knowledge matters v10 i2

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Volume 10 Issue 2 March 2016

Welcome all to another seasonal issue of Knowledge Matters. Easter is a time of rebirth and growth (and also chocolate), and this is no less true for the Quality Observatory. Some of you know that Kate Cheema, one of our long standing stalwarts of team QO, is moving onwards and upwards to new challenges, and as a result the team are taking the opportunity to shuffle around some workloads and give some people new growth opportunities.

Talking of growth we’re keeping ourselves busy at the QO—we’ve been recommissioned by NHS England to carry on with the Friends and Family Test dataset, and our Maternity Dashboard has had a lot of interest, especially in the wake of the recently published National Maternity Review. You can read about all of this inside this issue.

Other delights in this issue include a review of the Public Health Intelligence training provided by Public Health England, that some of the team went on. Nikki has been working closely with some of the Vanguard CCGs which has informed her article on collecting new

data for measurement.

Hope you enjoy this issue of Knowledge Matters. If there’s a burning topic you want to raise, or a piece of work that you want to show off then please let us know and you could contribute to future issues.

Have a relaxing (and chocolate filled) Easter holiday, and we’ll be

with you again in the summer.

Welcome to Knowledge Matters

Inside This Issue :

The South East Maternity Dash-

board

2 Friends and Family Test Contract 8 Public Health Intelligence

Training

11

Collecting New Data for Measure-

ment

6 Patient Insight & Feedback Con-

ference

10 News and updates 12

2

[email protected] www.QualityObservatory.nhs.uk

Long term readers may well remember the Maternity dashboard that we used to produce when we

were part of the old Strategic Health Authority, it was a big, clunky and colourful beast. It was useful,

but was limited, and severely in need of an overhaul.

The South East Strategic Clinical Network (SCN) thought so too, and have decided to revitalise the old

dashboard and re-build it with a greater focus on outcomes and how it can be used to show the kind of

activity that can be influenced by maternity professionals at a local level.

For many months the SCN went through a process of working through ideas with clinicians and other

senior staff across the Kent, Surrey & Sussex patch deciding what metric were needed, how they’re

going to be collected and how they are to be presented.

One of the disadvantages of the old collection methodology was that it put the entire onus on the trusts to collect the information every month. Whilst it is true that much of this information was being

collected anyway, getting from whatever system it was in then importing it into the dashboard was a labour intensive pro-cess, and not everyone was able to pro-vide everything every month. It was posit-ed that actually much data could be ob-tained by one person doing everything from a central repository of data. Rather helpfully the Royal College of Obstetri-cians and Gynaecologists (RCOG) have come up with a range of maternity indica-tors that they have extracted from HES. https://www.rcog.org.uk/en/guidelines-research-services/audit-quality-improvement/clinical-indicators-project/

The South East Maternity Dashboard

By Adam C. Cook, Specialist Analyst

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We have taken these as the core indicators for our new dashboard, and RCOG have supplied their

methodology so that we could recreate their work. This means that not only can we update the majori-

ty of the data monthly, but it only takes one person to do it, and every organisation can be updated. It

also means that we can also use the national data as a

comparator.

The other advantage that the RCOG indicators have is

that they have a standard nationally agreed definition,

and therefore data is replicable and comparable be-

tween organisations. We recognise that local organisa-

tions may operate to slightly different definitions on

some indicators – however it was decided that coming

to a consensus around some of these may well be diffi-

cult and time-consuming, so skipping that step and us-

ing nationally agreed data has enabled to project to

move on at a quicker pace. A detailed definition page is

included in the website.

The issue with HES data for maternity is that many

people feel that is doesn’t accurately reflect

the data that is held within local maternity

systems. This is obviously an issue that

needs to be addressed if maternity profes-

sionals feel that they need to be able to trust

the system To this end we have built in a ca-

pability whereby they can add in their own

data for all metrics and this will generate

comparator charts between their data and

the centrally extracted data. This will provide

hard evidence of what differences there are

and what steps need to be taken to address these issues, so that data quality is something that can be

relied upon.

Having a separate data collection is also useful because there are a number of indicators that cannot

be reproduced by centrally collated information systems, and we have to be reliant upon the trusts to

provide this data. We felt that this was important as it gives a more rounded picture of what’s going on

at the trust. Currently this data is submitted direct to the QO on a spreadsheet and we upload this to

the site.

The site is split into different sections. The homepage provides and introduction to the project and has

a maps showing the locations of maternity units across South East Coast – these have clickable icons

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which will provide summary statistics in a pop-out box.

There are two aspects to the site a public facing

part with data that is in the public domain, and a

site that only people who have registered with a

valid NHS e-mail address can see.

