Knowledge Matters Volume 5 Issue 3

Volume 5 Issue 3 August 2011 Welcome to Knowledge Matters Hello and welcome to this Carnival Edition of Knowledge Matters. I hope that our readers have enjoyed restful summer breaks. I have a rather unusual holiday planned in September which I will tell you about in the next issue…..

I’m really excited to announce that we are participating in a national pilot (see page 3) to support commissioners increase their skills and knowledge in commissioning intelligence. We are hopeful that the queries received during the pilot will increase our understanding of the needs of Clinical Commissioning Groups, which will in turn enable us to design support packages to assist this key group of customers moving forward. In addition, for the remainder of the year, the Quality Observatory will be supporting two CCGs within Surrey with business intelligence services. I have developed a draft service specification for analytical services to CCGS which I am happy to share with anyone who is interested.

You will of course be aware that SHA clusters will be established as of 3rd October 2011. South East Coast becomes part of NHS South of England. We are already in close contact with our colleagues in South Central and South West and will be getting together over the next couple of months to explore whether there are more effective ways of providing analytical services across the new geography. In advance of this, the 3 SHAs have already requested (and received) access from the Department of Health to Unify for all organisations within NHS South of England. No doubt more on this next time.

I would like to finish by saying a big personal thank you to Brian Derry for his help, advice and wisdom over recent years. I am sure that many readers have come across Brian who joined the NHS Information Centre in 2008 as Executive Director of Information Services. Brian retired earlier this month after many years of dedicated service to the NHS, having held a wide variety of posts in the field of Informatics and having been a great champion of Information Management. We did of course need to mark this important occasion in some way….. Have a look at the back page to read ‘Ode to Mr Derry’.

I look forward to seeing you again in October!

Inside This Issue : Outpatient Coding—Getting it Right

2

Systems Thinking in Norway

8

Information Centre Update

16

CCG Advice Pilot

3

Ask An Analyst

10

Chief Clinical Information Officer Campaign Launch

18

CCG Activity Explorer Tool

4

Enhancing Quality Update

12

Analysis Ancient and Modern

19

Skills Builder—A Picture is worth a thousand words

6

Taming The Beast

14

Variation

20

twitter.com/SECSHAQO issuu.com/SECQO

www.QualityObservatory.nhs.uk

Page 2

Outpatient Coding—Getting It Right

By Adam Cook, Specialist Information Analyst It is a truth universally acknowledged that an outpatient CDS in possession of a full set of administrative information is in want of some clinical coding. However the means of acquiring said information have often been inadequate or indeed entirely lacking. This sorry state of affairs has often been the cause of disapprobation from the Audit Commission come the time of their annual PbR Audit.

Whilst all are aware of the timeliness issues around the PbR audit report, there has also been recognition amongst trusts that something needs to be done about outpatient coding, and in a time austerity and management cost cutting that something needs to be done with the minimum of resources and capacity, and the maximum of innovation and creativity.

Making sure that clinical coding is done properly in outpatients has become of paramount importance, not only in terms of providers receiving proper renumeration through PbR, but also providing a wealth of clinical information around these attendances. This information can be used in monitoring outcomes and effectiveness, and helps fill in a gap when mapping out the patient pathway.

There are still many trusts who have yet to rise fully to challenge of getting this done, but pockets of good practice are emerging. Below are two examples from South East Coast where outpatient coding is being tackled head on.

A Clinical Coder, yesterday

We have changed our PAS system and there is now a clinic activity tab against each patient on the clinic diary. We are moving towards Clinicians themselves completing the information on this screen – pilots in Urology and Rheumatology have been successfully completed. From this screen they will be able to: • View results of their patients on the system • Record the secondary outcome from a pick list • Record in free text when they want to see the patient again and any specific instructions • Record the diagnosis of the patient from a pick list which is populated based on Specialty • Record any procedures performed in the clinic – again from a pick list populated from Specialty specific codes.

• Record exactly who saw the patient in clinic

Louis Inglis—East Kent Hospitals Trust

Jenny Garvey—Western Sussex Hospitals Trust

“…we've seen a significant increase in the number of OP Procedures recorded at East Kent, we did this by relaunching our clinic outcome forms with a specific form for each specialty, designed in conjunction with and signed off by each of the clinical directors. There is a section with the most popular OP Procedures performed in each spec and the consultants are asked to tick what they did in clinic, this is then coded onto PAS when the clinic is receptioned. I'm making it sound quite easy which is a huge underestimate of the amount of work that has gone into this, we have a clinical coding and income project board who have championed this within the Trust and the project has had dedicated resource but it does appear to have worked.”

Information on the levels of outpatient coding can be accessed Via the Information Centre website.. If you are interested in getting more involved in how we can improve the quality of coding you might like to join the Data Flows and Standards Group monthly meetings. This take place via Webex—so no travelling required. The next meeting takes place on 7th October 10am-11am For further details please do contact me! Adam.cook@southeastcoast.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

Page 3

Clinical Commissioning Group Advice Pilot

By Julian Patterson, Director of Marketing and Communications, PCC PCC has teamed up with NHS library and knowledge services (LKS) and the South East Coast Quality Observatory to offer commissioners free access to a one-stop shop for commissioning intelligence.

The Ask an Expert service brings together for the first time expertise in commissioning, evidence searches, data analysis and health intelligence in an easy-to-access format online.

Users are invited to put questions on commissioning, information analysis, data sets, procurement, contracts and evidence from research and best practice, which will be routed to the appropriate expert based on topic and geographic location.

The service is an unfunded pilot that will run until January 2012 and is available to NHS commissioners in England.

The pilot will draw expertise from PCC’s national adviser network, 32 of England’s local NHS LKS teams and the South East Coast Quality Observatory, which will field the analytical queries.

Helen Northall, chief executive, PCC said: “Commissioning is a multidisciplinary business involving a range of health professionals. Providing information and advice needs to reflect that diversity. No single organisation has all the skills needed or all the answers.”

NHS LKS teams provide expert information consultancy for acute trusts and community services across the country and in some areas are already fully embedded into the work of GPs and commissioners. The Ask an Expert service will allow many more GPs and primary care professionals to tap into their services.

Ben Skinner, head of library and knowledge services at the Brighton and Sussex University Hospitals NHS Trust, said: “To make the best decisions commissioners need to know what models and interventions have been proven to work and how they have been adopted elsewhere. We can help, but we haven’t yet made strong links with primary care. This pilot is a first step in that direction.”

Samantha Riley, head of the Quality Observatory, NHS South East Coast said: “Good commissioning decisions depend on sound analysis of data which is complex and potentially confusing for non-experts. Clinical commissioning groups may eventually bring some of these skills in-house, but I very much doubt whether many will be able to afford teams of analysts with experience in the analysis, interpretation and effective use of health data. My team and others like it around the country could fill that gap.”

Users of the Ask an Expert service will submit queries via a web form, but responses will require the human touch.

Ben Skinner said: “Good knowledge management is about knowing who to ask for advice. The web provides a lot, but the expertise of the partners in this project can’t be captured in a database. We expect plenty of interaction with commissioners as we help them frame their questions and make sure we provide exactly what they need.”

