Volume 6 Issue 2 June 2012 Welcome to Knowledge Matters Welcome to this special Diamond Jubilee (what an excellent excuse for a new dress and shoes!) edition of Knowledge Matters! The Quality Observatory has had a busy couple of months! The team have now completed work on the Outcomes Framework dashboards—read all about them over the page! We hope that these will provide a useful resource and mean that commissioners and providers do not need to replicate this type of analysis themselves. In addition, a new maternity dashboard has been developed and the existing end of life care dashboard redesigned and expanded to span the whole of the South (see pages 4 & 5 for details). Finally, a single database has been set up to store all of the information on Serious Incidents for the South—the patient safety teams in all three SHA locations can access this shared resource which provides great potential to reduce duplication and standardise reporting processes. Over the past 9 months or so, a member of the Quality Observatory team has worked closely with one of our Clinical Commissioning Groups to co-design a suite of dashboards designed to support their decision making on priority issues. As a result of this collaboration, quite a number of products have been developed and also a lot of insight gained into the intelligence needs of CCGs. We’ll cover more on this next time. Finally, last month saw the publication of the much awaited NHS Information Strategy entitled ‘The Power of Information’. The strategy sets out a ten year framework for transforming information and care. I would encourage Knowledge Matters readers to read the full document rather than the Executive Summary as it vividly paints a picture of the role of information on shaping decisions in the future. If you are interested in my thoughts on the strategy have a look at page 12. That’s all for now—see you in two months!
Inside This Issue : SoE Framework Outcomes Dashboards
2
Making Connections
8
EQ&R Programme Update
14
Births and Deaths
4
Skills Builder
10
Analysis Ancient and Modern
18
Patient Experience Tool
6
Information Strategy
12
Ask an Analyst
20
Effective Clinical Analysis
7
Where digital art meets science
13
News
22
twitter.com/SECSHAQO issuu.com/SECQO http://www.networks.nhs.uk/nhs-networks/sec-qo www.QualityObservatory.nhs.uk
2
NHS South of England Outcomes Framework Dashboards By Samantha Riley, Director of Information for Service Improvement The NHS Outcomes Framework was originally published by the Department of Health in December 2010 with an adapted framework for 2012/13 being published a year on. There are a total of 51 indicators within the framework including 31 improvement areas and these are spread across the 5 domains. In a previous edition of Knowledge Matters, I explained that a number of the indicators either require more work at a national level to finalise the methodology or the necessary data needs to be collected. In a number of instances though it is possible to use a proxy indicator which can provide an indication of the current position. The Quality Observatory team has worked hard over recent months to design a suite of Outcomes Framework dashboards for the whole of the South of England. Each of the dashboards has a notes page, definitions page, a view showing progress over time and also a view showing the variation in performance against each of the indicators. A different member of the team owns each of the dashboards so if you have any queries on a particular area or indicator you know who to contact. .
Domain 1 : Preventing people from dying prematurely This dashboard covers a range of mortality, life expectancy and cancer survival rate indicators and has been produced by David Harries. The dashboard incorporates confidence intervals and utilises colour to indicate significantly above (green) or below (red) England performance.
Domain 2 :Enhancing quality of life for people with long-term conditions The owner of this dashboard is our very own inhouse poet and soon to be Olympic Torchbearer Adam Cook. This dashboard utilises a range of different data sources including the GP survey, SUS and the labour force survey (which we hadn’t utilised previously). A range of measures are featured on the dashboard which relate to quality of life for patients and carers, employment and unplanned hospitalisation for ambulatory care sensitive conditions.
Quality.Observatory@southeastcoast.nhs.uk
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3 Domain 3 : Helping people to recover from episodes of ill health or following injury Simon Berry is the owner for this dashboard—in fact for this domain we have two dashboards as a number of indicators are commissioner focussed and others are provider focussed. Commissioner based indicators look at emergency admissions for acute conditions not usually requiring admission for adults and emergency admissions for children with lower respiratory tract infections. The provider dashboard covers emergency readmissions and the proportion of stroke patients discharged to their usual place of residence as a proxy outcome indicator prior to data from the new national stroke indicator becoming available.
Domain 4 : Ensuring that people have a positive experience of care Katherine Cheema adds to her array of patient experience tools with this dashboard for domain 4 which covers a broad range of experience measures for GP care, out of hours services, dental services, hospital care (inpatient, outpatient, A&E and maternity) and community mental health services. The main dashboard (shown here) usefully enables indicators from primary and secondary care to be viewed alongside.
Domain 5 : Treating and caring for people in a safe environment and protecting them from avoidable harm Rebecca Matthews is the owner of the final dashboard in the suite. This dashboard incorporates commissioner and provider tabs and includes key measures related to patient safety from a range of data sources including SUS, NRLS, HPA and STEIS.
All of the dashboards are available to download from the Quality Observatory. Please have a look and let us know what you think!
