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Jan Yates - Overview presentation

Jan Yates - Overview presentation

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Public Health England is responsible for the NHS Screening Programmes
Quality Assurance (London)
Abdominal Aortic
Aneurysm Screening
SQAS (London)
Network Day
27November2015
Jan Yates
Regional Head of QA,SQAS(London)
Housekeeping
• Fire exits – no drills planned
• Mobile phones etc. silent
• Wifi: hesura
• Toilets
• Breaks at 11.30, 1pm
• Close 4pm
• Active, learning style
• Hopefully fun!
2 Presentation title - edit in Header and Footer
AAA Network Day
Aim
To improve quality through the achievement of national pathway standards across all
London AAA Screening Programmes
Objectives
• To support London programmes in the delivery of safe and effective screening to their
populations
• To provide a forum for disseminating knowledge and sharing good practice on relevant
topics
Programme Highlights
• National and regional overview of AAA Screening – successes and challenges
• Define national training requirements for AAA personnel
• Focus on key roles and responsibilities within AAA screening teams
• Establish vigorous and standardised reporting for London AAA screening
3 London AAA Screening Programme Network Day 27 November 2015
Icebreaker
- Month of birth
- One hobby or pastime
- Your role in the AAA programme
4 Presentation title - edit in Header and Footer
NHS AAA Screening
Programme should
reduce ruptured
AAA mortality
by up to 50%
through early
detection, appropriate
monitoring and
treatment
NHS AAA Screening Programme
5 1Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm
Screening Study. BMJ, 2009, vol./is. 338/(b2307), 0959-535X;1468-5833
2 Outcomes after Elective Repair of Infra-renal Abdominal Aortic Aneurysm. A report from The Vascular Society March 2012
AAA screening is making a difference to the
health of men in England and London
It is estimated that
4 out of 5 men
with a ruptured AAA
will die before getting
to hospital or fail to
survive emergency
surgery
National AAA Screening Programmes
6
NHS AAA Screening Programme 2014/15, www.gov.uk/topic/population-screening-programmes/abdominal-aortic-
aneurysm
Total 41 Cohort
men
2014/15
London 5 34,633
North 8 85,205
South 11 79,688
Midlands
and East
17 94,723

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Jan Yates - Overview presentation

  • 1. Public Health England is responsible for the NHS Screening Programmes Quality Assurance (London) Abdominal Aortic Aneurysm Screening SQAS (London) Network Day 27November2015 Jan Yates Regional Head of QA,SQAS(London)
  • 2. Housekeeping • Fire exits – no drills planned • Mobile phones etc. silent • Wifi: hesura • Toilets • Breaks at 11.30, 1pm • Close 4pm • Active, learning style • Hopefully fun! 2 Presentation title - edit in Header and Footer
  • 3. AAA Network Day Aim To improve quality through the achievement of national pathway standards across all London AAA Screening Programmes Objectives • To support London programmes in the delivery of safe and effective screening to their populations • To provide a forum for disseminating knowledge and sharing good practice on relevant topics Programme Highlights • National and regional overview of AAA Screening – successes and challenges • Define national training requirements for AAA personnel • Focus on key roles and responsibilities within AAA screening teams • Establish vigorous and standardised reporting for London AAA screening 3 London AAA Screening Programme Network Day 27 November 2015
  • 4. Icebreaker - Month of birth - One hobby or pastime - Your role in the AAA programme 4 Presentation title - edit in Header and Footer
  • 5. NHS AAA Screening Programme should reduce ruptured AAA mortality by up to 50% through early detection, appropriate monitoring and treatment NHS AAA Screening Programme 5 1Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ, 2009, vol./is. 338/(b2307), 0959-535X;1468-5833 2 Outcomes after Elective Repair of Infra-renal Abdominal Aortic Aneurysm. A report from The Vascular Society March 2012 AAA screening is making a difference to the health of men in England and London It is estimated that 4 out of 5 men with a ruptured AAA will die before getting to hospital or fail to survive emergency surgery
  • 6. National AAA Screening Programmes 6 NHS AAA Screening Programme 2014/15, www.gov.uk/topic/population-screening-programmes/abdominal-aortic- aneurysm Total 41 Cohort men 2014/15 London 5 34,633 North 8 85,205 South 11 79,688 Midlands and East 17 94,723
  • 7. AAA National and Regional- similarities 7 Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data % of subjects with AAA ≥5.5cm referred within one working day Timely Referrals 97% Uptake about 8 in 10 men who receive a letter attend Self Referrals 1 in 10 screened men made 1st contact Men screened with an outcome of an aneurysm ≥3cm detected 1 in 100