Find the service at www.networks.nhs.uk/commissioning.

Contacts Samantha Riley, South East Coast Quality Observatory samantha.riley@southeastcoast.nhs.uk 01293 778842 Ben Skinner, Brighton and Sussex University Hospitals NHS Trust ben.skinner@nhs.net 01273 523303 Julian Patterson, PCC julian.patterson@pcc.nhs.uk www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

Page 4

CCG Activity Explorer Tool

By Rebecca Matthews, Performance and Planning Analyst The CCG Activity Trend Explorer is a tool that can be used to look at activity down to clinical commissioning group level, both historic activity levels and forecast activity levels for the remainder of the financial year.

The tool is populated using SUS data and contains data for elective activity (both ordinary inpatient and daycase), emergency and other non-elective activity. The emergency activity is split between long stay and short stay spells.

There are 2 views available within the CCG explorer – one shows data at a total CCG level, the second has CCG data with a provider split (note that there may be some very small numbers within this view) and each of these two tabs has a similar format.

FRIMLEY PARK HOSPITAL NHS FOUNDATION TRUST

Surrey Heath Consortium

Elective Daycase Elective Inpatient

450

All Elective 400

Show 2008/09 'all el.' baseline Show 'all elective' forecast

350

Emergency Long Stay

300

Emergency Short Stay All Emergency

Activity

Show 2008/09 'all em.' baseline Show 'all emergency' forecast

250

Other Non-Elective 200 Select calculation to display in table

150

70/30 calc.

Forecast cost

100

Total forecast costs (2011/12) Total forecast cost: emergency

50

Total forecast cost: elective

0

Daycase

Elective inpatient

Emergency Long stay

Emergency Short stay

Other non-elective

All Elective

All Emergency

2008/09 baseline

All emergency forecast

All Elective forecast

2008/09 Elective Baseline

2012_03

2012_02

2012_01

2011_12

2011_11

2011_10

2011_09

2011_08

2011_07

2011_06

2011_05

2011_04

2011_03

2011_02

2011_01

2010_12

2010_11

2010_10

2010_09

2010_08

2010_07

2010_06

2010_05

2010_04

2010_03

2010_02

2010_01

2009_12

2009_11

2009_10

2009_09

2009_08

2009_07

2009_06

2009_05

2009_04

Month

Annual % change from 2008/09 baseline 2010/11 All Emergency

47.27%

All Elective

23.99%

2011/12 forecast

Each chart has a set of tick boxes at the side which determine what activity will show on the charts. Actual activity (as described above) can be viewed along with 2008/09 baseline data for both elective and emergency activity and a forecast of activity levels by the end of the financial year.

The forecasting model uses data from April 2007 onwards and gives a reasonable forecast of activity for the majority of CCG/provider relationships up to the end of the current financial year (2011/12), although where a contract started after April 2007 this may affect the forecast.

There is also a table with financial data alongside the chart. Two options are available for this – the first is to calculate the 70/30 split of the value of emergency activity over the 2008/09 baseline. The second is to show forecast costs for total elective and emergency activity. Costs are calculated using an average cost for the main contracts for each CCG so any major changes in casemix may not be reflected in the costings..

The final table on the sheet shows the percentage by which activity has shifted above or below the 2008/09 baseline for emergency and elective activity. The summary and financial tables are only available on the chart which shows the provider split for each CCG’s activity.

The tool is updated monthly using the latest SUS data available - there are checks built in to ensure that where SUS data for the latest month is incomplete, data for this month is not used.

The aggregate sheet is the aggregate of the contract level data in the tool - this is limited to the top 100 providers for each Clinical Commissioning Group and as such may not reflect the absolute totals for each CCG, although any activity not included would be very small levels.

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

Page 5

Activity trend explorer: aggregate position dashboard DASH (Deal, Ash & Sandwich Heath)

(NB: this shows an aggregate of the contract level data shown in the main tool and as such doesn not reflect TOTAL activity as the main tool is limited to the top 100 providers. Thus, small amounts of activity at very specialist or distant providers may not be included in total shown here. This tool is designed to assess trends only.)

Select activity type to plot

180

Elective Daycase Elective Inpatient All elective All elective forecast

160

140 Emergency short stay Emergency long stay All emergency All emergency forecast

Activity

120

100 Other non-elective 80

60

40

20

2012_03

2012_02

2012_01

2011_12

2011_11

2011_10

2011_09

2011_08

2011_07

2011_06

2011_05

2011_04

2011_03

2011_02

2011_01

2010_12

2010_11

2010_10

2010_09

2010_08

2010_07

2010_06

2010_05

2010_04

2010_03

2010_02

2010_01

2009_12

2009_11

2009_10

2009_09

2009_08

2009_07

2009_06

2009_05

2009_04

0

Year & month Daycase Emergency Short stay All Emergency

Elective inpatient Other non-elective Emergency forecast

Emergency Long stay All Elective Elective forecast

The CCG explorer is available to download from the Resource Catalogue on the Quality Observatory website: nww.qualityobservatory.nhs.uk and will be updated as more SUS data becomes available.

The Quality Observatory gets fit for the Olympics!

The Quality Observatory is helping the SHA pro-actively participate in the NHS Sport and Activity Physical Challenge. The NHS (2012) Challenge has inspired NHS staff around the country to set up and take part in sports & physical activities in preparation for the 2012 Olympics which commence on 27th July. A number of SHA staff took part in ‘The Gatwick Walk’ on 27th last month (a year exactly until the games commence) - the route for which can be seen on the left (if you would like a larger copy with directions please e-mail us).

The Quality Observatory has also (surprise surprise) develo p e d a dashboard which enables SHA staff to log their physical activities in the run up to the games.

As well as monthly an cumulative graphs, the dashboard displays distanced travelled in terms of trips around the earth and distance to the sun and moon.

At the time of printing, members of the Observatory have collectively travelled 350km (since 27th July when the challenge commenced).

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

Page 6

“A Picture is worth a Thousand Words”…(or how to make numbers look good) ...

By Kiran Cheema, Workforce Analyst PART 1 - Choosing Graphs / Tables When presenting ideas that include references to data, it can be helpful to make the point using a graph or table.

These visual methods can make the point much stronger than simply describing the data.

Charts can help people understand data quickly, making comparisons, showing relationships, or highlighting trends, they help your audience "see" what you are talking about.

While they can be powerful methods, they also have the potential to convey the wrong message or they confuse the audience.

There are literally hundreds of graph types, but these usually are grouped into a few main “families” :- Bar , Line, Pie & Scatter Most popular computer systems allow users to map their data to a variety of graph types, which can be inappropriate for the situation!

Which chart is best for comparing 2 data sets , or showing a trend or relationships - How do I choose?

A quick look on the Internet found these 2 useful tools that might help you decide: Chart Chooser from Juice Analytics : The chart chooser allows you to filter 17 different chart types. you can look at suggestions for showing trends, distributions or relationships (amongst others!) http://www.juiceanalytics.com/chart-chooser/

The second is a “decision tree” by Dave Paradi of ThinkOutsideTheSlide.com with key questions around the type of data and the number of data series you want to show, hopefully helping to make your message clearer! http://www.thinkoutsidetheslide.com/articles/ using_graphs_and_tables.htm

What About Tables ?