The National Maternity review, which has recently

been published (more details in the news pages of

this newsletter) had an emphasis on mothers being

able to access useful information to help decide

where they are going to give birth, or to reassure

them of the quality of care at their local trusts.

The first bit of the public data comes from the pop-

out box accessed from the front page map. This

shows data for the most recent 12 months for the chosen trust and displays an infographic of how

women may expect to deliver should they go to that trust. From this page more a detailed service

overview can be accessed in depth with further infographic. This includes things like induction, as-

sisted labour, Friends and Family test and complaints. Detailed definitions of clinical terms are

linked to from NHS Choices, so that the public can understand the nuances of the terminology.

This data is also available to NHS personnel, however when they login the main dashboard page

becomes visible.

5


The main view of this shows all the indicators with a run chart and funnel plot for each one. Trusts

can be selected from a drop down menu at the top of the page.

The HES data is shown by

default on the line chart, but

other lines can be added.

This includes the National

average, the Kent Surrey

and Sussex average and

the equivalent data from the

trusts own maternity sys-

tems. One of the ad-

vantages in this is that trusts

can compare their own data

against HES and use it to

check data quality. This

could be used as the first step on the road to get greater alignment between HES maternity data and

local maternity system data.

Users can see the individual charts in greater detail by clicking on them. This will show a larger view

of the chart, along with three others that are related to that measure. This is to ensure that people

looking at the data are not just looking at activity in isolation, but are thinking of the bigger picture.

Improvement in one area may have a corresponding worsening in another area, so it is always im-

portant to look at these

things together. This view is

available for both run charts

and funnel plots.

Elsewhere on the site there

is section for help and sup-

port. This includes things like

how to interpret the funnel

plots, bug fixes, and user fo-

rums so that experiences

can be shared easily.

If you are interested in hear-

ing more about the maternity

dashboard please contact Adam Cook

[email protected] or you can take a look at public facing side yourself by going to: http://maternitydashboard.secscn.nhs.uk/

6


Collecting New Data for Measurement: a few basic rules and suggestions By Nikki Lawford, Specialist Analyst

Although it can sometimes feel as though we are awash with data in the NHS, there will always be

occasions when you need to measure something new, possibly activity or cost related or maybe a

qualitative area such as patient experience. Whether you are an analyst, part of a service re-design team,

a project manager or just someone trying to evidence how effective your work is, there are a few things to

bear in mind before you get started.

Focus your data needs

• Think carefully at the outset what you need to know and the message or story you hope to convey at the

end. Careful thought at this stage can save a lot of frustration and additional time later on!

• Consider the eventual reporting of your data and who the audience will be. For example, are you just

hoping to broadly demonstrate that you have achieved what you set out to do, or will you want to

provide regular feedback along the way to various stakeholders, staff or maybe patients?

• Wherever possible, try to collect exactly and only the data you will need. You need to be sure that all

the essential elements have been covered, however your data is much more likely to be consistent and

accurate, the less you try to collect.

What exactly do you need and not need to know?!

A ‘right first time’ approach

• Identify clearly who should, and should not, be

included in your data collection - think about age groups,

diagnoses, providers, type of patient contact, day/time of

activity etc.

• Although it may change over time, there is likely to be

a core set of metrics that will be needed in order to

demonstrate success. Think about short, medium and long term aims.

• How often will data be collected and reported?

• Who will record your data? Will it be best recorded by front line staff at the point of contact with the

patient, or would it be better to assign someone to collect the information later on? Get agreement early

on from those who will undertake the data collection.

• Once data has been collected ‘on the ground’, agree what will happen to it next - will it be sent on to a

manager, administrator or Business Intelligence contact? If so, how and how often?

• Ensure the complete process is in place prior to starting data collection, otherwise information could get

lost!

Simple categories

• Narrow these down to the really important ones and use ‘other’ for the rest

• Don’t try and capture data for every disease/condition/diagnosis individually - just

the ones where your project aims to show improvement

• For example, if your workstream is focused on respiratory diseases but not

particularly on pneumonia, maybe just give options for Asthma, COPD and Other

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Simple responses

• Try to keep possible answers to yes/no, a rating of 1-5 etc.

• This limits potential differing interpretations of responses and ultimately increases

the likelihood of getting meaningful analysis from your data

• Simplicity is particularly important if you are collecting patient experience data, or

if it will be collected manually and entered electronically later on

• Devise a separate way to handle any comments or anomalies

Test your new data collection procedure!

• Wherever possible, involve a staff member who might typically be asked to

record the information and test it on someone who might be asked to respond

• Make sure everyone involved fully understands what is required

• Check that the broader data collection process works efficiently - in other

words, that all your data ends up where it ultimately needs to be

• Ask a friendly local analyst to check that they can produce something

meaningful from the test data

• And then check it will definitely answer the question you are trying to answer!

