quality and risk profiles

Quality and Risk Profiles

Richard Hamblin October 2009

QRPs

• What are they?

• Who’s doing them?

• What will they do – for registration and beyond?

• What do we need to do now to deliver?

• (What will they look like?)

What are they?

1. A way of gathering all we know about organisation

2. so as to assess risk and thus prompt front line regulatory activity

3. And allow the judgements of this activity to be made robustly and add to the knowledge base

4. Critically, it builds over time and is never “perfect”

5. This is essential to support registration (or more specifically the ongoing monitoring of compliance following registration) but, because information can be used flexibly later versions could be focused on different issues

Three distinct things

1. Harvesting of different types of information; organising this according to a classification system relevant to purpose; and managing the flows.

2. A method for calculating risk and presenting findings in a way that front-line staff can use

3. A way for frontline staff to interpret the profile, use this to make decisions about what to do in response; make judgements and ensure that these are included in our knowledge base and are reflected in the profile.

Map to regs / outcomes / provider taxonomy

Data from providers

Application

Monitoring declarations

Variation

Info from people with experience of service

Info from stakeholders

National information

Knowledge base

The register

Periodic Review

Local Flavour

Registration

IR

OutcomesSafety

QoL

AccessVFM

Experience

Decision

Public information website

Workflow support system

Direct data collection

Data harvesting – passive /active, surveys, datasets, comments, infocab sweep Q&RP system

Intelligence system

Significant compliance

event

Activity log& context

Compliance risk by UoA

Concerns / regulatory

plan

Surveys Comments

Prompted Unprompted

Comments Findings Public ISAs

Flow diagram of the QRP

Drill down

Registration “core” of Q&RP

Contains

Distillation

Analysis

Inherent risk

PublicationAdditional

local evidence/

intelligence

Decision

Activities in response to view of riskDecision audit trail

CQC findings and judgements on quality

Complex and hackneyed by useWhat does this really mean





Knowledge base

The register


Intelligence system


eventSurveys Comments

Prompted Unprompted


1 – INFORMATION MANAGEMENT

2 Risk calculation and presentation

Periodic Review

Local Flavour

Registration

IR

OutcomesSafety

QoL

AccessVFM

Experience

Q&RP system




plan

Drill down


Contains

Distillation

Analysis

Inherent risk

3 Judgement framework

Knowledge base

The register

Decision




plan

Drill down

Distillation

Analysis

Additional local

evidence/ intelligence

Decision



Versioning

• This a long term project to get to work effectively and its project should be at the heart of our information strategy

• The demands of registration (its initial use) are much shorter term

• The solution is versioning

Versioning• Version 0.1 and 0.2 – NHS registration (by January 2010) and IHC/ASC (BY

April 2010)– Compendia of relevant previous judgements to support the process of initial

registration and re-registration

• Version 1.x – NHS ongoing monitoring – April 2010– Draws heavily from existing data, systems and risk methodologies– “A proof of concept”

• Version 2.x – Social care and IHC registration –October 2010– More dependent on qualitative information– May need slightly different risk calculation– Issues of scalability

Future developments• Version 3.x- 3.n – fully productionised system, other cuts of information (e.g.

safety, dignity of care etc etc) from 2011 onwards

What do we need to do now to deliver?





Knowledge base

The register


Intelligence system


eventSurveys Comments

Prompted Unprompted


Mix of qualitative and quantitative datadifferent for Social Care, NHS, and IHCNeed for a different balance of IMand analysis skills

The taxonomy is how we organise our information by defining to what it refers; to who it refers and whether it is good or not – this is the essential first step for managing our information and supporting risk assessment

Getting qualitative data into the knowledge base requires some combination of manual and automated search, classification and tagging – potentially resource heavy

Major task to identify available data and required data – and the gaps between!

We can build on existing COMPASSSystem to house knowledge base for version 1 – not clearly scalable for a huge number of providers

1 information management

Using qualitative info in a model is complicated• Qualitative to quantitative• Intelligent interpretation and

coding• Key to patient experience• Developed excellent consistency

and efficiency but resource intensive

• Need a step change in analysis and sourcing

• Quantity to quality• Multiple potential sources• Large volumes of information• Requires intelligent answers for

wide range of users• Hides significant complexity• Move from reactive to pro-active?