Tables are good:

• For small amounts of data • For showing exact values • For comparing individual values • Where you have multiple units of measurement (e.g. percentages and absolute numbers) Charts are good:

• When you have lots of consecutive data points • For communicating messages contained in the ‘shape’ of the data, for example trends

• For revealing relationships between variables

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

Page 7 QO Rules of Thumb . . .

One graph per answer :- the first question to ask before representing data is, "What questions am I trying to answer?"

. . . a Bar/Column Graph.

5 4.5 4 3.5

Bar graphs are used to compare things between different groups (discrete data) or to track changes over time (continuous / trend data). However, when trying to measure change over time, bar graphs are best when the changes are larger.

3 2.5 2 1. 5 1 0.5 0 1

2

3

4

5

6

7

8

. . . a Line graph.

5 4.5 4 3.5 3 2.5 2 1. 5 1 0.5 0 1

2

3

4

5

6

7

8

Line graphs are used to track changes over short and long periods of time. When smaller changes exist, line graphs are better to use than bar graphs. Line graphs can also be used to compare changes over the same period of time for more than one group. Usually used with continuous data (e.g. time series)

. . . a Pie Chart.

Pie charts are best to use when you are trying to compare parts of a whole. They do not show changes over time. you can only use one data series. Be careful not to use too many segments, more than six and it starts to get crowded, consider a bar chart instead.

. . . an X-Y / Scatter Plot.

5

4

3

2

1

0 0

2

4

6

8

10

X-Y plots are used to determine relationships between two different things. The x-axis is used to measure one event (or variable) and the y-axis is used to measure the other. If both variables increase at the same time, they have a positive relationship. If one variable decreases while the other increases, they have a negative relationship.

Sometimes the variables don't follow any pattern and have no relationship.

KEEP IT SIMPLE! Don’t overload your graph, you find yourself adding more than 5 data series to your graph stop, are you trying to answer more than one question? sometimes 2 graphs are better than 1!

KNOW YOUR AUDIENCE! you’ve read this guide, selected the right graph for the job, but your audience is still not happy! You just have to do what people want, if what they engage with is tables or only bar graphs, give them tables and bar graphs! Do what ever you can to get your audience engaged.

A few references for further reading … http://www.typesofgraphs.com/ http://www.mindtools.com/pages/article/Charts_and_Diagrams.htm http://www.upassoc.org/usability_resources/conference/2007/prp_049.pdf http://www.statcan.gc.ca/edu/power-pouvoir/ch9/5214821-eng.htm Raj M. Ratwani, J. Gregory Trafton, Deborah A. Boehm-Davis (2008). Thinking graphically: Connecting vision and cognition during graph comprehension. Journal of Experimental Psychology: Applied, 14 (1), 36-49 DOI: 10.1037/1076898X.14.1.36 Tufte, E.R. (1983) The Visual Display of Quantitative Information. Cheshire, CT. Graphics Press.

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

Page 8

Systems Thinking—What is it? What can it achieve?

By Andy Hyde, Director of Quality Management, Diakonhjemmet Hospital In the last edition of Knowledge Matters I described to you some of the improvements in quality that we have made at Diakonhjemmet Hospital in Oslo over the last five. We have achieved (and sustained) these improvements by applying systems approaches to the quality management and improvement process. In this edition, I want to describe to you the ‘systems thinking’ approach, and how this differs from more traditional approaches which are applied by most senior management teams to this day.

I talked last time about how we utilised tools for change. However, change doesn't happen on its own just because the tools are available. Even if users can use the tools that are provided this doesn't mean that change will happen. For change to happen one must employ a change management methodology and these come in two flavours; top down and bottom up.

I am sure that you are familiar with the top down approach (which is very frequently employed by senior management teams). It goes something like this……… Management decides that everyone will improve quality. A project group is established that analyses the current situation and produces a report. (By the way this can sometimes result in many hours of work for external consultants). The report contains recommendations and is adopted by the management that commissioned it. But who will implement it? To cut a very long, well repeated, story short. It ends up in a drawer and doesn't get implemented is often the answer. No insult meant to the few that get it to work that way.

Bottom up is a systems approach. Look up Systems Thinking on the internet if you are interested. Systems thinking is fundamentally different to traditional forms of analysis. Change methodologies based on this approach start at the bottom of the organisation. They build on synthesis and not analysis. The main hypothesis is that everything is interconnected and that by changing one part of the system there will be an effect on another part of the system. It is often summed up by saying the whole is more than the sum of the parts. Another realisation is that everybody has a different view of the world and the problem that is being addressed. To be able to resolve this you need to keep alive multiple views of the problem and see how the intervention affect them all not just one person's perception of it. The results when using a systems thinking approach often result in very different conclusions being generated by traditional forms of analysis.

Systems thinking is a great approach to use when dealing with complex issues that involve lots of interaction between different processes and individuals—in healthcare this of course the environment in which we function—next time you’ve got a really tough problem to solve give systems thinking a try!

Last time I provided you with evidence that our approach to improvement delivered impressive results with regards to discharge summaries being issued. We can demonstrate improvements in a range of other areas including waiting times (yes, we have targets for waiting times too—waiting is an important element of quality) and keeping treatment dates issued to patients. For patients who are undergoing planned, non urgent treatment, they are given a guaranteed treatment date. If the hospital breaks the guarantee it can have high financial and other consequences. The following shows the improvement in the number of breaks of guarantee after a year in which we worked hard to improve things—as you can see it worked!.

Antall fristbrudd = number of breaks of treatment guarantee Faktisk = Measured value Mål = target

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

Page 9

One negative side effect of change is often an increase in absence from illness. We have therefore tracked this measure systematically. I am pleased to report that the sickness rate has been falling slowly for the past two years.

As our management system is ideally designed to support the process of continual improvement, we have established a corporate governance system which utilises a composite measure of quality improvement to track our success overall.

Here we are looking at an index score (0100). As the graph shows the hospital has improved it total quality performance in relation to the targets year for year. The improvement is statistically significant from 2007 to 2008, 2008 to 2009 and 2009 to 2010.

So, in conclusion, The old paradigm for for managing a hospital has been measurem ent and reporting of performance. Targets are set and results are reported, often through pretty traffic light dashboards. Where targets are not met management commands change. However, this kind of command and control does not address the underlying issues and differences behind the numbers. Employees will just see another top down initiative, often perceived as unrealistic or irrelevant.

Once the use of data, information and knowledge are systematically implemented the culture of improvement will grow.

The final step is then to align the management with this culture so that management truly supports the clinical employees in the execution of the hospital's main activity, patient care and itself becomes part of the learning organisation.

Inpatient Survey Tool Updated

By Katherine Cheema, Specialist Information Analyst The Inpatient Survey Tool has been updated with survey data for 2009/2010. This benchmarking tool can be used to interrogate the data from five year's worth of the Inpatient Survey (ie 2006-07, 2007-08, 2008-09 and 2009-10).

