The Quality Observatory One of the relationship made explicit with the publication of ‘High Quality Care for All’ in June 2008, was the relationship between good quality and measurement. This important document made reference to the fact that high performance in all aspects of quality is nearly always present in organisations that proactively and effectively measure their activity and use the information gathered to drive improvements forward. One of the requirements of ‘High Quality Care for All’ was therefore the establishment of regional ‘Quality Observatories’ to support the local NHS with one of the seven elements of the Quality Framework – Measure Quality.

Clinical leadership

Bring clarity to quality – standards

Measure quality

Recognise and reward quality

Safeguard quality

Stay ahead

Publish quality performance

The key functions of a Quality Observatory are: • Enable and support benchmarking within and across regions; • Support the development of metrics to enable front line staff to effectively monitor and

improve their services • Identify opportunities for clinical staff to innovate and improve services, providing the

quantitative evidence to support change where required This booklet provides some examples of work undertaken by the South East Coast Quality Observatory to support improvements in quality and productivity.

Samantha Riley Head of the Quality Observatory

Development of Analytical Tools The Quality Observatory has developed over 80 tools and benchmarking products which focus on a wide range of areas including performance, productivity and the domains of quality. These tools are updated regularly and provided free of charge to the local NHS. Examples include : The Inpatient Survey Explorer Tool Healthcare Associated Infection Tools

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Monthly Summary of Healthcare Associated Infections - South East Coast SHA

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Data Source: HCAI Data capture system - Health Protection Agency (last downloaded 15th July 2009)

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Local Stretch Limit Previous year actual

Notes:Rate of MRSA bacteraemia reported per 10,000 admission - Based on HES 06/07 admissions

Rate of C. Diff cases (aged 2+) reported per 1,000 admissions - Denominator calculated using 06/07 HES data. For each episode within a Trust where the patients age at the start of the episode was 2 or more years ,and was classifed as an elective or emergency ordinary admission (this excludes daycases, but does include patients intended to be daycases but that stayed overnight, and patients intended to stay over night but discharged on the day of admission).

2009/10 National limit 288, stretch limit 188. Ap-July actual 54, 57% (31) hospital acquired; stretch limit of 72. SEC rate 4.09/10,000 admissions, range from 1.18 (ASPH) to 7.44 (BSUH). Rolling 12 month count fallen from 523 April '07 to 184 at July '09.

MRSA Performance:

C.Diff Performance:

Actions:

Commentary:

Local Stretch Limit for CDI currently under negotiation

2009/10 National limit 1721, local stretch limit 1155. Ap-July actual 304; stretch limit of 397. SEC rate of 4.17/1000 admissions. Fall in rolling 12 month count from 2241 at April '08 to 1173 at July '09. 3 month rolling average 75/mth at July '09.

SHA working with PCTs & Trusts to implement phase 2 of 3 year HCAI improvement programme. Focus on reducing avoidable MRSA bacteraemia, including review of 2008/09 cases. Receive weekly data of new MRSA & C. Diff & liaise as appropriate.

Estimated rate of MRSA bacteraemia reported per 10,000 admissions

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Local Stretch Rate (limit) Monthly SEC Rate (actual)

The Quality Observatory has worked with clinicians to develop a suite of tools using information relevant to Healthcare Associated Infections (HCAIs). Information on various elements of HCAIs can be viewed on one sheet enabling users to see month by month cases against defined limits and the cumulative position for these cases against agreed limits – in essence this enables users to understand whether the situation is improving (or not) and whether agreed limits and standards are being met.

This tool allows users to look at scored results over three years, drilling down to individual questions or looking at data grouped according to theme. The tool is presented with a graphical front end separated into three parts, each with a different way of looking at the data, illustrated below. This tool uses national data and is therefore of use to Trusts and PCTs throughout the country.

The provision of information on rates of MRSA and C-diff cases (rather than actual numbers of cases) enables a comparative view across Trusts to be provided. It is well known that healthcare associated infections (HCAIs) have high costs to both the patient and the healthcare. As part of the suite of HCAI analysis, the Quality Observatory has also undertaken work to develop a tool which enables the cost savings associated with reductions in infection rates to be modelled by hospital provider.

