NHS Clinical Leaders Network

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NHS Clinical Leaders Network

• METRICS STANDARDS
• S. Arulkumaran
• Professor Head of Obstetrics Gynaecology
• St Georges University of London
• President, Royal College of Obstetricians
  Gynaecologists

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The Next Stage of the journeyQUALITY AGENDA

• We need to continue the NHS Journey of
  improvements and move from an NHS that has
  rightly focused on increasing the quantity of
  care to one that focus on improving the quality
  of care.
• If quality is to be at the heart of
  everything we do, it must be understood from the
  perspective of patients
• 
  Lord Darzi

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Key Themes

• High quality clinical care
• Professionalism
• Innovation/safety
• Education and training Quality
• Choices
• NHS Constitution

SAFETY EFFECTIVENESS PATIENT EXPERIENCE
Lord Darzi
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The Quest for Quality Refining the NHS Reforms

• Effectiveness Appropriateness evidence based
  care reflected by reduction in mortality
  morbidity
• Access waiting times, diagnostics, after care
• Capacity staff, new facilities
• Safety e.g. hospital acquired infection
• Patient centeredness i.e. reported experience
  of care
• Equity largely free at the point of use still
  widening gap

Sheila Leatherman Kim Sutherland The Nuffield
Trust for Research Policy studies In Health
Services
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Next Stage Review Clinical Quality Metrics

• Primary use of quality metrics is to guide
  quality improvement through comparison and
  benchmarking to facilitate local improvement
  effort
• Key domains Safety, Outcome process quality
  Patient experience
• To be World class - effective set of clinical
  indicators
• Should provide support to a broad range of
  clinicians, nursing staff other health
  professionals in assessing improving quality of
  care they provide
• Clinical quality Indicators Phase 1 gt Phase 2
• It will be practical through full implementation
  of electronic records

Sir Bruce Keogh Medical Director, NHS
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Clinical Quality MetricsPrinciples for Indicator
Selection Phase 1

• Should relate to the quality of acute rather than
  primary care
• Should be based at provider rather than
  population level
• Should address the areas outlined by the Next
  Stage Review safety, outcomes, Pt experience
• Should be available on a regular basis
• Should be available to reasonably low levels of
  aggregation and allow for suitable bench marking
• Should be available for implementation by Apr09

Sir Bruce Keogh Medical Director, NHS
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Clinical Quality MetricsPrinciples for Indicator
Selection Phase 2

• Clinicians to drive development of clinical
  quality measures (?via NICE or via SHAs)
• Should be useful locally, regionally Nationally
• Developments based on specialties, conditions and
  treatment
• Cross cutting measures of safety and patient
  experience are important
• Multi-professional groups, patients, public
  CQC, DH, NICE,
• Clinically useful Durable indicators

Sir Bruce Keogh Medical Director, NHS
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Clinical Quality Metrics
NATIONAL
REGIONAL
LOCAL
We can only be sure to improve what we can
actually measure Lord Darzi
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PROPOSED ENGLISH NATIONAL QUALITY PROGRAMME

• Quality steering group, Selected target
  standard setting, NSFs with leads clinical
  networks, National measurement reporting,
  National Clinical Audits
• Data Analytic Centres
• Revised hospital payment method, Clinical centres
  of excellence, Electronic patient record, Volume
  controls in some areas
• Patient incentives, Decision support for
  clinicians, All doctors involved in peer review,
  Validation, Shared decision making, Revive
  clinician incentives

NATIONAL
REGIONAL

• INSTITUTIONAL

INDIVIDUAL
Sheila Leatherman Kim Sutherland The Nuffield
Trust for Research Policy studies In Health
Services
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VERTICAL INTEGRATION OF QUALITY REFORMS

• SET PRIORITIES
• RESOURCE ALLOCATION
• CLINICAL STANDRADS, NSFS
• QUALITY STEERING GROUP
• HIERARCHIAL QUALITY REPORTING
• CLINICAL GOVERNANCE
• INCENTIVES

