Secondary Healthcare Contract KPIs (Key Performance Indicators)Summary for operating period 2018(for more detailed information see the supporting information document)

Indicators are reported across 6 Themes:1. Professional Compliance2. Patient Safety & Experience3. Waiting Times4. Outpatient measures5. Inpatient measures6. Patient Focus

Professional Compliance Measures

Up to Date Job Plans & Job Descriptions

Completion of Annual Appraisals

Attendance ofAcademic Half Days

100% of job plans and job descriptions were in place for the operational year 2018.

94.9% of Consultants and Doctors had received an appraisal for the operational year of 2018. Analysis of those not completed has identified that long-term unavoidable absences have meant that a small number of appraisals had to be deferred.

Across 2018, this KPI has consistently exceeded the agreed target, achieving a median percentage of 76.5% attendance.

During 2018, 50% of HSC and MSG Consultants and Doctors attended seven out of 12 AHDs. Those who were unable to meet this target may have been dealing with emergencies or unscheduled events, or may have been on annual or sick leave.

There are three different meeting groups who support the Secondary Healthcare contract. These groups collectively reached a median percentage of 59.7% attendance in 2018.

One of the three meetings (the Clinical Reference Group) has a very wide membership because of its broad agenda which means it has not been able to achieve full attendance across the year. This in turn reduces the overall performance of this measure.

Compliance with Inpatient Discharge Summaries Process

During 2018, an average 63.2% of documentation was processed within 24 hours of patient discharge. Work continues to ensure the medical records team are fully staffed to improve performance against the stated target.

Monthly performance has been improving with the average for 2018 standing at 70.8%. Scheduled times can be impacted by emergencies that a Consultant/Doctor must attend given that Guernsey does not have junior doctors. Over-runs are also possible if cases are more complex than originally planned.

Attendance in the Cancer Multidisciplinary Team

Meetings

Attendance at Contractual Meetings

Meet expected timings for operating theatres

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Target 100%

Target 100%

Target 70%

7 out of 12 AHDs

Target 70%

100%

Target 85%

Hospital Acquired Infections RateTarget: 0 This is measured quarterly, with a median average occurrence of 1 per quarter across 2018.

Venous Thromboembolism (VTE) Risk Assessment RateTarget: 95%

This measure is audited monthly. We have seen a rise in compliance across 2018 from 36% in quarter 1 2018 to 84.8% in quarter 4 2018.

Patient Safety & Experience Measures2

Radiology Waiting timesTargets: 24 hours, 2, 6 or 8 weeks.

In 2018, this KPI has improved overall from 63.7% in April 2018 to 83% by year end. The average for the year was 76.8%. The service is delivered by a small team of skilled professionals and any absence of key staff, as happened earlier in 2018, directly impacts on the performance that can be achieved.

Inpatient Contract Waiting TimesTargets: 24 hours, 7 days, 2 or 8 weeks Including orthopaedic patients, 83.7% of inpatients were seen within the contractual waiting time target during 2018.

A specific project is underway jointly between HSC and MSG to improve inpatient waiting times for orthopaedic inpatients.

Outpatient Contract Waiting TimesTargets: 24 hours, 7 days, 2 or 8 weeksIncluding orthopaedic patients, 76.5% of outpatients were seen within the contractual waiting time target during 2018.

Following a waiting list initiative to bring orthopedic outpatient waiting times into contract, these have improved from 68.8% of outpatients being seen within contract in January to 89.1% in December 2018.

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Waiting Time Measures - Target: 95%3

Emergency Department Waiting TimesTarget: 4 hoursThe average performance for 2018 is 91.2% against a target of 95% or more of our service users being admitted and discharged within 4 hours of arrival.

This is also a UK measured target where 88.1% of UK service users were admitted and discharged within 4 hours between January and September 2018. The average over that same period in Guernsey was 90.1%.

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Outpatient Measures4

Failure to attend and Short Notice Patient Cancellation Rate –Adults.Target: less than 6%

The average failure to attend / cancellataion rate for adult outpatient appointments was 6.1% in 2018.