nww.qualityobservatory.nhs.uk
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Quality.Observatory@southeastcoast.nhs.uk
4
Births & Deaths By Adam Cook, Specialist Information Analyst Currently under development is a new maternity dashboard that spans the whole South of England. There are a range of measures, some specific to providers and some specific to PCTs, and some that fit both – as such the dashboard is divided into two sheets. One sheet covers the Commissioner measures and the other the Provider measures. The provider view has 12 measNHS South of England Maternity Dashboard - Provider View ures. Five of these have been NHS South of England taken from SUS and they show Thin black line shows linear trend Numbers of Births & Midwife Staffing Consultant Presence Caesarean Section total births and deliveries, the CDeliveries Levels on Labour Ward Rate section rate, babies with low birth weight, admission to neonatal units, and births to mothers aged 35 and over. Taken from STEIS are numbers of Serious Incidents, this is further subdivided into Never Events and Closures. Midwife staffing levels are taken from ESR. There are five further measLow Birth Weight Admissions to PROMS Births to Women Neonatal Units Aged 35+ ures that will come direct from trusts, these are consultant presence on labour ward, 1-to-1 care in labour, births in a midwife led environment, postpartum hysterectomies, and a patient reported outcome measure. The SUS, STEIS and ESR data is collected monthly. Most of the trust related measures will be reported on quarterly, with the exception of patient experience data which is planned to be bi-annual. 50
14000
1-to-1 Care in Labour 1.2
25%
1
20%
0.8
15%
0.6
10%
0.4
18
45
12000
100
40
10000
35
80
16 14 12 10
30
8000
8
60
25
15
4000
20
10
0
2000
5%
5
0
4 2 0 0.2
Closures, Suspensions, Diverts
Date1 Date2 Date3 Date4
Threshold 60 Threshold 98
Threshold
Trust
20%
12%
Never Events
Date1 Date2 Date3 Date4
SIRIS Trust
Threshold
1.2
1%
0
Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11
Apr-11
Trust
0%
Trust
Dec-11
Aug-11
Dec-10
Apr-10
Births
Aug-10
0
Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11
Deliveries
6
40
20
Ap r-0 O 9 ct -0 Ap 9 r-1 O 0 ct -1 Ap 0 r-1 O 1 ct -1 Ap 1 r-1 2
6000
SIRIS 20
30%
120
Threshold
Postpartum Hysterectomy
Births in a Midwife Led Environment 12%
0.00045
1% 1%
18%
1
10%
16%
1% 1%
8%
0.8
6%
0.6
4%
0.4
2%
0.2
0.0004 10% 0.00035
14%
8%
0.0003
12%
0.0002
8%
Threshold
Trust
Trust
0%
0
Trust
Threshold
Trust
Date4
Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11
Date6
Date5
Date4
Date3
Date2
Date1
Trust
Threshold
0.00005
Date4
0%
0
Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11
Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11
0%
0.0001 2%
Date3
2%
Trust
0.00015
4%
0% 0%
4%
Date2
0%
6%
Date1
0%
Date3
0%
0.00025 6%
Date2
10%
Date1
1%
Threshold
NHS South of England Maternity Dashboard - Commissioner View NHS South West Thin black line shows linear trend Numbers of Births & Deliveries
Caesarean Section Rate 25%
Low Birth Weight
Admissions to Neonatal Units
2%
Births to Women Aged 35+
12%
7000
18%
1% 6000
16%
10%
20% 1%
14%
5000
8%
1%
15% 4000
6% 8%
10%
3000
12% 10%
1% 1%
6%
4% 2000
0%
4%
5% 2%
0% 0%
Births
Trust
12 Week Access
Threshold
Trust
Threshold
Perinatal Mortality
100%
8.0%
90%
7.0%
0% Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11
Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11
Jul-11
Oct-11
Apr-11
Jul-10
Oct-10
Jan-11
Apr-10
Jul-09
Oct-09
Jan-10
Apr-09
Deliveries
2%
0% Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11
0%
0
Apr-09 Jun-09 Aug-09 Oct-09 Dec-09 Feb-10 Apr-10 Jun-10 Aug-10 Oct-10 Dec-10 Feb-11 Apr-11 Jun-11 Aug-11 Oct-11 Dec-11
1000
Trust
Trust
Threshold
Breastfeeding at Discharge
Linear (Trust)
Smoking at Time of Delivery 18.0%
82% 16.0% 80% 80%
14.0%
6.0%
70%
78%
12.0%
76%
10.0%
5.0% 60% 4.0%
50%
8.0%
74%
40%
3.0%
30%
2.0%
20%
1.0%
6.0% 72% 4.0% 70%
2.0%
Trust
Trust
Threshold
Confidence Limits
Quality.Observatory@southeastcoast.nhs.uk
Trust
Threshold
Confidence Limits
Trust
11/12 Q4
11/12 Q3
11/12 Q2
11/12 Q1
10/11 Q4
10/11 Q3
10/11 Q2
10/11 Q1
11/12 Q2
11/12 Q1
10/11 Q4
11/12 Q4
Threshold
10/11 Q3
11/12 Q3
0.0% 10/11 Q2
11/12 Q2
2010
11/12 Q1
2009
0.0%
0%
10/11 Q1
68% 10%
The commissioner view contains the five SUS measures in the provider dashboard, that are detailed above. Again these measures show data on a monthly basis. There are also three measures taken from central returns; 12 week access, breastfeeding at discharge and smoking at time of delivery. All of the central return measures show data on a quarterly basis. The final measure is Perinatal Mortality, this is pulled from the IC’s indicator portal and is based on the ONS births and deaths data. This final measurement is on an annual basis.
Threshold
www.QualityObservatory.nhs.uk
5 End of Life Care Dashboard Also recently developed is another South of England wide dashboard, this time at the opposite end of the life experience spectrum – End of Life Care. It has been difficult to get really good measures around End of Life Care from centrally available data, there is data there but it’s all held locally or in patient notes, so we must make do with a number of proxy measures that, whilst not giving us the whole story, can be taken together to give a very good indicative picture of what’s going on. There are four measures in this dashboard and they are all split down into CCG level. The first two measures are taken directly from SUS and they show monthly numbers of in-hospital deaths and the associated PbR tariff. The in-hospital deaths are split between deaths within 1 day and deaths between 1 and 3 days. People admitted with trauma or external causes of morbidity (ICD-10 chapter S onwards) have been excluded. The third chart is based on data from the Primary Care Mortality database, which is directly fed from the ONS monthly deaths extracts. This shows numbers of deaths at home (including nursing and care homes). People have been filtered by underlying cause of death, again excluding trauma and external cause of morbidity. The final measure is annual, this is from the QOF data and shows the percentage of patients on a palliative care register. NHS South of England End of Life Care Dashboard by CCG NHS South of England In hospital deaths (excluding injury/trauma & external
PbR Tariff for In hospital deaths (excluding injury/trauma & external
1800
£4,000,000
1600
£3,500,000
1400
£3,000,000
1200 £2,500,000 1000 £2,000,000 800 £1,500,000 600 £1,000,000
400
0
£-
Source: SUS
Deaths between 1 and 3 days
Deaths within 1 day
Deaths in Ususal Place of residence (excluding injury/trauma & external causes)
50%
Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12
£500,000
Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12
200
Deaths between 1 and 3 days
Source: SUS
Deaths within 1 day
Number on QOF Palliative Care Register 3%
45% 2%
40% 35%
2%
30% 25%
1%
20% 15%
1%
10% 5%
Source: PCMD
Deaths in UPoR
Source: QOF
2010/11
2009/10
2008/09
Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12
2007/08
0%
0%
Number on QOF Palliative Care Register
If you have any queries on either of these dashboards please contact me adam.cook@southeastcoast.nhs.uk
www.QualityObservatory.nhs.uk
Quality.Observatory@southeastcoast.nhs.uk
6
Patient experience: making the best of the national surveys By Katherine Cheema, Specialist Information Analyst On occasion I have heard people decry the national patient survey programme as ‘out of date’ or ‘pretty much useless’; I couldn't; disagree more but appreciate that the sheer volume of the data generated by the surveys can be a little daunting! Once you multiply this across multiple surveys it gets even worse and the concept of matching up, say, results from the outpatient survey with those from the inpatient survey becomes pretty horrible. So, here at QO Towers we took the most recent data from the inpatient survey, the outpatient survey and the emergency department survey and put them together, but in a slightly different way than usual. Rather than include all the questions, we used NICE’s excellent ‘Patient experience in adult NHS services: improving the experience of care for people using adult NHS services’ to map questions to the core domains of patient experience and built a tool that allows users to review questions from all three surveys in particular domains of experience. You can see from the diagram to the left that the patient is put firmly at the centre! Once you’ve selected the domain you’re interested in just click on the relevant circle in the diagram and you’ll be taken to a sheet that looks like the one below: charts a-plenty! In fact, there are only three, showing relevant questions from each of the three surveys, all on one page with a simple line of explanatory text for each question to the right of the chart. Wherever possible, upper and lower confidence limits are shown and the tool has a help page that can guide you through what all the dots and lines mean. The tool is designed not only to bring data together in one handy space, but to help users get an overview of how their organisation is doing in a particular area of experience and target those that are problematic. Because the data is already publicly released we have been able to build a tool with national coverage, and trusts can be selected from the front screen. Currently, we have only mapped and built the tool pertinent to acute trusts; if this proves useful then a community version or a mental health version could be developed (assuming enough interest!). As always your comments and feedback are very welcome; access the tool in the usual place and e-mail us at the usual address with your thoughts!
