Emergency flow improvement tool Changing the way we look at data 29 November 2017 Title slide with embedded images

If we look at data the same way we will get the same results The challenge If we look at data the same way we will get the same results NHSI.efit@nhs.net

Pleasant Surprise Trust : A&E performance This is also Pleasant Surprise Trust. Here we are looking at monthly data – we can see the improvement that was identified in the previous slide. But what happened before then? This is an SPC chart (not going to talk about these in detail in this session). If people want to know more about SPC I have some tips at the end. Simply by plotting the dots, it is easy to see where performance is changing over time –and to investigate what might have happened and to take action A pleasant surprise? A pleasant surprise? NHSI.efit@nhs.net

Take two different numbers, one will be bigger beware point measures, before and after

Sea of green or algae bloom The tool is provided as an improvement aid and diagnostic tool to help Trusts to understand the issues impacting most on flow through their hospital. By using the flow tool, Trusts will be able to focus interventions on these issues and understand whether changes that are being put in place are resulting in improvements. The flow tool uses an analytical technique (Statistical Process Control or SPC) which is helpful in identifying when changes have occurred which are statistically valid and not just random chance. NHSI.efit@nhs.net

Early warning obscured by fog of green The tool is provided as an improvement aid and diagnostic tool to help Trusts to understand the issues impacting most on flow through their hospital. By using the flow tool, Trusts will be able to focus interventions on these issues and understand whether changes that are being put in place are resulting in improvements. The flow tool uses an analytical technique (Statistical Process Control or SPC) which is helpful in identifying when changes have occurred which are statistically valid and not just random chance. NHSI.efit@nhs.net

Red Green blindness

Basically if there is not a threshold or target why are we RAGing it? Recognition of need to balance measurement for improvement and judgement Basically if there is not a threshold or target why are we RAGing it? https://improvement.nhs.uk/resources/developing-people-improving-care/ And to build capacity to help support the change https://nhsi.kahootz.com/connect.ti/SPC_Champs/groupHome NHSI.efit@nhs.net

Emergency flow improvement tool

Timeline Alpha testing 28th June 2017 – 10th September 2017 Launch of tool 11th September 2017 At Health and Care Innovation Expo 2017 Version Two November 2017 NHSI.efit@nhs.net

Co-designing the tool with acute trusts 150 users 30 acute providers Weekly WebEx’s Walkthroughs, polls, question and answer sessions One to one site visits and virtual demonstrations with North Middlesex West Suffolk South Tees Royal United Hospitals Bath Northumbria South Warwickshire

Inspired by Based on

Describing patient flow with 28 indicators Hospital Accident and Emergency    2018 

What does each chart show? Indicator title Benchmarking icon Upper control line Mean line Latest activity value Lower control line Data point roundels – one for each of the last 25 calendar months Grey – common cause variation Orange – special cause variation – cause for concern Blue - special cause variation – to note/investigate

What are the rules behind each chart? Six rules shown on the indicator detail page…. NHSI.efit@nhs.net

Why is six points significant? Probability Considering a random system with 50% chance of improvement and 50% of decline (e.g. based on a coin toss) A trend of 2 has the probability of 25% occurrence (one in four) = (0.5)*(0.5). A trend of 4 has the probability of 6.25% occurrence (one in sixteen) = (0.5)*(0.5)*(0.5)*(0.5) = 6.25% A trend of 6 has the probability of 1.56% occurrence (one in sixty-four) = (0.5)*(0.5)*(0.5)*(0.5)*(0.5)*(0.5) = 1.56% NHSI.efit@nhs.net

Finding out more Watch the webinar: https://improvement.nhs.uk/events/emergency-flow-improvement-tool-identifying-patient-flow-issues-your-trust/ NHSI.efit@nhs.net

Outreach 116 separate organisations and 448 unique users have accessed the Efit tool since launch in September 2017

How to access NHS Provider Staff Register for an account https://model.nhs.uk/ Other NHS Staff / Non NHS Staff Email NHSI.efit@nhs.net for terms and conditions which will govern your use of the tool NHSI.efit@nhs.net

So why is this different? Social change across #plotthedots Backed up by the leadership framework Finally starting to use technology Tableau visualisations available on multiple devices Paper, pdf, laptop, phone, tablet Automation daily downloads updates Daily sitrep flow tools with minimal human involvement Near real time tracking Replicable to other sectors and pathways NHSI.efit@nhs.net