Transcript Health Informatics – Francis, Berwick, Keogh et al

Paul Curley
Mid Yorkshire Hospitals NHS Trust
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To put in context role of Health Informatics in
the Keogh review process
To review “smoke alarm” indicators
Share insights into Keogh process – strengths
and weaknesses
Explore possible surrogate indicators of
quality
Explore Surgeon/service level data issues
Touch on Naughty Neighbour media storms..
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Francis report – Mid Staffs
“Could there be others ?”
14 organisations identified via HSMR or SHMI
Panel identification – RCS Invited Review
Mechanism
Data Pack analysis – NHS England/PwC
Visits – Announced / Unannounced
Risk Summit
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Expenses to support visits - £169,000
Contract award (PwC) support - £2,773,000
Filming Risk Summits - £28,000
Legal Advice - £30,000
Total - £3,000,000
$58,000
$1.1m
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Chair (Senior Nurse/Manager/Medical
Director)
Consultants (2-3)
Senior Nurses (2-3)
Student Nurse
Junior Doctor
CQC
Patient/Public Reps
Senior Manager NHS England
CCG Observers
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Inadequate governance, and pace and focus of change
to improve overall safety and experience of patients
Slow and inadequate responses to serious incidents and
a culture which does not support openness,
transparency and learning
Staffing shortfalls and other workforce issues across
staff groups which may be compromising patient safety
Lack of support for staff and effective, honest
communication from middle and senior management
level
Failure in governance to ensure adequate maintenance
of the estate and equipment
Significant weaknesses in infection control practices
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Drop in face-to-face staff meetings
Locum/Agency spend
Dealing with Serious Untoward Incidents
(never events)
Equipment management
PPI / Junior doctor / Student Nurse members
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Published June/July 2013
Several specialties
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Vascular – AAA, CEA
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Tables non-risk adjusted
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"I
am fain to sum up with an urgent appeal
for adopting … some uniform system of
publishing the statistical records of
hospitals. There is a growing conviction
that in all hospitals, even in those which
are best conducted, there is a great and
unnecessary waste of life … In attempting
to arrive at the truth, I have applied
everywhere for information, but in scarcely
an instance have I been able to obtain
hospital records fit for any purposes of
comparison … If wisely used, these improved
statistics would tell us more of the relative value of
particular operations and modes of treatment than
we have means of ascertaining at present?"
Florence Nightingale in Notes on Hospitals, London:
Longman, Green, Roberts,Longman, and Green, 1863.
Abortive
Aged
Bedridden
Bloody flux
Bruised
Cancer
Chilbed
Chrisoms
Consumption
Convulsions44
Cough
Dropsie
2
36
1
1
1
1
3
19
77
2
1
Males 107
Christened Female 109
In all
216
Executed
Feaver
Flox and smallpox
Found dead in the
street (an infant)
French pox
Gripping in the
guts
13
Jaundies
Infants
Killed with a fall
Murthered
Buried
33
10
5
1
1
1
18
3
1
Males
213
Females 196
In all
409
Overlaid
Quinsie
Rickets
Rising of the lights
Scowering
Scurvey
Stillborn
Stone
Stopping of the
stomach
Suddenly
Teeth
Winde
Worms
Plague
Decreased in the buriels this week - 63
Parishes clear of the plague - 130 Parishes infected - 20
2
1
8
8
1
2
9
1
3
6
16
3
1
0
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Pennine Acute Hospitals NHS Trust 266
4308472
4187787
3643174
3560031
6090793
89
*
84
50
*
3
*
11
14
*
86
*
73
36
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0.0%
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2.4%
2.0%
*
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Primary – STEMI
Planned – angina, NSTEMI etc
2 models :
 Centralised (Leeds, Newcastle)
 Distributed
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Good data submission
Is “geography/service model” an issue ?
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Health Informatics can develop “smoke alarm”
indicators
Detailed analysis of available data played an
important role in the Keogh review process
Informatics alone were not adequate to
diagnose issues in many of the Keogh sites
Multi-disciplinary teams brought huge value
to the Keogh process
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At current levels of sophistication, health
informatics are complementary to inspection
processes
Listening to staff and patients will continue to
play a vital role in assessments for the
foreseeable future
Developing a standard “data pack” for Acute
Trusts would be a valuable health informatics
task
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Wakefield Prison – category A
Highest concentration of Sex offenders and
Murderers in Prison population
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Only major Burns Centre in Yorkshire based
in Pinderfields
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Document Management
PAS replacement
Outsourced letter printing
EDsM
Order Comms
PACS/RIS
PMI duplicates
Managed networks
VoIP/Mobile voice/Faraday cage construction