Quality.Observatory@southeastcoast.nhs.uk
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7
Effective clinical analysis—avoiding the pitfalls By Simon Berry, Specialist Information Analyst Difficult as it is to believe, I have now worked with Samantha now for nearly 7 years! A significant proportion of this time has been focussed on providing analysis to:-
Evidence variation in clinical practice and clinical outcomes;
Support clinical improvement programmes across the region.
Over recent years I have supported a number of information teams across Kent, Surrey and Sussex on this topic and frequently receive questions on different elements of clinical analysis. So, it seemed like a good idea to run a series of articles on clinical analysis to provide you with my top tips on how to best do it. One of the first questions that I am frequently asked is what is the best data source to use for clinical analysis. The standardly available data sets are HES and SUS—which is the best to use? I’ll focus on this first question in this article. Let’s start with the basics…… Data is submitted by hospital providers from their Patient Administration System (PAS) to SUS on a regular basis. There are some rudimentary checks applied to the data to ensure it is in the right format and in the correct order with the right number of fields. There is no data cleaning carried out on this data. On a monthly basis after the “freeze” date, a feed is taken to HES and a range of data cleaning routines are carried out on this data. Assuming there are no significant issues the data is then made available in the latest Business Object universe, which is the method the majority of users use to access the data. If a trust finds an error in it’s submission to SUS after the “freeze” date it can re-submit it’s data to SUS and this will be reflected in any extracts taken from there, however, unless the trust requests and the correction is significant, this correction is not applied to HES until the next full refresh (which could be quite a while later). I have found through extensive experience with HES, SUS and the pre-SUS Trust MDS submissions that there are a number of reasons why it is preferable to use SUS rather than HES for regular local reporting and analysis. I hear you ask why therefore analysis undertaken by the Department of Health utilises HES? The answer is simple—the Department does not have access to SUS (yet). The first reason for my preference to use SUS are the data cleaning rules applied to HES. This may come as a surprise to you, but some of the data cleaning rules used when the SUS sourced data is processed into HES are a source of significant issues with using HES as the sole data source. When data is submitted to SUS all episodes within a patient’s spell contain the admission date and the discharge date. This means that, for example, if you want to carry out analysis on length of stay for an admitting condition you simply look at the first episode in the spell and calculate the length of stay from the admission date and final discharge date. Similarly if you want to look at length of stay for a particular procedure you would look for that procedure in the episodes of care and then calculate the LoS from the recorded dates in that episode. Unfortunately one of the data cleaning procedures carried out in HES is to delete the discharge date from all episodes in a patient’s spell with the exception of the final episode. This was originally set up years ago pre-SUS to deal with an issue where some trusts were submitting different discharge dates in the various episodes of the same spell. If all hospital spells only had a single consultant episode this would not be an issue, however, this is not the case. In my experience, I found that 70-80% of all admissions are single episode; for electives it is higher as you would expect with a significant proportion being day cases. This means that if you are relying on HES data to calculate your LoS for anything other than procedures or diagnoses in the final episode of care in a spell you are missing a significant proportion of patients from your analysis. Here’s an example……. As part of some national benchmarking I was carrying out for the National Technology Adoption Centre I was required to calculate LoS for certain groupings of procedures by trust for the whole country. It was noticed that the numbers of procedures for that trust for vascular surgery were incredibly low at just 3 procedures in the reporting period. This trust had, in fact, a very busy specialist vascular unit so this looked wrong. Working with an analyst at that trust who queried the local SUS data it was discovered that the number of those procedures carried out was actually around 120. Further investigation showed that although the procedures were elective all those missing from the HES analysis were multi episode spells. It turned out that once the patient had undergone the procedure they were transferred to a critical care consultant, generating a new episode of care. Once they had recovered they were then transferred back to the original consultant for recovery prior to discharge. This is not an isolated case, I have found similar issues across the rest of the HES dataset and there are other data cleaning rules causing further issues—I will cover these in a future issue.
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8 STATUM—Statistical Thinking and Methods e-newsletter By Helen Ganley RN CM Cert. QM Adv. Dip QM MQIHC, Manager - Compliance & Assurance , Northern Sydney Local Health District
A three month visit to the Antipodes in 1972 resulted in this Pom settling in Sydney, Australia. Professionally, this included graduating as a nurse and then midwife and gaining various other qualifications including a Masters in Quality Improvement in Healthcare. Having identified serious gaps in the use of data within healthcare organisations, I majored in epidemiology and statistical process control (SPC). In the late nineties, as a quality consultant for a large tertiary hospital, I identified that decision making by clinicians, clinician managers and support staff was rarely based on a valid analysis of objective data. This was often due to staff being unaware that there were a number of useful and accessible statistical methods to assist in understanding workplace issues. "Many clinicians and other healthcare leaders underestimate the great contributions that better statistical thinking could make toward reducing costs and improving outcomes" (Donald Berwick). As it is impossible to improve without information, the goal was to improve capacity in data collection, analysis, reporting and decision making. The Statistical Thinking and Methods Program, first implemented in 1999, was designed to fill identified gaps by demystifying the “scientific� aspect of improvement. Seminars and workshops using Minitab statistical software enabled staff to produce control charts, box plots, histograms, Analysis of Mean, scatter plots, Pareto charts and other analyses. An Organisational Performance Website triangulated the resources.
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9 However, many staff remained under-confident and even unaware of the workplace benefits of statistical thinking. Seminar and workshop participant evaluations indicated a need for ongoing support to maintain enthusiasm and impetus. The support needed to:
Be applicable to clinical, administrative and research staff; Address both “basic” and “advanced” users; Be technically correct, yet practically accessible; Give examples of good and bad practice; Include links to resources; Showcase projects & achievements.
