Service improvement –

using the power of data

for decision-making

NHS NSS:ISD

HSCBN Conference

29 November 2017

Taster examples of current ISD work (40 mins):

1 ‘Source’ Social Care data

Pete Knight peter.knight7@nhs.net

2 Ministerial Strategic Group improvement data

Alistair Smith Alistair.smith4@nhs.net

3 a local ISD/LIST Primary Care project

Paul Carroll paulcarroll@nhs.net

4 a local ISD/LIST HSCP project

Jenny Boyd Jennifer.boyd@nhs.net

Group discussion / feedback (25 mins):

1. how do ISD/others better share work from across

Scotland?

2. what new questions should we attempting to answer

(including from new data)?

3. how can we individually further use data, to help

service improvement?

websites – e.g. ISD and ScotPHO

Partnership X

Holding slide for Pete Knight

Alistair SmithPrincipal Information Analyst

Ministerial

Strategic Group

(MSG) Indicators

and ImprovementLocal

Intelligence

Support

Team

Ministerial Strategic Group for Health and Community Care

(MSG) Indicators

• Background to the indicators

• Guidance on producing and sharing local objectives

• How ISD and LIST can help

• Monitoring Performance

• Examples

This presentation

Initial Request

• Letter on 19th January – ‘Measuring Performance Under

Integration’

• 32 indicators; 6 High Level

• Objectives for each partnership were provided to the

MSG

• Trajectories and projections for these sent to ISD

• Returns to ISD/MSG were by end of February – under 6

weeks

• These were to be monitored regularly – quarterly reports

to the MSG

• Feedback on the initial ask sought – event in June

• Taken on board and a data working group set up

Background

Letter on 22nd November

Simplified returns and opportunity to contextualise

objectives

• Updated objectives to ISD for 2018/19 by end of

January 2018

• ISD will use these to produce trajectories

• Figures need to be put into context; different areas will

have different issues and priorities

• Partnerships will have the opportunity to present at MSG

meetings

• Other indictors will be included in the future (social care)

Update

Objectives should be returned for each of the following

indicators:

1. Number of emergency admissions into Acute specialties

2. Number of unscheduled hospital bed days, with separate

objectives for Acute, Geriatric Long Stay and Mental Health

specialties

3. Number of A&E attendances and the percentage of

patients seen within 4 hours

4. Number of delayed discharge bed days

5. Percentage of last 6 months of life spent in the community

6. Percentage of population residing in non-hospital setting

for all adults and 75+

Indicators for

Objectives

<insert

Partnership

name>

Unplanned

admissions

Unplanned bed

days

A&E attendances Delayed

discharge bed

days

Last 6 months of

life

Balance of Care

Baseline

Objective

How will it be

achieved

Progress

(updated by ISD)

Notes

MSG Improvement Objectives – summary of objectives for Adults and Children

Template

Information required in each section of the template

• Baseline

• Summary of recent trends

• Baseline suggested as 2015/16

• Objective

• Expected Change

• The baseline period this change is based on

• Expected figure for 2018/19

• How will it be achieved

• Progress – provided by ISD/LIST

• Notes

• Local context to the objectives

• Nuances of local data

• Data completeness issues

Expectations

Partnership A Unplanned admissions Unplanned bed days A&E attendances Delayed discharge bed days Last 6 months of life Balance of Care

Baseline 2016/17 change: 1% decrease

in overall total compared to

2015/16

2016/17 change: 2% decrease

in overall total compared to

2015/16

2016/17 change: 2% increase

in overall total compared to

2015/16

H&SC reasons: 5% increase in

2016/17 compared to 2015/16

Patient/Carer/Family-related:

3% increase in 2016/17

compared to 2015/16

Code 9 reasons: 2% increase in

2016/17 compared to 2015/16

2016/17 change: Percentage

of time spent in community in

L6M increased from 86.1% in

2015/16 to 87.2% in 2016/17.

Proportion of people (all ages)

living at home has gradually

increased from 97.8% in

2013/14 to 99.1% in 2015/16.

For the same time period for

75+, there has been an

increase from 83.8% to 85.6%

Objective 2017/18 change: 4% reduction

in overall total compared to

2015/16

Expected 2017/18 total:

16,320 admissions

2018/19 change: 7% reduction

in overall total compared to

2015/16

Expected 2018/19 total:

15,810 admissions

2017/18 acute change: 6%

reduction in acute total

compared to 2015/16

Expected 2017/18 acute total:

291,400 bed days

2018/19 acute change: 10%

reduction in acute total

compared to 2015/16

Expected 2018/19 acute total:

279,000 bed days

Maintain number of bed days

seen in GLS and Mental Health

specialties in 2015/16 during

2017/18 and 2018/19

Expected 2017/18 GLS total:

8,000 bed days

Expected 2018/19 GLS total:

8,000 bed days

Expected 2017/18 Mental

Health total: 52,000 bed days

Expected 2018/19 Mental

Health total: 52,000 bed days

2017/18 change: 4.5%

reduction in overall total

compared to 2015/16

Expected 2017/18 total:

31,990 attendances

2018/19 change: 6.5%

reduction in overall total

compared to 2015/16

Expected 2018/19 total:

30,980 attendances

Maintain average A&E % seen

within 4 hours (95.3%) in

2015/16 during 2017/18 and

2018/19

All reasons, 2017/18: 10%

reduction in total compared

to 2015/16

Expected 2017/18 total:

85,500 bed days

All reasons, 2018/19: 17%

reduction in total compared to

2015/16

Expected 2018/19 total:

78,850 bed days

Increase percentage of time

spent in community in L6M to

89.5% by 2018/19.

