The evolution of Dr Foster

Dr Foster's attendance at the NHS Health and Care Innovation Expo 2016 marks a new phase in the evolution of the organisation.

Dr Foster will be among the hundreds of exhibitors flocking to Manchester for this year’s NHS Health and Care Innovation Expo on September 7-8. The Expo is NHS England’s foremost annual event for showcasing exciting new developments, as well as for taking stock of the health service’s progress.

This year’s keynote speeches feature a roll-call of the great and good of healthcare, from NHS England’s chief executive Simon Stevens and medical director Sir Bruce Keogh, to US digital health guru Prof Robert Wachter and Chief Nurse Jane Cummings.

For Dr Foster, it will be an opportunity to inform visitors about its evolution since joining the Telstra Health family in April last year. In the intervening period, the company has been implementing an ambitious change programme which has seen work undertaken to improve its existing suite of products and services and develop new tools to enable NHS customers gain an even deeper understanding of data to deliver better quality and more efficient patient care.

For new Chief Executive, David Rose, Expo will be a chance to show the world the metamorphosis of the ‘old’ Dr Foster into a company entirely built around collaboration with customers.

With a 20-year career within the NHS, including chief executive roles in Hereford and Warwickshire, Mr Rose brings an insider’s view of what NHS organisations want and need from their data analytics.

A significant development from the company’s perspective is that it will no longer publish the Hospital Guide, the seminal annual publication which helped establish Dr Foster’s profile in the healthcare sector in the early 2000s. The reasons for this are straightforward, according to Mr Rose.

David Rose, Chief Executive of Dr Foster

“When we were established in 2001, there was a real problem with openness and accountability in the NHS,” he says. “Dr Foster set out to shine a light on performance, using national data to compare mortality rates across hospital trusts. This was hugely important in improving public confidence in healthcare quality, at a time when national scrutiny of performance was under-developed.

“However, our job is not to be a regulator,” he adds. “There was a pseudo-regulatory role in telling people how they were doing, but the world of regulation has moved on dramatically [for example with the creation of the Care Quality Commission and NHS Improvement].

“As someone who worked in the NHS for many years, it sometimes felt like Dr Foster was a campaigning organisation, but we’re not. We are all driven by a desire to see healthcare improve but we’re not a statutory body. In future, we’re much more concerned about being seen as a trusted partner to help healthcare organisations drive improvements rather than an observer and commentator on quality of care.”

For Mr Rose, the experience of turning around NHS trusts was a formative one that continues to inform his perspective on how the NHS needs to change to create truly integrated care pathways that deliver better outcomes for patients.

As chief executive of the Primary Care Trust (PCT) covering Warwickshire from 2006-2008, he oversaw the organisation’s transformation into ‘NHS Warwickshire’, changing the role of the commissioning body from a passive payer into a proactive organisation seeking the best outcomes for its population. Despite the abolition of PCTs and creation of Clinical Commissioning Groups under the reorganisation of 2010, Mr Rose believes this model acted as a blueprint not just for other PCTs at the time, but also presaged the move to population level improvement planning, illustrated most recently in the development of Sustainability and Transformation Plan (STP) ‘footprints’.

Recalling his time in Warwickshire, Mr Rose says: “We set out our stall from day one that the job of a commissioner is to use the money given to them to have the biggest impact on their population. Commissioners are system leaders in terms of deciding what the model is and having contracts with providers to deliver to certain standards, not just handing out money to whoever was currently providing services.”

New tools for modern healthcare organisations

This change of emphasis is being reflected in Dr Foster’s new product offering.

Its new commissioning business intelligence tool Commissioning Insight Manager has been co-created with commissioners from the 23 CCGs in Yorkshire and the Humber. Working as part of the eMBED Health Consortium, which was appointed to NHS England’s Lead Provider Framework for support services in early 2015, Dr Foster has spent six months designing a tool to meet the needs of modern commissioners.

This featured a co-design workshop in Leeds held in April this year where 70 representatives from the CCGs joined Dr Foster’s development team to outline what they wanted from the new tool and how it could simplify the task of obtaining and analysing information from disparate datasets used to monitor nearly 600 metrics.

“The value Dr Foster can add in the future is by helping the health system deeply understand the performance and value for money of its clinical services,” says Mr Rose. “In the case of commissioning, that means taking complex, messy and sometimes incomplete datasets to answer sophisticated questions about how well organisations are doing in caring for patients and you can only do that by working with your partner organisations. You have to have dialogue about what to investigate and interpret.”

But innovation isn’t limited to commissioning tools. Dr Foster is also pushing the boundaries at the provider end by working collaboratively with clinical teams to develop tools that will facilitate continuous improvement. One result of this work – MyPractice – is providing clinical teams at hospitals in Norwich, Salford and Liverpool with an online tool giving access to procedure-specific scorecards allowing consultants to compare their performance with colleagues and to local and national benchmarks. Importantly, the tool gives access to the patient records so consultants can investigate the data that underpin the metrics.