The first edition of STATUM was published in September 2002. Feedback confirmed that the publication was meeting a genuine need, and an ongoing publication was established which is now in its tenth year. The Statistical Thinking and Methods Program has grown from strength to strength with multiple modules that articulate with each other. The Program has a common focus on quality and safety achieved by fighting the common enemy of variability, whilst communicating primarily through the language of statistics. The Statistical thinking and Methods Program has won a major New South Wales state award (2000) and commendation (2003); quality improvement projects using statistical thinking techniques have won two international awards (1996; 2011) and one national award (2005). My current role includes that of SPC facilitator. I have also taught SPC at various universities and my seminal article Making Informed Decisions in the Face of Uncertainty continues to be required reading at various academic institutions including the University of Texas in their Productivity and Quality Management course which is concerned with the theory and practice of quality science. Salient publications which showcase statistical thinking and methods initiatives include: 2003 current
STATUM Published on New South Wales Ministry of Health GEM website (The Centre for Healthcare Redesign e-learning portal) https://gem.workstar.com.au/public/index.cfm?action=login&returnTo=/
2011
Best Practice Wound Care International Wound Care Journal http://onlinelibrary.wiley.com/doi/10.1111/iwj.2011.8.issue-2/issuetoc
2011
NSCCHS Patches up Wound Care with Minitab http://www.minitab.com/uploadedFiles/Company/News/Case_Studies/NSCCHS-EN.pdf
2011
NSCCHS uses Minitab to “STAMP” staff with statistical knowledge http://www.minitab.com/uploadedFiles/Company/News/Case_Studies/STaMP-EN.pdf
2007
Using the Indicators for Quality Use of Medicines in Australian Hospitals: Feedback example Indicators for Quality Use of Medicines in Australian Hospitals. NSW Therapeutic Advisory Group. http://www.ciap.health.nsw.gov.au/nswtag/publications/QUMIndicators/Introduction0408.pdf
2005
Making Informed Decisions in the Face of Uncertainty – A Better Way to Count, Measure and Draw Pictures. Improving Patient Access to Acute Care Services - A practical toolkit for use in public hospitals. Clinical Excellence Commission http://www.cec.health.nsw.gov.au/__documents/programs/patient-flow-safety/pfsc_toolkit.pdf
2000
Making Informed Decisions in the Face of Uncertainty Quality Progress. American Society for Quality http://asq.org/qualityprogress/past-issues/index.html?fromYYYY=2000&fromMM=10&index=1
1998
Chapter - Key Applications of the Australian Business Excellence Framework in the Health Care Australian Quality Council http://catalogue.nla.gov.au/Record/328428
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10
Raising the bars - understanding bar charts and histograms. By Kiran Cheema, Workforce Analyst
I was wondering what to write about in this issue of Skills Builder as I was looking through work that my 6 year old had brought home from school and came across a beautifully labelled bar graph. Full of paternal pride I looked over at him and said “Son this is a lovely bar chart!”, he shot me a withering look, in the way only small children can and replied “Dad it’s a histogram not a bar chart, don’t you know that!” ….. Histograms are probably the first experience that most people have of Data Visualisation and maybe that’s why we see them around so often!
William Playfair’s chart
Did you know that Bar Charts have been around for centuries! Many people attribute the popularity of the bar chart to Scottish Engineer William Playfair who used bar charts for visualising economic data the 1780’s. However there was a Frenchman Nicole Oresme who was creating bar charts in the 14th Century! Technically a bar chart can consist of horizontal or vertical bars and it is the area of the bars that denotes their value not just their height! This means that in theory the bars do not have to be of equal width! (don’t worry I’ve never seen this applied in practice, and it’s not something that you can do with Excel!) So what is the difference if any between a Histogram and a Bar chart?
Nicole Oresme’s 14th Century
The term “Histogram” is thought to have been introduced around 1890 by Karl Pearson an English mathematician.It is commonly believed to derive from the greek “histos” which means “anything set upright” and “gramma” which means ‘drawing, record ’ If you search the internet you will find many articles regarding the difference between the terms. Broadly this is what they say: Karl Pearson
“bar charts are visual representations of categorical/nominal data” “histograms are a frequency distribution of ordinal/continuous data”…. But what does that mean?
Lets take some example staff age data (this data does not bear any resemblance to the QO staff!) value
30 26 60 19 20 40 36
This data set could be described as Categorical or Nominal. This just means that the data items being measured all belong to the category “age “ We could order the values in any order we want and it would not matter or change our understanding or ability to interpret the data e.g: high to low, or randomly. 80
80
80
60
60
60
40
40
40
20
20
20
0
0
0
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11 Now we could turn the set data into ordinal data by counting the number (frequency) of values in “consecutive nonoverlapping categories” for example over time or age ranges. 3.5
age-range 0-20 21-30 31-40 41-50 51-60 number of staff 2 1 3 0 1 Now the order of the data really does matter! If we were to move the data around it wouldn’t make sense and would be very confusing to interpret!
Number of staff
3 2.5 2 1.5 1 0.5 0
So basically histograms are a type of bar chart!
0-20
21-30
31-40
41-50
51-60
Grouped Vs Stacked Bar Charts … Bar charts can also be used to display similar data sets together, for example we may want to compare data from last year to the same months of this year e.g : jan feb mar apr may jun jul This year 30 26 60 19 20 40 36 Last year 26 20 36 18 30 40 60 We can do this in a number of ways : Stacked Bar Chart:
120
In a Stacked bar chart you display the data points for each series on top of each other for each category.
100 80
It is quite easy to identify changes between the categories (i.e. month to month) for the bottom series but more difficult for the “stacked” (i.e top) data set.
60 40 20 0 jan
feb
mar
apr
may
jun
jul
Large changes between the series (e.g. this month this year vs this month last year) are easy to identify, however smaller changes can be difficult to see. Grouped Bar Chart :
70
With a grouped bar chart you display the data points for each series side by side for each category.
60 50 40
It is quite easy to identify changes between the categories (i.e. month to month).
30 20
It is quite easy to identify changes between series (e.g. this month this year vs this month last year) and small changes are more obvious.
10 0 jan
feb
mar
apr
may
jun
jul
It is easy to compare the distributions between series.
100%
e 50% g a 0%
Percentage Bar chart : A percentage chart displays the data as a percentage of the total for a category. These charts need to be used with care, they can be used to show differences between series, but give very little indication of distribution across the categories.
And the Golden rule of Thumb … don’t overload your graph MORE THAN 5 SERIES IS PROBABLY TOO MANY!
