Transcript Managing concerns at an early stage

Ensuring change occurs as a result of
clinical audit
Peter Belfield
Background for my views
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Personal
25 years as a consultant
20 years as a medical manager
3 years as an MD
Patient
Consultant
Consultant peers
Wards
Geography
Staffing
Multi-professional team
Directorate team
Admin
Divisional team
Information
Executive team
Trust Board
Ensuring change occurs as a result of
clinical audit
1.
Context
2.
Actions not words
3.
How to monitor the effectiveness of proposed changes
4.
Closing the loop or giving you hope!
Key issues at clinical audit forum December 2012
• Mandatory audits should have minimum standards identified
• Time and resource available to carry out clinical audit
• Digital issues, specifically the use of paper toolkits rather than
electronic collection of data
• The need for specialties/departments to have a process in place
to determine what is important to audit
• Ensuring that actions are taken as a result of audit
"Surgeons have a moral and professional
duty to know what they are doing, how well they are
doing it and to use that information to help them
improve – otherwise they have no right to be doing
it at all.“
Monday 14 June 2010
Guardian
http://download.drfosterintelligence.co.uk/H
ospital_Guide_2012.pdf
SYSTEM LEVEL INDICATORS
Preventing
Premature
Death
SHMI
Amenable
Mortality
Ambulance
Response
Quality of Life
for those with
L.T.C
Ambulatory
Care Sensitive
Conditions
(Adults)
Asthma,
Diabetes &
Epilepsy
(Children)
Recovering
from Ill Health
or Injury
Clinically
Unexpected
Emergency
Admisisons to
Hospital
Emergency
Readmissions
A Positive
Experience of
Care
Net Promoter
Score
Caring for
People in
Safety
Organisational
Issues
Infection Free
Bed Occupancy
Serious
Incidents
Nurse to Bed
Ratio
‘Never Events’
Doctor to
Patient Ratio
A&E Waits
Referral to
Treatment
Times
Urgent Cancer
Waits
Harm Free Care
Unexpected
Mental Health
Deaths
Staff Sickness
Rates
CONTRIBUTORY MEASURES
Disease specific
<75 mortality
Cancer Deaths
Baby / Child
Deaths
Learning
Disability /
Mental Health
Premature
Deaths
Self Care
PROMS
Employment
of those with
LTCs
Recovering
from Injury &
Trauma
Quality of Life
for those with
Mental Illness
& Dementia
Stroke
Recovery
Caring for
Carers
Restoring
Mobility &
Independence
Service
Specific and
Patient Group
Specific
Experiences
End of Life
Care
Maternity
Safety
Safe Care to
Children in
Hospital
Nurse to
Patient ratio
Agency rates
Quality Dashboard
Step 2: Organisation Navigation
Navigate through the NHS Organisation
Benchmarking
Step 1: Quality Dashboard
At-a-glance view of Quality throughout
the Organisation
Data Warehouse
Historic & Current Values
Generate
Statistical Alerts
Statistical Process
Control
Data processing
Step 3: Root cause analysis
Drill down into the detail of the relevant
Metrics.
Communication &
Workflow
Peer Group Analysis
Quality Dashboard
Continuous Improvement
Analyse
Review Metrics using Trend Charts, Data Tables,
Funnel Charts, Toyota Charts, Alerts, Performance
vs. Peer Groups and Performance vs. Peers...
Review Statistics and Alerts
Collaborate
Makes notes and record actions and
Status against Metrics and
Organisations
Take Action
Providers and commissioners
need assurance – more and
more for patients, CQC, NHSLA
Quality improvement
Quality assurance
Reactions to clinical audit
• Enthusiasm
• Obligation
• Doubt
• Exhaustion
Make your audit themes important
• Relate to real life
• Quality dashboard measures
• Never events - serious incidents
Feed the beast and then give
something back
Communication is two way
Aims
• To establish if all
equipment required is
available on all medical
and elderly wards in the
LGI
– Wards:16,17,18,19,26,27,28,2
9,30,37,42,43,59,60
• To see if the standards
have changed since the
original audit
Item Availability Comparing
Original Audit & Re-audit
O riginal audit
O ur audit
Co
e
ag
er
rt
Av
po
to
r
nn
ec
et
qu
ni
ur
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)
(d
is
p
h
us
Fl
co
Al
ps
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ho
St
lg
er
el
ile
G
Ca
lo
ve
nn
s
ul
a
pa
ck
s
Ca
nn
ul
as
Sy
rin
ge
P values:
Sharps bin p=0.0019
Tourniquet disp p= 0.0001
Connector port p= 0.0053
ETOH gel p=0.0295
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tra
y
n
Sh
ar
ar
ps
bi
es
ip
Sh
W
Tr
ol
le
y
*
To
100
90
80
70
60
50
40
30
20
10
0
Discussion
• Things that have improved:
– Availability of:
• cannulation ports
• sharps bins
• disposable tourniquets
– More wards have cannulation trolleys
• More likely to have equipment available when
wards have a cannulation trolley
Summary
• Elderly wins!
• Overall some improvement,
however still some way to
go
• More equipment available
when cannula trolley used –
also easier to perform
aseptic cannulation
Other levers : how to review clinical audit
in revalidation - a guide for appraisers
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Nothing magic
Find some evidence
Attendance at meetings
Supervision/participation in projects
Leadership and critical involvement
National bodies and commissioning groups involved with audit are now
looking for evidence of learning as a result of audit, and changes being
made to service as a result of this.
If clinical audit equates to quality health care, the culture, board
commitment and facilities need to be available to ensure it extends
beyond a data collecting exercise, to promote genuine clinical
engagement.
Audit has been with us a long time and will be
for the foreseeable future
In 1859 Florence Nightingale
wrote “thousands of patients
are starved annually in the
midst of plenty, from want of
attention to the ways which
alone make it possible for them
to take food”