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Local and national uses of data
Ramani Moonesinghe, Associate National Clinical Director for
Elective Care, NHS England
National data, local improvements?
Ramani Moonesinghe
Associate National Clinical Director for Elective Care, NHSE
Director, NIAA Health Services Research Centre, Royal College of Anaesthetists
Nuffield Trust /Health Foundation Data event
1 Nov 2016
Warning
• I’m going to be controversial
• All views are mine and not attributable to: – NHS England
– Royal College of Anaesthetists
– The Health Foundation
– The NIHR
– Anyone else quite frankly!
What are we currently using data for?
• Monitoring / inspection: – Care Quality Commission
– Quality accounts
• Improvement – National clinical audits
– NHS Right Care
– Getting it right first time (GIRFT)
CHALLENGES IN USING DATA
1. ACCESS AND DISSEMINATION
The data are all there!
• NHS Right Care: – By CCG
– Atlases of variation
The data are all there!
• GIRFT: – Trust and specialty level – Seeks to change practice, (e.g. prosthesis choice) in order to
improve patient outcomes (e.g. infection rates). – Data synthesis, “deep dive” visits and recommendations
– Follow up with “implementation tools”
• i. regular publication of provider-level performance data via a dashboard (clinical level intervention);
• ii. tailored written feedback to underperforming providers (top down intervention) and
• iii. commissioning levers to change behaviour (commissioner level intervention).
Top down vs. bottom up?
• Top down? – NHS England / Dept of Health / CQC
– External organisations e.g. Dr. Foster
• Bottom up? – National Clinical Audits
2. FACE VALIDITY
Face validity
• Structure and process – Validity of metrics
– Accuracy of data
– Trust in the data e.g. case ascertainment rates
• Outcome and cost – Risk adjustment
– “Value” = quality / cost
Value: NHS Rightcare definitions
• Allocative value – how well are assets distributed between population sub-sets – Between programmes e.g. between cancer and respiratory – Between systems in each programme e.g. between asthma and
COPD in the respiratory programme – Within each system, e.g. between prevention, drug therapy,
rehabilitation and long term care for people with COPD
• Technical value: how effectively do allocated resources achieve valid outcomes for all the people in need within the population – different from efficiency
• Personalised value: how well does an outcome relates to the values of each individual
Efficiency vs. value?
• Knee arthroscopy – Efficient (lots of surgery)
– ? Value (?benefit)
– ? Savings to be made through shared decision making etc?
3. IMPROVEMENT BASED ON DATA
Supporting local improvement
• What are we aiming for? – Top quartile?
– Avoidance of being an outlier?
– Continual improvement?
– Striving for perfection?
• Do our methods support local improvement? – Evidence-based approached
– Where are the resources?
Quality improvement cycle for national audits
Evidence-based Improvement principles: Ivers et al Cochrane SR 2014
Data should be valid & recent
• Behaviour should be targeted which is likely to be amenable to feedback
• Recipients should be capable and responsible for improvement
• Presentation should be multi-modal including either text and talking or text and graphical materials
• Delivery should come from a trusted source
• Feedback should include comparison data with relevant others
• Performance target should be provided
• Goals set for the target behaviour should be aligned with personal and organizational priorities
• Goals for target behaviour should be SMART & have clear action plan
4. MAXIMISING OPPORTUNITIES
Maximising opportunities
• Big resource investment – National clinical audits
• NHSE budget
• local investment
– Do we get maximum value?
– Monitoring vs. improvement?
• Combining datasets
• Breaking specialty silos