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12
The Information Strategy By Samantha Riley, Director of Information for Service Improvement The long awaited Information Strategy was published by the Department of Health on 21st May. The strategy sets out a new approach to information and IT across health and care and describes how this new approach can lead to more joined up, safer and better care for patients. In this article I want to highlight some of the areas which were of particular interest to me. It is encouraging to hear that information standards will be set nationally for the whole health and care system which should make it much easier to monitor across pathways of care which span different parts of the health and social care system. That is of course assuming that the Information Governance review underway currently recommends changes to current rules which in many cases hamper our ability to undertake this type of complex analysis. As you can imagine, one of the things that I was pleased to read was that ‘more information will be publicly available about care at clinical or professional team level and information that enables us to benchmark services such as clinical audit data’. In addition, more information will be available on the quality of care provided by local services. This is exciting news for the Quality Observatory team as it suggests that additional, granular data sets will be at our disposal to create meaningful analysis from. We can also expect ‘simpler performance measures that combine existing information into a small number of indicators which are easier to understand’. To me this suggests the development of composite indicators which I am not a fan of. In my experience composite measures can in fact be difficult to understand. The fact that they combine different indicators means that much of the richness of the data is lost. Plus the method by which composite indicators are developed can often be complicated and difficult to understand. Some real positives for me are: -
A move to collecting and using information on outcomes and quality rather than just activity and finance with more relevant clinical data being made available for a variety of uses;
Greater recognition of informatics as a profession;
Greater recognition of information skills for all working in health and care;
Linked to that last point, the strategy states that ‘lead clinicians or care professionals within individual organisations will be responsible for organising and interpreting information in support of better care’. I think that this is going to be one of our greatest challenges. Here at the Quality Observatory, we have worked closely with clinical teams over the past 6-7 years to co-design clinically meaningful analysis and then help teams interpret the output. This dialogue between clinicians and information experts has paid huge dividends. We have numerous examples of changes to clinical practice (resulting in improved care for patients) as a result of this collaboration. The problem is, though, that it takes time to develop effective relationships based on trust and equipping clinical teams with the skills to effectively interpret data does not happen immediately. In our experience, the support of an analyst in the early days of any improvement project is an essential component of information being utilised to support better care. Quality Observatories have been in a prime position to support the delivery of this particular aim—but with the future of Quality Observatory services still uncertain within the new architecture how is this critical culture change going to be achieved?
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13
Where digital art meets science By Carl Plant , Managing director Bitjam.org.uk First of all I would not call myself a data analyst nor a statistician however nowadays I find myself using some of the same skills and techniques. I would call myself a data artist, someone who manipulates data for creative means. I use a wide range of data in my creative work as a Director at bITjAM, examples of this include data mining and visualising all UK based Theatre check-ins on Foursquare while other data sources include using Xbox Kinect sensor data as part of an interactive art installation. It's strange writing this description of myself as I'm a Registered Mental Health Nurse however while working as a nurse I also worked as a digital artist. Over the last 5 years these two fields have come together quite harmoniously for example in 2010 I joined Maverick TV (from Embarrassing Bodies fame) on a new digital health service, NHS local. It was during this time that I focused on health data and I began to challenge current visualisation techniques. During the past 18 months I have been a campaigner for more open data and have been involved in a number of projects to make better use of health data. This included developing a public facing visualisation of West Midlands Acute Trusts situation reports (sit rep) which ran through the winter of 2010. Other health data work includes mashups of NHS Choices, Patient Opinion and social media data for example I data mined every single NHS website in England and measured the reading age of each one. I tend to publish most of my work on my blog so you can see for yourself the types of work I do (carlplant.com) I am currently enjoying life as a Director of my own company, an element of this includes working with PCT's and GP practices exploring ways to make better use of their data. I will soon be mashing together Crime data and Community Pharmacy consultation rates, weather data with ambulance call outs and even football fixtures and acute admissions data. Part of my health related data work at present will be just to develop apps and interactive visualisations possibly to replace traditional charts and graphics seen in the NHS while other areas of work involves using mashups of data to look for new insights. The plans for the future include pushing the limits of making the most out of the different types of data produced in various sectors, whether that involves creating CCG data dashboards or gesture based systems for people with physical disabilities, I hope using a creative approach will drive through innovation in turning data into useful applications. If you want to see what I’m up to my follow me on Twitter at @carlplant and @bitjam. Projects to watch out for on Twitter include #Geeklab on 14th July a live streamed event where we invite artists, digital technologist and friendly geeks to discuss digital, data and gadgets. There's the #NHShackday in September and #Digihealthhack on 30th June plus #devlab which is a project supporting Cultural organisations to use data to develop ways to engage new and existing audiences. I plan to keep people updated in future issues of Knowledge matter so watch this space!
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14
Enhancing Quality & Recovery (EQ&R) Programme Update By Paul Carter , EQ Communications and Engagement Manager Embedding a culture of quality improvement into organisations using evidence-based quality metrics requires persistence and commitment to get the data right and then to make changes that make a difference on the back of the knowledge gained. The Enhancing Quality & Recovery (EQ&R) programme used the opportunity of the first public disclosure of its Annual results to recognise and commend the work of all clinical teams working across four pathways (AMI, Heart Failure, Hips & Knees and Pneumonia) in Kent, Surrey and Sussex, to make three awards for excellence and to hear firsthand the views of the Department of Health, a local CCG and a patient representative on the role of EQ&R. The themes of innovation, integration of care between different settings and transparency will be picked up in an article to follow. At the EQ&R What a difference a year makes 1st Annual Results event attended by nearly 200 people including representatives from the Department of Health, the Care Quality Commission and NICE, three Awards were made. The Awards were given by Steve Fairman, Director of Improvement and Efficiency for NHS South of England. During the first year of EQ, overall quality of care of patients improved across this region by:
15% for pneumonia patients
15% for heart failure
8% for hips and knees
5% for heart attack.
