20 January 2012 WMQI Measuring and improving quality in neonatal care

“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 September 15

“We can only be sure to improve what we can actually measure” Lord Darzi, High Quality Care for All, June 2008 September 15

“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 September 15

“We can only be sure to improve what we can actually measure” September 15

“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 September 15

“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 September 15

“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." September 15

“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 September 15

“We can only be sure to improve what we can actually measure” NEONATAL INDICATORS September 15

“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

“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 September 15

“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? September 15

“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 O 2 Clinical Pathways Transfer Data Quality Capacity Staffing (medical & nursing) Temperature September 15

“We can only be sure to improve what we can actually measure” First set of metrics 1. Discharged home on O 2 2. NEC with surgery 3. 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 September 15

“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

“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

“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 September 15

“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

“We can only be sure to improve what we can actually measure” WMQI Contact – Richard: – Jag: Follow us Register at the website for updates and news of eventswebsite September 15