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WMQI. Measuring and improving quality in neonatal care. Talk. Who are we? What we have been doing? Why we are doing it? The future. “ We can only be sure to improve what we can actually measure” Lord Darzi, High Quality Care for All, June 2008. Origins of the quality observatories. - PowerPoint PPT Presentation
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20 January 2012
WMQI Measuring and improving quality in neonatal care
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
Talk• Who are we?• What we have been doing?• Why we are doing it?• The future
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
“We can only be sure to improve what we can actually measure”
• Lord Darzi, High Quality Care for All, June 2008
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
Origins of the quality observatories• “There is clear local support for quality improvement. A
new ‘Quality Observatory’ will be established in every NHS region to inform local quality improvement efforts.”
• “We will also ask each SHA to establish a formal Quality Observatory, building on existing analytical arrangements, to enable local benchmarking, development of metrics and identification of opportunities to help frontline staff innovate and improve the services they offer. “
High Quality Care For All
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
Approach and principles• Clinically championed Indicators
– No measure about me, without me– Bottom up development not top down
• Developmental not regulation– Metrics not targets– Helpful benchmarking and comparison– Helping clinicians to set their aspirations– Helping patients to compare different providers
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
Goal• Building clinician championed metrics is an expensive
investment• Takes time to build consensus• Benefit build local engagement with the data
– Closes feedback loop– Why do I both spending time entering the data, never see any
results?• Understanding your performance is crucial
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
• As Sherlock Holmes says in the Legend of the Copper Beeches: "Data! Data! Data!... I can't make bricks without clay."
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
Quality Indicators: clinician championed
• Vascular Surgery• Orthopaedics• Urgent care• General Surgery
• Mental Health• Learning Disabilities• Care of the elderly• VTE• Cardiovascular
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
NEONATAL INDICATORS
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
The team• WMQI Analyst based at UHBFT• Guided by a group of interested clinicians from across the
West Midlands– Consultants– Nurses– Specialised Commissioners
• Supported by the Staffordshire, Shropshire and Black Country Newborn and Maternity Network Co-ordinator
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
Journey• Process kicked off in October 2010 with presentation to
Partners In Paediatrics– Neonatalogy– Paediatric Surgery– Paediatrics
• Blank sheet of paper!• Global search for metrics
– Literature and internet• Refined during 2011 in a series of meetings
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
Building consensus• Workshop held in November• Over 30 from almost all of the Neonatal units• Reviewed the metrics
– Are these indicators clinically useful?– Are there any issues with the data required to measure these
indicators?– How would you like these reported back?– Are there other things that you would like measuring and
reporting on in the region?
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
Top 3 Priorities
• Mortality• 2 year outcome• Infection/CVL• Morbidity • NEC with surgery• ROP with surgery• Discharged home on
O2
• Clinical Pathways• Transfer• Data Quality• Capacity• Staffing (medical &
nursing)• Temperature
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
First set of metrics1. Discharged home on O2
2. NEC with surgery3. ROP with surgery• Piloting on 5 trusts
– Data quality• Complete, Accurate, Precise
– Statistical model of casemix adjustment• Review process and results with the steering group for
confirmation before processing
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
Badger Dataset • Your Clinical dataset • Opportunity to track most interventions on a neonate• Drawbacks are
I. In the ability to track patients once they are discharged from Neonatal care unit
II. No access to complete regional or national dataset• Opportunities are huge for embedding quality metrics
into their dashboards
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
Going beyond Badger• WMQI has access to the fully linked national dataset
– Birth, A&E, Admission, Outpatient, Death• Provides opportunity to track routinely:
– Survival– On going care post neonatal care
• Elective• Emergency
• Technically simple• Challenge is information governance
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
Transition• End of SHAs• Reinforcement of the provider-commissioner split• Where next for NHS supported development of metrics
– Provider sponsored?– Commissioned focused?
• Still to find out!• For us means focusing on delivery and sustainability
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
Summary • Developing clinician championed metrics takes time to build
consensus• Goal of WM work is to build local engagement with data• Challenge is to complete the work• Align to other work streams at NDAU/NNAP and national
dashboard• Build sustainability through quality dashboard on Badger
www.wmqi.westmidlands.nhs.uk
“We can only be sure to improve what we can actually measure”
WMQI• Email: [email protected]• Contact
– Richard: 0121 213 1987– Jag: 0121 695 2460
• Follow us at @wmqi• Register at the website for updates and news of
events www.wmqi.westmidlands.nhs.uk