National Homecare KPI performance Qtr 4 2016*

* aligned to NHS financial year

ForewordThis National Homecare KPI performance report – the second we have published – continues to shine a light on our performance quarter by quarter. We use this information internally not only to improve our services but also to enhance our patients’ experience.

The patient will always remain at the heart of Healthcare at Home. The data contained in this report is the raw measurements of the processes and systems that allow us to serve our patients. By measuring them, we can learn, iterate and ultimately improve.

You will see from the data that this focus on continuous improvement is working. Registration accuracy has increased, the number of deliveries has increased – as have their success levels with 97.8% arriving on time or early – and the number of prescriptions we process has increased.

There are also parts of our service we need to improve. For example, while the number of prescriptions we process has increased, there has been a marginal increase in both non-compliant prescriptions and prescriptions received without a PO. Knowing where improvements can be made allows us to work in close partnership with our NHS partners to make necessary changes.

As the leading provider of clinical homecare in the UK, we believe our data gives a snapshot not just of what is happening at Healthcare at Home but can point to overall trends within the market.

There is, of course, no way to prove that unless other providers publish similar results – and we gently challenge them to do so. In the meantime, Healthcare at Home will continue to publish on a quarterly basis, benchmarking for the entire sector.

As always, we want to hear from you. If you have any comments about our data, our KPIs or want to know more about the services we provide then please email hello@hah.co.uk.

Jim Featherstone Chief Operating Officer

SummaryThe standards set out in this the second edition of the quarterly Healthcare at Home National Homecare KPI report represent the quality measure requirements as defined by the National Homecare Medicines Committee based upon the recommendations set out in the Homecare Medicines – Towards a Vision for the Future report*.

The reporting period, January – March 2016, aligns with NHS quarters and further benchmarks our operational performance.

We are continually monitoring progress in all aspects of our services, and have worked with NHS colleagues to shape best practice. This has allowed improvements in the accuracy of the patient registration process and PO number availability. When possible, we take unnecessary tasks away from hospital teams wherever this can be done safely, and in accordance with regulatory and governance requirements.

The sustained improvement in successful deliveries is increasing patients’ confidence in our service. Over the past 3 months we have successfully managed both the New Year and Easter holiday periods, traditionally a difficult time to maintain high levels of delivery success because of disrupted patient routines. The introduction of proactive text messaging has been positively received by patients resulting in high levels of uptake; this improved communication has resulted in a fall in customer complaints. Further functionality will be added later in 2016, providing additionally flexibility for our patients in managing their delivery schedule.

Our partnership approach of working with the NHS will enable future enhancements such as document standardisation for patient registration and integration with existing NHS prescribing systems.

The launch of an electronic invoice solution in April 2016, will reduce the administration associated with invoice queries and give more accurate responses to our customers.

It is clear from this report that there are still opportunities to improve, Healthcare at Home is committed to addressing these areas for improvement and work collaboratively with all parties to raise the bar and provide the best possible Clinical Homecare service for patients.

* Authored by Mark Hackett, CEO University Hospital Southampton – 2010

For more information on these reports at a Trust level please contact hello@hah.co.uk

Qtr 4 vs YTD Avg Jan 2016 Feb 2016 Mar 2016 YTD Avg YTD Total

Patient Registrations

Number of Patients 160,252 162,164 163,080 140,145

New Registrations 4,347 4,895 6,253 4,833 57,993

KPI – % Correctly Completed Reg Forms 91.3% 93.2% 95.8% 92.8%

Service Finishers 3,439 4,228 5,982 5,043 60,515

Prescriptions Prescriptions Processed 38,200 36,725 38,523 38,007 456,085

KPI – % Non-Compliant Rx 4.2% 4.5% 5.1% 4.9%

KPI – % Rx Received with no PO 30.9% 30.7% 30.1% 32.4%

Deliveries Number of Deliveries 72,894 73,510 72,329 75,910 910,924

KPI – % Delivery Success 95.7% 95.6% 95.6% 95.1%

KPI – % HaH Culpable Failures 0.9% 0.9% 0.9% 1.2%

KPI – % Patient Culpable Failures 3.2% 3.3% 3.3% 3.5%

KPI – % Trust Culpable Failures 0.2% 0.2% 0.2% 0.2%

KPI – % Early & On Time 96.7% 97.5% 97.8% 95.1%

KPI – % In Full 99.6% 99.6% 99.3% 99.5%

Invoicing KPI – Overdue & Unpaid Invoice Value £47,067k £54,251k £49,178k £34,097k

