Quality and Risk Profiles QRP

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Quality and Risk Profiles (QRP)

• December 2009

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Quality and Risk Profiles (QRP)

• Introduction
• What are QRPs
• What they are not
• Information flow ideals and getting the best out
  of information
• The vision?
• Whats Happening Now
• Versioning and timelines
• V0s for NHS, ASC, IHC
• V1 for NHS
• Future

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Introduction
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What are they?

• A way of gathering all we know about organisation
  
• So as to assess risk and thus prompt front line
  regulatory activity
• Allow the judgements of this activity to be made
  robustly and add to the knowledge base
• Critically, it builds over time and is never
  perfect
• This is essential to support registration (or
  more specifically the ongoing monitoring of
  compliance following registration) but, because
  information can be used flexibly later versions
  could be focused on different issues

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What they are not

• QRP produces an automated initial risk estimate
  it does not produce judgements
• The QRP is designed to prompt action, NOT direct
  it it requires a decision by front-line
  inspection staff about what to do in response,
  tempered by local knowledge and guided by the
  judgement framework
• One size does not fit all the types and scale
  of data for NHS, independent health care and
  adult social care are entirely different.

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Three distinct QRP activities

• Harvesting of different types of information
  organising this according to a classification
  system relevant to purpose and managing the
  flows.
• A method for calculating risk and presenting
  findings in a way that front-line staff can use
• A way for frontline staff to interpret the
  profile, use this to make decisions about what to
  do in response make judgements and ensure that
  these are included in our knowledge base and are
  reflected in the profile.

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Direct data collection
Flow diagram of the QRP
Data from providers
Data harvesting passive /active, surveys,
datasets, comments, infocab sweep
QRP system
Info from people with experience of service
Info from stakeholders
National information
Significant compliance event
Surveys
Comments
Comments
Findings
Public
ISAs
Application
Prompted
Unprompted
Monitoring declarations
Variation
Map to regs / outcomes / provider taxonomy
Knowledge base
The register
Distillation
Compliance risk by UoA
Analysis
Activity log context
Drill down
Contains
Intelligence system
Public information website
Concerns / regulatory plan
Publication
Registration core of QRP
Additional local evidence/ intelligence
CQC findings and judgements on quality
Activities in response to view of risk
Decision audit trail
Workflow support system
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Turning information into evidence
NHS LA, PEAT and ALE already used in this way for
Core Standards Assessment of the NHS
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Care Quality Commission Quality Profile
Anywhere NHS Foundation Trust
Inherent Risks Registered in 2010 with 0
conditions imposed Provides general and acute
services including emergency surgery and
specialist services including Cardiac
surgery. For further details click here Summary
Amber
Current Intelligence April 15 2012
Surveillance data There is currently 1 live
alert There are 4 closed alerts all were data
anomalies Summary Green
Historic Performance Star Rating. AHC and
Periodic review performance Special
Reviews Patient Surveys Summary Amber
Situational Risk A relatively small Cardiac
Surgery department compared with national
averages but no consultants operating below
College Guidelines For further details click
here Summary Green
Registration outcomes 5/21 judgement categories
show highest level of risk of poor outcomes for
patients See all screening reports Summary Red
Written Intelligence Inspector interviews reveal
common themes of Dignity and respect (poor)
Patient safety (mixed) Hygiene and cleanliness
(good) Patient pathways with social care
(poor) LINKs report no concerns with this
Trust We have 294 comments received on our
website 73 (25) relate to Maternity services,
the majority are positive Summary Amber
Population Risk A more deprived, older population
with generally poorer CAA ratings for local
area For further details click here Summary Red
Regulatory Information Risk Summits show
widespread concerns about joint working with
social services and PCTs handling of patient
complaints and clinical leadership See all
regulatory information Summary Red
Uncertainty Risk 5 interactions in last 12
months. Data flows from trust judged
good Uncertainty judged LOWEST
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Whats happening now ?
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Time lines and versioning
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V0.NHS Delivery January 2010
Delivered January 2010 Sector NHS Purpose Support
registration Format Compendium of existing key
information and judgements Contents up to 20
data sources identified from CQC and partner
bodies up to 200 items available will finalise
a smaller subset) Delivery CRM Plan In
place Training Designed delivery in December
2009 Users Assessors, RIEOs Unit NHS trust (i.e.
super location) Risk model Simple Inherent
risk Minimal, contextual info
Version 0.IHC is designed to allow initial
registration to take place.
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V0.IHC Delivery April 2010
Delivered April 2010 Sector Independent
Healthcare Purpose Support registration
Format Compendium of key information for
locations mapped to GaC requirement where
possible, not using GaC sector as for
NHS Contents 9 data sources identified
Delivery CRM Plan In place Training To be
designed delivery as part of registration
tranche 2 training package Users Assessors,
RIEOs Unit Location (i.e. current registered
entity) Risk model Minimal identification of
information which shows concern Inherent
risk Minimal, contextual info
Version 0.IHC is designed to allow initial
registration to take place.
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V0.ASC Delivery April 2010

• Delivered April 2010
• Sector ASC
• Purpose Support registration
• Format Compendium of judgements against NMS regs
  mapped to GaC outcomes and other key information
  not mapped to GaC outcomes
• Contents NMS judgements, notification and
  safeguarding data, potentially others
  including skills for care data, but the
  overwhelming majority of information available
  is that gathered by inspectors
• Delivery tbd Nov 2009 but likely to be dynamic
  rather than a stand alone report
• Plan tbd Nov 2009
• Training To be designed delivery as part of
  registration tranche 2 training package
• Users Inspectors, RIEOs
• Unit Location (i.e. current registered entity)
  with provider TOP SHEET
• Risk model Minimal identification of
  information which shows concern
• Inherent risk Minimal

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V1.NHS Delivery May 2010

• Delivered May 2010
• Purpose Ongoing monitoring
• Format Granular data with information mapped to
  outcome level risk model tbd but minimum being
  aggregated at GaC section level to provide a
  section risk assessment designed to prompt
  regulatory action
• Sector NHS
• Contents 30 different data sources with 94 data
  streams
• Delivery CRM
• Plan In place
• Training to be designed by Dec 2009
  implemented Jan April 2010
• Users Assessors (compliance inspectors), RIEOs
• Unit tbc Location
• Risk model Included will develop in later
  versions
• Inherent risk Included model
• Feedback Mechanism to feedback inspector
  included precise approach tbd

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Future beyond these versions

• NHS
• Updated v1.NHS- As new data become available we
  will add additional data sources as the year
  progresses. Initially likely release QRP at set
  points (but no one big bang). Eventually develop
  into a live document.
• Version development v1.1- 1.n expected
  throughout 2010 and beyond, as we see it in
  action, test its efficacy, develop risk model and
  expand information collation and presentation in
  the QRP beyond registration outcomes
• IHC and ASC
• Development and delivery of version 1s - primary
  focus of 2010 in these sectors
• Designing and developing efficient information
  flows, feedback loops ect
• QRPs for other sectors? GPs, dentists, private
  ambulances etc