MRSA and CDI cost and bed days savings

Select cost and bed day option and chosen trust below. For guidance and references click

MRSA CDI2010/112011/12

Annual cost and bed-day estimate for post-72 hour CDI cases- NHS South East Coast

Enter forecast cases here

Annual cost and bed-day estimate for MRSA bacteraemia cases- NHS South East Coast

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1. Select maximum cost & bed day estimate

2. Select minimum cost & bed day estimate

3. Select mean cost & bed day estimate

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Annual comparison Costs Bed days Costs Bed days Costs Bed days Costs Bed days2003/04-2004/05 -£26,985 -57 £0 0 -£26,985 -57 -£26,985 -572004/05-2005/06 -£86,352 -181 £0 0 -£86,352 -181 -£113,337 -2372005/06-2006/07 £259,056 542 £0 0 £259,056 542 £145,719 3052006/07-2007/08 £1,052,415 2,204 £0 0 £1,052,415 2,204 £1,198,134 2,5092007/08-2008/09 £658,434 1,379 £6,585,814 19,026 £7,244,248 20,405 £8,442,382 22,9132008/09-2009/10 (projected) £248,262 520 £1,897,238 5,481 £2,145,500 6,001 £10,587,881 28,914

Total CumulativeYear-on-year and cumulative savings

MRSA CDI

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2009/10-2010/11 (projected) -£ 0 £10,587,881 28,9142010/11-2011/12 (projected) -£ 0 £10,587,881 28,914

Evidencing Innovation and Variation The Quality Observatory has been able to evidence innovative clinical practice and the associated variation across the region and country. The most powerful example of this is the short stay hip replacement programme led by an Orthopaedic surgeon in Hastings This is one of the examples of best practice (which improves the quality of care received by patients and also saves money) contained within phase 1 of the ‘Establishing the Evidence’ library. The Short Stay Hip Replacement Programme

Analysis has also been able to demonstrate that 67% of Mr Apthorp’s patients experience a maximum 2 day stay in hospital compared to 3% nationally. The care that is provided by Mr Apthorp’s team is safe, provides high levels of patient acceptance and positive feedback and saves money. Initial estimates suggest that approximately 12,000 bed days could be ‘saved’ across Kent, Surrey and Sussex if all Orthopaedic surgeons reduced their length of stay to the level of Mr Apthorp – this would result in savings of £3.5 million per annum

A bid to spread this innovative practice across the region has been approved and the Quality Observatory will be monitoring progress in each Trust over the forthcoming year.

Supporting clinicians

The Quality Observatory is supporting clinicians develop meaningful indicators to measure the quality of service provided to patients. A significant amount of analysis has been undertaken to support the Clinical Pathway Leads for our local vision Healthier people, excellent care. The Quality Observatory newsletter – Knowledge Matters – provides regular articles on analysis for a range of clinical areas.

The short stay hip replacement programme commenced in 2004 when Mr Hugh Apthorp, an Orthopaedic Surgeon working at the Conquest Hospital in Hastings, developed a programme to significantly reduce the amount of time spent in hospital for patients undergoing a total hip replacement. The Quality Observatory been able to evidence that Mr Apthorp has the lowest average length of stay nationally for this operation (2.7 days).

The most recent issue has an article on measuring our progress in achieving our regional vision. Issues of the newsletter can be viewed at the following website http://issuu.com/secqo

The Quality Observatory

What people say……

This is great! All the clinicians I have shown this to so far are very excited as it is the first time we have been seen at

data that is meaningful for End of Life Care provision across the SHA.

Clinical Pathway Lead, End of Life Care

I have used the information you supply on performance improvement consistently as my main key performance indicator's to get a consistent and unbiased update on the progress made to date. The information has always been

succinct, appropriate, impartial, timely and more accurate than any other source in the acute infrastructure.

Turnaround Consultant working in South East Coast

Thank you for the brilliant analysis you sent me regarding the hip replacement length of stay data. I am amazed by the work your team has undertaken in such a short period of time.

This type of work is essential to help modernise the NHS.

Consultant Orthopaedic surgeon working in Sussex

I have not seen anything approaching your analysis for drawing information together yet, to such a high standard of presentation.

Clinical Fellow, NHS Institute for Innovation and Improvement

The analysis presented today really had an impact. The value of data well presented to inform strategic thinking is so powerful! We will be doing quite a bit of work together!!

Author of the Ambulatory Care for Adults Directory & Consultant Physician

For further information contact : samantha.riley@southeastcoast.nhs.uk

01293 778842 07966 249957

www.qualityobservatory.nhs.uk