EQ&R QUALITY IMPROVEMENT TEAM AWARD Award for care pathway team with highest % quality improvement in the year 2012 Winner: Pneumonia Team Maidstone & Tunbridge Wells NHS Trust The three largest improvements were:
pneumonia team Maidstone & Tunbridge Wells NHS Trust - 35.42% improvement
heart failure team East Sussex Hospitals NHS Trust – 34.31%
heart failure team East Kent Hospitals NHS Trust - 29.42%
Pneumonia – Maidstone & Tunbridge Wells NHS Trust Improvement in quality was made by:
Introducing a new pathway for pneumonia (including issuing of pocket cards and posters) which ensured more use of CURB 65 score to assess severity
More prompt administration of anti-biotics through education and training and liaison with sepsis team
Smoking prompt on Electronic Discharge notification helping smoking status documentation and referral
Introduction of Medical Admission proforma
Multi-disciplinary team to resolve issues and implement improvements
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15 EQ&R COLLABORATIVE LEARNING AWARD Award for Trust who has contributed most to collaborative learning events. 2012 Winner: Ashford and St Peter’s Hospitals NHS Foundation Trust Collaborative learning is at the core of Enhancing Quality. The “public” discussion of quality results and sharing of best practice is proving to be a spur for clinical teams to compare and improve performance. Top three Trusts
Ashford and St Peter’s Hospitals NHS Foundation Trust
East Kent Hospitals NHS Trust
Medway NHS Foundation Trust
EQ&R PATIENT CARE QUALITY AWARD Award for Trust who has consistently provided the highest % of patients with all EQ quality measures in the year. 2012 Winner: Royal Surrey County Hospital NHS Foundation Trust The mantra of EQ is that every patient, every time should receive a minimum “care bundle”, based on clinically-agreed and evidence-based intervention, for common conditions. This is irrespective of what day or hour they present at hospital and which ward they go to. The hospital Trusts across this region included an “EQ qualified population” of 25,437 patients. The three most consistent performers in terms of overall quality of patient care (based on average across four pathways) are:
Royal Surrey County Hospital NHS Foundation Trust - 92.48%
East Kent Hospitals NHS Trust - 88.31%
Medway NHS Foundation Trust – 87.61%
EQ&R is succeeding in reducing variation in the provision of care across the region. Patient outcomes are beginning to benefit as well. This quality improvement work relies on data being believed and trusted by clinicians so they are motivated to improve upon it and to benchmark their performance with their peers both regionally and internationally. Early indications suggest that engaged clinical leads providing strong leadership is crucial to gaining significant and sustained improvement. Consequently, there are opportunities to collaborate and share learning between clinical teams within Trusts and between Trusts which needs to continue.
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16
New Health Informatics Apprenticeship Framework The new Health Informatics Apprenticeship Framework was launched on the 28th May 2012. Below are some questions and answers for those who want to know more.
Do you work in records or data management? Are you looking for an opportunity to further your career in health informatics? The Department of Health Informatics Directorate (DHID), NHS Wales Informatics Service, Skills for Health and City & Guilds Awarding Body have announced the new Health Informatics Apprenticeship Framework. The apprenticeship framework is underpinned by the City & Guilds extended level 2 health informatics qualification and on average takes a year to complete. What is an apprenticeship? An apprenticeship is not a qualification in itself, but a number of separately certified qualifications and courses known as a framework. Apprenticeships combine practical and theoretical skills, and are designed to help employees reach a high level of competency and performance. Follow the link to view full details of the Health Informatics Apprenticeship Framework on the Apprenticeship Frameworks Online site.
Who is this for? The apprenticeship is for anyone working in, or wishing to work in, a health informatics role. It may also be useful to human resources staff with an interest in workforce planning and staff working in a wide range of service support roles. What are the benefits of the apprenticeship and extended qualification? Apprenticeships are popular because they give people the chance to earn while they learn and to learn in a way that is best suited to them: through hands-on experience on the job. The key benefits of being a health informatics apprentice include:
earning a salary getting paid holidays receiving training having a mentor gaining qualifications learning job-specific skills improved prospects
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17 Where can I find out more about apprenticeships? You can visit the Apprenticeships website to find out more about the benefits, and apprenticeships in general. NHS apprenticeship opportunities are advertised on the NHS Jobs website and listed on the Apprenticeship Vacancies online database. What are the entry conditions for the apprenticeship framework? There are no specific qualifications required for entry to this apprenticeship framework but apprentices are expected to: Show enthusiasm for working in the health sector Have basic literacy, numeracy and communication skills Be willing to undergo an enhanced Criminal Records Bureau (CRB) check Be flexible, as there may be a requirement to work rotas Personal Attributes: Employers look for health sector apprentices who are:
Well organised Able to work with large amounts of information and data Conscientious Discreet Respectful Personable
What areas are covered by the learning? The level 2 extended certificate in health informatics that underpins the apprenticeship provides learners with the competence to deal with paper or electronic data/information, within a health environment and and to gain recognition for their skills. The qualification will give recognition to those working in areas such as records and information management and provide a spring board into a wide range of roles in and for the NHS where information handling is a key responsibility. The qualification covers a number of areas including the following:
Input and handling of data. Validation and quality assurance Production of reports from a variety of sources Storage, security, disclosure and dissemination of information.
Structure of the qualification To achieve the Level 2 Extended Certificate in Health Informatics learners must gain a minimum total of 32 credits, of which 29 credits must come from the mandatory units and a minimum of 3 credits from the optional units. Recognition of Prior Learning (RPL) may be available to candidates towards the Extended Level 2 Health Informatics qualification. Please check with your local training provider or City & Guilds for more information. Find out more: For more information, and to find out if this qualification is offered by a City & Guilds learning centre in your region, visit: http://www.cityandguilds.com.
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18
Analysis Ancient and Modern: Tales of Statisticians Adolphe Quetelet, 1796-1874 By Katherine Cheema, Specialist Information Analyst Okay, so perhaps a series entitled ‘Tales of Statisticians’ doesn't sound the most fascinating, but stick with it, these guys (and they are mostly guys) came up with the key tenets that underpin what we do on a daily basis and turn raw data into information and then knowledge. Adolphe Quetelet left us with a lasting statistical legacy….but we’ll come to that later. Born in Ghent, Belgium Adolphe was a bit of a mathematical prodigy, teaching mathematics at the age of 19, receiving his doctorate in maths at 23 and becoming a professor in Brussels in the same year. The area that Adolphe was interested in, the normal curve (bell curve, Gaussian distribution) had primarily been applied to astronomy, but he had other ideas and wanted to look at more social applications, specifically body measurements (weight, height etc.) and social phenomena such as crime. As he went about his work, he enunciated two central principles for the study of people: 1.
Causes are proportional to the effects they produce. If a man can lift twice as much as another man, he is twice as strong as that man. Study of man's moral qualities is possible only if this principle can be applied to them also. WHICH MEANS: design and operationalise your measures properly
2.
"The greater the number of individuals, the more the influence of the individual will is effaced, being replaced by the series of general facts that depend on the general causes according to which society exists and maintains itself." WHICH MEANS: you can’t reach exact conclusions on small numbers (it’s all about the sample size!)