The survey asks about the experiences of people who have been admitted to hospital overnight or for longer. The questions in the survey cover the issues that patients consider important in their care and some are also used in national assessments of NHS trusts. Many of the questions included in the survey are on the list of Quality Indicators compiled by the NHS Information Centre under 'Patient Experience'.

Data for all trusts in England gathered in 2006, 2007, 2008 and 2009 have been included here to allow benchmarking across the country. The data for each of the four years has been scored for all specific responses (i.e. exlcuding missing responses) according to the scoring mechanism used in the 2008 and 2009 surveys. This is available from the CQC website at http://www.cqc.org.uk/ usingcareservices/healthcare/patientsurveys/hospitalcare/inpatientservices.cfm As always this tool is available to download from our website nww.qualityobservatory.nhs.uk

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

Page 10

How to calculate a median Application: Microsoft Access/other databases Dear Quality Observatory I’m hoping that you can help….. My Director has asked me to provide some analysis using medians. I understand what a median is, however am struggling to work out how to undertake the analysis as the data set that I am using is pretty large. I’m not sure why I’ve been asked to use medians—I’ve never been asked to use them before. Anyway, any help you can provide would be much appreciated!

Anonymous Analyst A Trust in South East Coast

Solution: Complexity 4/5 — Relational database knowledge The median average is simply calculated by ordering your list of numbers from lowest to highest and picking the middle one. Medians are useful where your list of numbers includes an extreme outlier that would skew the mean average calculation. For example compare the results for these two sets of numbers 1, 2, 3, 4, 5

mean = (1+2+3+4+5)/5 = 3 median = 3

1, 2, 3, 4, 300

mean = (1+2+3+4+300)/5 = 62 median = 3

So you can see from this simple example that the mean is skewed significantly by just a single outlier in the dataset and the median is more meaningful.

Comparison of mean, median and mode of two log-normal distributions with different skewness.

So how is this useful in the NHS? When we are looking at, for example, length of stay we may have a single patient who, for perfectly valid reasons, might have a much longer length of stay than would be expected. If we are monitoring average length of stay we might assume that the typical length of stay is much higher than that actually experienced by the majority of patients, in this case using the median would give much more meaningful results.

However, it is important not to rely solely on medians for exactly the same reason. If, for example your outlier patients are delayed discharges and experiencing longer and longer stays in hospital for non medical reasons, in this case the median would completely mask this whereas the mean would gradually increase indicating a problem. It is therefore important that you do not solely rely on medians as a measure of performance or patient experience!

So how to calculate a median? For a relatively small dataset you can calculate it in Excel using the either the Median function or the Percentile function. For much larger datasets where Excel is not suitable things are a little trickier. It is possible, however, to calculate medians within a database with the following method. As we use Microsoft Access as a front end to our database I will describe it in terms of that package but the principles are easily applied elsewhere.

So for our example we are trying to calculate monthly median length of stay for a number of hospital trusts, how can we do this?

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

Page 11 Step 1 – Create a new table in your database with 3 fields, we'll call this tblMEDIANCALC ID – An autonumber field to provide a unique row number to each record KEY – A field containing an identifier that represents the trust and period, for example for the trust SASH for March 2011 I would use the following identifier – SASH201103.

TRUST – Identifier for trusts (optional) PERIOD – Numerical representation of the month in YYYYMM format (optional) VALUE – A field containing the numerical value for the length of stay

Step 2 – Create an APPEND query that adds your data to the KEY and VALUE fields of the new table above. This query adds a new row for each patient discharged in the month containing their length of stay. Note that you need to add ascending sorts to your data firstly on the KEY field data, secondly on the VALUE field data. In this case a simple query would to do this would be along the lines of Insert Into Select

From Group By

Order by 1

[tblMEDIANCALC] ([KEY],[TRUST],[PERIOD],[VALUE]) [TRUST] & (year([DISCHDATE])*100)+month([DISCHDATE])1 as [KEY], [TRUST], (year([DISCHDATE])*100)+month([DISCHDATE]) as [PERIOD], [DISCHDATE]-[ADMDATE] as [VALUE] tblSUSDATA [KEY], [TRUST], [PERIOD] [KEY], [VALUE]

Converts the discharge date into a numerical format YYYYMM

Step 3 – Create a new query using your new table above with the following SQL code, we'll call this qryMEDIAN Select From Group by

[KEY], int(Max([ID])-Min([ID])/2)+Min([ID]) as [MEDID] [tblMEDIANCALC] [KEY]

This query will extract for each unique value of KEY the value if ID that corresponds to the median length of stay in a field called MEDID. We can now use this to extract the median from our table MEDIANCALC.

Step 4 – Create a new query linking tblMEDIANCALC to qryMEDIAN using the field MEDID linked to ID as follows Select

[qryMEDIAN]![KEY], [tblMEDIANCALC]![VALUE]

From where

[tblMEDIANCALC], [qryMEDIAN] [qryMEDIAN]![MEDID] = [tblMEDIANCALC]![ID]

You will now have a dataset as below containing the median length of stay for each trust and month which can now be used to drive your dashboards, I would use the [KEY] field in conjunction with the sumif formula in Excel to drive the dashboard. An alternative version using a crosstab query in Access would be: Transform

sum([tblMEDIANCALC]![VALUE])

Select

[tblMEDIANCALC]![TRUST]

From

[tblMEDIANCALC], [qryMEDIAN]

Where

[qryMEDIAN]![MEDID] = [tblMEDIANCALC]![ID]

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

Page 12

Enhancing Quality and Recovery Programme Update

By Kay MacKay, Director, Enhancing Quality and Recovery Community Trusts and Mental Health Trusts across the South East Coast region are just embarking on the Enhancing Quality (EQ) journey with data collection beginning on the Heart Failure and Dementia pathways respectively. This article looks at what they have in store based on the experience so far of EQ in Acute settings where data collection began in July 2010 on the Pneumonia, Heart Failure, Hip & Knee and AMI pathways and is now focussed on demonstrating improvement in quality of care.

Quality measurement The culture of data collection and processing is generally less well developed in Community Trusts and Mental Health Trusts, compared to Acute Trusts who have become more familiar with this role and the opportunities this presents.

Nevertheless, with the right attitude and foresight these issues are not insurmountable. Take the example of the Dementia pathway where very real issues do exist but there is clear momentum and enthusiasm to im“While we have had the chance prove.

Kay Mackay, EQ Director said: “The attitude of the mental health Trusts has been both refreshing and commendable. They have worked very hard to get to the stage where data can be collected against two dementia measures: assessment and diagnosis and anti-psychotic prescribing. There have been some very complex issues around robust comparability and bench-marking but the overall commitment to improving quality for patients has overcome all obstacles.