HSC and MSG are working together to investigate improvements that could be made to improve attendance rates for both inpatients and outpatients.

Organisation Cancelled Outpatient Appointment Rate.Target: less than 10%

The average for 2018 was 13.5%, however, it should be noted that a cancelled appointment can include changes made in the best interests of the patient, such as changing an appointment to an earlier time/date.

Failure to attend and Short Notice Patient Cancellation Rate –Paediatrics.Target: less than 11%

The average failure to attend / cancellation rate for Paediatrics in 2018 was 10.2%. Non attendance directly costs HSC and MSG in terms of lost time and re-arrangements.

Organisation Initiated Radiology Cancellation Rates. Target: less than 10%

Data on this KPI has been recorded since August 2018 and has been at or below 1% for every month to the end of December 2018.

Delayed Transfer of Care DaysTarget: less than 100 days/monthThis measure was introduced in July 2018 and has achieved a median average of 91 days across all delayed discharged patients.

Emergency Readmission Rate within 28 Days of DischargeTarget: less than 10%This measure was consistently achieved during 2018, with a median average of 6.5%.

Day Case unit to Inpatient Conversion Rate. Target: less than 5%The median average for 2018, was 1.7%.

Organisation Initiated Cancellation RatesTarget: less than 10%This data was reported for the first time in April 2018 and has been consistently within target since, attaining a median average of 8.8% for the year.

Average Length of Stay (Elective admissions only) –Target: less than 6 daysThe median average across the monthly averages of 2018 is 3.9 days per stay and other than in January and February when the health care system generally experiences higher demand (due to winter pressures), performance in this area has achieved the target.

Inpatient Measures5

Return to Theatre within 28 daysTarget: less than 2.5%The data has been reported since July 2018 and shows the number of returns to be very low, not being more than 0.3% per month.

Failure to attend and Short Notice Patient Cancellation Inpatient Rate. Target: less than 2%The median average for 2018 was 2.8%.

Patient Focus Measures6

Off Island ActivityNumbers of incorrect or inappropriate referrals have significantly reduced during 2018 compared to previous years with an average of 9 (out of around 140 referrals) per month (6%).The Off-Island Team continue to work with colleagues within both HSC and MSG during 2019 to further improve performance.

Complaints ProcedureAn average of 85.6% of complaints were successfully resolved within 20 days, with the balance relating to complex complaints which take longer to investigate and resolve.

Family & Friends TestThis is a recognised NHS measure which identifies the percentage of service users who respond “extremely likely” to the following question: “How likely are you to recommend this service to friends and family if they needed similar care or treatment?”

The percentage of responses who were “extremely likely” to recommend our service was 39.8%.

Monitoring of these responses provides a meaningful and essential source of information for identifying gaps and developing an effective action plan for quality improvement within secondary healthcare services in Guernsey.

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Secondary Healthcare Contract: 2018 Key Performance Indicators

Supporting Information:

The purpose of this document is to provide information to support the publication of the

Key Performance Indicators (KPIs) in relation to the first year of the Secondary Healthcare

contract (SHC).

Prior to 2018, although data was kept on various elements of activity with Health & Social

Care (HSC) and the Medical Specialist Group (MSG), it was not reported on or monitored in

the same way. During 2018, and following the launch of a new Secondary Healthcare

contract, a considerable amount of work has been undertaken by both HSC and MSG to

allow us to report on the KPIs detailed within the contract. As part of this process, some KPIs

have required changes to systems and ways of working to allow the data to be collected and

some have only become reportable later on within the year. The teams within HSC and MSG

continue to work closely together to ensure the data that is reported is accurate and of the

best quality possible and this may result in further improvements to processes and

reporting in future years to ensure that the data is useful for all stakeholders and can assist

decision making.

The KPIs have been set to reflect the highest standards of practice and patient care and they

encourage a culture of continual development and improvement towards excellence.

