Volume 5 Issue 1 April 2011 Welcome to Knowledge Matters Welcome to a very special edition of Knowledge Matters which celebrates both the Royal Wedding and Knowledge Matters entering its 5th Year……… I hope that readers like my new dress……. I hope that you remember that last summer the NHS Institute for Innovation and Improvement opened an ‘ideas channel’ to gain examples from across the country of where measurement had supported improvements in cost and quality. 50 submissions were received from across the country and these can be accessed from the Institute website. As well as the original submissions, a number have been published as one page PDF case studies (including a number submitted by the Quality Observatory). The Institute are keen to receive examples of measurement supporting improvements and the site will remain open to ensure that examples of good practice can continue to be shared. To view the pdf case studies, original submissions and to make a new submission, go to the following website http://www.institute.nhs.uk/cost_and_quality/qipp/measurement_for_quality_and_cost.html I talked last time about some of the work that we have undertaken to support establishing GP consortia. Significant progress has been made with the web-based QOF tool – we will cover this in some detail in the next edition of Knowledge Matters. For the first time, the Quality Observatory has developed a dashboard which is viewable by GP practice and GP Commissioning Consortia. The diabetes dashboard has been developed with the intention of both helping identify areas for improvement in diabetes care and highlighting localities that are performing particularly well. A range of indicators are displayed from both primary and secondary care that, when viewed together, describe the current status of diabetes services for South East Coast practices and consortia. As always, the dashboard provides a range of graphs in an easy to understand format and has a helpful guide which describes the data sources and methodology. We will cover further detail on the diabetes dashboard in the next edition – if you can’t wait until then please contact Kate (katherine.cheema@southeastcoast.nhs.uk) That’s all for now. Happy reading and enjoy the sunshine!
Inside This Issue : Innovation in Outcomes Competition
2
Quality in Care Programme
8
NHS Evidence—Supporting QIPP
13
The Safety Thermometer
3
Quality Observatory Promotional Materials
9
Innovation Expo 2011
14
Oesophageal Doppler Benchmarking Tools
4
Ask An Analyst
10
News
15
Skills Builder—the Slider
6
Analysis, Ancient and Modern
12
twitter.com/SECSHAQO issuu.com/SECQO
www.QualityObservatory.nhs.uk
Page 2
Innovation in Outcomes Competition By Samantha Riley, Head of the Quality Observatory The NHS Outcomes Framework was published on 20th December 2010. This important document sets out the outcomes and corresponding indicators that the Secretary of State will use to hold the NHS Commissioning Board to account. As I am sure you are aware, the NHS Outcomes Framework is split into five domains: -
For those of you who have read the document in detail, and are familiar with the datasets which are currently available to describe NHS care, you will be aware that there are in fact a relatively small number of outcome indicators which can currently be populated from electronic data sources. The NHS Outcomes Framework will evolve over the coming months and years and no doubt new indicators will evolve along with changes to a number of data sets. It may well be, however, that in different parts of the country, innovative measures are currently being used by teams, individuals and organisations which provide a useful indicator of the quality of care (and outcomes) experienced by patients. Keen to discover which indicators may be in use in different parts of the system, the Department of Health has recently launched an open competition asking for suggestions of new, innovative indicators that are not currently in use nationally but would provide good measures of health outcomes. The Department hopes that this competition will stimulate novel approaches to measuring and reporting and are keen to discover indicators that can be developed with minimal cost and burden which use existing data sources. Indicators are sought in the following areas:
• • • • • • •
improving recovery from stroke; improving children’s and young people’s experience of healthcare ; improving outcomes for people with learning disabilities (particularly reducing premature death); improving the functional ability of children with long-term conditions; enhancing the quality of life for children and young people with mental illness; enhancing the quality of life for older people with dementia; improving patient safety across all care settings, particularly primary and community care
In addition, suggestions for other novel, cross-cutting outcome indicators are encouraged. The closing date for applications is 1st June. Further details of the competition along with the entry form are available from the Department of Health website http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_124920 ‘What’s the prize?’ I hear you asking…… All entrants that reach the eligibility criteria will be invited to a reception hosted by the Secretary of State for Health and the Chair of the NHS Commissioning Board. This will be held in Richmond House in the early summer. So, get your thinking caps on and send in those applications!
