T
NHS Sutton
37
12
17.5
12.2
24.8
6.1
11.4
SEL
07Q
NHS Bromley
32
11
8.5
5.8
12.2
-0.2
8.8
UCLH
08F
NHS Havering
41
14
13.6
9.7
18.9
2.9
10.7
Greater Manchester total
317
106
9.61
8.6
10.8
0.0
9.6
RM Partners total
483
161
15.28
13.9
16.8
1.7
13.5
SEL total
192
64
12.65
10.9
14.7
-1.2
13.8
UCLH Cancer Collaborative total
458
153
15.29
13.9
16.8
1.5
13.8
London total
1,084
361
14.8
13.9
15.8
1.1
13.7
England overall
7,853
2,618
12.04
11.8
12.3
0.6
11.4
Region
CCG code
921
CCG
Numbers of tumours per year (2012-2014) 8
Rate 7.0
Lower CI (95%)
Upper CI (95%)
Change in rate from previous 3 years (2009-2011)
Data sets for each cancer type required a column chart of Age-standardised Incidence and Mortality rates. However, the following additional requirements presented a challenge: Overall Incidence and Mortality rates for England to be shown as lines on the column chart Data to be grouped by region Regional incidence and mortality figures to be displayed on the chart as four captions National Incidence and Mortality rates to be displayed as flat trend lines Additionally: If the Upper CI (Column H) is less than the England Rate, the charted rate will feature a border shaded GREEN If the Lower CI (Column G) is less than the England Rate, the charted rate will feature a border shaded RED
Incidence and mortality data were extracted from the source files and summarised in table format on two separate tabs, with Male, Female and Persons data forming three subsets per tab. An example layout is shown below. The conditional formatting applied to the Rate column identifies the columns in the chart that require coloured border overlays to be applied. Columns were added onto the end of the extracted data for each cancer data set, and were used to identify which CCG’s data required a red or green overlay. The upper and lower Confidence Intervals for England were set as named ranges in Excel to ensure that the templates would require minimal adjustment between data sets. Some simple formulas were then used to populate the “Overlay Guide” sections, with the Incidence/Mortality rate value copied across if the condition was met. If the condition is not met, the cell contents are forced to a blank value; for example: =IF(H8<Incidence_LowerCI_England_Male,F8,"") (Copy rate value if Upper CI < England Lower CI) Following this, it was then possible to compile the data to be plotted on the charts. At this stage, all required data exists, however the data requires some restructuring in order to present it the required manner. There are three charts to prepare, with eight data series to be plotted per chart overall. As an example, for the Male Incidence/mortality chart, the following data series are required: For simplicity, a new “Chart data” tab was created to collate the chart data. The CCG names were displayed on the left, and a series of VLOOKUP functions were used to pull the data through from the data tabs. Part 2 of this article will look at how the charts were created.
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8
Power Pivots By Danielle Collier The Insights tool uses data from other sources to build an informative view of what is happening within a selected area. For example, you can select a GP Practice and view a timeline of their Friends and Family (FFT) results.
We use a .CSV file of the FFT data to create this web view. Unfortunately, to enable the backend queries to work, we need to amend the way in which the data is input into the database. When we download the data from NHS England website, it has the following columns that we need: Practice Code, Total Responses, Percentage Recommended, Percentage Not Recommended, Extremely Likely, Likely, Neither, Unlikely, Extremely Unlikely, and Donâ&#x20AC;&#x2122;t Know.
I have just 4 columns in my database table: Date, GP_Code, Data_Type, Value
Now, one option I have is to create another .CSV. I will rename the columns to match the data type in my table and add in the date column. The Data_Type works as a lookup (or Attribute).
Now the data looks like this:
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9
Now if I upload this .CSV to my table, all that will be included is the first 4 columns (Date, GP_Code, 1, 2). This is no good. I need all the data! I could copy and paste the data repeatedly to create all the rows I need with each column. This is very fiddly and time consuming. Luckily, Microsoft has a really useful tool to sort this. What I need to do is use ‘Microsoft Power Query’ and the ‘Unpivot columns’ query within this. First download and install the add-in from www.microsoft.com (search for ‘Power Query’ within the website and download either the .32bit or .64bit dependant on your version of Excel). When this is installed, select the ‘Power Query’ tab. From this ribbon select the following: ‘From File’ à ‘From CSV’ à Select your amended CSV to use à ‘Edit’
Click on ‘Use First Rows As Headers’ this will give you your column names. Next hold down CTRL and select the columns you want as new rows (1-9), then on the ribbon click ‘Transform’ Columns’.
‘Unpivot
Close this and select ‘Keep’ changes. You will now have 4 columns of data with ‘Attribute’ and ‘Value’. You can then copy this new data as Values into a new CSV to upload to your data base.
