Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.

1. Local and national uses of data
Ramani Moonesinghe, Associate National Clinical Director for
Elective Care, NHS England

2. National data, local improvements?
Ramani Moonesinghe
Associate National Clinical Director for Elective Care, NHSE
Director, NIAA Health Services Research Centre, Royal
College of Anaesthetists
Nuffield Trust /Health Foundation Data event
1 Nov 2016

3. Warning
• I’m going to be controversial
• All views are mine and not attributable to:
– NHS England
– Royal College of Anaesthetists
– The Health Foundation
– The NIHR
– Anyone else quite frankly!

4. What are we currently using data for?
• Monitoring / inspection:
– Care Quality Commission
– Quality accounts
• Improvement
– National clinical audits
– NHS Right Care
– Getting it right first time (GIRFT)

5. CHALLENGES IN USING DATA

6. 1. ACCESS AND DISSEMINATION

7. The data are all there!
• NHS Right Care:
– By CCG
– Atlases of variation

9. The data are all there!
• GIRFT:
– Trust and specialty level
– Seeks to change practice, (e.g. prosthesis choice) in order to
improve patient outcomes (e.g. infection rates).
– Data synthesis, “deep dive” visits and recommendations
– Follow up with “implementation tools”
• i. regular publication of provider-level performance data via a
dashboard (clinical level intervention);
• ii. tailored written feedback to underperforming providers (top
down intervention) and
• iii. commissioning levers to change behaviour (commissioner
level intervention).

10. Top down vs. bottom up?
• Top down?
– NHS England / Dept of Health / CQC
– External organisations e.g. Dr. Foster
• Bottom up?
– National Clinical Audits

11. 2. FACE VALIDITY

12. Face validity
• Structure and process
– Validity of metrics
– Accuracy of data
– Trust in the data e.g. case ascertainment rates
• Outcome and cost
– Risk adjustment
– “Value” = quality / cost

13. Value: NHS Rightcare definitions
• Allocative value – how well are assets distributed between
population sub-sets
– Between programmes e.g. between cancer and respiratory
– Between systems in each programme e.g. between asthma and
COPD in the respiratory programme
– Within each system, e.g. between prevention, drug therapy,
rehabilitation and long term care for people with COPD
• Technical value: how effectively do allocated resources achieve
valid outcomes for all the people in need within the population –
different from efficiency
• Personalised value: how well does an outcome relates to the
values of each individual

14. Efficiency vs. value?
• Knee arthroscopy
– Efficient (lots of surgery)
– ? Value (?benefit)
– ? Savings to be made through shared decision making
etc?

15. 3. IMPROVEMENT BASED ON DATA

16. Supporting local improvement
• What are we aiming for?
– Top quartile?
– Avoidance of being an outlier?
– Continual improvement?
– Striving for perfection?
• Do our methods support local
improvement?
– Evidence-based approached
– Where are the resources?

17. Quality improvement cycle for national audits

18. Evidence-based Improvement principles:
Ivers et al Cochrane SR 2014
Data should be
valid & recent
• Behaviour should be
targeted which is likely to
be amenable to feedback
• Recipients should be
capable and responsible
for improvement
• Presentation should be
multi-modal including either
text and talking or text and
graphical materials
• Delivery should come from a
trusted source
• Feedback should include
comparison data with
relevant others
• Performance target should
be provided
• Goals set for the target
behaviour should be aligned
with personal and
organizational priorities
• Goals for target behaviour
should be SMART & have
clear action plan

19. 4. MAXIMISING OPPORTUNITIES

20. Maximising opportunities
• Big resource investment
– National clinical audits
• NHSE budget
• local investment
– Do we get maximum value?
– Monitoring vs. improvement?
• Combining datasets
• Breaking specialty silos

21. National data, local improvements?
@rmoonesinghe
ramani.moonesinghe@nhs.net