KPI – % Credit Note Value 6.0% 2.6% 5.3% 4.5%

Complaints Formal Complaints 200 141 131 182 2,183

Formal Complaints as a % of Deliveries 0.27% 0.19% 0.18% 0.24%

Summary

Ongoing performance management and focus is driving all aspects of Healthcare at Home solution delivery, resulting in continued strong up lift across key parameters.

Registration form accuracyAs we continue to work with the teams at individual hospitals, the accuracy of registration forms we receive is steadily improving. The greatest volume and accuracy was seen in March 2016.

We support the registration process by providing registration templates, and have been involved in designing some innovative ways to reduce hospital workload, providing practical solutions to enable bulk registration of patients during periods of significant patient transfer.

In order to improve and simplify the registration process, we are continually monitoring progress, and are taking unnecessary tasks away from hospital teams wherever this can be done safely, and in accordance with regulatory and governance requirements.

Future thinking…

HaH is actively supporting the programmes under way within the NHS to standardise documentation. We are providing evidence to support proposed changes and hope to work closely with Trusts to enable future development.

Qtr 4 Avg YTD Avg

New Registrations 5,165 4,833

Correctly Completed Registration Forms

4,839 4,483

% Correctly Completed Registration Forms

93.7% 92.8%

New Registrations KPI – % Correctly Completed Registration Forms

7,000

6,000

5,000

4,000

3,000

2,000

1,000

0

97.0%

94.0%

95.0%

96.0%

93.0%

92.0%

91.0%

90.0%

89.0%

New

Reg

istr

atio

ns

% C

orre

ctly

Com

plet

ed R

egis

trat

ion

Form

s

Apr2015

May2015

Jun2015

Jul2015

Aug2015

Sep2015

Oct2015

Nov2015

Dec2015

Jan2016

Feb2016

Mar2016

4,327 3,967 5,118 6,346 4,210 4,886 4,350 4,515 4,347 4,895 6,2534,779

93.2%

92.4%

91.3%

92.5%

92.1%

91.7%

92.8% 92.8%

93.2%

95.8%

91.3%

93.3%

Registration form accuracy

Ongoing collaborative work is demonstrating improvement, and supporting the provision of a safe, timely and accurate service to patients

Prescription accuracyAs we work with individual hospital colleagues, we establish ever improving ways of working, some of which help to shape best practice. As a result, we have developed better ways to use technology, allowing us to pre-populate prescription forms when new patients are transferred onto our system in significant numbers, for example following a major policy change in hospital prescribing, or a move onto our service from another provider.

We have recently enhanced our internal processes to enable us to double check PO data entry, ensuring it flows through systems more effectively, improving the timeliness and accuracy of your invoices.

Future thinking…

We will be working to make it much easier for Trusts to complete all the relevant information with the launch of our e-prescribing project. We are already in contact with some Trusts to establish the best way to link with existing NHS systems.

Qtr 4 Avg YTD Avg

New Prescriptions 37,816 38,007

% Non-Compliant Prescriptions 4.6% 4.9%

% Prescriptions Received Without a Purchase Order

30.6% 32.4%

% N

on-C

ompl

iant

/ %

No

Purc

hase

Ord

er

40.0%

30.0%

35.0%

25.0%

20.0%

15.0%

10.0%

5.0%

0%Apr2015

May2015

Jun2015

Jul2015

Aug2015

Sep2015

Oct2015

Nov2015

Dec2015

Jan2016

Feb2016

Mar2016

KPI – % Non-Compliant Rx KPI – % No Purchase Order on Rx

4.9% 5.0% 5.0% 5.4%

32.7%

35.0%33.3% 33.7% 34.0% 33.8%

5.0%

30.1%

4.6%

31.2%

4.5%

30.9%

4.2%

30.7%

4.5%

30.1%

5.1%4.9%

33.0%

5.6%

Prescription accuracy

As prescription volumes grow, progress continues on the accuracy and PO number availability on the documents we receive

Delivery overviewWe are delighted to show such consistency in our overall delivery metrics, and hope you are seeing this reflected in patient experience at a local level.

