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Attain’s Analytical Capabilities
High quality analysis that meets our customers’ needs
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Attain has a team of dedicated analysts who specialise in providing rigorous analysis, insight and modelling to the NHS and Social Care
• Role of analytics in the NHS and social care• Commissioners, clinicians and managers use data, information and analysis to
underpin their decisions on a daily basis.• There is a vast amount of data and information in the NHS – the challenge is to
make sense of it all and use the right information to make timely, informed decisions.
• Attain’s approach to analysis• Attain’s focus is on analysis and modelling to support transformational change
in health and social care. We don’t focus on ‘business as usual’ BI such as data management, data warehousing and reporting.
• We have a team of dedicated analysts with a broad range of backgrounds and experience from across the NHS and industry.
• Our approach to analytics is based on extensive research with our customers, the Commissioning Intelligence Model and the considerable experience of our staff.
• This presentation is broken into 4 key areas:• Our understanding of our customers; our techniques and approaches; our quality
assurance programme and the tools we use.
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Attain’s analytical offering is based on four areas
1. Strong understanding of our customers - What do our customers need?
- Strong relationships with commissioners- Strong relationships with other Attain teams- Embedded teams of analysts within CCGs- Problem structuring support
2. Breadth of techniques and approaches - What can we do?
- Team of highly capable analysts with range of health commissioning analysis support experience- Range of techniques and approaches to solve your problems
3. Robust quality assurance process - How do we ensure a consistent high standard to our outputs?
- Quality Assurance process- Delivery Management and Assurance- Peer review
4. Analytical tool expertise - What tools do we use?
- Analysis and data management tool expertise- Modelling and simulation tools- Dashboard tools- Evidence base
Attai
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anal
ytica
l cap
abili
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1. Strong Understanding of Our Customers
What do our customers need?
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We understand what our customers needs from a number of perspectives
• All of our analysts have a wealth of experience supporting NHS and social care commissioning, from data analysis and interpretation to informing strategic reviews – we understand the depth and breadth of data sources and the common problems you face.
• Talking to our customers – our analysts are based on site with CCGs meaning they develop strong relationships and gain a full understanding of your needs.
• Attain’s wider skillsets – we work closely with our Service Transformation, Contracting and Procurement team colleagues to ensure that we have a holistic view of the current commissioning landscape.
• NHS analytical framework - We have structured our offering around the Commissioning Intelligence Framework (right) to ensure that we are aligned to CCG’s and patient’s needs.
• Our team has a range of problem structuring approaches that can be used to help makes sense of a situation and decide on a course of action before service level modelling is needed.
How healthy are our populati
on?
What’s really
happening in this
system?How much
are we spendin
g?How do
we compar
e?
Are my provider
s delivering what
they agreed?
What differenc
e have we
made?
How could things
be better?
What are our future plans?
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2. Breadth of Techniques and ApproachesWhat can we deliver for you?
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Attain has the ability to support you with a range of analytical and modelling approaches to help you meet your strategic goals
• The following slides detail some of the approaches we use along with case studies for each.
• Attain’s analytical capabilities are not limited to these examples; but they provide a useful guide to the relevance and impact of our work for commissioners. They include:
1. Demand and capacity modelling2. System modelling3. Activity shift modelling4. Forecasting5. Dashboards
• Attain works across the commissioning cycle and our analysts are embedded in cross functional teams with colleagues from our Strategy, Service Transformation, Procurement and Contract Management teams, meaning that this analysis is usually part of a wider programme of work.
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1. Demand and capacity modelling• What is it?
• An understanding of activity in the past can help inform what is likely to happen in the future.
• Our analysts specialise in not just asking how much or how many there are of a particular element of the system, but also why they’re seeing these trends to get a deeper understanding of what is driving performance in the system.
• How does it support commissioners?• This type of analysis is often overlooked in the NHS - quantitative analysis combined
with Attain’s and the commissioners qualitative local knowledge can be a powerful tool for understanding their health system and informing what actions to take.
• What are the generic project requirements?• This analysis is quick to set up - upwards of 1 day as needed.
What?
When?
Why?
•Activity, capacity and demand analysis show us what happened and in what volumes.
•Time series analysis show us when events happened.
•Linking all the analysis together with our experience gives us insight into why thing happened and what can be done about them.
Click for case study
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2. System modelling
• What is it?• System modelling involves building a simulation model that spans several areas of the health system
to see how changes in one area affect another.• Its value lies in being able to model a complex range of interaction and dynamic feedback within a
system, something that Excel spreadsheets cannot do.• The specific modelling technique used depends on the project – For example System Dynamics works
best at a strategic level whilst Discrete Event Simulation works best for tactical analysis.• How does it support commissioners?
