20 January 2012 WMQI Measuring and improving quality in neonatal care

20 January 2012

WMQI Measuring and improving quality in neonatal care

www.wmqi.westmidlands.nhs.uk

“We can only be sure to improve what we can actually measure”

Talk• Who are we?• What we have been doing?• Why we are doing it?• The future




• Lord Darzi, High Quality Care for All, June 2008



Origins of the quality observatories• “There is clear local support for quality improvement. A

new ‘Quality Observatory’ will be established in every NHS region to inform local quality improvement efforts.”

• “We will also ask each SHA to establish a formal Quality Observatory, building on existing analytical arrangements, to enable local benchmarking, development of metrics and identification of opportunities to help frontline staff innovate and improve the services they offer. “

High Quality Care For All





Approach and principles• Clinically championed Indicators

– No measure about me, without me– Bottom up development not top down

• Developmental not regulation– Metrics not targets– Helpful benchmarking and comparison– Helping clinicians to set their aspirations– Helping patients to compare different providers



Goal• Building clinician championed metrics is an expensive

investment• Takes time to build consensus• Benefit build local engagement with the data

– Closes feedback loop– Why do I both spending time entering the data, never see any

results?• Understanding your performance is crucial



• As Sherlock Holmes says in the Legend of the Copper Beeches: "Data! Data! Data!... I can't make bricks without clay."



Quality Indicators: clinician championed

• Vascular Surgery• Orthopaedics• Urgent care• General Surgery

• Mental Health• Learning Disabilities• Care of the elderly• VTE• Cardiovascular



NEONATAL INDICATORS



The team• WMQI Analyst based at UHBFT• Guided by a group of interested clinicians from across the

West Midlands– Consultants– Nurses– Specialised Commissioners

• Supported by the Staffordshire, Shropshire and Black Country Newborn and Maternity Network Co-ordinator



Journey• Process kicked off in October 2010 with presentation to

Partners In Paediatrics– Neonatalogy– Paediatric Surgery– Paediatrics

• Blank sheet of paper!• Global search for metrics

– Literature and internet• Refined during 2011 in a series of meetings



Building consensus• Workshop held in November• Over 30 from almost all of the Neonatal units• Reviewed the metrics

– Are these indicators clinically useful?– Are there any issues with the data required to measure these

indicators?– How would you like these reported back?– Are there other things that you would like measuring and

reporting on in the region?



Top 3 Priorities

• Mortality• 2 year outcome• Infection/CVL• Morbidity • NEC with surgery• ROP with surgery• Discharged home on

O2

• Clinical Pathways• Transfer• Data Quality• Capacity• Staffing (medical &

nursing)• Temperature



First set of metrics1. Discharged home on O2

2. NEC with surgery3. ROP with surgery• Piloting on 5 trusts

– Data quality• Complete, Accurate, Precise

– Statistical model of casemix adjustment• Review process and results with the steering group for

confirmation before processing



Badger Dataset • Your Clinical dataset • Opportunity to track most interventions on a neonate• Drawbacks are

I. In the ability to track patients once they are discharged from Neonatal care unit

II. No access to complete regional or national dataset• Opportunities are huge for embedding quality metrics

into their dashboards



Going beyond Badger• WMQI has access to the fully linked national dataset

– Birth, A&E, Admission, Outpatient, Death• Provides opportunity to track routinely:

– Survival– On going care post neonatal care

• Elective• Emergency

• Technically simple• Challenge is information governance



Transition• End of SHAs• Reinforcement of the provider-commissioner split• Where next for NHS supported development of metrics

– Provider sponsored?– Commissioned focused?

• Still to find out!• For us means focusing on delivery and sustainability



Summary • Developing clinician championed metrics takes time to build

consensus• Goal of WM work is to build local engagement with data• Challenge is to complete the work• Align to other work streams at NDAU/NNAP and national

dashboard• Build sustainability through quality dashboard on Badger



WMQI• Email: [email protected]• Contact

– Richard: 0121 213 1987– Jag: 0121 695 2460

• Follow us at @wmqi• Register at the website for updates and news of

events www.wmqi.westmidlands.nhs.uk

Documents

20 January 2012 WMQI Measuring and improving quality in neonatal care