Quality.Observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
Page 3
Taking the Temperature of Safety By Katherine Cheema, Specialist Information Analyst A couple of issues ago we reviewed the Safety Thermometer, a prevalence estimation census tool that has now been run three times across multiple health care sectors in NHS South East Coast. The Safety Thermometer has been designed as a first step in taking the 'safety temperature' of the system and in alerting frontline staff to key safety issues and highlight focus areas for potential change, and forms part of the Safety Express programme under QIPP Right Care. It is designed to track improvement over time, however, as yet we are building baselines and cannot make any judgement on improvement (for as we all know, three data points does not a trend make!). The completion of the Safety Thermometer is not mandatory, but the response in NHS South East Coast has been phenomenal; the region currently boasts 100% coverage and the last quarter included data from nursing homes as well! This gives us a really good holistic picture of key safety issues for all our patients, not just those in hospital, across the region. At the end of March we presented the Safety Thermometer data so far to the regional Safer, Smarter Nursing learning event, and as a follow-up to our previous article thought it would be of interest to our loyal readers to see the results so far– there are some surprises! At the event in March we challenged the audience to see whether they could make a reasonable guess what the data looked like before the big Powerpoint-based reveal. See if you can do the same– how close did you get? Drop Safety Thermometer September 2010 to us a line at the usual address to let us know. March 2011– Vital Statistics (all settings)
Percentage of patients with a pressure ulcer, old or new, any severity?
9.6%
What percentage of patients with a catheter, also have a UTI?
15.4%
What percentage of patients had a fall of any severity?
2.7%
What percentage of patients underwent a VTE assessment?
39.6%
What percentage of patients were prescribed VTE prophylaxis?
36%
What percentage of patients had NO HARMS reported? www.QualityObservatory.nhs.uk
76.6%
What about the future for the Safety Thermometer? There will be a new release of the Safety Thermometer very soon from the Information Centre who created it and now look after it’s development. As the Safety Thermometer has been up and running for a while, a refocused measurement steering group (upon which the QO will serve!) will focus on how the data collected can actually be used to encourage and support improvement in patient safety throughout the system. Watch this spot for more information as it comes.
In the meantime, if you have any further questions or would like to take a look at the suite of dashboards developed around the Safety Thermometer, check out the website or drop us a line at the usual address. Quality.Observatory@southeastcoast.nhs.uk
Page 4
Oesophageal Doppler Benchmarking Tools By Simon Berry, Specialist Information Analyst South East Coast Quality Observatory has recently worked in partnership with the NHS Technology Adoption Centre (NTAC) to develop a suite of analytical tools to evidence the impact of Oesophageal Doppler guided fluid management during surgery. A suite of tools have been created to enable Trusts within England to benchmark themselves and measure improvements after adoption of this technology. Data for the tools are sourced from the latest published Hospital Episode Statistics, currently 2009/10. All of the Trust benchmarking tools contain drop down boxes allowing you to select a number of options Specialty, as defined by the procedure groupings provided by NTAC; Elective / Non-Elective admissions; Mean / Median national average; Trust, this highlights the selected Trust the chart in red, other trusts in the peer group are highlighted in cyan; • Peer group comparator, this allows you to select whether you want to view other Trusts in the selected Trust’s parent SHA or whether you want to compare NTAC Doppler Length of Stay Benchmarking by Specialty 2009/10 HES Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust (RDZ) Highlighted - 156 Patients against the selected Trust’s ONS The Non-elective - All Specialties - South West SHA Peer Group Comparator 35 peer group. Top Decile • • • •
All Specialties
Top Quartile Mean
25
20 17.6
15
15.3 13.6
10
Drop down boxes enable the user to select a speciality and provide the option to view information for elective or emergency admissions. In addition, the use can elect to view mean or median information.
5
The Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust (RDZ) Highlighted - 114 Patients Non-elective - General Surgery - South West SHA Peer Group Comparator 10
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Quality.Observatory@southeastcoast.nhs.uk
RA4
RVJ
RH8 RN3
RD3 RD1
RB
RD RB
RA3
RN
RA9
RBZ RT RK9
RA7
REF
0
-4
RVJ
RN3
RD1
RH8
RA4
RD3
Casemix Adjusted Length of Stay
NTAC Doppler Spell Casemix Adjusted Length of Stay Benchmarking by Specialty 2009/10 HES
-2
RK9
RBA RB RDZ RTE
RBZ
RA9 REF
0 RNZ RA7
The first tool in the pack is the length of stay tool, this shows mean length of stay for all Trusts in England. It is possible to select an individual Trust and select comparator information for Trusts within the same region or Trusts within the same peer group.