  • 8. AAA National and Regional-variations 8 Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data, 0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 1 2 3 4 5 London England AAA-PS-2: % Percentage of eligible subjects who are tested (Coverage) London AAA programme Acceptable ≥75% Achievable ≥85% Coverage% AAA Screening Programmes
  • 9. AAA National and Regional-variations 9 http://www.phoutcomes.info http://www.fingertips.phe.org.uk/ % of men eligible for abdominal aortic aneurysm screening who had an initial offer of screening in London by area (2013/14) Compared to London London achieved better proportions than England in inviting men for screening however, there are areas in London where more men did not benefit from a screening offer compared with the rest of the region
  • 10. AAA National and Regional-variations 10 Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data, 0.00 20.00 40.00 60.00 80.00 100.00 120.00 140.00 160.00 1 2 3 4 5 London England AAA-PS-12: % of subjects with aorta ≥5.5cm seen by vascular specialist within 2 weeks. London AAA programme Acceptable >90% Achievable >95% % AAA Screening Programmes Highlights data quality issues
  • 11. AAA – The Journey So Far National implementation of abdominal aortic aneurysm (AAA) screening (6 areas) Full service roll-out and established national policies and quality standards Developments and improvements -Utilise local, regional intelligence to review screening pathway standards -Start of the process of developing new NICE guidelines on diagnosis and management of AAAs 11 London AAA Screening Programme Network Day 27 November 2015 Development of QA Prioritisation process, Self- assessment, Desk top review of self- assessment and evidence, External quality assurance review. QA Visit pilots roll-out 2009 2013-2015 On-going 2014-2015
  • 12. Successes detected more than 10,000 aneurysms requiring monitoring and treatment referred more than 2,500 men for treatment for large aneurysms preventing premature deaths in men aged 65 years and over one millionth 65-year-old man screened 1.3 million men invited Large aneurysms perioperative mortality rate <1.5% 12 Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data https://phescreening.blog.gov.uk/2015/11/11/hear-all-about-it-aaa-screenings-successes-and-challenges/
  • 13. Challenges Data reporting Timely treatment of large aneurysms impacted by up to 4 months delay in elective non- screen detected aneurysms >20% of invited men decline or DNA and this is associated with social deprivation Screening technician staff low retention (London ONLY) Establishing surveillance thresholds for rupture risk, mortality and other outcomes Accountability requires consistency in resource allocation for QA image review (CST) and clinical leadership 13 Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data https://phescreening.blog.gov.uk/2015/11/11/hear-all-about-it-aaa-screenings-successes-and-challenges
  • 14. Timely Treatment of Large Aneurysms 14 Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data Taking into account patient choice • 20 programmes (49%) reached the acceptable threshold and of those, 5 programmes (12%) reached the achievable threshold Taking into account both patient choice and patient comorbidity • 34 programmes (83%) reached the acceptable threshold and of those 15 (37%) reached the achievable threshold Taking into account patient choice and comorbidities • 7 programmes (17%) have yet to meet the acceptable threshold- 2 of these are in London
  • 15. AAA Current and Future work 15 London AAA Screening Programme Network Day 27 November 2015 Communication  Regional familiarisation visits  National Helpdesk All external queries – effective from 1 April 2015; PHE.screeninghelpdesk @nhs.net • Regional feedback on enquiries  Executive summaries of QA visit reports will be published on the GOV.UK website Data reporting  KPIs  2015/16 - AA1: Completeness of Offer  2016/17-3 new KPIs  Guidance on reporting death  Regional work on identifying and improving on data quality Quality Improvements • Standard letters • Improving Nurse specialist role • Reducing treatment delays • National study to ascertain whether our threshold for referring men for surgery is at the right level • Incident reporting • QA visits Phase One and PACA training • Screener training and retention • CST role • Reducing inequalities
  • 16. Improving Access and Reducing Inequalities - Uptake inKensington, Chelsea & Westminster 16 NHS AAA Screening Programme 2015 https://phescreening.blog.gov.uk/wp-content/uploads/sites/152/2015/10/Nurse- Specialist-update-slides-30.09.2015.pdf Variations in uptake of AAA screening in the KCW region (3 clinic locations indicated)
