Improving Quality and Reducing Cost
The Role of Measurement
Carrie Marr
Associate Director Change & Innovation
Tayside Centre for Organisational
Effectiveness
Integrating Finance and Quality
Context
Financial
Waste
Demographic
Harm
Safety & Quality
Variation
Healthcare demand is growing
Demographic change for population aged 65+ Scotland
Potential impact on emergency bed numbers 2007-2031
16000
14000
12000
NHS Tayside
+148 beds 2016
+517 beds 2031
A new Ninewells
Hospital by 2031!
84%
61%
Beds
10000
9%
8000
41%
24%
6000
4000
2000
0
Y/E Mar 2007
Projected
2011
Projected
2016
Projected
2021
Year
Projected
2026
Projected
2031
Evidence of Waste in Healthcare Systems
Increase Capacity of Outpatient
Clinics?
Question 1 – Are there significant Outpatient Capacity
losses?
25.0
20.0
Opportunity?
15.0
%
New
Return
10.0
5.0
0.0
Discharged
•
AWAITING TEST
RESULT
REFD OTHER
CLIN/HOSP
DNA-Total
27% of New Outpatient appointments are being wasted!
Could Not Wait - FA
REFER TO OTHER
HOSP
District Nursing
» There are approx 430,000 District Nurse Visits in a year
(56% of District Nurse time was non-patient facing)
Comparison of band 6 and band 5 activity
Ad
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in
Pa of M
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W i ativ ds
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ire mm rt v
ct
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c
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an atio
ag
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en
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t
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om nd
pu ove
r
te
rw
or
k
C
om Tra
fo vel
rt
br
ea
k
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Band 6
Band 5
Evidence of Clinical Variation in
Healthcare Systems
Cost per Head by GP Practice 2006/07
(incl. GMS)
1600
1400
1200
1000
800
600
400
200
0
GP Practices
Examples of Variation in Clinical
Practice
•
•
•
•
Poly pharmacy
Rates of admissions in over 65 years
Lengths of stay in over 65 years
Referral patterns into acute specialist care
Achieving Quality Improvement
and
cost reduction
Developing
and Improving Services
QUALITY INITIATIVES
NEW DEVELOPMENTS
1
Costs more
2
COST REDUCTION PROGRAMMES
EFFICIENCY SAVINGS
3
4
5
Cost neutral Improves quality Quality neutral Reduces
& reduces costs
quality
Improving Quality and Reducing
Costs
Our Choice
Surviving – the 5%
Thrive – the 95%
2009 - 2011
TACTICAL
STRATEGIC
PRODUCTIVITY &
EFFICIENCY
SERVICE
OPTIMISATION
CRES
DEALING WITH
THE 5%
TRANSFORMATION
SPENDING THE 95%
BETTER
2010 - 2013
TACTICAL
STRATEGIC
PRODUCTIVITY &
EFFICIENCY
SERVICE
OPTIMISATION
CRES
DEALING WITH
THE 5%
TRANSFORMATION
SPENDING THE 95%
BETTER
Steps to Better Healthcare
Mental
Health
Out
Patients
Theatre
Capacity /
Planned
Care
Workforce
Older
people
Shifting Optimisation Prescribing
the
of Health
and
Balance
Facilities
Medicines
of Care
across
Tayside
Scenario Planning, Financial Baselines, Benefits Tracking, Business
Cases
Workforce Modelling, Engagement & Communications with staff
Other
Labs
Maternity
Finance Support
Workforce Support
Communications with public and staff
Comms Support
Organisational Effectiveness support
OE Support
How I engage
with the centre:
Technology
Enabling
Health
To develop trained experts in quality
improvement organisational development
and leadership to support improvement
work prioritised by our joint clinical boards.
The focus of this expertise will be mobilised
to support front line staff and clinicians to
build capability in improvement methodology
and support key improvement programmes
Improvement
&
Development
Support
Real time information resource to
support quality improvement of
clinical services
Enhance spread and share of
good practice through use of technology
ie web portal
Improvement
Academy
Develop a innovative education
and training resource to assist in
our quality improvement needs
through improvement science
and optimising e health resources.
Business Support
Real time information and measurement
systems
NHS Tayside Clinical Portal:
CHKS
• Annual and Bi annual reports which will take a
high level organisational perspective
• Specific reports designed to address issues
identified within the organisational reports or at
the request of the organisation when internal
review may have identified issues which need
further clarification
• Continuous review of data quality and feed
back to the organisation to support audit and
development
Average Length of Stay : General
Surgery
Approaching length of stay either at specialty level as part of other indicators
or specifically length of stay within the hierarchy by specialty 3.3 days (peer 2.6 )
Consultant Level Average Length of
Stay (GS)
•
The table identifies
the consultants
involved in the
management of
cases in General
Surgery
•
Most individuals
have a greater
average length of
stay than the peer
•
Bed day opportunity
is derived from
average length of
stay and volume of
activity
•
Some individuals
have very small
volumes of cases
Length of Stay by Condition
(HRG)
• The table above illustrates the 8 HRGs with the
greatest potential for bed day improvement based on
volume and comparative length of stay to peer
average.
• Off note is the number of cases with no associated
procedure for some of these condition groupings
Outpatients
• The outpatient indicators concentrate on new to
review ratios and DNA rates
• At organisational level new to review – 1 to 0.5 (peer
1 to 2.1)
• At organisational level DNA rates 8.2% (peer 7.9%)
Business Support Hub
• Collect once use for many purposes
• Collect from a wide range of sources
NHS, Local government, Public health
• High Data Quality Standards applied
• Systems to support business
requirements
• Training & education
• Predictive modelling
Clinical
Quality
Organisational
Effectiveness
Financial
Planning
To build capability within the
Business Support Unit
Development of 2 tiers:
Production – automating regular
reports as much as possible using IT
solutions eg. BO and VBA
Health Intelligence / Innovation






 Unique Patient Tracking
 Clinical Dashboards
+ Quality Metrics
 Statistical Process Control
+ Variation reporting
 Strategic improvement data
analysis (variation and waste Data)
+ Service Improvement
 Patient Pathways
 Predictive Risk Score Modelling
Waiting list reporting
Full patient tracking
Weekly position summary
Bed statistics / utilisation
A&E submissions
others...
Clinical Dashboards – Pilot Metrics
• Real-time Bed Management, e.g. available / occupied
beds
• Service / Resource Utilisation, e.g. boarding patients,
same day surgery rate,
outpatient dna rates
• Waiting Times & Access, e.g. 18 weeks RTT, inpatient /
daycase / new outpatient
• Infection Control, e.g. hospital acquired infection,
handwashing, cleanliness
• Patient Safety, e.g. anti-biotic policy, early warning scores,
compliance with central line insertion,
daily safety briefings compliance
Patient Safety
28
Click to
view trend
line
29
Hover over
data point for
detail
Click for
more details
Data Table
30
The Current Challenge facing
NHS Tayside
• Data for discussion, not judgement supports a
shift in culture
• Education programmes that build capacity and
capability in data and analysis
• Supporting staff to build confidence in handling data
and align to real time delivery of services
• real-time information and measurement systems
that connect whole systems – clinical and nonclinical
• Prospective capacity management
• Dashboards for clinical quality, business
information and governance