Mean
Strategic Health Authority
30
RA3
Length of Stay
Non-elective
** The Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust (RDZ)
The second tool in the pack allows a comparison between Trusts adjusting for casemix using the length of stay by procedure for all England Trusts as a reference. The zero line represents the Trust performing as per all England Trusts based on its casemix. If a Trust is performing better than expected it’s bar shows a negative value and conversely where it is worse the bar shows a positive value. In the example to the left the highlighted Trust’s length of stay for the selected specialty is 1.5 days better than expected.
www.QualityObservatory.nhs.uk
Page 5 NTAC Doppler Crude Mortality Benchmarking by Specialty 2009/10 HES Buckinghamshire Hospitals NHS Trust (RXQ) Highlighted - 755 Patients
Crude In-Hospital Mortality
Non-elective - All Specialties - Medium Acute Peer Group Comparator 16.0% Top Decile Top Quartile Mean 14.0%
The final benchmarking tool allows a comparison of crude in-hospital mortality rates. The same selection criteria are available as described previously.
12.0%
10.0%
8.0% 6.68%
Over the coming months these tools will be refined on the basis of feedback received from users—and the tools will be regularly updated so that Trusts can see how their improvement efforts have impacted on key indicators.
6.0% 4.77%
4.0% 3.34%
2.0%
RQ
RPA
RR7
RKE RVY RK5 RNS RBK RAS RDZ
RFR
RN5 RDD RFS
RD1 RGP
RTK
RGC
RTP RJ6
RCB RNH
RN3 RMC RNA
RJR RC9 RNL RDE
RVW RDU
RW RBA
RBN RAX
RD3
RGN RGQ
RAJ
RA2
RQ8 RCC
RWJ RD7 RA9
RAP
RJ2 RXQ
REM
0.0%
Monitoring the Improvement NTAC Doppler Procedures All Specialties Elective Length of Stay Rolling Quarter Smoothing SHA Average
Rolling Quarter Smoothing Rolling 12 Month Average
Trust 1
Patch 1
Trust 3
Trust 2
Patch 2
Trust 4
Trust 5
Patch 3 10
9
9
8
8
8
8
8
8
7
7
7
7
7
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6
5
5
5
5
5
5
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4
4
4
4
3
3
3
3
3
3
2
2
2
2
2
2
1
1
1
1
1
1
0
0
0
0
0
0
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11
Trust 7 10
Trust 8
Trust 10
Trust 9 10
10
Trust 6
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11
10
9
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11
10
9
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11
10
9
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11
10
9
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11
10
Trust 11
10
10
9
9
9
9
9
8
8
8
8
8
7
7
7
7
7
6
6
6
6
6
5
5
5
5
5
The tools described so far provide comparative information as a snap shot in time. An additional tool has been developed which shows progress over time for key indicators. This dashboard has been populated with data for Trusts within South East Coast. Due to limitations with regards to accessing data, it is not possible for the South East Coast Quality Observatory to populate this tool for all Trusts nationally.
4
4
4
4 3
2
2
1
1
1
1
1
0
0
0
0
0
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11
2
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11
3
2
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11
3
2
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11
3
3
Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11
The Observatory has provided both the q uer y m et hodolog y and clear instructions for use so that this tool can be rapidly adopted across the NHS so that every organisation and commissioning consortia can access this data on an ongoing basis from their local HES data or via their regional Quality Observatory. 4
The measures on the dashboard are • • • • •
Admissions; Bed days; Length of stay; Crude in-hospital mortality; 30 day readmission rates.
The tool is designed to be easily updated by local analysts using SUS data extracts. For further information on this suite of tools, please e-mail simon.berry@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
Quality.Observatory@southeastcoast.nhs.uk
Page 6
The Slider By Adam “Metal Guru” Cook, Specialist Information Analyst
Well this could go one of two ways I could write about T.Rex’s glam rockin’ 1972 album “The Slider”, or I could write about how to put a slider bar into your excel charts so that when you’ve got a whole lot of data, but only need to display a proportion of it you can choose what to display. Alternatively I could write about one using the other as a symbolic reference point… Well, imagine you’ve got a dashboard with a whole heap of graphs, and it rocks but those bottom axes are all looking a bit squashed and samey as over time more and more data is added. Don’t fret you can add a bit of Glam sparkle to the charts with The Slider. I’ve done this with the maternity dashboard (available to download from the Quality Observatory Catalogue). In it we have a set of charts with new data being added in each month, but actually looking at a 12 month period is fine for the trends. So what we’ve done is plotted the charts based on a table with twelve points, but those 12 points are populated from the raw data by using a sliding or scrolling bar. To build this we need a formula called OFFSET. This formula requires three elements a starting point in the raw data, then how far up from your starting point the data you want is and how far along from you starting point. Below is a truncated example: Our raw data starts in cell C5, if we wanted to display the data from that cell we need the formula =OFFSET(C$5,0,0), i.e. start at cell C5 and go 0 rows up and 0 rows down.