The community providers have worked brilliantly to pilot the heart failure data and are now gearing up for full implementation in September. The clinicians are very engaged and keen to see the first results”

to observe from a distance how EQ works in Acute and Community Trusts it has been a real ‘eye-opener’ to be involved in this process. While there are still practical difficulties to overcome we are excited by the rapid improvement opportunities for Dementia patients that this programme has seen on other pathways “ Quote from a Mental Health Trust

Getting the Community Heart Failure and Dementia (Acute & Mental Health) pathways up and running has required breaking new ground using the “EQ model” because the detailed background work hasn’t previously been done elsewhere. For example; analysis of the optimisation of drug treatments for Heart Failure uses a methodology developed from work by Clinical Lead Richard Blakey.

After completing a three-month pilot the Heart Failure pathway has begun data collection in community settings across the region covering three measures:

• • •

care planning; Management; end-of-life care.

Getting to this stage has involved collaboration between clinicians; using evidence to determine the effectiveness measures and the detail behind the questions being asked; data specialists to determine how to collect and merge the data ; detailed discussions about interpretation and consistency and information governance issues; programme managers to oversee the process and analyst support from the Quality Observatory to specify and design a spreadsheet that is easy to input data and can provide the necessary information from which to provide a baseline and measure improvement.

EQ Clinical Adviser, Grant Kelly said: “A balance has to be drawn between keeping the measures simple but informative against being over complex and hard to collect for clinicians. The feedback received during the pilot stage and the one month pre-baseline collection period has been instrumental in ironing out specific collection issues and improving the quality of the data we will be able to collect. The lack of issues has been especially pleasing.”

The detailed work around setting up processes for data capture can reap immediate benefits.

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

Page 13 “We noticed immediate and tangible benefits to the care we offer during the pilot stage just from having to think through our processes and reviewing our performance.”

For the pilots, which focused on specific measures, we used single spreadsheets but for the full data collection they were amalgamated into a composite spreadsheet with the addition of measures information as a quick and easy reference guide.

Fatai Ogunlayi, QIPP Analyst at the South East Coast Quality Observatory said: “Our task included producing a user-friendly data collection tool which would be suitable for our Community providers. In addition to ensuring that the data collected is capable of providing meaningful analysis (provide answers to our questions), we also wanted to simplify the data capture process and ensure that the data collected are comparable amongst our providers by identifying differing data recording practices and suggesting solutions which have since been implemented.

We also worked closely with the EQ team to identify valid and reliable parameters which could be included in a meaningful Composite Quality Score. This has required gaining a more detailed understanding of the complexities and interactions involved in establishing improvement measures.

Being involved at the ‘front end’ of this process and not just the analysis of the data that has been collected has allowed us to ensure that the Quality of the data collected was fit for purpose.”

While it is still early days for EQ its success and impact can be measured by achievement in a number of different ways—we’ll cover this in the next edition of Knowledge Matters.

For further information please have a look at our website http://nww.enhancingqualitycollaborative.nhs.uk/

Local Alcohol Profiles for England launched On behalf of Professor Mark Bellis at the North West Public Health Observatory, we are pleased to announce the release of the Local Alcohol Profiles for England 2011 (LAPE).

The profiles can be accessed online at www.lape.org.uk and bring together 25 alcohol-related indicators for every local authority (LA) and 22 for every primary care trust (PCT) in England. As well as local area data on alcoholrelated hospital admissions and alcohol-related crime, the 2011 profiles include new experimental data on levels of abstainers in each Local Authority and the proportion of drinkers who drink at lower, increasing and higher health risk levels.

If you have any queries about the Local Alcohol Profiles for England, or would like help interpreting them, please contact Julia Humphreys at NWPHO - j.humphreys1@ljmu.ac.uk

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

Page 14

Taming the Beast—Principles & Practices in Handling Data

By Katherine Cheema, Specialist Information Analyst High quality, well presented information, coupled with the ability to correctly interpret data are critical requirements for clinical commissioners to undertake their roles effectively. But do commissioners have the skills and knowledge required to do this currently? Our experience of recently working with Clinical Commissioning Groups (CCGs) has led us to develop a series of training modules which we believe will help increase the knowledge and skills of staff within CCGs within this critical area.

This course is presented in five modules that reflect the key competencies required for CCGs to get the most out of the wealth of data that is available to them. No previous experience of NHS information is presumed and the course is suitable for all clinical and professional staff with an interest in NHS information and its effective use in commissioning and improving the quality of patient care, and increasing productivity and value for money.

Modules are presented with a mix of delivered content, practical exercises and real-life examples that delegates are encouraged to discuss and critique. By the end of the course delegates will be able to:

• • • • • • • •

Identify existing data sources that they can access to assist in their daily business; Be able to describe the importance of data quality, access a range of tools to help them assess this in their main providers and understand their role in improving it; Identify freely available tools that they can access to assist with their analysis; Carry out simple analyses based on well defined requirements; Present data using a method appropriate to the data and their audience; Understand the concept of variation and interpret information appropriately; Be able to create a vector of measures to assist in building a picture of a service or system; Be aware of resources and services available to delegates to help assist them in sourcing, analysing, presenting and interpreting data and information.

The course can be delivered either over a period of 1 day, or through a series of WebEx online events, of an hour each, with delegates to complete exercises between sessions.

The modules are as follows:

• • • • •

Understanding NHS data flows; Data quality- don’t throw the baby out with the bathwater!; Analysis and presentation; Interpretation; Using data with others;

An additional optional module is available - evaluating the patient experience: an example of bespoke data collection.

The main areas covered in each module are as follows: Understanding NHS data flows • Covers the main data flows that are currently in place in the following areas: •Primary care •Secondary care •Community and mental health •Social care •Performance and official statistics • Discuss current and future developments in these areas

Quality.Observatory@southeastcoast.nhs.uk

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Page 15 Data quality- “Don’t throw the baby out with the bathwater!”

• What is data quality?

• Clinical coding, why it is so important, how it can go wrong and what you can do about it • Tools to assess data quality: Data quality dashboard and the PbR assurance benchmarker.

Analysis and presentation • What is already done for you?

•NHS Comparators •QO tools • Introduction to the guide to information sources • Doing analysis- keeping it simple •Asking the right question(s) •Choosing the right analytical method •The power on your desktop- introduction to pivot tables • Key principles of presentation Interpretation • Why we don’t like Red, Amber, Green- using measurement for improvement over judgement • Time series analysis • Principles of variation •Common •Special cause • Building a picture to tell the story: using a vector of measures Using data with others- hints, tips and examples • Use at the executive level • Use for performance management • Use for service design and delivery • Use with patients • Use with the public [OPTIONAL MODULE: Evaluating the patient experience] • An introduction to survey methods as an example of bespoke data collection • Sampling frame and sample sizes • Developing questions • Capturing the data All of the course materials have been developed already—we are simply now waiting for a few ‘guinea pigs’ to be the first to experience the course! Ideally I would like to test out the course in both formats— both as a full day (I’m happy to come to you) and as a series of hour long Web-exs (the later requires no travelling—you can simply participate from your desk!)

If you have comments on the proposed course specification, if you think that I’ve missed anything or if you are willing to be a guinea pig please do contact me!

