What can you expect from your Quality Observatory

1
What can you expect from your Quality Observatory?

• 9th September 2009
• Samantha Riley
• Head of the Quality Observatory

2
The role of a Quality Observatory

• High Quality Care for All required regional
  Quality Observatories to be established
• Enable local benchmarking
• Support the development of metrics
• Help frontline staff innovate and improve
  services
• Key to
• Improving quality
• Improving productivity
• Engaging clinicians
• Creating a measurement for improvement culture

3
South East Coast

• Well established team
• Benchmarking tools and products (60)
• Development of clinical metrics
• Stroke
• Dementia
• Supporting NSR clinical leads
• Education and training
• Analysis
• Interpretation
• Construction combination of metrics
• Evidencing innovation
• Progress in other parts of the country variable

4
Help for commissioners

• Training analysts
• Developing benchmarking
• Set priorities
• Monitor progress
• Inform contracts with providers
• Turning data into information for improvement
• Made practical
• SPC training and guide
• Advice on metrics, data quality, statistics, data
  sets
• Informaiton on quality for discussion at PCT
  quality boards

5
Benchmarking length of stay
6
Tools using national data
7
Combining metrics to tell a story Dementia
8
Combining with other data sets

• Utilised NAO prevalence model
• Comparison with numbers on dementia registers

Admissions to acute hospital Primary diagnosis
2.6 million First three positions 17 million
9
Creating a new culture
BANNED

• Technical training for analysts
• Measurement for improvement training offered
• Part of core SHA development programmes
• Bespoke for teams/organisations
• Targeted support for Commissioners
• Bookable slots with the Quality Observatory
• Helping teams make better use of their data
• Knowledge Matters newsletter
• Website
• Provision of well presented information
• Key messages reinforced

10
Evidencing innovation
Trust B
Trust F
Trust C
Trust D
Trust E
Trust A
Trust K
Trust L
Trust H
Trust J
Trust G
Trust I
does this indicate innovation???
11
Overnight hip replacement

• One consultant
• One hospital site
• 50 patients stay overnight
• 80 patients stay 48 hours
• Improved staff morale
• 25 reduction in requirement for elective beds
• Patients love it
• Safe
• Doesnt cost more

12
Hip replacement average length of stay
13
Variation between hospital sites?
14
Variation by Consultant ?
At site B, patients rarely stay less than four
days
Trust 4 Site B
15
Patients admitted to Site A stay less time
16
Mr Apthorps patients
17
Unintended consequences?

• Re-admission rates less than the SHA average
  (5.5 vs 7.1)
• Mortality rates comparable to other surgeons
• Infection rates comparable to other surgeons

• 25 reduction in bed stock
• Increased throughput
• Improved morale
• Reduced length of stay for all joint replacements
• 99.5 patients like the service
• Exceeded initial goal (48 hour length of stay)

18
How?

• Un-acceptance of current system
• Minimally invasive surgery
• Innovative anaesthetic techniques
• Superb pre and post hospital planning
• Close working with patients
• New ways of working outreach model
• Effective team working and empowered staff
• True devolved leadership
• Celebration of success

19
Costs and savings

• 1 wte additional nurse
• Trust estimate saved bed days 300k per annum
• Other savings
• Reduced staff turnover
• Reduced sickness rates
• More motivated workforce
• Initial SHA estimate 3.5 million
• Further analysis required
• How can cash be released

20
LOS Distribution
21
Differentiated by volume
22
Challenge for commissioners

• Skills and capacity
• Analytical
• Interpretation
• Can you tell a coherent story?
• Be clear about
• The questions you are trying to answer
• The information you require
• Information to triangulate
• Specify Quality Observatory support
• Processes to ensure analysis is utilised by
  front-line staff to improve quality in a
  sustainable way

23
www.QualityObservatory.nhs.uk