Information Governance

Before launching your new data collection process, be sure that it passes all necessary IG scrutiny! You may

need to undertake a Privacy Impact Assessment in advance, or new data sharing agreements may be

needed before data can be shared across organisations.

A note about proxy measures

It may be that you are unable to collect exactly the data needed to tell the story you wish to. If so, consider

using a proxy measure. In other words.... when you can’t measure exactly what you need, measure what

you can. For example, instead of reporting on a specific group of patients, maybe you could use available

data for a pre-defined age group and/or geographical area, with a specified set of co-morbidities, and so on.

It may not give you absolute certainty of the outcome of your project but it might give a reasonable degree of

confidence that you achieved your aims and also evidence any wider ‘knock-on’ effects. It may also be

helpful to use a proxy measure until you have enough of your new data, just to show you are on the right

track.

In summary

• Aim to get it right first time as much as you can

• Keep it focused

• Keep it simple

• Check IG requirements

• Test the process, and.....

... check you are definitely measuring what you need! Re-visit your original aims and double-check. And, if

you can’t measure what you need, measure what you can.

If you would like any further information please do get in touch at [email protected]

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The Quality Observatory are delighted to have retained our contract with NHS England for our work around the Friends and Family Test, following a frantic festive season of filling in tender documents and an interview for Rebecca and Kate in Leeds in January. What do we do? Our work falls into 2 main areas: firstly we manage the data processing for all of the collections, dealing with any issues uploading the returns, chasing up missing returns, validating the data and checking out any oddities in the data with providers and finally producing the outputs that get pub-lished on the NHS England website and the data that gets sent to other people for their use e.g NHS Choices.

Secondly we also run the national FFT help desk, dealing with any questions around anything to do with FFT so if you have an FTT related query and email [email protected] or call 0113 824 9494 you'll be speaking to one of our lovely FFT team.

Who are the FFT team? There are 5 of us in the Quality Observatory's FFT team: Rebecca (me) I nominally manage the team but everyone else knows far more about FFT than me! Feel free to contact me though for any FFT related issues or questions or if you want to learn more about what we do: [email protected] Dani, Becki, Liam and Trishna are the experts in all things FFT related and know all of the many guidance documents inside out. So if you have an FFT question, do contact us on the details above!

Friends and Family Test Contract

By Rebecca Matthews, Specialist Analyst

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Rebecca and Kiran spent a day in Leeds on 17th March exhibiting

at the Patient Insight and Feedback Conference. The conference

was aimed at NHS staff leading patient insight and experience

work in both provider and commissioning services and provided an opportunity to look at what has

been learned so far from the Friends and Family Test and other sources of patient insight. Speak-

ers at the event included Anu Singh, Director of Patient and Public Participation and Dan Wellings,

Head of Insight and Feedback at NHS England and also included a session with four patient panel

members.

The winners of the FFT awards were also announced at the conference - the full list of winners is available here: https://www.england.nhs.uk/2016/03/fft-awards-patient-feedback/

The Quality Observatory were one of

12 exhibitors at the conference and

we took the opportunity to demo our

Insights platform and Friends and

Family Test Analysis website, as well as running an FFT data drop-in surgery throughout the day,

giving advice on how (and how not) to use your FFT data. We also had time for a quick photo with

Monkey from Monkey Wellbeing!

Patient Insight and Feedback conference

‘It is a capital mistake to theorize before one has data. Insensi-bly one begins to twist facts to suit theories, instead of theories to suit facts.’- Sherlock Holmes

As with so many things, Sherlock understands what the QO is all about; evidence based decision making, based on reliable, and incidentally beautiful, data. It’s a message I’m going to be taking out even wider in my new role as Head of Transfor-mation Analytics for South, Central and West CSU. It’s going to be wrench leaving the QO not least because the very lovely people in it, past and present, have all helped me learn so much. I’ll still be based at QO Towers though, so at least I’ll still get to see everyone’s smiling faces occasionally! The new role will be a challenge, not least with the current expectation of the NHS delivering huge savings, but there is no question that my time at the QO will have given me the very best possi-ble preparation for it. I look forward to being merely a contrib-utor to Knowledge Matters and seeing the QO team continue to go from strength to strength.

Goobye from Kate...

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Public Health Intelligence Training by Becki Ehren

A couple of us at the Quality Observatory were invited to attend a pilot course put on by Public Health

England to provide training on public health intelligence. The course ran over 5 days, each covering a

different topic ranging from the background of public health and the role of PHE, Epidemiology, health

inequalities, health patterns and displaying the information (to name a few).