Katherine.cheema@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

Page 16

Patient Reported Outcome Measures

By Tim Straughan, Chief Executive, The NHS Information Centre A whole year has flown by since we published the first report on Patient Reported Outcome Measures – fairly well-known to most in the heath community by its acronym – PROMs. The report was eagerly awaited by a broad spectrum of groups and people. This was unsurprising, given it offered the first insight into how patients think they benefit from their care on a national scale – but also down to an organisational level. In fact PROMs is thought to be the biggest and most comprehensive study of its kind in the world.

A similar level of anticipation has surrounded this year’s report – released on August 17. Although we publish updated PROMS data on a monthly basis – this new report is the first annual publication of finalised post operative data to have been made available providing a benchmark for future comparison.

That, in some ways, is the most precious nugget of information.

After all it tells you how much patients think they have benefited from their particular procedure. Or how little, in some cases. The report can be downloaded from the HES-online website.

The report is an example of how we are continuing to develop PROMS at the NHS IC. The publication of high level figures on a monthly basis and quarterly organisational level data tables will be supplemented with the exploration of topics of interest adding greater depth to the available data. With patient empowerment expected to remain very much a focal point of NHS policy moving forward, good data about the actual views of patients is like information gold dust.

In a nutshell, PROMs data stems from questionnaires that patients are asked to fill in before and after one of four different operations; hip replacement, knee replacement, groin hernia surgery or varicose vein surgery. The questions are tailored according to the procedure – and so is the time period between the procedure taking place and the postoperative questionnaire being sent out to the patient.

To add to the value and context of the data, we link it with our Hospital Episode Statistics (HES) information. So, between April 2009 and March 2010 – the period the report looks at -, we know there were just short of 240,000 eligible hospital episodes covering the four procedures. This compares to about 158,000 pre operative questionnaires that were returned – so overall participation was about two-thirds. Provisional data is also available for 2010-11. And to complete the full circle you of course need the post operative questionnaires and scores – and we received more than 121,000. This translates to an 80 per cent return rate and is very encouraging, as patients may choose not to take no further part for a number of reasons.

The questionnaires are analysed and translated into scores – there are five scoring systems in total; three of which are condition-specific and focus on clearly defined aspects of the patient’s clinical condition which would be expected to be affected by their procedure (Aberdeen Varicose Vein Questionnaire score and Oxford Hip and Knee scores). There are also the EQ-5D Index EQ-VAS scores, which reflect general health status in a broad way across the board for all four conditions. So what does the new report tell us? Overall, if you use the EQ-5D Index score to compare apples with apples; the report shows that a greater percentage of hip operation patients – 87 per cent – report an increase in general health compared to the other three procedures. About 78 per cent of knee patients reported an increase; compared to 52 per cent for those who had varicose vein surgery and 49 per cent who had groin hernia surgery.

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Page 17 What is of particular interest is very clear regional variation. Using data mapping, again with the EQ-5D index as an example, there are differences across the country in the extent to which patients feel they have benefited from their care.

Each scoring system for each procedure is accompanied by a series of three maps: firstly based on pre operative scores, secondly on post operative scores, and thirdly - perhaps most importantly - on the average adjusted health gain.

So if you look at EQ-5D index; large parts of East Anglia for example have a higher average adjusted health gain when it comes to the improvement of varicose vein procedure patients, but the gain of patients in Cumbria appears much less for this procedure. However, when it comes to knee operations, Cumbria appears to have a higher average adjusted health gain.

So why would that be? This is just one example of potentially hundreds, perhaps thousands, of questions, when it comes to looking at the results. As a solid foundation of robust data, PROMS for the first time allows these questions to form and begin to be addressed. It enables organisations to consider the collective patient view of care; and how this compares to patient opinion of other organisations across the country.

There will most likely be some areas that health professionals can now explore and consider when it comes to effective planning and use of resources. Given these times of austerity and increasing the patient footfall on the NHS, this is more crucial than ever before.

The full 2009/10 report is at www.ic.nhs.uk/pubs/finalisedproms0910 Provisional data for 2010/11 is available from www.ic.nhs.uk/pubs/provisionalmonthlyproms

Meet the Observatory— Dr Quality interviews Charlene Atcherley-Steers So Charlene, can you tell me what it has been like to work at the Quality Observatory?

Well, I can honestly say that working within the Quality Observatory has been great. We all work hard, but there is always something fun and interesting going on. There is always something new to learn or an interesting question to answer. Luckily all of the team members are very knowledgeable so someone usually knows the answer or knows where to find it.

And which specific areas of work have you had responsibility for? What has been your biggest achievement?

When I first started working for the Quality Observatory my main tasks involved updating performance dashboards such as the 18 weeks dashboards and acute performance dashboard. I was also responsible for the board report and helped with the daily sitreps. When it was decided that our website needed to be updated I was selected to help Kiran as I had done web programming during my degree After some training we got to work on designing and creating the website. We released the first version earlier on this year, and the second version is near enough ready. There are still lots of features in the pipeline but we have focused on the basics for now. Although there are still a few bugs I am pleased with what we have some up with so far, as it has all been built from scratch and improved on as we’ve been working on it. I have also been responsible for designing Samantha’s costumes for Knowledge Matters—I hope you have liked them.

Finally, I hear that you are sadly leaving the Observatory—why?

I am off travelling the world for 6 months. I’m starting with 3 months in South America visiting Peru, Bolivia and Argentina, then South East Asia for the other 3 months, where I will be visiting Vietnam, Cambodia and Thailand, and of course will be reading Knowledge Matters whilst I am on the road (and possibly contributing to it if I can find an internet café!)

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

Page 18

Chief Clinical Information Officer Campaign Launch

By Jon Hoesksma, Editor, eHealth insider The NHS reforms now underway depend on the availability and use of high quality information to support improvement in quality of care and drive up productivity. An information revolution has been promised to boost transparency and improve the spread of best practice, enabling patients to be fully involved in informed decision about their care. Launching the NHS Information strategy consultation in October, Secretary of State for Health Andrew Lansley, said: “We need an information revolution to ensure that what is currently seen as good practice becomes the norm.”

Realising this revolution will require a new breed of local clinical information leaders, who are focused on using available clinical data to review and improve care delivery and models of care. Online health IT new service eHealth insider (EHI) has launched a campaign to encourage all NHS trusts to take steps to develop Chief Clinical Information Officers (CCIOs), to provide local leadership on clinical information use.

Partly inspired by the successful development of similar clinical leaders in the US healthcare system over the past decade, the CCIO role will create a dedicated, senior clinical champion for IT projects and the use of information to improve the quality of patient care. EHI has launched the campaign because it believes clinical engagement and leadership are a hallmark of almost all successful NHS IT and information projects. There are many highly capable clinicians who do elements of the CCIO role already, but realising the full potential will require trusts to invest in new clinical information leaders.

Supported by the Royal College of Physicians and the British Computer Society, the CCIO campaign was launched in June with the publication of an open letter to the health minister. The letter calls on him to recommend urge every NHS trust in England to identify a clinical information champion as a first step towards appointing a CCIO to lead the information revolution promised for staff and patients.

The initial response has so far been extremely positive with support from the health minister Earl Howe, four of the Royal Medical Colleges, the BCS and a growing number of IT vendors and individual health professionals.

