workshop 4: data flow: how can we achieve good data flow to achieve better care? conference suite 4
TRANSCRIPT
Workshop 4:
Data flow: how can we achieve good data flow to achieve better care?
Conference suite 4
DATA FLOW: HOW CAN WE ACHIEVE GOOD DATA FLOW TO ACHIEVE BETTER CARE
Summary of findings –ENGAGING CLINICIANS IN QUALITY IMPROVEMENT THROUGH NATIONAL CLINICAL AUDIT
Dominique AllwoodPublic Health Registrar and Improvement Science Fellow
Engaging Clinicians in Quality Improvement through National Clinical AuditBackground•Despite being well organised and reasonably well funded, large scale audits are undervalued as a potential resource to support quality improvement •The Francis Inquiry report highlighted the need for trusts to focus more on quality •HQIP commissioned ISL to undertake a project to understand more
Aim•To better understand the barriers and facilitators in engaging clinicians with national clinical audit to support local quality improvement
Method•Thirty participants contributed their views through interviews or focus groups conducted in 2013
Participants
Themes
1. Technical and practical factors
2. Communication
3. National and local alignment to quality improvement
Key Findings (1)• There is a need to clarify the content and purpose of some national
clinical audits so that local healthcare providers understand the relevance and importance of audit and can use this data to make improvements to services
• Support with how to analyse and interpret data and present findings to others in user-friendly ways would help people to engage better with audit findings
• Incentives to drive improvement could act as both barriers and facilitators. Recognition of good practice was seen as a powerful motivator while financial incentives received a mixed response
Key Findings (2)• The right resources, knowledge and skills are needed to
encourage engagement with clinical audit. Face to face events were seen as one of the best tools for building understanding and sharing best practice
• Organisational structures, governance, staffing and culture all had a strong influence on the take up of clinical audit and on whether data was used to encourage improvement
• More could be done to engage clinical leads with HQIP. Participants would like to see greater involvement of clinicians and input from patients in the design and reporting of clinical audits
Stages
Discussion – variation• Content, output, presentation, support, timeliness• Whether factors were barriers or facilitators• Processes and practices of individuals, organisations• How much suppliers should be responsible for vs local
clinician ownership• Presentation, interpretation and summarising• Highlighting areas for improvement
Recommendations• Commissioners of audit (HQIP)• Suppliers of audit• Both commissioners and suppliers of audit• Provider organisations• Individual clinicians and audit teams
RecommendationsCommissioners of national clinical audit: HQIP and NHS England•Consider developing a strategy that places national clinical audits in the context of a vision for improvement•Consider a balance of data on clinical effectiveness, patient experience and safety when commissioning audits•Further work could be undertaken to evaluate the effectiveness of specific mechanisms and drivers for improvement
Suppliers of national clinical audit•Audits should include clear objectives about quality improvement, explanation of the purpose of data items•Linking to evidence-based standards and differentiating non-evidence-based targets from descriptive data•Consider ways to provide real-time feedback to support continuous improvement •Customisable outputs that can be manipulated for local analysis. •Involvement of clinicians and patients in design and reporting
RecommendationsBoth commissioners and suppliers of national clinical audit:•Consider a dual approach to interpreting data focusing on:
• ensuring data is analysed and presented in a way that is meaningful with adjustment to allow valid comparisons
• supporting the user population to gain the relevant skill sets to interpret the data
•Explore streamlining data collection methods with consideration to broader informatics work
•Resources and opportunities for clinicians to discuss findings, share best practice, and compare performance
•Strengthen communication strategies to improve engagement and recognition• dialogue with clinical leads, medical directors and clinical commissioners as well as
the media • Highlighting and celebrating improvements and providing support to manage local
and national media.
RecommendationsProvider organisations:•Support clinical audit teams and clinicians to undertake national clinical audit and focus on ensuring adequate skills and resources (skills in collection, interpretation, analysis and presentation of data, quality improvement, change management, and clinical leadership)•Trusts should ensure appropriate processes are in place use national clinical audit proactively in improvement and share best practice for management of national clinical audit processes and ensure this is integrated within the quality agenda of the organisation.
Front-line staff: clinicians, audit staff and managers Greater ownership of and engagement with national clinical audits may be fostered by increasing understanding of local and national approaches to improving quality and the role of audit in the broader development of knowledge and skills for measurement and improvement of quality from undergraduate training onwards.•Clinicians should explore available resources to support them in using national clinical audit for improvement and utilise forums to learn from and share good practice•Strengthen relationships between the medical director, clinical audit teams, and clinical leads and managers
Improving national audit data flowKate Godfrey
Director of Operations Quality Improvement
and Development
www.hqip.org.uk
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Data flow…..
Data Flow
• Collection, submission - Local• Collation, analysis, reporting, feedback - National• Interrogation, action, improvement - Local
• Assurance - local– Boards– Commissioners– Regulators
Recommendation 2
• When commissioning new national clinical audits and reviewing contracts, consider a balance of data on clinical effectiveness, patient experience and safety.
• NCA methodology primarily drives improvement in clinical effectiveness by reporting how well structure and process measures are achieved against established standards and by comparing outcomes between providers
Recommendation 2
• CORP looks at safety – rolling programmes• We will be working with NHS England over the next 6
– 12 months to develop and agree the commissioning intent for patient-reported outcome and experience measures within the Programme.
Recommendation 4
• Stimulate engagement through a communications strategy that focuses on creating broader awareness of HQIP’s remit and reach and the role of national clinical audit for quality improvement.
• in development - HQIP Communications Strategy• Closer working with QI partners• All new NCAs must have improvement driven aims
and objectives to which all activities are aligned• HQIP review reports, press releases to ensure
improvement messages are clearly articulated
Recommendation 5
• Further work could be done to evaluate the effectiveness of specific mechanisms and drivers (financial incentives, using data for appraisals and clinical excellence awards, workshops) for using national audit for improvement
• Best Practice Tariffs• HQIP analyse feedback on the degree to which care
improvement can be attributed to mechanisms and drivers such as those listed. This is undertaken at each commissioning decision point
Recommendation 5
• Working with AoMRC to review and update the guidance on revalidation, focussing on supporting clinician’s participation in national audit and their use of national audit data to drive improvement in the quality of care delivery and patient outcomes.
• The extent to which NCAs report how their data is used as a mechanism/lever to drive improvement forms part of the ‘The Audit of Audits’ which has been completed by all National Clinical Audits and will publish in December 2014.
Recommendation 8
• Consider ways to provide real-time feedback to support continuous improvement as well as providing datasets that can be manipulated for local analysis
• All new contracts require that data extracted is always accessible locally and this local availability should be accompanied by reporting mechanisms which have local utility to support quality improvement.
Recommendation 11
• Explore how to streamline data collection methods and combine processes and systems with consideration to broader informatics work and the context in which national clinical audits sit.
• We will continue to streamline data collection and minimise local burden and share this responsibility with the HSC IC and the Confidentiality Advisory Committee who also scrutinise data set size and burden.
Group Work
Two Questions
What can HQIP to do to support you?
What can you do differently / Share good ideas
Recommendation 20
• Clinicians, audit staff, and managers need to integrate more to take ownership of and engage with audit. Relationships between the medical director, clinical audit teams, and clinical leads are particularly importantLocally…–NCA data flow within your organisationHQIP….–Commissioning of NCA/ guidance / training / events