In 1844 Adolphe first published the fact that variations in physical characteristics were symmetrically distributed about the mean (normally distributed). He was able to derive a theoretical frequency distribution which predicted the variation in height, weight, or chest circumference of various groups in the population. This had philosophical leanings: it assigned the ideal not to the most evolved extreme, the highest end of the distribution, as many had done up to that time, but rather to the mean, the least extreme, in the middle, the value with the most examples in that population. That shift of emphasis in effect made the "average man" the “ideal man”. This early work gave rise to something called the Quetelet Index, which looks like this. Seem familiar? Yep, it’s the body mass index. To be fair, Quetelet didn’t actually come up with the formula, someone else did that in the 1970s based on the normal curves he came up with (which means we’re all comparing ourselves to 1850s Belgians, but moving on…..). Quetelet went on to collect and analyse statistics on crime, mortality etc. for the Belgian government and devised improvements in census taking. His work produced controversy among social scientists of the time as it raised the prospect that a persons life (outcomes, if you will) is more determined by social factors (gender, profession, educational level etc.) than by free will. Philosophy and statistics….see, told you it would be interesting!
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19
Meet the Observatory— Sister Safety interviews Adam Cook Hello Adam, Hello Sister Safety, thanks for taking time out of your busy schedule to interview me. Not a problem Adam, I have been looking forward to it. May I ask how long have you been working at the Quality Observatory? I started working at Surrey and Sussex Health Authority 7 years ago since then it’s become South East Coast, and now part of South of England. I was in the Information team, which became the Knowledge Management team, which in turn evolved into the Quality Observatory. I guess that makes me one the elder statesmen of the team! What did you do prior to working at The QO? I graduated with a degree in Information and Knowledge Management. I worked at Surrey and Sussex Healthcare for a few years, prior to that I spent several years in a public health research unit in Tunbridge Wells, and before that I was in the Health Authority (this was before they were Strategic!) in my home town of Gloucester. So I’ve been an NHS information analyst for about 17 years now! And which specific areas of work have you had responsibility for at The QO? Having graduated from performance information I’m now more focused on clinical improvement and quality. I have three main work streams—Maternity, Mental Health and End of life Care (Birth, death and all the madness in between!). I’ve also got interests in a few other projects; Safety, Adult Safeguarding and some Prison Health. I’d be interested in dabbling in community and social care data when I can. I also run the Data Flows and Standards group which primarily looks at what’s going on with SUS, data quality, changes in rules and definitions for data and data submissions. I also have the important role of writing the poems for Knowledge Matters. So I have heard, I always enjoy them. I hear you’ve got a special event coming up….. Yes, I’m going to be carrying the Olympic Torch in Redhill on July 20th, if anyone wants to come and watch! I got one of the 20 NHS places that were up for grabs. I was nominated by the Health and Wellbeing committee here at the SHA for encouraging people to go for healthy walks at lunchtime and also for developing a fitness dashboard. I suppose I ought to think about starting a training regime that doesn’t involve only biscuits soon!
Samantha’s Latest Holiday Antics….. Yes— Samantha has been travelling again since the last edition of Knowledge Matters—this time a week in Dahab in Egypt. The highlight of the trip was climbing Mount Sinai to see dawn, which was very beautiful and visiting Saint Catherine’s Monastery. Here’s a picture of the church at the top of the mountain……. It was a significant climb taking many hours—here’s the view from the bottom!! It took a week for Sam’s leg muscles to recover!!
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20
Why can’t I copy graphs from a dashboard? Application: Microsoft Excel 2007/2010 Dear Ask an Analyst I am trying to copy one graph from one of your dashboards to use in a presentation. I can select and copy the entire dashboard without any problem, but if I try and select just one graph it just won’t do it! I know that you could do this with excel 2003 but it I can’t get it to work in 2007! Please help Louise Fowler National Coach QIPP - Long Term Conditions Workstream Department of Health
Solution:
Complexity 2/5 — Moving Chart locations and optional macros Well this does appear to be a very odd thing to happen! This is something that is very important for us at the QO to understand as all of our products use a dashboard style layout! We have looked into this and basically (without getting too technical!) this is to do with the way newer versions of Excel have been designed, that is they don’t handle multiple chart objects on a chart sheet very well. The whole chart sheet is treated by the program as a single object so that you can select and copy the whole dashboard :
example2
example1
1.2 1 0.8 0.6 example2
0.4 0.2 0
1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
example3
example1
Copies to application example4
1.2
0.8 0.7
1
0.6 0.8
0.5
0.6
0.4 example3
0.4
0.3
example4
0.2 0.2
0.1
0
0
Does not Copy example2
example1
1.2 1 0.8 0.6 example2
0.4 0.2 0
1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0
example3
example1
example4 0.8
1.2
0.7
1
0.6 0.8
0.5
0.6 0.4
0.4 example3
0.3
example4
0.2 0.2 0
0.1 0
Well there are a number of different ways we can solve this. However the simplest way is to just move the chart that you want to copy from the chart sheet and onto either its own chart sheet or on to a worksheet.
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21
We would recommend that you create a copy of the chart sheet first before you attempt to change the location … Just in case anything goes wrong!
To move the Chart select the chart and then Right Click -> Move Chart Then select the location you want to move it to Then you are able to copy and paste away!
This does seem like a rather painful process to go through every time you just want to copy a graph, so we looked at ways to automate this process. We were not able to make Excel VBA copy a chart from a chart sheet that had multiple charts directly. If you know of a way please let us know! We came up with 2 solutions which are shown below. We would recommend copying these to your personal.xls workbook! Macro 1 : Copy the charts into separate chart sheets : Sub copycharts() On Error Resume Next For Each Chart In ActiveSheet.ChartObjects Chart.Activate Chartname = Chart.Name & " copy" ActiveChart.Location Where:=xlLocationAsNewSheet, Name:=Chartname Next Chart End Sub Macro 2 : Copy the charts into one worksheet Sub copycharts2() ‘copy the sheet this is Important! ActiveSheet.Copy Before:=Sheets(1) ‘the new sheet will be the first one and we can reference it for later Set sheetcopy = Sheets(1) On Error Resume Next For Each Chart In sheetcopy.ChartObjects Chart.Activate Chartname = Chart.Name & " copy" ActiveChart.Location Where:=xlLocationAsObject, Name:="Sheet3" Next Chart sheetcopy.Delete End Sub
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22 NEWS Olympic SitReps During the Olympics the Department of Health will be collecting a Daily SITREP to report on local pressures. There are 2 returns, one for ambulance and one for acute trusts. Both are mandatory returns and will cover the whole country. The Acute Trust SITREP is largely based on the daily winter SITREP but with fewer indicators. Both returns will be collected via Unify2. Daily SITREP reporting is scheduled to start from Tuesday 3rd July (the first Unify return is due on 4th July in respect of the previous 24 hours) and reporting requirements will be stood down on Monday 10th September. All guidance and supporting documentation is available via Unify. Daily reports should be submitted to Unify by 11am.