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10
Creating Dependent Drop-Down Lists by Becki Ehren Application: Microsoft Excel There are times when two drop down lists are needed by the choices in the second are dependent upon the results of the first
Solution: Complexity 2/5 I was recently asked to create a tool in Excel where individuals could go in to a specific sheet and select one option from a dropdown list in column A, and have column B provide further options based on the selection in column A. This sounded quite straight forward, but it took me a while to figure it out so I thought I would write an ‘Ask an Analyst’ article to help anyone else out that might need it! To start, you will need to create the first Named list. In an empty section of your workbook (perhaps a lookups tab for example), make a list of all of the entries that you want to appear in your drop down. For this example, I will use only two options – cake and sweets.
Once you have created your first named list, you will need to create the supporting lists and name these too.
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11 Once you have created all of your named lists, you will need to add the drop downs. To do this, select the cell you want your list to appear in and go to ‘Data’, and ‘Data Validation’. Amend the settings under the ‘Allow’ box to list and in the Source box type =Produce (this refers to the first list that we created at the beginning).
Next, you will need to set up your first dependent list. In cell H3 (for example) repeat the above process of going to ‘Data’, ‘Data Validation’ and adding a list to this cell. Instead of putting =Produce, type =INDIRECT(G3). G3 is the cell which we want our list to relate to in this example. If G3 is blank, you will see a message pop up that says ‘The source currently evaluates to an error. Do you want to continue?’ Click yes as this just means that at there is currently no data to work from. This will change once you have made a selection in the Produce Type list.
Make a selection from your first list in column G3, and you should then be able to make a selection based on your first choice. If you want to apply these settings to multiple cells, either copy and paste the cells, or drag them down to use the same formatting.
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12 Fourth Biennial Early Diagnosis Research Conference, Cancer Research UK By Julia Hugason-Briem, Interim AEDI Programme Manager,South East Cancer Clinical Network On 23rd and 24th February, Dr Tina George and Julia Hugason-Briem attended the fourth biennial Cancer Research UK Early Diagnosis Research Conference in London. Over the two days we heard from leaders in the field of cancer research such as Sir Harpal Kumar, CEO of CRUK and Chair of National Cancer Advisory Group. Amongst the many topics covered, we heard about the future of screening and how to improve screening participation; outcomes of two of the ACE projects; using local data to inform policy and to support timely diagnosis and treatment; approaches to reduce inequalities in access; patient views and influences on help seeking and timely diagnosis; international perspectives from Australia, Denmark, and the Netherlands; and a spotlight on lung cancer. The conference has certainly given us much food for thought.
Following submission of an abstract about our work with Coastal West Sussex and Hastings and Rother CCGs on primary careâ&#x20AC;&#x2122;s role in reducing the number of cancer diagnoses via emergency presentations (which is known to have poorer outcomes than via a two week wait referral), we were delighted to be invited to present a poster at the conference. Our poster was one of over 100 being displayed and was one of the most colourful and eye-catching around! We were proud to be able to present our work in such a prestigious forum. Thanks goes to the expert input from Rebecca Matthews from the Quality Observatory, who completed the data analysis.
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13
NEWS NHS England’s Innovation and Technology tariff On 2 November 2016, NHS England set out plans to fast-track the introduction of six new types of medical technology products and apps during 2017/18 through the Innovation and Technology Tariff (ITT). The ITT removes the need for multiple local price negotiations and instead guarantees automatic reimbursement.
address patient safety and all will improve both outcomes and experience. The ITT will go live on 1 April 2017 and we are keen to encourage the adoption and spread of these technologies. WebEx Sessions around this are on: Monday 27th March 2017
https://www.england.nhs.uk/2016/11/innov-techtariff/
10:00 -11:00 join the meeting
For five of the above NHS England will centrally pick up the costs, where these have been incurred in line with requirements about use.
14:00-15:00 join the meeting
The sixth innovation is an alternative to existing surgical procedures, and is already funded as part of tariff calculations. The innovation categories are: •
•
•
•
Guided mediolateral episiotomy to minimise the risk of obstetric anal sphincter injury Arterial connecting systems to reduce bacterial contamination and the accidental administration of medication Pneumonia prevention systems which are designed to stop ventilator-associated pneumonia Web based applications for the selfmanagement of chronic obstructive pulmonary disease (COPD)
•
Frozen Faecal microbiota transplantation (FMT) for recurrent Clostridium difficile infection rates
•
Management of Benign prostatic hyperplasia as a day case (purchased through National Tariff)
In parallel, but separately from the tariff, NHS England is centrally funding the purchase of mobile ECG technology which will be managed through the AHSN network. We believe these products will offer significant improvements such as reducing outpatients’ visits, inpatient length of stay and additional treatments/ procedure costs. A number of the innovation types
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12:00-13:00 join the meeting
16:00-17:00 join the meeting Tuesday 28th March 2017 10:00-11:00 join the meeting 12:00-13:00 join the meeting Wednesday 29th March 2017 14:00-15:00 join the meeting 16:00-17:00 join the meeting Emergency Care Data Set (ECDS) NHS Digital have been running a series of Webinars about the Emergency Care Set , which is set to replace the A&E MDS. The scope and timetable of the implementation is:
In scope
Timescale
Type 1 & Type 2 Emergency Departments (approx. 190 sites)
From October 2017 (early adopters sooner)
Type 3 & 4 Emergency Departments & UCC’s (approx. 240 sites)
Any time from October 2017, must complete by Oct 2018
Out of scope currently: Ambulatory Emergency Care (AEC) Please contact ECDS@nhs.net for more details
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14
NEWS Team News: We’ve had three new team members join us in the last couple of months, but also we have lost one of the founding members of the QO. So without further ado I’ll hand over to Simon... Ding, Ding, All Change! It’s been a long time working in Horley for the Quality Observatory and its previous guises. I started there in 2005 working for Samantha Riley as a Performance Improvement Analyst after working 2 years at Brighton PCT. I’ve had a great time working within and heading up the analytical element of the fantastic team at the QO, but decided that it was the time to spread my wings and take the leap in to the (semi) unknown realm of NHS providers!
