Health Informatics – Francis, Berwick, Keogh et

alPaul Curley

Mid Yorkshire Hospitals NHS Trust

To put in context role of Health Informatics in the Keogh review process

To review “smoke alarm” indicators Share insights into Keogh process –

strengths and weaknesses Explore possible surrogate indicators of

quality Explore Surgeon/service level data issues Touch on Naughty Neighbour media storms..

Aims

Francis report – Mid Staffs “Could there be others ?” 14 organisations identified via HSMR or

SHMI

Panel identification – RCS Invited Review Mechanism

Data Pack analysis – NHS England/PwC Visits – Announced / Unannounced Risk Summit

Keogh Review process

Expenses to support visits - £169,000 Contract award (PwC) support - £2,773,000 Filming Risk Summits - £28,000 Legal Advice - £30,000

Total - £3,000,000

$58,000 $1.1m

Costs

Chair (Senior Nurse/Manager/Medical Director)

Consultants (2-3) Senior Nurses (2-3) Student Nurse Junior Doctor CQC Patient/Public Reps Senior Manager NHS England CCG Observers

Panel

HSMR Funnel Plot

Activity

Demographics

Demographics 2

Demographics 3

Selection of 14 Trusts

SHMI vs HSMR

SHMI Tree

SHMI Gen Med breakdown

HSMR Tree

HSMR Tree breakdown

LOS / Readmission rates average/low

Patient Experience (inpatient survey)

Staffing Challenges

Staff Engagement

Inadequate governance, and pace and focus of change to improve overall safety and experience of patients

Slow and inadequate responses to serious incidents and a culture which does not support openness, transparency and learning

Staffing shortfalls and other workforce issues across staff groups which may be compromising patient safety

Lack of support for staff and effective, honest communication from middle and senior management level

Failure in governance to ensure adequate maintenance of the estate and equipment

Significant weaknesses in infection control practices

Key Findings

Drop in face-to-face staff meetings Locum/Agency spend Dealing with Serious Untoward Incidents

(never events) Equipment management PPI / Junior doctor / Student Nurse members

Most Useful Indicators

Published June/July 2013 Several specialties

Vascular – AAA, CEA

Tables non-risk adjusted

Surgeon Level Outcomes

Florence Nightingale 1863"I am fain to sum up with an urgent appeal for adopting … some uniform system of publishing the statistical records of hospitals. There is a growing conviction that in all hospitals, even in those which are best conducted, there is a great and unnecessary waste of life … In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purposes of

comparison … If wisely used, these improved statistics would tell us more of the relative value of particular operations and modes of treatment than we have means of ascertaining at present?"

Florence Nightingale in Notes on Hospitals, London: Longman, Green, Roberts,Longman, and Green, 1863.

Weekly Bills of MortalityLONDON week ending 31st January 1634The Diseases and Casualties this week

Overlaid 2Quinsie 1Rickets 8Rising of the lights 8Scowering 1Scurvey 2Stillborn 9Stone 1Stopping of the stomach 3Suddenly 6Teeth 16Winde 3Worms 1

Males 107Christened Female

109In all 216

Males 213Buried Females196

In all 409Plague 0

Decreased in the buriels this week - 63 Parishes clear of the plague - 130 Parishes infected - 20

Abortive 2Aged 36Bedridden 1Bloody flux

1Bruised 1Cancer 1Chilbed 3Chrisoms 19Consumption 77Convulsions 44Cough 2Dropsie 1

Executed 33Feaver 10Flox and smallpox 5Found dead in the street (an infant) 1French pox

1Gripping in the

guts13

Jaundies 1Infants 18Killed with a fall 3Murthered 1

Raw vs Risk-Adjusted data

Pennine Acute Hospitals NHS Trust 266

4308472 89 3 86 0.0%

4187787 * * * * 3643174 84 11 73 2.4%

3560031 50 14 36 2.0%

6090793 * * * *

Information / Data

Primary – STEMI Planned – angina, NSTEMI etc 2 models :

Centralised (Leeds, Newcastle) Distributed

Good data submission Is “geography/service model” an issue ?

Coronary PCI

HSMR Mortality Funnel Plot

Information hidden in data !

Health Informatics can develop “smoke alarm” indicators

Detailed analysis of available data played an important role in the Keogh review process

Informatics alone were not adequate to diagnose issues in many of the Keogh sites

Multi-disciplinary teams brought huge value to the Keogh process

Conclusions

At current levels of sophistication, health informatics are complementary to inspection processes

Listening to staff and patients will continue to play a vital role in assessments for the foreseeable future

Developing a standard “data pack” for Acute Trusts would be a valuable health informatics task

Conclusions

Wakefield Prison – category A Highest concentration of Sex offenders and

Murderers in Prison population

More Paedophiles and murderers reside in Wakefield than any other city in UK

Only major Burns Centre in Yorkshire based in Pinderfields

Fatality from Burns higher in Wakefield than Leeds, Bradford, Hull, Huddersfield and Halifax combined

Document Management PAS replacement Outsourced letter printing EDsM Order Comms PACS/RIS PMI duplicates Managed networks VoIP/Mobile voice/Faraday cage construction

As for IT Projects !