• What are the generic project requirements?• Data needs depend on the scale of the model, but assumptions can be made and tested about
variables that are unknown. • Projects tend to take longer than spreadsheet modelling.• >6 weeks, depending on complexity.
What are the interdependencies
between them?
What happens to the flow of activity/patients/etc. (intended and
unintended) if we start a new initiative? How will it affect waiting
lists/times?
A B
A&E
GP
Trust
System
Which aspects of the system will be affected?
Click for case study
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3. Activity shift modelling
• What is it?• Modelling the shift of activity from one setting to another, for example from acute
into community, or outpatients into primary care – including demand, activity, finance and workforce.
• Questions may include:
• How does it support commissioners?• Shifting activity to the community is a complex initiative that requires understanding
of cost, activity and workforce implications. Attain can support you through this process, building a model that can calculate cost savings over a defined period.
• What are the generic project requirements?• These projects tend to be data intensive – usually requiring information from social,
community, primary and acute care.
What services can we develop in the community and cease in acute
services?
What financial benefits will the BCF provide for
health /social care and which services
should we commission together?
What would be the impacts on activity
and finance?
Click for case study
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4. Forecasting• What is it?
• Forecasting future activity levels based on historical data and expected changes to demographics, clinical practice, policy and technology can be used to estimate the size of a population, activity, demand etc. a set number time periods into the future.
• There are a range of approaches depending on the amount of data, its seasonality and how far forward we want to project.
• How does it support commissioners?• Attain’s robust forecasting approaches give CCGs the
confidence that they are using and submitting validated forecasts rather than standard ‘last year plus x%’ analysis.
• The addition of qualitative elements that impact on the analysis give us the ability to incorporate a range of information types into the forecast.
• What are the generic project requirements?• Relatively quick to do (needs robust historical data) and
can be delivered in an interactive Excel file. • Projects can range from simple annual forecasts to HRG
level seasonally adjusted forecasts for different geographies or patient groups.
Historical data
Qualitative inputs
Robust forecast using appropriate technique
Click for case study
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5. Data visualisation dashboards• What are they?
• Our interactive performance dashboards draw together information and metrics from a number of sources into a single, integrated tool to provide CCGs with ‘one version of the truth’ – supporting effective commissioning decision making and performance management against a variety of indicators.
• How do they support commissioners?• A well designed, bespoke dashboard can be used to
present familiar data in new, interesting and impactful ways.
• They allow users to interact and drill down into areas of interest or take a more strategic view of the information by bringing together disparate information sources from across the health system.
• What are the generic project requirements?• Dashboards are relatively quick to set up, providing
that the data is present and clean – upwards of 2 days.
Attain can use these sources to create insightful analysis
Internal data
Health system
data
Patient surveys
Click for case study
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3. Robust Quality Assurance Processes
How do we ensure consistent high standard to our outputs?
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Attain has a number of processes in place to ensure that the services you receive are of the highest quality
• We have a Quality Assurance process for all of our modelling and analytical work that involves peer review of outputs to ensure there are no errors or omissions.
• In addition to this all Attain projects have a well established quality assurance process• Internal delivery assurance framework• Delivery management process• Incorporate recognised project documentation and processes e.g. PID, Plan,
Risks, Issues• Standardised mobilisation approach• Ensures clarity of roles and expectations• Structured governance and reporting mechanisms
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4. Analytical Tool Expertise
What tools do we use?
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We use the most appropriate tools to deliver the highest quality outputs for every project
Our analysts are experts in a whole range of modelling and analysis tools.• Analysis
• In addition to standard Microsoft tools of Excel, Access and SQL we have also used Tableau and Alteryx for more complex analysis.
• Dashboards• We use Tableau and Qlikview for information dashboard creation and delivery.
• Simulation• We have access to simulation modelling software like Simul8 and Stella for discrete event
and system dynamic modelling respectively.
• Statistics• We have expertise in STATA, SAS, R and SPSS for statistical analysis
• Decision analysis• We use Visa and Hiview for multi criteria decision modelling.
• Knowledge Management• Our team is the home for tools for knowledge management and collaboration within the
company.
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Summary
• Attain is very placed to be your partner in analysis and modelling to support better commissioning.
• Our team of analyst has a strong heritage of delivering high quality analysis and strategic input that provides an evidence base for commissioning decisions.
• Please contact Matt Jones [email protected] for more information about the details in this presentation.
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Appendix
Case studies
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Case Study: Demand and Capacity Modelling• The CCG’s question:
• As part of the review performance of their main Mental Health provider, a North of England CCG asked Attain to help them to understand the following:
• Future demand for acute and community based Mental Health services
• Required acute bed capacity to meet current and future demand?• Attain’s solution:
• We modelled future demand for services using age specific population projections for the local area
• We developed a dynamic bed capacity model for all acute wards. This model allowed the CCG to estimated the required number of beds at different levels of demand, average length of stay and occupancy.
