Over the years, I have spent a great deal of time talking to chief information officers and heads of information at NHS trusts. One of the clearest messages they send is that monitoring indicators is time consuming.
A brief look at the number of indicators that are routinely monitored gives you an idea of the scale of the challenge. NHS National Standard Contract indicators (such as the four-hour A&E target, cancer waiting times, mortality, emergency admissions and readmissions) aside, the Single Oversight Framework requires the monitoring of 30-plus organisational indicators for the typical acute trust. In addition, the NHS specifies that the 13 national requirements are supplemented by indicators agreed at a local level with commissioners.
Take into account the fact that operational indicators (such as average length of stay) are not only reported at national level to show trust-level variance, but can also be reported at specialty and admission level and this could add a further 40 indicators for the average small to medium-sized trust. That’s just one of the operational indicators.
There are also initiatives and emerging indicators that the NHS will focus on, for example Rightcare and GIRFT that contribute to indicator generation, as organisations seek to replicate and disaggregate information. So, it is easy to see how the total number could reach into hundreds.
The upshot is that we have seen a dashboard industry develop that shows no sign of slowing. Dashboards are helpful – when data is presented in a meaningful way it can help put data into action. All too often, however, dashboards simply present the same information in a different way.
Given the scale of the monitoring effort, I’m not the only one who thinks it’s about time we started to consider what these indicators are actually telling us about quality and outcomes. You could argue, for example, that the four-hour A&E target doesn’t tell you much about outcomes. It’s time we used an evidence base to derive a smaller number of indicators to monitor quality, safety and outcomes.
This is the first in a series of posts that will focus on data collection, the way we monitor indicators and the questions we need to ask to improve what they tell us about safety, quality and efficiency and at the same time reduce the burden on NHS trusts.