=OFFSET(C$5,4,5)
You’ll notice that I’ve anchored the row (5) with the $ symbol – so that you can drag this formula along and it will pick up the D5 as the next starting cell reference, and so on.
OK – that seems logical enough what if I want to pick up the data in cell H9 from the same starting point? So then your formula would be =OFFSET(C$5,4,5). So far so good, but we want this to be dynamic and change with a slider how do we go about that? First we need a reference cell – this will be linked to the slider and change as you scroll across. This reference cell will then be used as the “data points along” in the formula. Secondly you need a scroll bar – choose Toolbars from the View menu, and select the Forms toolbar. Select the Scroll Bar option. Next you need to re-size the bar to the size you need, then right click on the bar and choose format control from the menu. In the Control section of the dialog box you need to link the scroll bar to the reference cell. In the example on the right I’ve set up cell A1 as the reference cell (starting with 0) and linked this to the scroll bar. Once this is done click the OK button , and then test your scroll bar as you slide it to the right the number in the reference cell should increase, slide it back and it will reduce back to zero.
Quality.Observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
Page 7 Now we can re-write the formula. Again assuming we initially want to see the ouput of cell C5, and the reference cell is set to 0 then we need this formula: = OFFSET(C$5,0,$A$1). Again note the anchoring of cells – just so that when you drag the formula along the correct cells will always be referenced. Drag this formula along for however far you need to show, then try scrolling up using the slider. Move it along so you reference cell displays 1 and you’ll see that, instead of displaying the contents of cell C5, the results of D5 are now there. We can add one further level of dynamism into this as you can see from the example we have six lines of data we may be picking just one for our chart using a drop down menu. (These have been covered in previous editions of Knowledge Matter). Drop downs also need a reference cell so you can use this as the rows down element of the formula. Important note to remember is that drop-downs start from 1, but the OFFSET function starts from 0. Therefore if you want to return data line 8, our fourth row of data, this will be labelled as 4 from the drop-down reference, but will actually be 3 in the formula. So let’s imagine our drop down reference cell is B1 and this reading 4 because we’re looking at the data in that row. We can’t just reference that cell because then the OFFSET formula will show the row below, we need to make that 4 into a 3, which can be done in the formula thusly: =OFFSET(C$5,($B$1-1),$A$1) Drag this across and we have a fully functional dynamic range of data that will change at the operation of a slider and a drop-down. You can even make your labels dynamic by using the OFFSET function – here they are the row about our starting point so the formula to do that will be =OFFSET(C$5,-1,$A$1). Now you’ve got you’re your dynamic data range you can turn it into a chart, cut and paste your slider and drop down onto the chart sheet, hide your raw data and working sheets, and you’ve got a fully interactive chart. South East Coast Maternity Dashboard
Total rate (planned & unscheduled)
Activity: C- Section - Total rate (planned & unscheduled) Between Feb-10 and Jan-11 SUSSEX
Oct-10
Nov-10
Dec-10
Jan-11
Oct-10
Nov-10
Dec-10
Jan-11
Aug-10
Sep-10
Apr-10
Jul-10 Jul-10
Aug-10
Sep-10
May-10
Apr-10
Jan-11
Oct-10
Dec-10
Nov-10
Jul-10
Aug-10
Sep-10
Jun-10
May-10
Apr-10
Mar-10
Feb-10
Jan-11
Dec-10
Oct-10
Nov-10
Sep-10
Jul-10
Aug-10
Apr-10
0
Jun-10
0
Mar-10
0
May-10
0
Feb-10
0
Jan-11
0.1
Dec-10
0.1
Nov-10
0.1
Oct-10
0.1
Jul-10
0.1
Aug-10
0.2
Sep-10
0.2
Jun-10
0.2
Apr-10
0.2
Mar-10
0.2
May-10
0.3
Feb-10
0.3
Jan-11
0.3
Oct-10
0.3
Dec-10
0.3
Nov-10
0.4
Jul-10
0.4
Aug-10
0.4
Sep-10
0.4
Jun-10
0.4
May-10
0.5
Apr-10
0.5
Mar-10
0.5
Mar-10
Medway
0.5