The recent introduction of proactive text messaging has been well received by patients, with high levels of uptake. This service will be enhanced later in the year, giving patients additional levels of flexibility.

Future thinking…

Some patients, especially those who work full time, tell us that they would find weekend or evening delivery more suitable. We are now working with our logistics partners to extend our delivery hours.

Qtr 4 Avg YTD Avg

Deliveries 72,911 75,910

% Delivery Success 95.6% 95.1%

% Early & On Time 97.3% 95.1%

Delivery overview

% D

eliv

ery

Succ

ess

/ %

Ear

ly &

On

Tim

e

Del

iver

ies

100.0%

98.0%

96.0%

94.0%

92.0%

90.0%

88.0%

84.0%

86.0%

90,000

70,000

60,000

50,000

80,000

40,000

30,000

20,000

10,000

0Apr2015

May2015

Jun2015

Jul2015

Aug2015

Sep2015

Oct2015

Nov2015

Dec2015

Jan2016

Feb2016

Mar2016

91.2%

77,200 73,462 78,237 84,549 72,090 76,017

89.7%

90.8%

96.1%

95.2%

% Early & On Time% Delivery Success

95.0%94.4% 94.5% 94.4%

96.2%

95.1%

75,279

95.5%

94.6%

75,273 72,894 73,510 72,329

96.4%

95.5%

96.7%

95.7%

97.5%

95.6%

97.8%

95.6%

80,084

94.6%

94.9%

Deliveries

93.9%

We are seeing a consistent positive trend of improving performance as our internal logistics model continues to evolve

Late and partial deliveriesSustained improvement in the timeliness of deliveries over many months is increasing patients’ confidence in our service. This was reflected in our recent Patient Feedback survey, in which 97% of patients said they were ‘happy’ or ‘very happy’ with their deliveries, representing a 3% improvement over the previous 3 months.

Technology changes made during 2015 to our logistics and planning systems are now fully embedded, enabling us to increase the accuracy of our estimated delivery times for patients.

Future thinking…

Further improvements will be made to minimise late deliveries as our new fleet vehicles become available across the country and our planning models become more sophisticated. We will also be updating our supply chain systems to ensure that we have the right product available at the right time.

Qtr 4 Avg YTD Avg

Deliveries 72,329 75,910

% Late Deliveries 2.7% 4.9%

% Partial Deliveries 0.5% 0.5%

Late and partial deliveries

% L

ate

/ %

Par

tial D

eliv

erie

s

12.0%

10.0%

8.0%

6.0%

4.0%

2.0%

0.0%Apr2015

May2015

Jun2015

Jul2015

Aug2015

Sep2015

Oct2015

Nov2015

Dec2015

Jan2016

Feb2016

Mar2016

KPI – % Late Deliveries KPI – % Partial Deliveries

4.8%

8.8%

10.3%

9.2%

3.9%

4.5%

3.6%3.3%

2.5%2.2%

5.4%

0.4%0.4% 0.3% 0.5% 0.5%0.3% 0.3% 0.4% 0.4% 0.4%

0.7%0.4%

6.1%

The timeliness of our deliveries is continuing to improve, and we are seeing sustained high levels of performance

Delivery failureWith the help of prescription management teams in hospitals, over the past 3 months we have successfully managed both the New Year and Easter holiday periods, traditionally a difficult time to maintain high levels of delivery success because of disrupted patient routines. Over this period we have seen a consistently low level of patient failed deliveries, in part due to improved bank holiday planning, as well as the implementation of patient text message reminders earlier this year.

Delivery failures due to processing errors at Healthcare at Home or in hospitals remains below 1%, although on-going process improvement work through QMS is continuing, in order to make further improvements.

Future thinking…

The next stage of development to our proactive patient text messaging service continues at pace, with further functionality due to be implemented later this year. As well as reducing the overall level of failed deliveries, it will also provide more flexibility for patients.