  • 17. AAA Regional Matrix Working • contribute to the accountability and governance arrangements for ensuring quality screening to the population • Supports and advises on screening pathway and risk management • Commission and performance monitor local AAA providers as agreed within Section 7A National Service Specifications • Provides and delivers screening to eligible men in accordance with National guidance Local AAA NHS England London Other Stakeholders (GPs, LA) Screening QA Service London 17 London AAA Screening Programme Network Day 27 November 2015
  • 18. Screening QA Service (London) 18 London AAA Screening Programme Network Day 27 November 2015
  • 19. Purpose of Quality Assurance To help ensure that local screening services are safe and effective Quality Assurance (QA): » Checks that national programme standards are met » Encourages continuous improvement » Delivered through a programme of QA activities 19 London AAA Screening Programme Network Day 27 November 2015 A systematic programme of activities to monitor performance against pre-set quality standards and support improvement A Bowling (2002) Research Methods in Health: Investigating Health and Health Services
  • 20. Screening QA Service Operating Model Quality monitoring • Triangulation of information – data analysis including data quality, soft intelligence through programme boards and incidents Supporting providers and commissioners by • Systematic risk assessment to prioritise and tailor support to meet individual service needs • Network meetings and quality improvement projects to facilitate improvements across regions Expert advice • Quality criteria for re-commissioning screening services or for new programmes • Assessment and management of screening incidents • Monitoring trends, sharing lessons identified, guidance development and implementation (national and regional role) External quality review • QA visits and securing peer advice • Organising training for clinical and professional advisors 20 London AAA Screening Programme Network Day 27 November 2015
  • 21. Screening Quality Assurance Service 21 London AAA Screening Programme Network Day 27 November 2015
  • 22. 22 London AAA Screening Programme Network Day 27 November 2015 A critical friend can be defined as a trusted person who asks provocative questions, provides data to be examined through another lens, and offers critiques of a person’s work as a friend. A critical friend takes the time to fully understand the context of the work presented and the outcomes that the person or group is working toward. The friend is an advocate for the success of that work Costa, A. and Kallick, B.(1993) "Through the Lens of a Critical Friend". Educational Leadership 51(2) 49-51
  • 23. Monitoring Quality Screening Programmes Internal: » Monitoring of programme specific: KPIs and national quality standards » Demonstrating compliance against national standards(or action plans to meet them) » To implement continuous improvement strategies » Reporting and responding to incidents and ensuring lessons learned » Programme specific failsafe points along pathway » Service specifications External: » Formal QA visit – review of pathway standard achievement 23 London AAA Screening Programme Network Day 27 November 2015
  • 24. KPIs and Pathway Standards KPIs introduced 2010/2011 to • Drive up quality of services – acceptable and achievable standards of performance • Highlight some measurable national standards for particular focus • Raise the profile of screening programmes • KPIs give a high level overview of the quality of screening programmes at key points on the screening pathway KPIs contribute to the quality assurance of screening programmes but are not, in themselves, sufficient to quality assure or performance manage screening services 24 London AAA Screening Programme Network Day 27 November 2015
  • 25. Monitoring AAA Programme Specific: KPIs and national quality standards (pathway standards) 20 Pathway Standards (PS) and SOPs for validation • Period – Quarterly and Annually • Comparisons – Trends • Standard definitions Challenges • Data quality • Standards evolving and makes familiarisation difficult • Cross-referencing of standards to validation guidance • Cumulative data collection results in an inability to undertake periodic trend analysis • Time required for validation processes and improving input from QA and commissioners • Terminology used in standards- consistency and clarity • Consistency in reporting filters used in SMART and backend processes for data extraction 25 London AAA Screening Programme Network Day 27 November 2015
  • 26. London Pathway Standards 2013-2015 26 Public Health England, Abdominal aortic aneurysm screening: 2013 to 2015 data Nationally published data used in external reports, press releases and available in public domain • Annual data tables https://www.gov.uk/government/collections/aaa-screening-supporting-documents#data-and-research • Key performance indicators: https://www.gov.uk/government/collections/nhs-screening-programmes-national-data- reporting