2012 Health Profiles The 2012 Health Profiles are now publicly available and can be accessed via the Health Profiles website at www.healthprofiles.info. The Health Profiles contain a summary of information on the health of the people in your local authority area and some factors that may influence their health. You may find this information useful when planning how to improve health locally. You can find the Health Profile for your area from the 'Find Profiles' page at http://www.apho.org.uk/ default.aspx?QN=HP_FINDSEARCH2012 We have a User Panel whom we consult when we need users' thoughts and feedback. If you would like to join the panel, please email: HealthProfiles@sepho.nhs.uk with your name, role and organisation details.
1000 Lives Plus Seminars This summer, 1000 Lives Plus is hosting two online seminars with Dr Anthony DiGioia, a world-leading expert on delivering patient and family-centred care. The two seminars are free and are being held on the following dates and topics: Friday 13 July: 4.00-5.00pm Session 1: Introducing the Six Steps to Patient and Family-Centred Care Methodology.
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Friday 3 August: 4.00-5.00pm Session 2: Patient and Family-Centred Care Methodology in Practice. The singular goal of the programme is to codesign exceptional care experiences for patients and their families by viewing all aspects of care through their eyes. During the online seminars, Dr DiGioia will explore six simple steps to achieve person-centred care. The sessions also involve input from colleagues at Aneurin Bevan Health Board and their medical director, Dr Grant Robinson, who are applying Dr DiGioia‟s framework to a Welsh setting. For further information and to register your place please visit website: www.1000livesplus.wales.nhs.uk/six-steps
NICE QIPP collection The QIPP collection on NHS Evidence (www.evidence.nhs.uk/QIPP) provided by NICE shows how staff are saving money without compromising quality. If the examples in the collection were adopted by 50% of eligible organisations, they have the potential to save the NHS over £1.9 billion. The website now includes a link to a full list of all published QIPP case studies including a tool that allows potential savings to be calculated and sorted based on quality gains. This link can also be found within the introduction section of the QIPP web page. The QIPP collection illustrates that there is no shortage of evidence-based, cost-saving, quality improvement initiatives in the NHS If you have a good initiative that you are currently implementing or have implemented already, we want to hear from you. Our analysts will be happy to talk to you and provide advice on the suitability of your initiative for the collection and the type/level of information required. To find out more about making a submission, visit www.evidence.nhs.uk/QIPP or email qipp@nice.org.uk.
HCIF Change Advisory Board Kate has been invited to join the Health Informatics Career Framework Change Advisory Board. Kate will be the England service user representative on the board which will review, approve or escalate changes required to the HICF.
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23 NEWS NW PHO consultation
Open Data Platform Expert Reference Group
The North West Public Heath Observatory have launched a consultation, on behalf of DH and the IC, on the methods used to estimate alcohol-related hospital admissions for England. The consultation document and response form are available from the LAPE website (www.lape.org.uk) and the closing date is 23rd August 2012. Comments are invited from all interested parties.
Samantha has been invited to be a member of the Open Data Platform Expert Reference Group. The Open Data Platform (ODP) will enable comprehensive and secure access to health and social care data for a variety of business purposes. Read more on this in a future edition of Knowledge Matters.
Clinical Commissioning Groups The NHS Commissioning Board published the first official list of CCGs and practice-to-CCG mappings on 24 May 2012.
HSJ Awards Applications The HSJ Awards are back for its 31st year. The HSJ Awards ensure that individuals or teams are recognised and awarded for work that raises the standard of health care in the UK.
You can access this list via: h t t p s : / / w w w . w p . d h . g o v . u k /c o m m i s s io n i n g b o a r d / files/2012/05/ccg-practice-list.xls Please note that further changes can be expected in these mappings.
Teenage Pregnancy resources EMPHO has updated the Teenage Pregnancy resources with data for 2010. These resources include links to the latest data, along with forecasts of under 18 conception rates to 2020, and a set of interactive maps which allow analysis of the data. The resources are available from the network of Public Health Observatories’ website at: http://www.apho.org.uk/resource/view.aspx?RID=116350
NICE new role for Samantha Samantha has recently been successful in her application to become a measurement expert on the National Institute of Clinical Excellent (NICE) Quality Standards Advisory Committee. Committee members are drawn from the NHS, health and social care professionals, patients and carers and academia. They do not represent their organisations but are selected for their expertise, experience of working with multidisciplinary and lay colleagues and understanding of evidence based healthcare. As well as being significant levers for improvement in quality across the healthcare system, the standards developed will be used to develop indicators for potential inclusion within the Commissioning Outcomes Framework (COF) and Quality and Outcomes Framework (QOF) for general practice.
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If you feel you or your team have done work that has raised the standard of health care in the UK then why not enter. You can view the categories, register and submit your entry on the HSJ awards website: http://www.hsjawards.co.uk/ Applications close on the 6th July, so get submitting!
Jubille Flotilla Sam and Nikki both enjoyed the Jubilee Flotilla in London this month. Nikki watch it from the Battersea Park Festival where she enjoyed the boats and the rain. Sam watched from the Royal Festival Hall with her very special Jubilee shoes on.
Trolley Dolly update… Since the last issue we have had lots of goodies on our tea trolley, including; three lots of birthday treats, chocolate brownies supplied by Simon Hodge, Turkish Delight brought back from Sam’s trip to Egypt, Beetroot Chutney made by Kate and gummy planes brought back from Germany by Charlene.
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JUBILEE POEM (or sequential limericks) By Adam C. Cook As part of the Jubilee, The queen she did decree An extra day’s hols, For parties and balls, And bunting from every tree. Such marvellous and grand pageantry,
Birthdays…. Since the last edition we have celebrated 3 birthdays here at QO HQ. The first was Rebecca Matthews’, Performance and Planning Analyst. Rebecca received a Mother to Be pampering set and spent her birthday at Ikea after her plans to go to Ascot were rained off!
British spirit at its true apogee, Parties in streets And other such treats, In the name of the Royal family. An incredible 60 year reign,
Next was the turn of Simon Berry, Specialist Information Analyst. Simon received a traditional QO gift of a selection of beers and ciders.
The commonwealth, her domain, Achieving great stuff, Without getting tough, Graceful and always urbane. Hip, Hip Hooray for queen, Long may she stay on the scene, It's been a good life For Prince Philip's wife, Giving the crown jewels their sheen.
Simon says……. If you ever find yourself stuck in the arctic and running out of food and manage to get hold of a polar bear, don’t eat its liver. It takes only 60 to 90 grammes of polar bear liver to give you a fatal dose of vitamin A.
The last for this edition was Kiran Cheema, Workforce Analyst. Kiran also received a selection of beers and ciders from the team. He celebrated his birthday with his usually birthday BBQ and was presented with an iPad cake.
Fascinating Facts Did you know the Queen has sent around 100,000 congratulatory telegrams to UK and Commonwealth centenarians and more than 280,000 to couples celebrating their diamond anniversary. That’s around 17 telegrams a day for her reign!
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