Feb-10
Jun-10
0.6
Maidstone & Tunbridge Wells
Western Sussex
0.5
www.QualityObservatory.nhs.uk
Mar-10
Feb-10
Jan-11
Oct-10
Dec-10
0.6
Surrey & Sussex
Jun-10
0.6
Feb-10
Feb-10
Jan-11
Oct-10
Dec-10
Nov-10
Jul-10
Aug-10
Sep-10
Apr-10
Jun-10
Mar-10
Jan-11
Oct-10
Dec-10
Nov-10
Jul-10
Aug-10
Sep-10
Apr-10
Jun-10
Mar-10
May-10
Feb-10 0.6
Royal Surrey County
Nov-10
0
Jul-10
0
Aug-10
0
Sep-10
0.1
Apr-10
0.1
Jun-10
0.1
Mar-10
0.2
Jan-11
0.2
Oct-10
0.2
Dec-10
0.3
Nov-10
0.3
Feb-10
0.6
0.3
0
0
Jan-11
Oct-10
Dec-10
Nov-10
Jul-10
Aug-10
Sep-10
Apr-10
Jun-10
Mar-10
May-10
Feb-10
0
0.4
Jul-10
0.1
0.1
0.4
Sep-10
0.1
0.4
Jun-10
0.2
0.2
May-10
0.2
0.5
Aug-10
0.3
0.3
Feb-10
0.3
0.5
Apr-10
0.4
0.4
East Kent
Dartford & Gravesham
0.5
Mar-10
0.5
0.5
0.4
0.6
East Sussex
May-10
Brighton & Sussex University
Frimley Park
0.5
0.6
May-10
Ashford & St. Peter's
KENT
0.6
0.6
0.6
May-10
SURREY 0.6
Quality.Observatory@southeastcoast.nhs.uk
Page 8
Quality in Care Programme By Thomas Meek, Assistant Web Editor, PMGroup The future of the way the NHS is structured and managed may still be uncertain as I write, with Health Secretary Andrew Lansley’s plans causing concern for the many stakeholders that form part of this vast system. No matter the outcome of the Government’s ‘listening exercise’ though, one thing that remains evident in this debate is the need to drive efficiency and innovation in an increasingly budget constrained health service. Recognising those projects that do provide quality care in as productive and effective a manner as possible, and disseminating those ideas on a country-wide level, has long been one of the biggest headaches the NHS has had to deal with however. The Quality in Care (QiC) Programmes are a new initiative, developed by publishing company PMGroup in line with the Department of Health’s QIPP (Quality, Innovation, Productivity, Prevention) agenda, to identify, commend, evaluate and share examples of good practice in patient care within the UK, and allow a platform for the people and teams behind those projects to share their ideas. QiC also aims to highlight good healthcare practice and effective collaboration between the NHS, patient groups and the life sciences industry within each programme. Instead of focusing on healthcare as a whole though, each QiC Programme covers a specific priority therapy area that represents the highest human cost and burden of healthcare resources, commencing with diabetes – a condition estimated to cost the NHS £9bn a year and affect nearly three million people in the UK.
Organisations, teams and individuals producing quality outcomes in the field of diabetes are invited to enter their work into QiC Diabetes, with each nominated initiative to be assessed by an expert panel of judges, headed by NHS Diabetes director, Anna Morton. There are 15 categories in QiC Diabetes covering the condition’s broad range of care needs, including self-care; prevention of type 2 diabetes; emergency/ inpatient care; and a special People’s Award, supported by Diabetes UK, to celebrate an individual who has gone out of their way to make a difference in diabetes. Those projects deemed to be the best examples of good practice in each category will then be invited to an Awards evening in October 2011, where the overall winners that demonstrate best such key themes as ambition, integration and patient engagement, will be announced. Following the Awards, each finalist will have a chance to share their ideas in a series of showcase events in November 2011, before the publication of a ‘QiC Good Practice Casebook’ in 2012. Further initiatives to share what is learned from QiC Diabetes will continue throughout the year in online, print and reallife settings, including a chance to share ideas at the Diabetes UK Annual Professional Conference 2012. With its aims and ambition, QiC Diabetes has been endorsed by a variety of organisations and bodies across healthcare, industry and patient organisations, with both NHS Diabetes and Diabetes UK helping to develop the Programme and determine the projects producing good practice.
