How better use of data can help address key challenges facing the NHS

The Health Foundation | January 2022 | How better use of data can help address key challenges facing the NHS

This long read from The Health Foundation explores how the NHS in England can better use routine health data to help address current challenges, including winter pressures, the ongoing coronavirus response and the growing elective care backlog.

Image shows healthcare staff on a ward using a tablet

The Health Foundation examines the longstanding barriers to widespread use of data and data science, consider what actions might help to overcome these, and explore whether the data strategy for health and social care will deliver the change needed.

It explores the following:

1. How can health data help the NHS?
2. What is preventing this potential from being realised and what can be done about it?
3. Will national policy help realise the potential of data and data science?

The Health Foundation How better use of data can help address key challenges facing the NHS

Speeding up NHS service transformation – how can we do better?

The Health Foundation | February 2022 | Speeding up NHS service transformation – how can we do better?

In this webinar Dr Tim Ferris, NHS England’s Director of Transformation, joins The Health Foundation to explore the next steps for service transformation at scale. Against the backdrop of the recent Wade-Gery review, the data strategy, the forthcoming Goldacre review and AI strategy, the new tech fund to support elective recovery, and a renewed focus on delivering the tech ambitions outlined in the Long Term Plan, how can these be linked to support service transformation better in practice? What will be different this time?

Webinar 23 March 2022 11:30 AM  GMT held over Zoom (requires registration with The Health Foundation)

Speeding up NHS service transformation – how can we do better?

National Bowel Cancer Audit Annual Report 2021

National Bowel Cancer Audit (2022). National Bowel Cancer Audit Annual Report 2021

Early in the COVID-19 pandemic, there was a large impact on the diagnosis and treatment of bowel cancer patients. However, bowel cancer services had largely recovered by March 2021.

For this year’s audit, The National Bowel Cancer Audit (NBOCA) has undertaken additional work looking at the impact of the COVID-19 pandemic on bowel cancer services in England and Wales. For example unplanned return to theatre (which allows evaluation of serious post-operative complications) and separation of data related to rates of stoma formation into permanent stoma rates versus unclosed diverting ileostomy rates. Furthermore, in response to the updated NICE recommendations, the report provides data on rectal cancer volumes by trust, hospital and MDT that may influence current discussions surrounding specialisation with regard to rectal cancer surgery.

The report is divided into two sections. Part 1: Pre-pandemic (Patients diagnosed 01 April 2019 to 31 March 2020), and Part 2: Recovery of bowel cancer services from the COVID-19 pandemic (Patients diagnosed 01 April 2020 to 31 March
2021). (Source: National Bowel Cancer Audit).

Image shows the diagnosis and care pathways for patients with bowel cancer. Image source: nboca.org.uk

National Bowel Cancer Audit Annual Report 2021

See also:

NBOCA Quality Improvement Plan

Deliver and improve: A board members’ guide to trust- wide improvement

NHS Confederation | February 2022 | Deliver and improve: A board members’ guide to trust- wide improvement

NHS Providers trust-wide improvement programme, supported by the Health Foundation, aims to support NHS trust leaders to develop their understanding of organisation-wide approaches to improvement and develop the skills and confidence they need to support their organisation to take the next step on its improvement journey.

As part of this, the programme offers opportunities to reflect on the implications for improvement from COVID-19 and support trusts to sustain the beneficial changes made in response to the pandemic. The programme provides opportunities for board-level peer learning through webinars, workshops and action learning sets, and online resources to support their improvement journey. Our strategic partnership with the Health Foundation enables us to draw on its extensive work on this topic, and existing communities of improvement leads across the sector through the Q Community.

 This resource seeks to help you navigate these by bringing together a selection of useful articles, reports, videos and podcasts to support conversations at board and quality committee level, to support you in decision-making and taking action.

The content aligns with the factors required to drive and embed improvements in a health care organisation or system, as highlighted by the Health Foundation in their guide Quality improvement made simple, recently updated. We also signpost to the current range of learning support available to boards.

See also:

NHS Providers’ online hub

Deliver and improve: A board members’ guide to trust-wide improvement

The impact of management on hospital performance

Asaria, M., McGuire, A. & Street, A. (2022). The impact of management on hospital performance. Fiscal Studies.https://doi.org/10.1111/1475-5890.12293

In this paper, the authors assess whether there is an association between managerial input and hospital performance in the English NHS. In order to do so, they create measures of the amount and quality of managerial input as well as a collection of indicators against which to assess hospital performance.  They outline a suggested mechanism linking management input to outcomes. They define our measures of management quantity and management quality, and we describe how we construct these measures. They introduce our empirical specification and report our key results. They conclude with a discussion and interpretation of our findings.

Abstract

There is a prevailing popular belief that expenditure on management by health-care providers is wasteful, diverts resources from patient care, and distracts medical and nursing staff from getting on with their jobs. There is little existing evidence to support either this narrative or counter-claims. We explore the relationship between management and public sector hospital performance using a fixed effects empirical econometric specification on a panel data set consisting of all 129 non-specialist acute National Health Service (NHS) hospitals in England for the financial years 2012/13 to 2018/19. Measures of managerial input and quality of management practice are constructed from NHS Electronic Staff Records and NHS Staff Survey data. Hospital accounts and Hospital Episode Statistics data are used to construct five measures of financial performance and of timely and high-quality care. We find no evidence of association either between quantity of management and management quality or directly between quantity of management and any of our measures of hospital performance. However, there is some evidence that higher-quality management is associated with better performance. NHS managers have limited discretion in performing their managerial functions, being tightly circumscribed by official guidance, targets, and other factors outside their control. Given these constraints, our findings are unsurprising.