• We included sensitivity analyses to show which variables had the greatest impact on bed capacity
• The model outputs for agreed scenarios were included in the review findings and the model was provided as stand alone tool.
• Project duration• The project took 2 weeks including data preparation, researching
assumptions, model building and model testing.• Impact:
• The model was considered a very useful tool with outputs providing the CCG with the necessary evidence to challenge the provider on both current utilisation and proposed plans for the reconfiguration older peoples’ acute mental health beds.
• Potential variations• This approach can be widely used to support service planning and
development
Adults Older adults PICUActual Admissions (Unit) - FOT 2013/14 445 128 7Admissions on other 5BP wards - FOT 2013/14 74 7 0All CCG admissions - FOT 2013/14 519 135 7Target Average Length of Stay (ALOS) 30 45 0Actual ALOS - 2013/14 M11 YTD average 36 53 197Commissioned Beds 50 25 4Commissioned Bed days 18250 9125 1500Actual Bed days (FOT 2013/14) - commissioned wards only
15842 6767 1291
Actual Bed days (FOT 2013/14) including admissions to other 5BP wards
18490 7164 1291
Commissioned Occupancy 100% 100% 100%Actual occupancy (2013/14 M11 YTD average) 87% 74% 88%Actual occupancy (2013/14 M11 YTD average) Including bed days on other 5BP wards
101% 79%
Bed number to achieve 100% occupancy at 2013/14 admission levels and current ALOS
50.7 19.6 3.5
Bed number to achieve 85% occupancy at 2013/14 admission levels (all admissions) and current ALOS
59.6 23.1 4.2
Total beds required in 2019/20 due to demographic growth -at current ALOS and 100% occupancy
50.8 21.9 3.7
Total beds required in 2019/20 due to demographic growth -at current ALOS and 85% occupancy
59.8 25.8 4.3
Sensitivity of bed numbers to changes to the number of admissions (ALOS remains unchanged) by level of occupancy (100% or 85%) - 2013/14
• Additional beds required to achieve 100% occupancy at
current level of admissions
• Additional beds required to achieve 85% occupancy at
current level of admissions
• Additional beds required if admissions
increase by more than 20% at 100%
occupancy• Additional beds
required if admissions
increase by more than 5% at 85%
occupancy
• Additional beds required if admissions
increase by more than 10% at 100%
occupancy• Additional beds
required to achieve 85% occupancy at
current level of admissions
Unit
Bed model - Ward 1
Possible admissions at current ALOS and 100% occupancy
172
Possible admissions at current ALOS and 85% occupancy
146
Admissions Beds Bed daysContracted occupancy Current ALOS
128 18.5 6767 100% 53128 21.8 6767 85% 53
135 19.6 7164 100% 53
135 23.1 7164 85% 53
151 21.9 7991 100% 53
151 25.8 7991 85% 53
11.5%
Ward 1: Estimated beds currently in the next 5 Years by level of occupancy. Assumes no change to Average Length of Stay is expected
Sephton unitCurrent activity (2013/14 FOT)Current activity (2013/14 FOT)
Current activity (2013/14 FOT) + admissions to non MH units + Demographic changeCurrent activity (2013/14 FOT) + admissions to non MH units + Demographic change
Current activity + admissions to other wards
Current activity + admissions to other wards
Model
Summary output
Back to presentation
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Case Study: Primary and urgent care system model• The CCG’s question:
• A CCG in the North of England approached Attain wanting to build a simulation model of their health system to save time and money on pilot programmes and test initiatives.
• Attain’s solution:• We worked with a wide range of stakeholders across the CCG to build a
System Dynamic model, first focussing on Primary Care.• System Dynamics uses a series of stocks and flows to model complex,
dynamic relationships that we see in the health system – something that Excel struggles to do.
• We delivered the model with an interface for GPs to use and a manual to understand how to best use it.
• Project duration• The main model building took 6 weeks plus time for validation and testing
with local GPs.• Impact:
• The project had many benefits – it helped commissioners and GPs see how each other viewed the system and how they reach consensus on what to do - The CCG Chair said it made him look at primary care in a different way and had helped him realise a range of possible new initiatives.
• It provided quantitative clarity on the impact of changing workforce and demand.
• The second phase of the project was to add A&E to the primary care model – this modular, iterative approach means that we could start small and build, working closely with the stakeholders as we went.
• Potential variations• This approach can be used for the whole system, or parts of the system – for
quantitative analysis (such as GP appointments) or qualitative (e.g. patient behaviour).