Qtr 4 Avg YTD Avg

% HaH Failed Deliveries 0.9% 1.2%

% Patient Failed Deliveries 3.3% 3.5%

% Trust Failed Deliveries 0.2% 0.2%

Delivery failure

4.5%

4.0%

3.5%

3.0%

2.0%

2.5%

1.5%

1.0%

0.5%

0.0%

% D

eliv

ery

Failu

re

Apr2015

May2015

Jun2015

Jul2015

Aug2015

Sep2015

Oct2015

Nov2015

Dec2015

Jan2016

Feb2016

Mar2016

KPI – % HaH Failed Deliveries KPI – % Patient Failed Deliveries KPI – % Trust Failed Deliveries

0.2% 0.3% 0.3% 0.3%

3.6%

3.9%

4.1%3.9%

3.4%

2.4%

0.3%

3.9%

0.2%

3.3%

0.2%

3.2%

0.2%

3.3%

0.2%

3.3%

0.2%0.2%

3.7%

0.3%

0.9%

1.3% 1.3%1.1% 1.1%

1.3%

1.0%0.9% 0.9% 0.9%

1.1%

2.0%

Improved Bank Holiday planning and the introduction of text messaging has delivered consistently lower rates of patient failed delivery over recent months

InvoicingInvoice queries, leading to delayed payment, has been one of the key reasons we have not seen the level of improvement we would like in this KPI. Managing this process continues to place a significant admin burden on all parties and delay can create financial risk on hospital reimbursement.

In response, we are committed to working closely with Trusts to identify the most appropriate solution to benefit both parties.

Future thinking…

It’s critical that the NHS and Healthcare at Home work together to continue to create a robust electronic invoice and query solution in order to better manage the process and reduce the administrative burden.

Qtr 4 Avg YTD Avg

Overdue & Unpaid Invoices £50,166k £34,097k

% Credit Notes (compared to invoices)

3.9% 3.8%

% Credit Note Value (compared to invoices)

4.6% 4.5%

Invoicing

£60m

£50m

£30m

£40m

£20m

£10m

0

Ove

rdue

& U

npai

d In

voic

e Va

lue

(£)

Apr2015

May2015

Jun2015

Jul2015

Aug2015

Sep2015

Oct2015

Nov2015

Dec2015

Jan2016

Feb2016

Mar2016

£0k £56,222k £42,149k £39,369k £45,341k £35,177k £46,339k £51,342k £47,067k £54,251k £49,178k£45,018k

Levels of overdue invoices remain fairly static, we will continue to work collaboratively with Trusts to identify the most appropriate solution moving forward

ComplaintsSince we have started sending text messages to patients, and by providing more flexible delivery options, there has been a corresponding fall in customer complaints. The on-going training in the call centre is improving the quality of the calls we make, which has a positive impact on the patients and has resulted in a reduction in the number of complaints related to delivery timing and accuracy. Due consideration to the number of patient touch points is continually reviewed with each point being considered in terms of the real value it delivers to the patient experience.

Future thinking…

On-going assessment of customer service interventions to support patient services is well underway. In the long-term, future projects include development of a patient portal and a ‘self-serve’ option to further enhance and improve communications to patients.

Qtr 4 Avg YTD Avg

Informal Concerns 139 153

Formal Complaints Received 157 182

Formal Complaints per ‘000 Deliveries

2.16 2.40

Formal Complaints as a % of Deliveries

0.22% 0.24%

Complaints

600

500

400

300

200

100

0

4.5

3.5

3.0

2.5

4.0

2.0

1.5

1.0

0.5

0.0

Num

ber o

f Com

plai

nts

Form

al C

ompl

aint

s pe

r ‘00

0 D

eliv

erie

s

Apr2015

May2015

Jun2015

Jul2015

Aug2015

Sep2015

Oct2015

Nov2015

Dec2015

Jan2016

Feb2016

Mar2016

Formal Complaints Informal Concerns Formal Complaints per ‘000 Deliveries

177 196 314 251 130143 169 200 141 131184147

2.29

2.67

4.01

2.04

1.71

2.442.25

2.71

1.921.811.79

2.97

As the accuracy of deliveries has improved, the number of complaints has fallen

DefinitionsNumber of Current Patients

Patients who are registered, excluding those ‘on-hold’, irrespective of whether a delivery has been due that month.

New Registrations Number of new registrations of patients for the homecare therapy in the reporting period, regardless of whether or not they have received a delivery. Includes new registrations of previously permanently inactive patients (as opposed to just ‘on-hold’) and the registration of current patients for additional therapy areas. “Date as Registered” is the date that the patient is registered on the Homecare Providers’ system (which may be different to the actual date on the patient registration form).

