Promoting quality for better health services

Surgeon-level outcomes

Where next?  

Ben BridgewaterHQIP Director of Outcomes Publication

Rebecca CosgriffHQIP Outcomes Publication Project Manager

Outline

• Background

• Looking ahead

• Group discussion

Background

• In December 2012 NHS England asked HQIP to manage the publication of procedure numbers and survival rates from ten national clinical audits by summer 2013

• Time from Outcomes Publication team appointment to publication = 3 months!

Background

Adult cardiac surgery Orthopaedic surgeryBariatric surgery Thyroid and Endocrine 

surgeryColorectal surgery Upper gastro-intestinal 

surgeryHead and Neck surgery Urological surgeryInterventional cardiology Vascular surgery

The ten specialties

Publishing consultant data: Aims

• Improve the quality of care

• Help patients make informed decisions

• Improve monitoring and governance

• Reassure that the standard of clinical practice is being actively monitored

• Provide evidence for Revalidation

Case study

• Hawthorne Works electric factory wanted to know if workers performed better with higher or lower levels of light

What do you think happened when the factory lights were turned up?

What do you think happened when the factory lights were turned down?

Case study

Action ResultLights turned up Productivity improvedLights turned down  Productivity improvedExperiment ends Productivity returns to ‘normal’

The act of measuring results independently triggered an increase in productivity (The Hawthorne Effect)

Challenges• Timescales• Professional buy-in (consultant vs. team)• Dataset issues (e.g. No GMC code)• Validation• Risk adjustment• Presentation format• Communications• Multiple stakeholders

Consent• Legal advice = Best practice to seek consent• ~3,500 consultants in total• High response/consent rate brings public

interest clause into effect• Outcome

– 82% response rate with >99% of respondents consenting

– 21 non consenting names and rationale published on NHS Choices

Publishing consultant-level data

• All ten audits have now published

• Hub page: www.nhs.uk/consultantdata

• 21 non consenters; none ‘outliers’

• <10 outliers in total– Reassurance that standard of care is high

What information is available?

Where next?

Where next?

• Nationally– Minimum requirements for reporting

• More outcomes measures, regional searches, patient input etc.

– More audits

– Integrated reporting via NHS Choices

– Longer data collection/validation timeframes

– Consent unlikely to be a requirement

Where next?

• Local requirements– Use of data for revalidation– Resources/time for data entry and

validation– Participation in all Offer 2 audits– Dialogue with HQIP

Any questions?

Discussion

• Number 2’s: Move tables!• On your tables

– Introduce yourselves– Discuss for 15 minutes:

• Have you used the consultant-level analysis locally? If yes, how? If no, why not?

– Appoint a spokesperson and a secretary to feed back your best answer for each point