SD Model
User DashboardBack to presentation
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Case study: Acute to community shift• The CCG’s question:
• Attain was engaged to support the development of Wigan CCG’s Commissioning Strategy.
• The CCG wanted to identify savings of circa £50 million over a five year period. Attain were tasked with reviewing the acute contract and identifying potential activity shifts from an acute to a community setting and the impact this shifts on activity, finance and estates.
• Attain’s solution:• Summarising the 6 months SLAM activity and financial data provided by WBCCG by
Specialty, POD and HRG plus detailed analysis of 6 month SLAM data by HRG line. Analysis of community-based resources.
• Face to face meetings held with contracting, finance and commissioning colleagues to validate information provided, initiatives proposed and any assumptions made, as required.
• The development of an Excel model to calculate the impact on activity and budget and savings from the initiatives identified over a five year period.
• Quality assurance of the model by a modelling expert who was not involved in the development of the model to ensure that the logic, assumptions and formulae were accurate.
• Review of initiatives against national evidence, best practice and benchmarks • Prioritisation of initiatives together with production of a practical plan setting out
the proposed sequence for implementation over 5 years. • Development of a bespoke training programme for Commissioning Managers.
• Project duration:• The analytical element of the project lasted for 8 weeks.
• Impact:• Attain identified three lists of services - removal from contract altogether; transfer to
community (with or without service redesign); retain in hospital setting. • Potential savings of £50 million over 5 years were identified.• A strategic review of current health estate was also undertaken as a result of this
work.
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Case study: Activity forecast• The CCG’s question:
• An English CCG had historically produce forecast based on the previous years activity plus a % increase for population growth. They wanted a more sophisticated and robust approach for these forecasts to give confidence in their activity submissions.
• Attain’s solution:• We demonstrated a range of forecasting techniques to see which
best fitted the data and the needs of the CCG, eventually settling on a method that takes the seasonality of the data into account (Holt Winters method of forecasting).
• We created forecasts for activity across six specialties and built the models so that they could be updated easily in the following years. In addition, we provided a range of analysis to help the CCG understand what was driving this growth (First follow up ratios, prevalence, population ageing etc.)
• Project duration• This project took 5 weeks, but this would depend on the volume of
data or number of specialties to be forecast.
• Impact:• These forecasts gave the CCG the confidence that they were
submitting robust analyses to the DH.• The models were built in excel in way to make them reusable in
future years with minimal adaption.
• Potential variations• These techniques can be used for anything from demand and
activity through to disease prevalence.
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23
Case study: Qlikview dashboard
• The CCG’s question:• CCG required specialist support to develop a comprehensive
performance reporting dashboard, and accompanying reporting structure, to ensure they had access to up-to-date information on provider performance at a variety of levels for multiple audiences within the CCG.
• Attain’s solution:• We worked with the CCG to develop an overarching reporting
structure and developed a bespoke dashboard using Qlikview.• This dashboard allowed the CCG to drill down into particular
areas of interest or concern and understand the underlying reasons.
• Project duration• This project lasted 6 weeks but dashboards can be created in
minutes given the right information and a clear design.
• Impact:• Central to this project was creating a single set of consistent data
so there is ‘one version of the truth’ across contract, performance and CCG board reports.
• Potential variations• Dashboards range between very simple Excel spreadsheets to
more complex online tools that use many different information sources. Attain can work with you to understand your reporting needs and design an appropriate solution.
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Data management
How can we ensure access to timely and accurate data on services?
Capture, aggregation and validation of datasets and storage in data warehouse; Invoice validations and checking; Local data extraction; Information governance advice.
Support How can we best support the BI service team?
Provision of IT, finance and HR support to maintain BI team.
Risk profiling; Demographic forecasting; Surveys; GIS/Mapping.
ReportingHow can we ensure we are compliant with statutory reporting returns?
Fulfilling national reporting requirements.
Intelligence
How healthy is our population?
What is happening locally?
How much are we spending?
How do we compare?
How could things be better?
Are my providers delivering?
Reconfiguration of BI service; BI service strategy.
What impact have we made?
What are our future plans?
Capacity and demand analysis ; Pathway analysis.
Service costing ; Budget reporting and variance analysis.
Benchmarking disease prevalence, activity, cost and practice.
Scenario modelling and simulation of changes in pathways
Contract monitoring and analysis.
Cost/quality measures pre and post intervention inc dashboard
Decision support for changes in system to achieve cost or quality targets; Simulation of changes with cost benefit analysis .
BUSINESS NEEDS BI SERVICE PROVISION
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How can Attain’s analytical team help support transformational change in the NHS?
Examples of some of these approaches are given on the following pages