Where targets have not been met during this first year of monitoring, we have a good

understanding of why and thus a platform from which to make further improvements over

the coming year.

The KPIs are reported over six ‘themes’ which collectively provide a detailed overview of the

quality of services provided.

Professional Compliance

Up to Date Job Plans & Job Descriptions Target: 100%

Job Plans describe how our doctors and consultants spend their working days whilst Job

Descriptions contain the list of skills and competencies required from each professional.

They are reviewed periodically to ensure that they reflect current working arrangements.

All job plans and descriptions in place and up to date.

Completion of annual appraisals Target: 100%

Annual appraisals are formal peer reviews that ensure doctors and consultants are up to

date and fit to practice and they can highlight personal development objectives to assist the

doctor in meeting their professional obligations.

This indicator is measured in April of each year with a view to the previous calendar year. As

at April 2018, 94.9% of annual appraisals had been completed in the previous twelve

months. Analysis of those not completed has identified that long term unavoidable

absences have meant that a very small number of appraisals have been deferred.

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Attendance in the Cancer Multidisciplinary Team (MDT) Meetings Target: 70%

It is recognised as best practice that patient care pathways are discussed and agreed at a

MDT meeting. These meetings bring together the blend of healthcare professionals with the

necessary knowledge, skills and experience to ensure high quality diagnosis, treatment and

care for patients.

In 2018, the median percentage of attendance achieved over the year was 76.5%.

Attendance of Academic Half Days Target: 7 out of 12 AHDs

Academic Half Days (AHDs) are an ongoing programme of presentations, training and

continuing professional development (CPD) for both HSC and MSG consultants and doctors.

CPD is crucial to healthcare providers as it allows a medical practitioner to learn and

discover ways to improve on the patient care they deliver. It also enables medical

practitioners to stay current with the latest developments within their specialty, addresses

real-world challenges that medical practitioners face day to day and meets the regulator’s

revalidation requirements.

During 2018, 47.1% of HSC and MSG Consultants and Doctors attended seven out of the 12

AHDs which were provided. Analysis of this result has indicated that those who were unable

to meet this target were generally dealing with emergencies or unscheduled events, or may

have been on annual or sick leave.

Attendance at Contractual Meetings Target: 70%

There are three contractual meetings attended by a number of professionals from multiple

groups within all areas of both primary and secondary healthcare. These meetings cover

contract management, governance and clinical services and the effective management of

core healthcare services.

All meetings across 2018, apart from the Clinical Reference Group meeting scheduled for 28

December 2018, were quorate. The median percentage of attendance at the meetings was

59.7%. The achievement of the KPI was affected by the contractual definition of the

membership of the Clinical Reference Group which included some representatives from

primary care as well as HSC and MSG who realistically were only required to attend for

specific agenda items and their attendance of all meetings would not have been the most

efficient use of their time.

Compliance with Inpatient Discharge Summaries Process Target: 100%

Once a patient is discharged from the inpatient care of either an MSG consultant, HSC

doctor, or a visiting consultant, a discharge note should be sent to the patients GP within 24

hours. This is then followed by a full discharge summary, care plan, details of investigations

and findings. This KPI measures if this process and the documentation is processed in a

timely manner as it is important that as part of any on-going care, the patients’ GP is kept

informed.

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In 2018, this KPI recorded a compliance rate of 63.2%. This KPI has been impacted by an

increase in clinics delivered whist the medical records team did not operate at full

complement.

Meet expected timings for operating theatres Target: 85%

This measures the percentage of scheduled operating theatre sessions that start and/or

finish late and assists with identifying any recurring issues that impact on the theatre team

being able to commence surgery at the scheduled time.

The monthly figure has been improving since reporting commenced in July 2018, with the

average at the end of 2018 standing at 70.8%. Scheduled times can be impacted greatly by

emergencies that a consultant/doctor may have to attend given that Guernsey does not

have junior doctors. Over-runs are also possible if cases are more complex than originally

planned.