Expect to maintain 2015/16

proportion of people living at

home until 2018/19.

How will it be achieved Falls prevention, Care and

Repair, Home Safe Initiative

Progress

(updated by ISD)

April to September 2017

update: 3% reduction in

overall total compared to

same period in 2015/16

April to September 2017

update: 6% reduction in acute

total compared to same

period in 2015/16

GLS and Mental Health figures

similar to same quarter in

2015/16.

April to September 2017

update: 5% reduction in

overall total compared to

same period in 2015/16.

Average A&E % seen within 4

hours similar to same quarter

in 2015/16.

April to September 2017

update: 12% reduction in all

delayed bed days, compared

to same period in 2015/16

Information presented

annually – update will be

included once data for this

period becomes available.

Information presented

annually – update will be

included once data for this

period becomes available.

Notes Ward attenders included

within admissions

Step-up and step-down beds

included within figures. See

section 2.1 for details.

MSG Improvement Objectives – summary of objectives for Adults and Children

Completed

Partnership A Unplanned admissions

Baseline 2016/17 change: 1% decrease in overall

total compared to 2015/16

Objective 2017/18 change: 4% reduction in overall

total compared to 2015/16

Expected 2017/18 total: 16,320 admissions

2018/19 change: 7% reduction in overall

total compared to 2015/16

Expected 2018/19 total: 15,810 admissions

How will it be achieved Falls prevention, Care and Repair, Home

Safe Initiative

Progress

(updated by ISD)

April to September 2017 update: 3%

reduction in overall total compared to

same period in 2015/16

Notes Ward attenders included within admissions

MSG Improvement Objectives – summary of objectives for Adults and Children

Example – Unplanned Admissions

• Produce objectives and return to ISD

• Liaise with local LIST analysts

• Monitor progress against these – data available monthly

• Quarterly feedback to MSG

• Opportunity to refresh objectives

• Partnerships to present at future MSG meetings

• Provide local context

• Opportunity for discussion

Next Steps

Monitoring Progress

alistair.smith4@nhs.net

nss.list@nhs.net

Alistair SmithPrincipal Information Analyst

Local

Intelligence

Support

Team

LIST

Inverclyde

New Ways

Primary Care

Background and overview

• Tests of change

• Advanced nurse practitioner

• Advanced practice physiotherapist as first point of

contact for MSK conditions

• Specialist paramedic

• Culture change

• Prescribing support pharmacists

• Week of care audit

New Ways

• Profile of activity in

primary care

• Appointment types

• Presentations

• Overview of tests of

change

Week of care analysis

Week of care analysis

Week of care analysis

Week of care analysis

Future developments

• Effect of physiotherapist on mainstream physiotherapy

waiting times.

• SAS want to investigate whether paramedic work is

affecting emergency presentations and outcomes for

patients who are admitted.

• Build on and reinforce existing links between health and

social care.

The Way

Local

Intelligence

Support Team

(LIST)

Hospital Flow

Dashboard for

Lothian HSCPsJennifer Boyd,

Principal Information Analyst

Information Services Division

Performance, Performance, Performance!!!

Some of the Lothian HSCP Performance

Indicators

• 23 National Core Set of Integration Indicators

• “Big Six” Ministerial Strategic Group

Indicators

• IJB Performance and Quality Group

• HSCP Annual Performance Report

• NHS Lothian HSCP Scorecard

Updated

on a

monthly,

quarterly

and

annual

basis

Transforming the Data Reporting

Process

Previous report Dashboard

Paper based Online

Static data Interactive

Time consuming

to produce

Automated

No statistical

evidence of

change

Statistical Process Control

Did not meet

user needs

Specification been developed by

the customers

Statistical method of measuring improvement:

• Helps to understand variation

• Differentiates type of variation

Understanding variation allows us to:

• Improve system

• Test change

• Enable prediction

• Identify process capability

Data Visualisation: SPC Charts

SPC Chart – Standard Layout

Upper Control

Limit

Lower Control

Limit

Mean/ Centre

Line

Data

Points

Outlier = Data points outside one of the control limits:• 0.3% chance it’s caused by the normal process.

SPC Chart – Interpretation Rules

Outer 1/3 (2 sigma) = Two of three data points outside one of the

warning limits:• Probability for two out of three points in a row is ~ 1%.

Higher warning limit

Lower control limit

Shift = Eight data points in a row on the same side of the centre line:• The probability of getting eight points on the same side is ~ 1%.

SPC Chart – Interpretation Rules

Trend = Six points in a row increasing or decreasing:

Centre Line

Summary

dashboard

A&E

The

Dashboard

Admissions

Delayed

Discharges

Social

Care*

*where

supplied

Dashboard Layout

Partnership

selections

A&E AttendanceSelecting AE Attendance Dashboard tab

Drop down

selections for:

•Partnership

•Locality

•Practice

Locality

•GP Practice

•Hospital

•Sex

•Age Band

Hospital Admissions

Delayed Discharges

Training completed in Edinburgh, Midlothian

and East Lothian

Implemented a buddy system for support

NHS Lothian Improvement Advisor support

Phase 2 development:

• Delayed Discharges

• Packages of Care

• Social Care Assessment Flow

• ‘Targets’ on overview page

Going Forward

Contact Details

jennifer.boyd@nhs.net

07970 404010

Group discussion / feedback (25 mins):

1. how do ISD/others better share work from across

Scotland?

2. what new questions should we attempting to answer

(including from new data)?

3. how can we individually further use data, to help

service improvement?

Questions ?