The training provided a great insight into where

the information comes from, how it is analysed

and what it is used for. One of my particular

favourite parts was the section on Epidemiology

and how Field Epidemiologists are vital in helping

counties and organisations to minimise the

negative impact on people’s lives during an event.

This part of the course also covered how it is so

important to consider the wording and imagery

that is used when data is published because

everyone interprets things differently. For

instance, the media will often use the term

‘epidemic’ to get a better reaction and to create better headlines, however this is the same as referring to

something as a cluster or an outbreak, which I think we can agree doesn’t sound half as dramatic as an

epidemic! The course also covered how it is really important to remember that how you use infographics

is very important due to the sensitivity of some subjects, and also to remember that whilst we may view

an image one way, a member of the public who does not have an analytical background may see it

completely differently.

It was great to meet people who work in various

roles that use public health data – some of who

worked in completely different backgrounds, so I

found it really useful to hear their view on some of

the data that is published. Attendees varied from

analysts, council workers, NHS staff, insurance

advisers and many others. Some of the training

that we covered involved looking at different types

of graphs and thinking about how even the

smallest change such as the colour of a line can

have a huge impact on how the target audience

receives the information.

One of the most useful tools that we were shown is

‘Fingertips’ by PHE. It’s great for looking through specific data in order to compare local areas against the

England average. You can change the way the data is displayed through various charts and graphs, and

the tool allows you to select additional comparatives to look deeper into the data. If you are interested,

the link to the site is http://fingertips.phe.org.uk/

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CAS

The Central Alerting System (CAS) is a web-based cascading system for issuing patient safety alerts, important public health messages and other safety critical information and guidance to the NHS and others, including independent providers of health and social care.

Alerts currently available include safety alerts, CMO messages, drug alerts, missing patient alerts and medical device alerts.

We currently provide the service for the South and South West regions, with Devon and Cornwall being our most served areas. Alerts are sent to a number of service providers including GP practices, pharmacies, dental practices, substance abuse clinics and more.

Further information can be found here:

https://www.cas.dh.gov.uk/Home.aspx

CAMHS Modelling Tool

The CAMHS Strategic Modelling Tool has been created to help plan and improve the commissioning and delivery of Children and Adolescent Mental Health Services.

The scope for the model is across health, education, third sector and local authority services.

The tool is designed to enable a ‘whole system’ view of CAMHS in an area, regardless of the commissioning / funding route and the setting and provider of the service. Providers can enter a variety of figures into the tool and be provided with information such as how to optimise patient appointments based on waiting time, staffing cost estimates, yearly commission activity estimates and more.

Further information can be found here - http://www.scwcsu.nhs.uk/about-camhs

National Maternity Review

This review by Baroness Julia Cumberlege was releasesd in February of 2016. It says that:

”Maternity services in England must become safer, more personalised, kinder, professional and more family-friendly. “

Hopefully the South East Maternity dashboard goes some way to helping these ideals become reality. To read more about the report go to: https://www.england.nhs.uk/2016/02/maternity-review-2/ Or you can download it from: https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf

Birthdays Showing the kind of remarkable efficiency for which the QO is known Aleksandra and Charlene had their birthday on the same day in February. Here there are enjoying traditional QO Birthday goodies!

QO Latest Projects NEWS

Knowledge matters is the newsletter of the NHS Quality Observatory. To discuss any items raised in this publication, for further information or to be added to our distribution list, please contact us.

Hosted by: South Central and West Commissioning Support Unit

E-mail: [email protected]

To contact a team member: [email protected]

We're here to say goodbye to Kate, and wish her well in her endeavour,

We'll miss her when she is gone, and collectively be less clever.

She's Wrestled with performance, and sent returns away,

And she's made up targets for C-Diff and MRSA.

She's been the leading light of the Safety Ther-mometer,

The spreadsheets and the website they just could not beat her.

Her advice has been relied upon in matters quite statistical,

Always true, and thoughtful, and never egotistical.

Thanks to Kate for her good humour and her sense of fun,

And her sense of perspective in getting the job done.

We'll see her round the office, she's not going far away,

So will still enjoy her company, just not every day.

Good luck to her in your her job, we know that she'll be great,

We send her off with all our love, goodbye, and good luck to Kate.

In above grid-shading puzzle, each square is ei-ther black or white. One of the black squares has already been filled. Each row or column is labelled with a string of numbers. The numbers indicate the length of all consecutive runs of black squares, and are displayed in the order that the runs appear in that line. For example, a label "1 2 3" indi-cates sets of one, two and three black squares, each of which will have at least one white square separating them. The final image, when scanned will reveal a hid-den message. Good luck!

An Easter

Puzzle

For Kate

knowledge matters v10 i2

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