In addition, the Day Patient Unit (DPU) does not currently record start and finish times and

therefore are not included within this report at this time.

Productivity & Quality

Waiting Times – Outpatients and Inpatients Target: 95%

This KPI measures the percentage of patients referred to an MSG consultant, HSC doctor or visiting consultant who were seen within the agreed waiting time based on their referral priority. The KPI includes both referrals from primary care for outpatient episodes and from the date of the decision to admit a patient until they are admitted as an inpatient. The Secondary Health Care Contract sets out expectations for patient elective waiting times as: • 8-week Routine for Outpatients (following referral by GP) • 8 week Routine for Inpatients (following outpatient appointment) • 7 Days Urgent • 24 hours Emergency • 2 weeks Cancer Referral 76.5% of patients were seen within the contractual waiting times for outpatient episodes. For inpatient episodes, 83.7% were seen within the contractual waiting times. The percentage when taking into account both measures was 81.5% across 2018. Although orthopaedic waiting times for outpatients exceeded the target waiting time during the first half of the year, a successful initiative over the summer ensured that consultants were booking orthopaedic outpatient appointments within contractual waiting times by September. This action had an adverse effect on the waiting times for inpatients however which currently exceed the target waiting times by a considerable margin and a specific project is underway jointly between HSC and MSG to improve the waiting times in this area of increasing demand.

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Waiting Times – Emergency Department Target: 95%

This measure looks at the time from checking in at the Emergency Department (ED) to the

time a patient is either admitted or discharged. The achievement of this KPI can therefore

involve professionals beyond the ED service itself.

The average for 2018 is 91.2% and performance has improved steadily throughout 2018.

Patients in Guernsey are seen very quickly by a healthcare professional when they attend ED

but they may need to see a consultant outside of ED before a decision can be made about

how to progress that patient’s care. If that consultant is already undertaking surgery or

occupied with patients elsewhere, there may be a delay. Such unavoidable waits can impact

upon closing an episode of care for an individual which impacts on the achievement of the

target.

This is also a UK measured target with 88.1% of UK service users being admitted and

discharged within 4 hours between January and September 2018. The average over that

same period in Guernsey was 90.1%.

Radiology Waiting Times Target: 95%

This KPI measures the three timeframes for radiology examinations; referral to

examinations within 6 weeks (where patients attend their exam within six weeks of their

referral for a radiology examination), 8 week referral to report (where the first verified

report is available within eight weeks of the patients referral for examination) and Cancer

Two Week Wait (where the first verified report for a patient following a cancer pathway is

available within two weeks of the patients referral for examination). In addition, there is a

requirement for inpatient reports to be turned around within 24 hours.

Guernsey does not have a wide pool of professional clinical staff available to deliver

services, which means that when key individuals within a service such as Radiology become

unavoidably absent for personal reasons, delays can occur. Despite this happening earlier in

2018, this KPI has improved over the year from 63.7% in April 2018 to 83% by year end. The

average for the year was 76.8%.

Average length of stay (Elective admissions only) Target: <6 days

This KPI measures the (mean) average of the time in days that elective patients stay at the

PEH. The length of stay is considered to be a well-accepted indicator of hospital efficiency

with a shorter stay being considered to be more efficient, as it makes beds available more

quickly, reducing the cost per patient and enabling care for more patients. However, stays

that are too short may reduce the quality of care and diminish patient outcomes.

The median average across the monthly averages of 2018 is 3.9 days per stay and, other

than in January and February when the health care system generally experiences higher

demand owing to winter pressures, performance in this area has achieved the KPI target.

Emergency Readmission Rate within 28 Days of Discharge Target: <10%

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This KPI measures the percentage of incidences where the same person is admitted to the

PEH as an emergency within 28 days of the last time they left following a stay at hospital. It

should be noted that if a person is readmitted for an issue unrelated to their previous

episode of care, they would still be counted within this KPI and detailed analysis is needed

to understand whether anything can be learned from the readmission which would improve

quality of patient care.

