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Measuring Clinical Performance in Secondary Care Bill Shields Director of Finance & Performance Portsmouth Hospitals NHS Trust

Measuring Clinical Performance in Secondary Care Bill Shields Director of Finance & Performance Portsmouth Hospitals NHS Trust

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Measuring Clinical Performance in Secondary Care

Bill Shields

Director of Finance & Performance

Portsmouth Hospitals NHS Trust

Measuring Clinical Performance in Secondary Care

• Where are we now?

• Why is measurement important?

• Future developments

• Current issues

Where are we now?

• The Impact of Payment by Results means:

Activity volumes = Income

• Star Ratings:

Primary Targets about Waiting Times

Secondary Targets include some indicators of clinical quality

• Measurement of outputs NOT outcomes

Elective Inpatient Activity (FFCEs)

-500

0

500

1,000

1,500

2,000

Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05

Profile

Actual

Cum Var v Profile

Day Case Activity

-1,000

-500

0

500

1,000

1,500

2,000

2,500

3,000

3,500

Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05

Profile

Actual

Cum Var v Profile

Emergency Inpatient Activity (FFCEs)

-1,000

0

1,000

2,000

3,000

4,000

5,000

Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05

Profile

Actual

Cum Var v Profile

All New Outpatient Attendances(inc non-GP referrals)

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05

Plan

Actual

Cum Var v Plan

NEW GP OUTPATIENT WL Shape

0

200

400

600

800

1000

1200

1400

1600

1800

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Shape

Change

INPATIENT & DAY CASE WL Shape

-100

0

100

200

300

400

500

600

700

800

Shape

Change

Primary Star Targets

OUTPATIENT WAITING

INPATIENT WAITING

12 HOUR TROLLEY WAITS

4 HOUR A&E WAITS

BOOKING

2 WEEK CANCER WAITS

HOSPITAL CLEANLINESS

FINANCIAL PERFORMANCE

Secondary Star TargetsCLINICAL FOCUS:

Thrombolysis within 30 mins 5Child Protection 3

Clinical Governance 5Clinical Negligence 3

Participation in Audits 5Deaths within 30 days of heart bypass op NA

Deaths following selected non-elective surgical procedures 3Emergency Readmissions (Adults) 3

Emergency Readmissions following # hip 3Stroke Care NA

Infection control procedures 4"Winning Ways" 5

PATIENT FOCUS:

4 hour A&E admission waits 2Patient Survey - info/choice 3

Patient Survey - clean comfortable friendly 3Patient Survey - building relationships 3

Patient Survey - safe quality co-ord care 3Patient Survey - Access & waiting 3

Better Hospital Food 3Breast Cancer treatment <1mth from diagnosis 3Breast Cancer tTreatment <2 mth from referral 3

Cancelled Ops 4Day Case booking 5

Delayed transfers of care 2Patient complaints % resolved <4 weeks 2

heart op waits NA6 month inpatient waits 3

13 week outpatient waits 4

Secondary Star Targets

Benchmarking

• E.g. Day Case Rates; LoS; Beddays; mortality

• Sources include:– CHKS– Dr Foster– Performance Investigator

Standards for Better Health

• NHS Performance Rating developing beyond Stars

• Less Quantitative measures of waiting etc

• More holistic view of all aspects of NHS Organisations

• More on Quality of care and Patient Experience

Standards for Better Health

• New Framework for monitoring NHS performance• Core and Developmental Standards organised into the

following domains:• Safety• Clinical & Cost Effectiveness• Governance• Patient Focus• Accessible & Responsive Care• Care Environment & Amenities• Public Health

Current Issues

• Data Quality– Especially clinical coding – completeness, accuracy

and depth

• Credibility and relevance to Clinicians– Poor data quality prevents proper Clinician

Engagement

• Statistical significance– Improving methods for indicating whether “outliers”

are significant– Especially important for “alerts”