Quality.Observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
Page 9
The Department of Health has also added its support too, with Dr Rowan Hillson, National Clinical Director for Diabetes, stating: “People with diabetes deserve the highest standards of personalised diabetes care, no matter where, when or by whom they are cared for. I am delighted to support this initiative to celebrate and share innovations that deliver these high standards in the very varied healthcare environments in which we work.” QiC Diabetes is only the beginning though, and future therapy areas QiC is looking to cover include cancer, mental health, dementia, arthritis, and cardiovascular and respiratory diseases.
To keep track of the progress of QiC, and to find out more about entering QiC Diabetes, details can be found at http:// www.qualityincare.org With collaboration at the heart of this initiative too, we value your views, feedback and ideas on the development of this programme. You can chat with us on Twitter, where we are http:// @QiCProgramme, or follow our blog at www.qualityincareblog.org where you’ll be able to find out all about the key issues in UK healthcare and diabetes, as well as being the first to hear about ongoing developments in QiC.
Quality Observatory promotional materials A range of additional leaflets have been developed over the last couple of months which describe specific products which have been developed by the South East Coast Observatory team. A total of 41 documents are now available to view and download from the Issuu website http://www.issuu.com/secqo The Quality Observatory would like to thank Paul Levy, avid health blogger, for mentioning Knowledge Matters in his blog on two occasions. The graph to the right shows the number of daily hits on the December newsletter which has now been viewed 740 times.
1st day back to work after Xmas break
1st Paul Levy blog 2nd Paul Levy blog
Unsurprisingly Most of the traffic from the last issue came from the UK & Northern Ireland, however there has been an increasing interest from the United States, Canada and Alaska, and even some traffic from Italy and the Netherlands (if you look closely!) Watch Out World Here We Come!
www.QualityObservatory.nhs.uk
Quality.Observatory@southeastcoast.nhs.uk
Page 10
Problems with =SUM() Application: Microsoft Excel 2003 Dear Quality Observatory I am having some problems with =SUM() function: I’m Clicking on Autosum (Σ—sigma), then holding down the CRTL button and clicking cells to add to the sum (they are not consectutive cells) when I hit enter it fails, what am I doing wrong? Vincent O'Mahoney Information Analyst Surrey PCT - East Locality
Solution: Complexity 2/5 — Uses Functions HI Vince At first glance this seems like a bit of a puzzler … so lets take this one step at a time !
The first thing to do is have a look at the function description this can be done through the Excel Help file or through the fx button in the formula bar or clicking the SUM part of the tooltip (if it comes up)
This is what the help file says:
SUM Adds all the numbers in a range of cells.
Syntax SUM(number1,number2, ...) Number1, number2, ... value or sum.
are 1 to 30 arguments for which you want the total
The Key Point here is 1 to 30 arguments , in this function an argument is an array or cell reference,
Quality.Observatory@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
Page 11
This means that you can have a MAXIMUM of 30 Arrays or cell references ( “A2:C5” = 1 array)
In this case you are using more than 30 Arguments in you function and this is causing it to fail. Instead of the SUM() Function you can use the SUMIF() function described below
SUMIF Adds the cells specified by a given criteria.
Syntax SUMIF(range,criteria,sum_range) Range
is the range of cells you want evaluated.
Criteria is the criteria in the form of a number, expression, or text that defines which cells will be added. For example, criteria can be expressed as 32, "32", ">32", "apples". Sum_range are the actual cells to sum.
In this case you will need to place a “marker” in a separate row to indicate which columns should be summed
you can then use the =sumif() function as demonstrated below:
Just Remember to utilise Absolute References ($C$R) if you plan on copying your formula down a range !