The impact of management on hospital performance

Improving delivery of low tidal volume ventilation in 10 ICUs

Donadee, C. et al.(2022). Improving delivery of low tidal volume ventilation in 10 ICUs. BMJ Open Quality. 11. e001343. doi:10.1136/ bmjoq-2021-001343

Low tidal volume ventilation (LTVV) improves mortality in patients with ARDS and is associated with decreased morbidity and mortality in mechanically ventilated patients without ARDS. This QI project succeeded in improving compliance with LTVV in all ICUs that participated in the project.

Abstract
Low tidal volume ventilation (LTVV) is standard of care for mechanically ventilated patients with acute respiratory distress syndrome and has been shown to improve outcomes in the general mechanically ventilated population. Despite these improved outcomes, in clinical practice the LTVV standard of care is often not met. We aimed to increase compliance with LTVV in mechanically ventilated patients in 10 intensive care units at 3 hospitals within the University of Pittsburgh School of Medicine Department of Critical Care Medicine. Four Plan-DoStudy-Act (PDSA) cycles were implemented to improve compliance with LTVV. Initial compliance rates of 40.6 per cent–
60.1 per cent improved to 91 per cent–96 per cent by the end of the fourth PDSA cycle. The most impactful step in the intervention was providing education and giving responsibility of selecting the tidal volume to the respiratory therapist. The overall intervention resulted in improved compliance with LTVV that has been sustained.

Improving delivery of low tidal volume ventilation in 10 ICUs

Voices and stories are central to improving healthcare

Fitzsimons B. (2022). Voices and stories are central to improving healthcare. BMJ. 376. o114 doi:10.1136/bmj.o114

This opinion piece in The BMJ considers the importance of voices and stories and their role in improving healthcare.

Stories can be used to great effect to galvanise effort. They not only engage the listener, but they persuade too. They reflect the humanity that is fundamental to healthcare.

Piece available from The BMJ

See also:

Cribb, A., Entwistle, V., & Mitchell, P. (2021). Talking it better: conversations and normative complexity in healthcare improvement. Medical humanities. BMJ

Wu, F., Dixon-Woods, M., Aveling, E. L., Campbell, A., Willars, J., Tarrant, C., … & Martin, G. P. (2021). The role of the informal and formal organisation in voice about concerns in healthcare: A qualitative interview study. Social Science & Medicine, 280, 114050. Social Science & Medicine

[Webinar] Using health data to improve outcomes for patients

Eventrbrite & Office for National Statistics |n.d | Using health data to improve outcomes for patients

Hosted by ONS’ Data Science Campus and Health Analysis Team, this brand-new seminar series is an exciting opportunity to hear about recent developments in health data science, to generate ideas, and to help build the health data science community

The seminars provide a dedicated space for data scientists, policymakers, health professionals, academics, epidemiologists, statisticians and other members of the data science community to come together to explore the potential of data science to improve health and health policy.

At this seminar you will hear from Dr Adam Steventon, who is Director of Data Analytics at the Health Foundation. Adam will be presenting on “Using health data to improve outcomes for patients”

Abstract

Adam will be talking about how NHS and social care organisations can be using data more effectively to improve services, and the steps that national organisations, academia and industry can be taking to support that endeavour. Adam will look back at the last twenty years to draw out some of the lessons, analyse current strategy and make some recommendations for the future.

Seminar will be held Thu, 17 February 2022 15:00 – 16:15 GMT

Booking and further information from Eventbrite (free, but requires registration)

Challenges experienced by clinical teams in measuring improvement

Woodcock, T., Liberati, E.G., Dixon-Woods, M. (2021). BMJ Quality Safety. 30. 106–115.

This article published in the BMJ Quality and Safety uses data from a mixed-methods independent evaluation of a nine-site UK patient safety improvement programme to report on clinical teams’ experiences of using locally selected measures. The researchers aimed specifically to describe their experiences of planning and conducting measurement activities, collecting data and analysing and interpreting data for their improvement projects.

Abstract

Objective Measurement is an indispensable element of most quality improvement (QI) projects, but it is undertaken to variable standards. We aimed to characterise challenges faced by clinical teams in undertaking measurement in the context of a safety QI programme that encouraged local selection of measures.

Methods Drawing on an independent evaluation of a multisite improvement programme (Safer Clinical Systems), we combined a qualitative study of participating teams’ experiences and perceptions of measurement with expert review of measurement plans and analysis of data collected for the programme. Multidisciplinary teams of frontline clinicians at nine UK NHS sites took part across the two phases of the programme between 2011 and 2016.

Results Developing and implementing a measurement plan against which to assess their improvement goals was an arduous task for participating sites. The operational definitions of the measures that they selected were often imprecise or missed important details. Some measures used by the teams were not logically linked to the improvement actions they implemented. Regardless of the specific type of data used (routinely collected or selected ex novo), the burdensome nature of data collection was underestimated. Problems also emerged in identifying and using suitable analytical approaches.

Conclusion Measurement is a highly technical task requiring a degree of expertise. Simply leveraging individual clinicians’ motivation is unlikely to defeat the persistent difficulties experienced by clinical teams when attempting to measure their improvement efforts. We suggest that more structural initiatives and broader capability-building programmes should be pursued by the professional community. Improving access to, and ability to use repositories of validated measures, and increasing transparency in reporting measurement attempts, is likely to be helpful.

[Full paper] A mixed-methods study of challenges experienced by clinical teams in measuring improvement

Key facts and figures about the NHS

The King’s Fund | January 2022 | Key facts and figures about the NHS

This release from The King’s Fund provides key facts and figures on the NHS, it covers the following:

• How much does it cost?
• What does the money buy?
• How many…?
• The long-term trend in demand
• The impact of Covid-19
• What does the average day in the NHS look like?

The King’s Fund Key facts and figures about the NHS