Mr Rose explains: “Our view is that in the future higher quality care should also cost less. So we’re bringing together individual doctors and clinical teams to identify areas where quality is higher and costs are lower and showing how they can apply those learnings in other parts of the organisation.”

This work is being taken a step further in a unique partnership with NHS Croydon University Hospital. There, Dr Foster is bringing together all of their complex data in a single online platform providing near real-time information on what is going on across the hospital, from A&E through to discharge.

Meanwhile, existing tools Quality Investigator, Practice and Provider Monitor and Hospital Marketing Manager have been given a radical overhaul and combined in a single platform, Healthcare Intelligence Portal. The amalgamation is based on the need for speed – in the past year alone, Dr Foster has improved its ability to process monthly Hospital Episode Statistics (HES) data from three weeks down to just five days. But there will also be increased functionality, making it possible to integrate NHS trusts’ own internal data including from A&E and maternity departments with national data to provide much more immediate analytics to help spot warning signs more quickly and put in place evidence-based solutions.

The new developments are being coupled with a laser-like focus on customer feedback and satisfaction, which is now a central component of Dr Foster’s own performance management systems in line with Telstra’s company-wide ethos.

In Telstra’s home turf of Australia, gathering customer feedback with a view to improving products and services is hardwired into the company’s approach. As detailed in its Bigger Picture 2016 Sustainability Report, over the past year Telstra surveyed more than 27,000 customers on average per day and used their feedback to improve the customer experience. Telstra sees this process as central to encouraging customer advocacy – something it describes as its “number one strategic priority”, in recognition that happy customers are the most powerful brand advocates available.

“Being part of Telstra Health means we now have direct access to innovative companies around the world that are building the digitally-supported healthcare ecosystem that are going to be such a crucial feature of future healthcare,” says Mr Rose. “Telstra is seriously focused on how it can best meet the needs of its customers, with huge investment at all levels to drive that, and that’s challenged Dr Foster to find out what our customers really want and need. Some of Dr Foster’s products were answering the questions of five years ago rather than the questions of today. We’re changing that.”

“For me it’s about continuous improvement,” he adds. “As we get much more frequent feedback and ratings from customers we’re introducing much faster cycles in how quickly we operate. I’m looking for a model where every time we do something for one client we’re building that into the core product for all clients. We are building a portal which is the one place you will need to go to get all the information about your performance.”

The customer view

Dr Foster’s gradual transition to its new identity has been imperceptible to many customers, with Dr Andy Haynes, Medical Director of Sherwood Forest Hospitals Trust, calling it “seamless”.

In the past 18 months, Dr Foster has carried out an external review of mortality rates at the trust, which had been placed in special measures due to several indicators being too high.

“For me, the really important thing we’ve done through working with Dr Foster is converting data into information and intelligence,” says Dr Haynes. “That’s an area that was quite weak in the trust when I arrived two and a half years ago. I think it’s really important for a medical director to get a thorough knowledge of the statistics. I’ve had to help some of my non-clinical colleagues on the executive and the board understand mortality. Getting that fundamental understanding – not just a superficial working knowledge – is very important and Dr Foster has been very supportive in developing that for me.”

Dr Haynes has noticed the increased focus on integrating datasets to provide a more complete picture of care for commissioners and providers alike.

“We’ve had a strong working relationship with our local CCG, which Dr Foster has been supporting,” he adds. “The datasets could have been completely separate, but it’s been really valuable having a common group that explored both datasets and understood what that meant for the trust within the context of the locality. As we move ahead into the Five Year Forward View, where the dialogue beyond acute trusts is really important, that’s been a really good model for me on how we can work differently to share and understand data and produce action plans.”

His view is echoed by Natasha Robinson, until recently Associate Medical Director for Clinical Governance at Northampton General Hospital, with responsibility for audit and monitoring clinical outcomes. She has a background in anaesthesia and is a Fellow of the Royal College of Physicians.

She worked with Dr Foster’s team to directly upload hospital-generated data to Dr Foster’s platform to create an ‘early warning’ metric to rapidly flag up areas of concern.

“The principle is that we will have early warning of any problems that may be arising, we’ll be able to investigate them promptly, we’ll be able to work with our clinicians to implement changes in the service if necessary and – very importantly – we’ll be able to see the impact of those changes and understand whether they’re effective or not.

“I think every healthcare organisation wants to understand its outcomes in real time and the sooner it understands problems, the sooner it can introduce solutions and it needs to be able to monitor whether those solutions are effective and I think this tool offers that opportunity.”

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