Dr Foster at the NHS Health and Care Innovation Expo 2016

Over the past couple of days, a team from Dr Foster has been at the NHS Health and Care Innovation Expo 2016 in Manchester.

As well as hearing keynote speeches from NHS England chief executive Simon Stevens and health secretary Jeremy Hunt, some top-level panel discussions on the future direction of innovation in the health service and meeting potential customers, we also gave three well-attended presentations looking at the uses of data analytics in the modern NHS.

Dr Foster’s business director for the London region, Thibaut de Cours, spoke alongside Croydon Health Services NHS Trust’s head of performance, Owen Chinembiri about improving hospital clinical and operational productivity through analytics.

Thibaut explained how Dr Foster is working with Croydon to build a ‘data warehouse’ to collect ward level information to bring regularity to their outpatients operations scheduling, as well as putting in place My Practice, a tool that allows clinicians to directly enter data and instantly benchmark their performance against peers in their own hospital, across the UK and even against some of the best performing international hospitals.

Mr Chinembiri said the experience of working with Dr Foster had been extremely positive, with the team developing a bespoke solution that fitted Croydon’s requirements – you can find out more in our video below.

Scorecards – what are the pitfalls?

Our second session, chaired by Telstra Health’s Managing Director, Shane Solomon, featured an assessment of the usefulness of scorecards for assessing organisational quality, given by Dr Foster head of commissioning business intelligence George Murgatroyd and senior analyst Nisha Rajendran.

George recounted how Dr Foster participated in a piece of work for NHS England last year to understand how it might be possible to produce a robust scorecard for GPs, concluding that only a small number of metrics were fit for purpose.

More recently, working with CCGs in Yorkshire and the Humber as part of the eMBED Health Consortium, he underlined the complexity of producing useful scorecards by pointing to the 584 indicators across the seven frameworks to judge the quality of primary care. Indeed, it’s estimated that the NHS Digital (formerly HSCIC) monitors around 3,000 indicators in total.

“There are just too many data points and metrics,” George explained. “The NHS is good at adding more and more measurements, but not particularly good at reviewing and removing metrics and getting back to basics.”

Nisha added that it was critical to appraise the statistical, methodological and scientific robustness of data, highlighting how in a recent assessment of the cancer prevalence metric it was discovered that cancer rates were being underestimated by around 70%, putting a question mark over the metric itself. It was important to follow best practice methods for scrutinising data, she added, and this process could lead to the abandoning of less robust or ‘duplicate’ metrics.

George added that the time delay between data capture and publication could often be significant – up to two years in some cases – meaning that some indicators effectively described a historic snapshot that could give a misleading impression of actual performance by the time they are made public.

Shane Solomon wrapped up the discussion with an anecdote about his time as undersecretary for health at the Victorian Department of Human Services in Australia.

Embarking on a programme of reform to metrics, Shane said the initial service agreement with hospital chiefs on the metrics to be monitored stretched to 1,000 pages long. Calling the creation of new KPIs a ‘health system management disease’, he said that in Victoria they had been able to reduce the number of key indicators – for which people could be sacked for significant underperformance – to just 22.

“It’s all about focus,” said Shane. “We’re human beings and we have to make things simple enough so that we can decide what is success and what is failure.”

Reforming metrics meant finding KPIs that were ‘drivers’ of outcomes, he added. “Your outcome might be to reduce Healthcare Associated Infections (HAIs). A driver might be how many people were participating in the handwashing regime because you believe hand washing will reduce HAI rates. Choose a very limited number of indicators and choose drivers that will drive the final outcome that you’re trying to seek.”

Using analytics to tackle patient flow problems

Our final event featured contributions from Thibaut de Cours, Sasha Kurasevic of the Nuffield Trust and Patrick Turner from Hillingdon Hospitals NHS Foundation Trust.

Thibaut highlighted the success of Patient Flow Manager, a new product Dr Foster will be marketing in the UK. Developed in Australia by HealthIQ, another constituent Telstra Health company, it’s in use in roughly 50% of Australian hospitals to help them manage demand and capacity and ensure discharges occur promptly by identifying blockages in the system.

Setting the scene, Sasha Kurasevic said that the implications of an ageing population and increasing co-morbidity were creating a strategic problem not being reflected in planning by hospital trusts. Demographic realities, with 10% of patients (many very elderly) taking up 65% of bed days and a rising cohort of over-85s, indicated that 9,500 extra hospital beds would be needed across England  by 2020.

Patrick Turner, who spent part of his career at the 1,400-bed Royal Melbourne Hospital in Australia, said that before implementing Patient Flow Manager, the hospital didn’t have a clear understanding of patient journeys. Monitoring and performance management systems were decentralised, with many highly manual systems.

With Patient Flow Manager, the hospital had a centralised ICT enabler that could provide it with real-time data at the point of patient care so clinicians could see what was going on and potentially holding up the next stage of their journey, such as diagnostics or point of discharge barriers. Wards now have digital ‘journey boards’ as standard, allowing clinicians to see at a glance where every patient is on their pathway through hospital.

In just a couple of years, the hospital was able to increase its performance against a national benchmark for discharges from around 40% to approximately 75%, meeting the target.

You can watch a round up of Dr Foster’s presence at Expo in the video below.

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