In addition, the chief medical officer for England, Sir Bruce Keogh, who decisively championed the publication of cardiac surgery mortality data, has also lent his support to the campaign: “The power of information to transform how citizens and clinicians manage healthcare is fundamental, whether providing real choices based on evidence of outcomes, improving performance by exposing variations, or shining a light on seriously poor practices which must be stopped. I am glad to see eHealth Insider campaigning for NHS trusts to recognise the importance of information in achieving clinical goals. A chief clinical information officer would help plug the credibility gap that exists between data in the system and the reality of clinical activity and outcomes."

Job descriptions, person specifications and model CCIO career pathways are currently being developed and details should be published later this year.

John Williams, director of the Health Informatics Unit at the Royal College of Physicians, said: “The Royal College of Physicians is pleased to support this campaign. Clinical leadership is essential if the benefits of information technology and management are to be harnessed to deliver better, safer, patient care in the NHS.” To find out more about the campaign and show your support visit the dedicated website http://www.ehi.co.uk/ campaign/ccio, which provides the campaign briefing paper, plus features and articles on the campaign and the case for CCIOs.

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

Page 19

Analysis, Ancient and Modern

By Samantha Riley, Head of the Quality Observatory John Snow (15 March 1813 – 16 June 1858) was an English physician and a leader in the adoption of anaesthesia and medical hygiene. How many of you are also aware that John Snow is considered to be one of the fathers of epidemiology?

‘What’s epidemiology?’ I hear some of you ask! You might want to go and have a chat with your colleagues working in the field of public health to get an in depth answer, but in brief (and according to Wikipedia), epidemiology is the study of health-event, healthcharacteristic, or health-determinant patterns in a society and is the cornerstone method of public health research.

John Snow is considered one of the fathers of epidemiology because of his work in tracing the source of a cholera outbreak in the Soho district of London in 1854.

During the 1854 outbreak, John Snow (with the help of a local Reverend) spent time talking to the local residents of Soho and as a result of this identified the source of the outbreak as the public water pump on Broad Street (now Broadwick Street where there is now a memorial to John Snow—see below). John plotted on a map the location of all the cases he learned of and used statistics to illustrate the connection between the quality of the source of water and cholera cases.

Water in that part of London was pumped from wells located in the various neighbourhoods. Snow's map (see right) revealed a close association between the density of cholera cases and the Broad Street well. He showed that the Southwark and Vauxhall Waterworks Company was taking water from sewagepolluted sections of the Thames and delivering the water to homes with an increased incidence of cholera (by the way it was later discovered that this well had been dug only three feet from an old cesspit that had begun to leak fecal bacteria).

Despite the fact that the chemical and microscopic examination of the sample of the Broad Street water was not able to conclusively prove its danger (in fact the infectious agent that causes cholera was not clearly recognized until 1905), John’s studies into the patterns of disease were conclusive enough to persuade the local council to disable the pump. The pump handle of the Broad Street well was therefore removed—a key action which helped put an end to the epidemic.

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

Page 20

Variation

By Samantha Riley, Head of the Quality Observatory In the June edition of Knowledge Matters I talked about natural variation (pages 20 and 21) and in this article I intend to continue with this theme and have a look at a data set which I recently collected.

The data set is a time series (don’t worry about what the data is at the moment—I’ll come onto that later).

Thinking about the fact that judgements are often made in terms of good and bad performance based on three consecutive data points, there are a whole variety of patterns which can be seen here. I have identified a few of them (but by no means all of them).

In terms of my performance, I imagine that my boss would have been unhappy during ‘downward trend’ and ‘downturn’, happy during ‘upturn’ and ‘upward trend’ and overjoyed on 21st April when I would have received a beautiful bouquet of flowers for such great work!

But how much influence did I have over each of these data points? In fact, I didn’t have any control of ‘my performance’ over this period of time…… So, ‘what is the data set?’ I hear you ask!

This data set relates to the number of daily views that my internet dating profile had over a period of months (well—you do everything else on the internet so I thought I might as well give it a whirl). Now there are quite a number of variables which influence this data set—but the vast majority were outside of my control.

Although I haven’t got any evidence to prove this, there is no doubt in my mind that the weather and day of week had a definite impact on the number of daily views. The ‘special cause’ (when I received that lovely bunch of flowers) was in fact the day before the Easter Break, so it was a very different day, however this potentially very good performance was outside of my control.

Several weeks after embarking on my voyage into internet dating (and handily having established a baseline), I bumped into a friend who turned out to be a very good photographer and who offered to take some new photos for me. My friends theory was that by replacing my holiday snaps with professionally taken photos would have a considerable impact on the number of views that my profile received.

So……. What was the impact? Did the photos make much difference?

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

Page 21 Now if you were implementing a change in a Trust which you expected to result in an improvement, the point at which you introduced the change would be when you would re-calculate the control limits (to see whether the change that you had implemented had resulted in an improvement).

Hopefully this brief, real example, has helped to again illustrate the concept of natural variation and help you to look out for real process change.

If you would like to learn more about variation and how to utilise statistical methods and tests to evidence change, we would be more than happy to assist—simply e-mail us at quality.observatory@southeastcoast.nhs.uk

Tip of the month—Are you my Mummy?

Pyramids – vast architectural edifices built as monuments to long dead Pharaohs, made to contain their mummified mortal remains on transit to the afterlife, and now these mighty mausoleums have become enslaved by the world of info graphics. Have a look at this pyramid based on a real world example. The numbers could be anything, but in this case they’re sales.

90.09

64.07

65.47

There are a number of things wrong with this.

Firstly the design of the pyramid makes it im-

12.37

100.00

possible to tell which is the biggest value – it’s actually the blue area – but just by looking at the chart it could easily be the green or yellow. Pyramids need to have strong foundations to support their structure, but this one is built on the slenderest section of data giving a false impression of the importance of this bit of information. 3D charts may add prettiness, but also add confusion and noise, as more perspective is added it distorts the view of the data and makes it difficult to compare the different layers with each other. Another fault is that it cannot show us a time series if we get figures for other time periods.

90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00

0.00

1

2

3

4

180.00

160.00

140.00

120.00

Series1

100.00

Series2 Series3 80.00

Series4

60.00

40.00

20.00

0.00 M1

M2

M3

www.QualityObservatory.nhs.uk

M4

As ever, simplicity is the answer data like this could be shown much clearer in a column or bar chart. Then should further information be added for later time periods it could be done

M5

Quality.Observatory@southeastcoast.nhs.uk

Page 22

NEWS New Mortality Indicator coming soon

ROCR review of the Monthly Activity Return

Look out for the new Standardised Hospital-level mortality indicator which is due for publication via NHS Choices and the Information Centre website in October. More information on this in the October edition of Knowledge Matters.

The Review of Central Returns Team (ROCR) are evaluating an application to renew the collection licence for the Monthly Activity return data collection and are keen to collect as many views on this as possible, in particular comments on the time this collection takes Trusts to complete. The supporting documents and feedback form can be accessed from:

Cancer Rates in Europe—how does the South East Compare?