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Analysis, Ancient and Modern By Adam Cook, Specialist Information Analyst Excel’s great, isn’t it? You can do your sums, your charts, your dashboards, your whatever and still probably only using a small proportion of the true capabilities of the system. Then there are those times when you need to do more, and just are not sure what to do – fret not because someone else has already done it! There are a number of guys that I always turn to when I’m in fix and need to work something out. The first of these is John Walkenbach, a spreadsheet guru who’s written more books about Excel than you’d ever want to read. His webpage http://spreadsheetpage.com/ has links to a wide range of handy hints from unlinking pivot tables from their source data, to formulas to show day of the month, to complicated developer tips in VBA. He’s also created a number of spreadsheets and add-ins that are free to download. He’s even got a page of spreadsheet jokes! So go and have a poke around and see what you can use. Jon Peltier is another wizard of excel, especially when it comes to charts. When you can visualise in your mind how you want your chart to look, but can’t work out how to create then chances are that Mr. Peltier has already worked it out and posted it on his page: http://peltiertech.com/Excel/Charts/ Panel charts, waterfall charts, box and whisker plots, and many others you’ve probably never even thought about. All with handy step-by step instructions, so that you can follow them easily an create that little something special that you need. Jon Peltier also blogs regularly about excel and its good and bad uses – this can be accessed through his Twitter feed, http://twitter.com/#!/Jon_Peltier One more recommendation for Excel I would make is to go and download ASAP Utilities and install this. It’s free for personal use, but has a charge for corporate use. Built by Bastien Mensink in the Netherlands this nifty little add-in puts together in one menu all those functions that should be in Excel – but for some reason aren’t. Download it from http://www.asap-utilities.com/ download-asap-utilities.php . For example has your spreadsheet got multiple hidden sheets and you need to unhide them all – normally you’d have to do this one by one – but this add-in lets you do them all at once. Have you got rows and columns at the end of your sheet that look blank but just have null values in and so increase the file size – then there’s a delete all empty rows and columns function in there. So many things that need multiple steps have been reduced into a couple of clicks.
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Supporting the Quality, Innovation, Productivity and Prevention (QIPP) agenda What is QIPP? The most important challenge facing the NHS is to deliver a service with quality as its organising principle through a period of significant financial challenge. Quality, Innovation, Productivity and Prevention (QIPP) is the NHS response to this challenge – a response that will be designed and delivered locally. Reasons to get involved:
•The NHS must not lose its focus on quality because of the economic challenges it faces •Addressing inefficiencies to benefit patient care is the responsibility of all in the NHS •Trusts will become known as local, regional and national beacons of
dy u t s Case
How does NHS Evidence support the Quality, Innovation, Productivity and Prevention (QIPP) agenda? NHS Evidence brings you evidencebased success stories. The QIPP collection showcases practical examples of how NHS organisations are improving quality whilst making efficiency savings. The collection will provoke ideas and discussions about how staff locally and nationally can deliver ‘more for less’.
Southend Hospital NHS Trust has slashed its bill for dialysis transport services by almost 60% after tailoring transport to users’ individual needs. Users’ home addresses were mapped into closest postcode districts and treatment times were adjusted. Mobility of people using ambulance transport was reassessed . drop in dialysis
Total annual dialysis transport costs were reduced from £277,000 to £113,732. The most significant saving was in ambulance costs, which were reduced from £160,056 to £53,352 after reassessing eligibility. An average PCT would save around £164,000 in the first year so considerable savings could be made nationwide.
How do you access NHS Evidence? Go to www.evidence.nhs.uk. You can also download a version for mobile phones so you can search for information on the go.
Share your success •NHS Evidence needs your help to build a comprehensive QIPP collection of best practice so we are calling on all NHS organisations and all NHS Trusts to contribute examples of best practice to the QIPP collection.
•Got something to smile about? If you’ve been involved in a successful QIPP initiative, why not share it with your NHS colleagues? Visit the NHS Evidence website to find out how.
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On 9th and 10th March, the Quality Observatory was lucky enough to exhibit at the 2nd Innovation Expo at the Excel Centre in London. The (unusually smart) Quality Observatory Expo team comprised (from left to right): David Graham, Simon Berry, Katherine Cheema, Samantha Riley and Kiran Cheema) who spent an exhausting but productive 2 days describing analytical products which have been developed by the Quality Observatory to support a number of innovative clinical approaches. The QO had 3 Themed Pods to Highlight selected projects that we have been working on recently. The first two of these were the region wide normalising birth programme and short stay hip replacement programme - both of which received regional innovation funding. The third of these was the Oesophageal Doppler Benchmarking Tools (see page 4) developed in collaboration with the National Technology Adoption Centre. Promotional materials describing the three show-cased products were available along with laptops which enabled visitors to the stand to use the tools developed. In addition, large screens were available which enabled Kiran to demo the Quality Observatory website and catalogue. The Quality Observatory stand had nearly 200 visits over the two days from a whole range of different NHS and other organisations. Visitors included the Editor of ‘Ambulance Today’, a reporter from the ‘Health Service Journal’, representatives from the British Trade and Cultural Office in Taiwan, a variety of visitors from the Department of Health and the Clinical Director at the BMJ Evidence Centre. We managed to secure some additional Knowledge Matters readers from across the country and also some contributors for future editions……….. One of the highlights for the team was the NHS Institute stand which provided the opportunity to create your very own front cover of the HSJ. Maybe one day……………...
