health informatics – francis, berwick, keogh et al
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Health Informatics – Francis, Berwick, Keogh et al. Paul Curley Mid Yorkshire Hospitals NHS Trust. Aims. 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 - PowerPoint PPT PresentationTRANSCRIPT
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 !