the data warehouse team and last, but definitely by no means least, the clinical coding team. It’s great to put some faces to names for people I’ve produced analysis for in the past and bumping in to the odd blast form the past, Kevin Kelly, who was part of the analytical team at Surrey Sussex SHA when I started there, is part of my team of analysts. We’ve got some big challenges ahead of us, particularly the new ECDS that replaces the current A&E dataset. What a difference perspective makes, previously I was looking forward to being able to analyse the new extended dataset, now I have to make sure we are able submit it!! I’m enjoying learning how a provider works and working with the various teams here to ensure that we can develop the right tools to support them and help them understand operational issues and opportunities. It’s also great to be able to get access to the various different kinds of data that just weren’t available in my previous roles and see what we can do with them. What is pretty key is having the most up to
So, here I am, 2
months now down the line as Head of Information Services at Ashford & St Peter’s NHS Foundation Trust based over in Chertsey and it’s certainly an eye opener! I’m responsible for managing 30 people across the analytical team, the data quality team,
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date information is important, a lag of even hours can be critical for decision making in some circumstances! Anyway, no doubt there will be more updates from provider land going forward so watch this space!
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15
NEWS We are very pleased to welcome 3 new team members to the QO fold: Hello! I’m Sophie and one of the new Programme Support Assistants who started on January 3rd. I’m an exteacher from Yorkshire, so you’ll often see me indulging my addiction to strong and sweet teaV heat optional! I’m a keen Épée fencer and will be re-joining Crawley sword club sometime soon, but most evenings you’d find me curled up with a good book or binge watching Doctor Who! I’m eager to get started and I look forward to working with you all.
or upcycling the latest offerings of the generous folk on Freecycle. December, January & February are busy times for QO Birthdays (Note to self next time we need to employ someone make sure that their birthday is in summerV), but as ever much merriment was made:
Hello! My name is Lisandra and I joined the team and the NHS on 3rd January as a Programme Support Assistant. New Year, new job! There is a lot still to learn but I am happy so far with everything and with the supportive team I have. This job position involves customer service, which is I really like to do and where I have experience. At the moment I am helping with the Primary Care inboxes and with our new project: Safety Thermometer. Hi. I’m Annette and I joined the team on the 6th February as an Information Analyst. My last role in the NHS was at East Surrey Hospital and before that, I was involved in various projects for government departments and the energy industry. I am pleased to have joined the team and am looking forward to working on the Maternity Dashboard and the PSC Atlas. You may hear me talking about my other projects which can be anything from helping students with academic papers, improving my Parkrun statistics
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Christmas Crossword Answers Well done to the digital transformation team at SCWCSU who completed the crossword on the day that the last Knowledge Matters was released. Some sort of reward will eventually be heading your way! Answers: Across:3 Carpenters; 4 Herod; 6 Capricorn; 8 Narnia; 9 Nine; 16 Australia; 17 Caspar; 20 mistletoe; 21 Aladdin; 23 Turkey; 24 Cranberry; 25 Chaplin; 26 Four; 27 Pipers; 28 Hogmanay Down:1 Pennsylvania; 2 Norway; 5 Swan; 6 Canada; 7 Mexico; 10 Whisky; 11 Bethlehem; 12 Almond; 13 Bach; 14 Cromwell; 15 Goose; 18 Candles; 19 Advent; 22 Grinch; 24 Cook Solution: No winter lasts forever; no spring skips its turn
Simon saysDD.
A Brace of STP Limericks
GOODBYE!
Plans for Sustainability and Transformation, Are sweeping across this great nation, Reforming the NHS Enabling greater success And building a stronger foundation.
There's a footprint for each STP, Made from a collaborative community, Local councils and NHS Are united in a process To deliver savings and quality
Knowledge matters is the newsletter of NHS South East Coastâ&#x20AC;&#x2122;s Quality Observatory, to discuss any items raised in this publication, for further information or to be added to our distribution list, please contact: Hosted by: South Central and West Commissioning Support Unit
E-mail: qoteam.scwcsu@nhs.net