  • 27. London Pathways Standards 2014/15 27 Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data Pathways standards meet acceptable or achievable thresholds for >3 London programmes 1,2,3,4, 9, 10,15 Pathways standards do not meet acceptable thresholds and are below the regional average for >2 SPs 2, 4,11, 12, 13, 17 Standards cannot be measured on SMaRT 7, 8, 14, 18, 19,20 Standards by Theme Coverage/Uptake Test Minimising harm Diagnosis Intervention/ treatment Commissioning and governance Outcome AAA-PS-1 AAA-PS-5 AAA-PS-9 AAA-PS-11 AAA-PS-12 AAA-PS-14 AAA-PS- 15 AAA-PS-2 AAA-PS-6 AAA-PS-10 AAA-PS-13 AAA-PS- 19 AAA-PS-3 AAA-PS-7 AAA-PS-17 AAA-PS- 20 AAA-PS-4 AAA-PS-8 AAA-PS-18 AAA-PS-16
  • 28. Number of Pathway Standards (PS) where a London programme did not meet either the acceptable threshold or regional average 28 Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data London Pathways Standards 2014/15 6 out of the 20 pathway standards cannot be measured on SMART
  • 29. London Pathways Standards 2013-15 and Quarter Data 2015-16 29 Public Health England, Abdominal aortic aneurysm screening: 2013 to 2016 data PS1- Offer Acceptable ≥ 90.00% Achievable ≥ 99.00% London AAA programme 2013/14 2014/15 Q1 Q2 Expected to complete year London programme 1 99.70 99.56 42.60% 70.96% 29.04% London programme 2 99.77 99.74 78.12% 97.65% 2.35% London programme 3 100.00 99.99 55.19% 78.60% 21.40% London programme 4 99.97 99.94 26.54% 46.91% 53.09% London programme 5 99.99 100.00 49.99% 62.83% 37.17% London 99.89 99.85 50.85% 71.36% 28.64% England 98.83 99.84 43.55% 68.63% 31.37% Cumulative Quarterly progress monitoring to support adequate capacity and contingency planning
  • 30. AAA- PS1- Progress on Invitations Q1-Q2 15/16 30 Public Health England, Abdominal aortic aneurysm screening: Q1/Q2 2015/16 data Q1 Q2 Expected to complete year Cumulative Q1 Q2 29.04 % London programme 1 Q1 Q2 2.35% London programme 2 Q1 Q2 21.40 % London programme 3 Q1 Q2 53.09 % London programme 4 Q1 Q2 37.17 % London programme 5 Q1 Q2 28.64 % London Q1 Q2 31.37 % England
  • 31. London Pathways Standards 2014/15 31 Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data low percentage of images of acceptable quality may indicate a training issue with staff or a problem with the screening equipment
  • 32. London Pathways Standards 2014/15 32 Public Health England, Abdominal aortic aneurysm screening: 2014 to 2015 data Variation due to difference sin interpretation of this standard. Known issue nationally and has been escalated for review
  • 33. Guidance on Reporting Pathway standards: https://www.gov.uk/government/publications/aaa-screening-quality-standards-and- service-objectives Reporting process: https://www.gov.uk/government/publications/young-person-and-adult-screening-submit- key-performance-indicator-data Validating quarterly and annual reports: https://www.gov.uk/government/publications/aaa- screening-validate-annual-pathway-standards Available in the report section of SMaRT • Quarterly pathway standards report (second Tuesday after end of quarter) • Annual pathway standards report (July for preceding screening year) • Clinic and appointments report (14th of each month) • Screener tests (annual & monthly; 14th of each month) • Tracker (quarterly, 6 weeks in arrears) NHS England has introduced standardised reporting at programme board and the next session will focus on reviewing the template and discussing consistency in utilisation 33 Presentation title - edit in Header and Footer
  • 34. In addition….Reporting Mortality • Currently under-reported in London • Guidance: https://www.gov.uk/government/publications/aaa-screening-protocol-for- reporting-deaths (follow algorithm) • Categories • Deaths during screening (men on surveillance) • Deaths following referral • Deaths following treatment • Deaths following a decision not to operate • Deaths in patients screened negative 34 Presentation title - edit in Header and Footer AAA-PS-19 30 day mortality following elective AAA surgery AAA-PS-20 1 year mortality following elective AAA surgery
  • 35. London AAA SP Quality Management Strategy (QMS) QMS “Doing the right things right” A Raffle and M Gray (2007) Screening Evidence and Practice Leadership Stakeholder engagement Processes and Protocols 35 London AAA Screening Programme Network Day 27 November 2015 • Purpose: to drive up quality through ensuring a systematic way of achieving desired goals and to ensure that programmes consistently deliver exactly what is expected • Next steps: SQAS to collate feedback from today and co-productively agree a London Quality Management Systems for AAA screening programmes • accountability across the screening pathway- key personnel • programme boards- purpose, frequency and quoracy • regular audits- DNA, mortality, staff training • reporting incidents, failsafe • improving patient experience • establishing cross professional liaison- GP, vascular teams, local authority public health