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2 Risk calculation and presentation

Periodic Review

Local Flavour

Registration

IR

OutcomesSafety

QoL

AccessVFM

Experience

Q&RP system




plan

Drill down


Contains

Distillation

Analysis

Inherent risk

A method of calculating risk requiredCan build on the “screening approaches-but the are alternatives which we should investigate for version 2.0 onwards(particularly if we have a majority of qualitativedata)

This selection of cutsis purely illustrative

Inherent risk refers to what a provider does,

its particular conditions (e.g

financial, managerial)

and the nature of those they

provide services to

What the QRP actually looks like(design of the report) is critical to itsSuccessful use and adoption

3 Judgement framework

Knowledge base

The register

Decision




plan

Drill down

Distillation

Analysis

Additional local

evidence/ intelligence

Decision



The QRP is designed to promptaction, NOT direct it – it requiresa decision by front-line inspectionstaff about what to do in responseA judgement framework needs to be put in

place to support consistent regulatory judgements

Judgements in themselves form additional intelligence that need to be included in the knowledge base. They need to both a/ ‘turn off’ individual risk alerts and b/ be analysed to identify where alerts are consistently misleading and alter the risk model accordingly

What will they look like?

Quality and Risk Profiles for Registration:First draft of potential format

Level 0: Corporate, drill down to unit of assessment (UoA)

Provider: Melchester Hospitals NHS Trust

Provider ID: AAA42

Services:Maternity Registered 1/4/2010

A&E Registered 1/4/2010

Surgery Registered 1/4/2010

Diagnostics Registered 1/4/2010

Maternity and midwifery services

Surgical procedures

Diagnostic procedures

Treatment of disease, disorder or injury

Regulated activities:

Provider level concerns:Something ORP like in this box??

Level 1: Registration summary for UoA

Service: Melchester Hospitals Maternity Service


Sites:Melchester Hospital 30 beds 1 Melchester Road, Melchester MC4 RR1

Kingsbay 10 beds 42 Kingsbay Ave, Kingsbay MC1 AA1

Maternity and midwifery servicesRegulated activities:

Provider ID: AAA42Service ID: ZZ3456

Involvement and information

●●●●○○○○○○

Risk profile:

Recent activity:Inspection around Quality and management 16/5/2011

Annual compliance declaration received 5/1/2011

Application for removal of condition received 23/11/2010

Personalised care, treatment and support

●●●○○○○○○○

Safeguarding and safety

●●●○○○○○○○

Suitability of staffing

●○○○○○○○○○

Quality and management

●●●●●●●●○○

Suitability of management

●●●○○○○○○○

Inherent risk

High

Situation risk

Low

Population risk

Low

Registered 1/4/2010

Level 2: Regulatory theme level



Personalised care, treatment and support Personalised care, treatment and support

●●●○○○○○○○

Judgement Performance Risk Uncertainty RiskView more

What we said last time What we think now

R07: Care and welfare of people who use services

Compliant ●○○○○ Low

R12: Meeting nutritional needs

Almost met ●●●○○ Medium

R22: Cooperating with other providers

Compliant ●●○○○ Low

Level 3: Regulation level



Theme: Personalised care, treatment and support

Judgement Performance Risk Uncertainty Risk


Compliant ●●○○○ Low


Performance Risk

Uncertainty Risk

See full data set for R12

People using the service:• Receive safe and coordinated care, treatment and support when more than one provider is involved, or when they move between services.

This is because providers who are compliant with the law will:• Cooperate and share information with others involved in the person’s care, treatment and support while having regard to peoples’ rights to confidentiality. This occurs when:– they are either sharing responsibility or transferring responsibility for care, treatment or support– they work together to respond to emergency situations– the person is supported to access the health and social care services they need.

Personalised care

●●●○○○○○○○

Information

●●●○○○○○○○

Risk Management

●●●○○○○○○○ Prompt Risk

There are 2 items from Survey of NHS Staff relating to partnership working. Of these, 2 items (100%) are much worse than expected (using data from 2008 to 2009). ●●○There is some triangulation between the 5 independent sources relating to partnership working, with 2 of them (40%) having at least one item that was much worse than expected (using data from 2007 to 2009). ●○○

The last inspection in this area was over two years ago ●●○

There are 13 data items related to this area ●○○

Level 4: Underlying data level



Theme: Personalised care, treatment and support

R22: Cooperating with other providersPersonalised care

●●●○○○○○○○

Information

●●●○○○○○○○

Risk Management

●●●○○○○○○○

Personalised Care

Information

etc

quality and risk profiles

Documents

nhs registration

risk profilesrichard

information strategythe

experience of serviceinfo

line regulatory activityand

presenting findings

usea way

initial use