Sheila Leatherman Kim Sutherland The Nuffield
Trust for Research Policy studies In Health
Services
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QUALITY SAFETY
FAILURE OF CLINCIAL GOVERNANCE Adequate
Capacity Adequate, well trained and experienced
Staff Educational courses Training Good
communication Team work Guidelines for all
staff on intranet Patient complaints and
Feedback Good Risk Management gt feedback to
improve services Audit of Practise and
Complications (e.g. Near miss)
Speed limit - Failure of brakes Untrained
driver Driver slept New territory Faulty/new
tracks Faulty/new signals No speed check




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CLINICAL GOVERNANCE
Leadership Administrative Clinical
(Med/Nurses/MW/ AHW)
Accreditation of Services Space Equipment
Professionals (Revalidation)
EB Guidelines Education Training Audit
Patients Complaints
Clinical Risk Management
PCTs SHA - Trust - DOH
Planning is power
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EACH SLICE REPRESENT ONE OF THE ITEMS OF
CLINICAL GOVERNANCE
RISK MANAGEMENT ROOT CAUSE ANALYSIS SYSTEM FAILURE
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Ensure high quality safe care. Tool for
Commissioners, Providers, Consumers and
Regulators
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Standards Delivery of care, Outcome Measures,
Patient Experience Metrics Built on
auditable standards

• Four Royal Colleges have shown leadership and
  team working to produce these standards
• For the first time all the standards in one
  document from prepregnancy care to transition to
  parenthood, produced jointly by four colleges

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Maternity Standards - 30

• Prenatal (2)
• Antenatal (9)
• Intrapartum
• Postnatal (8)
• Generic (10)

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Standards in Safer Child Birth, Maternity Care
Gynaecology
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Preconception

• 1 Looking forward to pregnancy
• 2 Pre-pregnancy care for women with existing
  medical conditions or significant family or
  obstetric history

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Antenatal Standards

• 3 Access to maternity care
• 4 Early Pregnancy Services
• 5 Maternity booking and planning of care
• 6 Pre-existing medical conditions in pregnancy
• 7 Women with social needs
• 8 Pre-existing and developing mental health
  conditions in pregnancy
• 9 Antenatal Screening
• 10 Routine Antenatal Care
• 11 Pregnancy related conditions

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Intrapartum and Postnatal Care

• 12 Intrapartum Care
• 13 Neonatal care and assessment
• 14 Postnatal assessment and care of the mother
• 15 Supporting infant feeding
• 16 Care of babies requiring additional support
• 17 Care of babies born prematurely
• 18 Promotion of healthy parent-infant
  relationships
• 19 Transition to parenthood
• 20 Supporting families who experience
  bereavement, pregnancy loss, stillbirth, or early
  neonatal death

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Generic Standards

• 21 Choice and appropriate care
• 22 Communication
• 23 Training and professional competence
• 24 Documentation and confidentiality
• 25 Clinical Governance
• 26 Development, implementation and review of
  local maternity services strategy
• 27 Maternity and Neonatal Networks
• 28 Child protection and safeguarding babies
• 29 Infection Prevention and Control
• 30 Staffing

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STANDRADS IN GYNAECOLOGY

• Generic Standards
• Gynaecological Examination
• Outpatient Clinic Times
• Full Record Keeping
• Risk Management
• Early Pregnancy Loss
• Ectopic Pregnancy
• Pelvic Inflammatory Disease
• Abortion
• Female Sterilisation
• Recurring Miscarriage
• Hysteroscopy
• Laparoscopy
• Urogynaecology
• Menopause
• Benign Vulval Disease
• Infertility
• Colposcopy
• Heavy Menstrual Bleeding

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DESIGN SERVICES TO DELIVER CARE EXPECTED BASED
ON STANDARDS CONSIDER THE MOST IMPORTANT AUDIT
INDICATORS TO FORMULATE QUALITY METRICS QUALITY
METRICS BASED ON AUDITABLE STANDARDS gt PRODUCED
BY NICE AGREED LOCAL, REGIONAL NATIONAL
METRICS
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NHS CLINICAL LEADERS NETWORKSHOULD HELP TO
PROVIDE
QUALITY, SAFE CARE WITH GOOD PATIENT
EXPERIENCE

THANK YOU