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NEWS Weekly Sitreps collections in 2011/12 It has now been confirmed that the weekly sitreps returns for A&E data, will continue in 2011/12. The A&E data collection will remain unchanged, but no mappings will be applied in any publications that use this data. The ambulance weekly data will continue to be collected until the end of May, when a new set of returns will be required from ambulance trusts. Full details and upload templates are available on Unify2. Information Standards Board Bulletin Did you know that the Information Standards Board for Health and Social Care (ISB), publishes a regular informative bulletin which provides an overview of recent items of interest. To subscribe to the bulletin simply e-mail isb@nhs.net NICE Standards Published The NICE quality standards team is very pleased to announce the launch of the NICE quality standards for depression, diabetes and glaucoma . NICE quality standards are a set of specific, concise statements that act as markers of high-quality, clinical and cost-effective patient care, covering the treatment and prevention of different diseases and conditions. Full details of all published standards can be accessed from the NICE website http://www.nice.org.uk/aboutnice/qualitystandards/ qualitystandards.jsp New National Mental Health Dashboard available The South East Coast Quality Observatory has created a new dashboard which uses national data by Trust from the Mental Health Minimum Data Set as reported quarterly by the Information Centre. This dashboard reports on 6 activity metrics and 10 data quality ones. It will be updated quarterly and is available to download from the Quality Observatory website. For further details contact adam.cook@southeastcoast.nhs.uk
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NICE Consults on Draft Quality Standards for Breast Cancer The draft quality standard for breast cancer is now available on the NICE website for consultation. Consultation started on Wednesday 6th April and finishes on Wednesday 4th May at 5pm. Details of all draft standards are available from the NICE website : http://www.nice.org.uk/guidance/qualitystandards/ indevelopment/qualitystandardsindevelopment.jsp NICE recruits to Hip Fracture Topic Expert Group Recruitment to the hip fracture quality standard topic expert group (TEG) has now started. Adverts for members of the hip fracture TEG were released on 20th April. These quality standards will be developed by the group which developed the relevant clinical guidelines on which they will be based. However it has been identified that several additional members are required. Information on the posts is available on the NICE website, please follow this link for details: www.nice.org.uk/getinvolved/joinnwc/ join_a_nice_committee_or_working_group.jsp. The deadline for applications to these posts is 9 May 2011 (12 noon). Samantha takes hot air balloon flight In mid April, Samantha was lucky enough to take a balloon flight over Sussex. Taking off from Slindon College, the 90 minute flight ended with a bit of a bumpy landing in Wisborough Green and a well received celebratory glass of champagne! South East Coast Quality Observatory featured in the HSJ A 2 page article describing some of the work undertaken by the South East Coast Quality Observatory appeared in the HSJ on 3rd March‌‌ We hope you saw it!
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Farewell to Nia……... On Friday 25th February, the team said a fond farewell to Nia. Nia received a selection of gifts from the team including cuddly MRSA and swine flu bugs (see picture to the right), a selection of edible goods and a Quality Observatory mug. Nia was also awarded a farewell ode written by our in-house poet Mr Cook (aka MC AC). Nia was delighted with her poem which was laminated and included a selection of photos from team outings (see photo left).
Ode to Nia
Fascinating Fact
Here is a little poem to say goodbye to Nia, and wish her well with the rest of her career. It has been a good few years since she first came here, and got to grips with UNIFY without showing any fear. She took on public health with humour and good cheer, and with HCAIs did steadfastly persevere.
Did you know that between April 2010 and March 2011, across South East Coast, there were 100 admissions with 'disruption of family by separation and divorce' (otherwise known as ICD10 code Z63.5) as a contributory factor to their admission. 94% were emergency admissions—largely linked to gastric and psychological primary diagnoses.
So this little poem has a message most sincere, to thank you for the good work in each and every sphere, and thank you for the fun times, which we hold most dear. Next time you're sat in Nando's think of us and raise a beer, Please do stay in touch with us - don't just disappear, Goodbye, good luck, and all the best to our good friend Nia.
Quality Observatory Drop-In Sessions Are you struggling with a piece of analysis? Not sure which statistical technique to use? Wondering which data might be available to provide a baseline for your improvement programme? If you are struggling with any analytical challenge or would like some advice on measurement you might want to think about spending some time with a member of the Quality Observatory team. The team sets aside 1 day every month when individuals or teams can book some time with the Quality Observatory to (hopefully) sort out your problem. Dates for the coming months are : • 25th May • 22nd June • 20th July To book a slot, simply e-mail us at quality.observatory@southeastcoast.nhs.uk
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