We are pleased to note that this target was achieved throughout 2018, with a median

percentage of 6.5%.

Delayed Transfer of Care Days Target: <100 days per month

This KPI measures the number of days in aggregate that patients stay in hospital after they

are considered fit for discharge. In some cases, a patient may need further help at home or

admittance to a nursing home, but they do not need the level of care given by an Acute Care

Hospital Ward. Delayed transfers of care reduce the number of beds available to other

patients who need them, as well as causing unnecessarily long stays in hospital for patients.

Delays may be caused by the inability to secure a nursing home bed or due to the patient

still awaiting a review by the Needs Assessment Panel (NAP) to assess further care needs.

We have only been reporting on this KPI since July 2018, in which time the median average

was 91 days across all delayed discharged patients.

Organisation Cancelled Outpatient Appointment Rate Target: <10%

This is the percentage of outpatient appointments which are cancelled or rearranged by HSC

or MSG. It does not include appointments which are cancelled due to an administrative

error if the patient was not aware of the error but it does include changing of appointment

times.

It should be noted that a cancelled appointment can include changes made in the best

interests of the patient, such as changing an appointment to an earlier time/date.

The 2018 average was 13.5%.

Organisation Initiated Inpatient Cancellation Rates Target: <10%

This KPI measures inpatient admissions which have been cancelled by HSC or MSG and

includes times when the patient came into hospital and we were unable to carry out their

procedure.

This data was reported for the first time in April and May and from June onwards, this KPI

has been within target, attaining a median average of 8.8% for the year.

Organisation Initiated Radiology Cancellation Rates Target: <10%

This KPI measures the percentage of booked attendances for Radiology investigations which

were cancelled prior to the patient attendance but does not include referrals to walk in

services.

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Data on this KPI has only been reported since August and has consistently been at or below

1%.

Return to Theatre within 28 Days Target: <2.5%

This KPI measures the percentage of unplanned returns to theatre within 28 days of a

procedure being performed by a consultant or doctor. It excludes any planned returns

which are supporting a course of treatment but includes returns for surgical procedures on

the same site. Returns may include occasions where there is an unexpected complication, or

where a surgeon considers it to be in the best interest of the patient.

The data has been reported since July 2018 and shows the number of returns to be very

low, not being more than 0.3%, with a mean average of 0%.

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Failure to attend and Short Notice Patient Cancellation Paediatric Outpatient Rate

Target: <11%

This KPI measures when patients did not attend (DNA) their appointment or when the

patient has cancelled their appointment with less than 24 hours’ notice. It is very difficult to

fill an appointment slot if someone cancels their appointment at short notice and such DNAs

increase the costs incurred by HSC and MSG.

Children have a different target from adults due to the reliance on parents/guardians to

assist them in meeting the appointment.

During 2018, 10.2% of paediatric patients failed to attend or cancelled at short notice.

This KPI seems to be affected by seasonal changes with higher DNA rates around school

holiday times. Both HSC and MSG are considering whether any system or process changes

can be made to help improve this situation.

Failure to attend and Short Notice Patient Cancellation Outpatient Rate Target: <6%

This KPI measures when patients have failed to attend their outpatient appointment or

when the patient has cancelled their outpatient appointment with less than 24 hours’

notice. It is very difficult to fill an appointment slot if anyone cancels their appointment at

short notice and such DNAs increase the costs incurred by HSC and MSG.

The median average for the year was 6.1%.

Failure to attend and Short Notice Patient Cancellation Inpatient Rate Target: <2%

This KPI measures when the patient has failed to attend for an admission to hospital or has

cancelled their admission with under 24 hours’ notice. It is very difficult to fill an

appointment slot if anyone cancels their appointment at short notice and such DNAs

increase the costs incurred by HSC and MSG.

The median average for 2018 was 2.8%.

HSC and MSG are working together to investigate improvements that could be made to

improve attendance rates for both inpatients and outpatients.