The South East Public Health Observatory has recently published the second report in the South East European Comparisons Series. The report is available at the link below. http://www.sepho.org.uk/Download/Public/13956/1/ Cancer%20rates%20in%20Europe%20-%20how% 20does%20the%20SE%20compare.pdf This second report in the series focuses on cancer. It examines differences in cancer mortality between countries and regions, and between men and women.

By exploring differences in incidence and survival for four key cancers across European countries, it also goes one stage further in ‘unpicking’ the disparities in cancer mortality.

PbR Benchmarker update New benchmarking reports based on the analysis in the National Benchmarker have recently been developed aimed at senior staff at PCTs. The report has been designed to be easy-to-digest, with a headline page and just four pages of main analysis. The aim of the new report is to show how the different parts of the National Benchmarker (particularly the new volume analysis) can be used together to inform local work.

In addition the National Benchmarker was recently updated with 2010/11 Q4 data for inpatients, outpatients and accident and emergency.

Data for 2011/12 Q1 is expected towards the end of September 2011. This data will be accompanied by updates to our Classic Benchmarker indicators and scorecards, as well as adding outpatient HRG and accident and emergency HRG4 analysis to the National Benchmarker.

An article detailing further developments will feature in the next edition of Knowledge Matters.

Quality.Observatory@southeastcoast.nhs.uk

https://panelsurveys.ic.nhs.uk/rocrsurveys/210-032/ default.aspx The deadline for any comments to be received is 5pm on 12th September.

New Admin processes for Unify2 Accounts From September, Unify2 will be looking to move administration of Unify2 account from SHAs to individual organisations, giving key people within each organisation accounts with User Manager status and have been asking for Unify users to let them know if they should hold this role for their organisation. To date very few people from the SEC region have replied, so if you are the main Unify user for your organisation please let them know: unify2@dh.gsi.gov.uk and they will be able to give you user manager rights.

Catalogue update and tweeting The SECQO catalogue has been updated! the layout has been updated, there is now a keyword search function and a lot of “behind the scenes” activity. The most exciting new feature is our twitter interface.. every time something is updated or added to the catalogue a tweet will automatically be generated in our tweet stream! follow us at twitter.com/SECSHAQO Drop In / Clinic Sessions The next Drop In session dates are: 21st September 19th October These are available to all NHS Staff who want help with projects or just to develop their skills. e-mail Quality.Observatory@southeastcoast.nhs.uk for more information.

www.QualityObservatory.nhs.uk

Page 23

NEWS Publication of new A&E Clinical Quality Indicators

Charlene’s Song

The first publication of the new A&E Clinical Quality Indicators is now available on the Information Centre website. Data is taken from April HES data and includes a range of data quality measures in addition to performance against the 5 headline indicators.

(To the tune of “Jolene” by Dolly Parton) Charlene, Charlene, Charlene, Charlene A trip around the world is your plan

This can be accessed via: http://www.ic.nhs.uk/statistics-anddata-collections/hospital-care/accident-and-emergency-hospitalepisode-statistics-hes/provisional-accident-and-emergencyquality-indicators-for-england-experimental-statistics-byprovider-for-april-2011

Charlene, Charlene, Charlene, Charlene You're gonna do it now, whilst you can.

Quality Observatory Celebrations

Off to Oz and then oriental It truly is transcontinental As you roam around the globe, Charlene

Since the last edition of Knowledge Matters there have been a number of team celebrations. In the middle of July Samantha celebrated her birthday and was awarded with suitable gifts by the team— all of which having been beautifully wrapped by Suzanne with particularly apt wrapping paper.

Also in July the team celebrated the wedding of Fats (see more on the back page) and on his last day at work adorned him with a variety of gifts for his exotic honeymoon to South East Asia.

We've come to wish you fond adieu Before you leave for far Peru With Incan temples waiting to be seen

Don't dream the website in your sleep You've done all you can do to keep It working thru' the next few months, Charlene And we can easily identify How you could easily miss UNIFY But you don't have to think of that, Charlene Charlene, Charlene, Charlene, Charlene A trip around the world is your plan Charlene, Charlene, Charlene, Charlene You're gonna do it now, whilst you can.

And we are all anticipating The dashboards that will need updating When you’re not around for us, Charlene

It was with regret that the Quality Observatory bid a fond farewell to Charlene who leaves the team to go travelling around the world for 6 months. Charlene received a number of farewell gifts which should prove useful on her travels, a personalised farewell card and was the first member of the Quality Observatory to have a song written especially for them (thanks to Mr Cook). The team sang the song to Charlene on her last day (viewable on YouTube).

Best of luck we wish you well In everything you will excel, And stay in touch with us your pals, Charlene

A big thank you to Charlene for all of your hard work—we look forward to hearing abut your progress around the globe!

http://www.youtube.com /watch? v=21NuAj6LGAM

www.QualityObservatory.nhs.uk

Charlene, Charlene, Charlene, Charlene A trip around the world is your plan Charlene, Charlene, Charlene, Charlene You're gonna do it now, whilst you can.

Charlene, Charlene

Check out the teams rendition of ‘Charlene’ on YouTube

Quality.Observatory@southeastcoast.nhs.uk

Fascinating Fact

Ode to Mr Derry…..

A big thanks to Brian Derry, we're sad to see you go.

You helped us out with so much - our man in the know.

You've kept us in the loop, and championed our cause,

At the Notting Hill Carnival last year the London Ambulance Service treated 549 people, of which 41 had to be taken to hospital.

You've been our point of sanity and pointed out the flaws, Helped out with the IC, and done wonders with ASSIST, The people you helped us contact is an endless list.

Congrats to Fats…….

Always speedy with responses, and with sensible advice, We know that we would never need to ask you twice.

You've always done your bit to support the good ol' NHS Forging ever forward, always eager to progress, Giving Samantha inspiration to trying to get stuff sorted, You've been someone to rely on and made us feel supported.

So big thanks to Brian Derry, we're sad to see you go.

You helped us out with so much from South East Coast QO.

Basil joins the team We are pleased to announce the addition of Mr Brush to the team. Although the usual stringent Quality Observatory selection criteria were applied to the recruitment of Basil, it was disappointing that he had to be disciplined during his first week for BOOM BOOMing at an inappropriate point in a team meeting. On a positive note, Rebecca reports that Basil has been extremely helpful in supporting her with some complex activity modelling.

Who married long time sweet heart Mary Bamgbade on Saturday 23rd July. Fats remained very calm during the run up to the wedding, even though there over 300 guests to organise!!!

The couple looked absolutely stunning, wearing western dress during the day and changing into traditional Nigerian dress for the evening.

The wedding cake was an incredible 9 tiers and was extremely tasty.

A theme to the wedding was dancing with the bridal party dancing down the aisle at the start of the wedding, the bride and groom dancing pretty much everywhere….. And lots of dancing in the evening.

Kate and Nikki’s dancing at the reception was so impressive that they earned real American Dollars…….

Their rates for evening entertainment are extremely reasonable. Get in touch if you would like to make a booking …..

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