Number of Correctly Completed Registration Forms

A correctly completed registration document is one that contains sufficient information to facilitate the legal and safe delivery of treatment to the patient. If it must be returned to the referrer for alteration or requires the Homecare Provider to contact the referrer for clarification it should be recorded as non-compliant.

For clarity, 1 patient = 1 document set, irrespective of the number of forms per registration.

KPI – % Correctly Completed Registration Forms

Number of correctly completed patient registrations received as % of total number of new patient registrations received.

Number of Patients Ending Service

Patients permanently removed from the Homecare Providers’ register, where service end date is within reporting period. If a patient is made permanently inactive but subsequently re-starts treatment, this patient should be re-registered as a new patient for KPI reporting purposes, even when the permanently inactive patient record is technically re-activated to maintain the full clinical history. If a patient is simply ‘on-hold’, this does not qualify as no longer registered.

New Rx Received Total number of prescriptions (new and repeat) received by the Homecare Provider and placed on the system. For clarity, a prescription is one prescription form, regardless of how many instalments or items are on that prescription.

Non-Compliant Rx A compliant prescription is one that is legal, safe, clinically appropriate, as defined by the responsible dispensing pharmacist, and contains, or is provided with, information as defined in the SLA.

If it must be returned to the Trust or prescriber for alteration or requires the Homecare Provider to contact the prescriber for clarification, it should be recorded as non-compliant.

Rx without a PO Prescriptions not including either reference to purchase order generated by Trust or supplied with an accompanying purchase order document.

KPI – % Non-Compliant Prescriptions

Number of non-compliant prescriptions as % of total prescriptions received.

KPI – % Prescriptions Without a PO

Number of prescriptions received without a purchase order number included as % of total prescriptions received.

Number of Deliveries Made

Total number of deliveries made, whether partial or in full. This will also include any ‘out of schedule’ deliveries required for any reason.

Late Deliveries The number of deliveries that were made on the scheduled day, but not within the allocated delivery time slot agreed with the patient. If the delivery must be rescheduled to a different day it is not recorded here but is recorded as a Failed Delivery.

Early & On Time Deliveries

The total number of deliveries which have a recorded arrival time minus the number of late deliveries as defined above.

Failed Deliveries Total A Failed Delivery is where a delivery has been scheduled with the patient, but the patient did not receive it, and as a result it was necessary to reschedule the delivery on a different day.

Delivery Success Total number of deliveries scheduled to be made by HaH minus Failed Deliveries as defined above.

Failed Deliveries HaH Number of Failed Deliveries due to service provider, also including those failures where the culpability is unclear.

Failed Deliveries Patient Number of Failed Deliveries due to patient.

Failed Deliveries Trust Number of Failed Deliveries due to NHS Trust/Purchasing Authority.

Partial Deliveries A Partial Delivery is where the full expected complement of medicines and ancillaries is not received.

KPI – % Late Deliveries Number of medicines and ancillaries deliveries not on time as % of total number of deliveries.

KPI – % Failed Deliveries Number of Failed Deliveries as % of total number of deliveries.

KPI – % Failed Deliveries HaH

Number of Failed Deliveries due to service provider as % of total number of deliveries.

KPI – % Failed Deliveries Patient

Number of Failed Deliveries due to patient as % of total number of deliveries.

KPI – % Failed Deliveries Trust

Number of Failed Deliveries due to NHS Trust/Purchasing Authority as % of total number of deliveries.

KPI – % Partial Deliveries

Number of medicines and ancillaries deliveries not in full as % of total number of deliveries.

KPI – Overdue & Unpaid Invoice Value

Value of invoices issued and remaining overdue for payment.

KPI – % Credit / Debit Note Value

Value of Credit or Debit notes as % of value of invoices issued.

KPI – % Credit / Debit Note

Number of Credit or Debit notes as % of number of invoices issued.

Complaints Number of both informal and formal complaints logged in Quality Management System.

every member of our team, from specialist clinician to driver, lives by the same simple philosophy: the patient comes first

For more information on these reports at a Trust level please contact hello@hah.co.uk