Day Case Unit to Inpatient Conversion Rate Target: <5%

This KPI measures the number of patients who have been admitted as a day patient, but

who have needed to stay overnight after their day patient procedure due to unforeseen

circumstances. It is good practice only to offer some procedures as a day case admission,

making best use of resources. However, medical complications may arise and some

admissions may be potentially avoidable.

The median average for the year was 1.7%.

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Patient Safety & Experience

Hospital Acquired Infections Rate Target: 0

This KPI measures the number of infections for E.coli, C. Diff. MRSA and MSSA which

patients have acquired in hospital within 48 hours or more after admission to hospital after

an a operation.

In 2018, there were three hospital acquired infections, out of a total of 3,456 admissions

that stayed over 48 hours (0.001%).

Venous Thromboembolism (VTE) Risk Assessment Rate Target: >95%

Venous Thromboembolism (VTE) is a condition in which a blood clot forms most often in the

deep veins of the leg, groin or arm and travels in the circulation, lodging in the lungs. VTE is

preventable in the hospital setting and this KPI measures, through monthly audits, the

percentage of patients aged 18 or over admitted during a period who have had a VTE risk

assessment completed within 24 hours of their admission to hospital. This assessment

allows the appropriate prophylaxis to be administered to patients who require it.

There has been continuous improvement within this KPI during 2018, with the last quarter

showing at 84.8% of patients being assessed. The median average for 2018 was 67.5%. The

audits we undertake are also fed into the National Audits.

Sustainable service

Off-island Activity Target: 0

Off-island referrals are carefully monitored in order to identify opportunities to improve on-

island provision and to ensure that there are no inappropriate referrals.

This KPI measures the number of referrals made by consultants or doctors to HSC’s Off-

Island Team which required further scrutiny because the agreed referral process has not

been followed or which are rejected as the treatment is available on island or because the

referral does not comply with the HSC Commissioning Policy.

Numbers of incorrect or inappropriate referrals have significantly reduced during 2018 with

an average of 9 per month. The Off-Island Team continue to work with colleagues within

both HSC and MSG during 2019 to further improve this KPI.

Friends & Family Test Target: >85%

The Friends and Family Test is a nationally recognised feedback tool that asks the following

question to service users: “How likely are you to recommend this service to friends and

family if they needed similar care or treatment?” When combined with supplementary

follow-up questions, this question provides a mechanism to highlight both good and poor

patient experience and allows us to benchmark against the national average.

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There are five categories of response in the survey, and the percentage who were

“extremely likely to recommend our service” was 39.8%. The total of all positive responses

was 43%.

Complaints Procedure Target: TBA

This is the percentage of formal complaints that are completed within 20 operational days

as set out within the Complaints Policy. An average of 85.6% of complaints were successfully

resolved within 20 days, with the balance being complex complaints which take longer to

investigate and resolve.

This KPI recognises the importance of responding to formal complaints on a timely basis.

Not only can this help to put the patient’s mind at rest but it can also lead to the

identification of potential service problems, help identify risks, prevent them reoccurring

and highlight opportunities for improvement.

Key Performance Indicators – not yet published

There are other key performance indicators which have been in place during 2018 but are

not included in this summary. The primary reason for not including them in the publication

is the ongoing work on improving the methodology to report on a measure (e.g. Compliance

with Discharge Planning Process or Theatre Utilisation). In addition, to protect patient

confidentiality owing to their very small incidence rate, a decision has been taken to report

on Never Events1 every three years.

For two of the indicators there has also been a clinical decision following NHS guidance to

move them from a target driven indicator to a reporting requirement only. These are the

serious incidents as well as the number of caesareans. There are also some indicators which

have been agreed as future measurements but which require further data system

developments before they can be put in place.

1 Never Events are serious incidents that are wholly preventable because national guidance or safety measures are available and should have been implemented to stop the incident from happening. By measuring and reporting on them, we can learn from them to help improve the care we provide.