This document discusses measurement for quality improvement. It explains that measurement in improvement aims to provide a basis for action to improve processes and outcomes, rather than just estimating parameters. Improvement measures should be simple, specific, and available in real-time. Statistical process control methods are important to separate normal variation from changes resulting from interventions. Examples are provided of run charts measuring improvements in recording BMI for mental health patients and compliance with care bundles. The document advocates making the theories behind improvement efforts more explicit.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Effectiveness of the current dominant approach to integrated care in the NHS:...Sarah Wilson
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
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.
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Effectiveness of the current dominant approach to integrated care in the NHS:...Sarah Wilson
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
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.
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Magnus Liungman: RCTs in complex settings Nuffield Trust
Magnus Liungman and Dr Gustaf Edgren present on the lessons learned from developing a healthcare prevention intervention for frequent emergency department visitors.
Laura Eyre and Martin Marshall: Researchers in residence Nuffield Trust
Laura Eyre, Research Associate and Martin Marshall, Professor of Healthcare Improvement at UCL give an inside perspective on moving improvement research closer to practice.
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
Expediting Colonoscopy for Patients with + Faecal Occult Blood Test in a Publ...Cancer Institute NSW
Colon cancer is the commonest cancer in Australia. The Federal Gov. has recently accelerated the rollout of the National Bowel Cancer Screening Program to 2nd yearly after age 50 by 2018. We anticipate up to 1000 extra colonoscopies on the public system at NSLHD.
Clinician Satisfaction Before and After Transition from a Basic to a Comprehe...Allison McCoy
Healthcare organizations are transitioning from basic to comprehensive electronic health records (EHRs) to meet Meaningful Use requirements and improve patient safety. Yet, full adoption of EHRs is lagging and may be linked to clinician dissatisfaction. In depth assessment of satisfaction before, during, and after EHR transition is rarely done. Using an adapted published tool to assess adoption and satisfaction with EHRs, we surveyed clinicians at a large, non-profit academic medical center before (baseline) and 6-12 months (short-term follow-up) and 12-24 months (long-term follow-up) after transition from a basic, locally-developed to a comprehensive, commercial EHR. Satisfaction with the EHR (overall and by component) was captured at each interval. Overall satisfaction was highest at baseline (85%), lowest at short-term follow-up (66%), and increasing at long-term follow-up (79%). This trend was similar for satisfaction with EHR components designed to improve patient safety including clinical decision support, patient communication, health information exchange, and system reliability. Conversely, at baseline, short-term and long-term follow-up, perceptions of productivity, ability to provide better care with the EHR, and satisfaction with available resources, were lower at both short- and long-term follow-up compared to baseline. Persistent dissatisfaction with productivity and resources was identified. Addressing determinants of dissatisfaction may increase full adoption of EHRs. Further investigation in larger populations is warranted.
Ruth Thorlby: capturing patient and staff thoughts in evaluation Nuffield Trust
Ruth Thorlby, Acting Director of Policy at the Nuffield Trust, presents reflections on the challenges of capturing patient and staff thoughts in evaluations
Current clinical electronic health record systems do not provide accessible information for quality assurance and research purposes. Furthermore, data entry is limited due to inappropriate and/or insufficient fields.
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
Professor Kamlesh Khunti - Introduction to CLAHRC East MidlandsCLAHRC-NDL
Professor Kamlesh Khunti, Director of NIHR CLAHRC East Midlands - Introductory presentation given at CLAHRC East Midlands launch event, 14 February 2014, Loughborough.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Magnus Liungman: RCTs in complex settings Nuffield Trust
Magnus Liungman and Dr Gustaf Edgren present on the lessons learned from developing a healthcare prevention intervention for frequent emergency department visitors.
Laura Eyre and Martin Marshall: Researchers in residence Nuffield Trust
Laura Eyre, Research Associate and Martin Marshall, Professor of Healthcare Improvement at UCL give an inside perspective on moving improvement research closer to practice.
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
Expediting Colonoscopy for Patients with + Faecal Occult Blood Test in a Publ...Cancer Institute NSW
Colon cancer is the commonest cancer in Australia. The Federal Gov. has recently accelerated the rollout of the National Bowel Cancer Screening Program to 2nd yearly after age 50 by 2018. We anticipate up to 1000 extra colonoscopies on the public system at NSLHD.
Clinician Satisfaction Before and After Transition from a Basic to a Comprehe...Allison McCoy
Healthcare organizations are transitioning from basic to comprehensive electronic health records (EHRs) to meet Meaningful Use requirements and improve patient safety. Yet, full adoption of EHRs is lagging and may be linked to clinician dissatisfaction. In depth assessment of satisfaction before, during, and after EHR transition is rarely done. Using an adapted published tool to assess adoption and satisfaction with EHRs, we surveyed clinicians at a large, non-profit academic medical center before (baseline) and 6-12 months (short-term follow-up) and 12-24 months (long-term follow-up) after transition from a basic, locally-developed to a comprehensive, commercial EHR. Satisfaction with the EHR (overall and by component) was captured at each interval. Overall satisfaction was highest at baseline (85%), lowest at short-term follow-up (66%), and increasing at long-term follow-up (79%). This trend was similar for satisfaction with EHR components designed to improve patient safety including clinical decision support, patient communication, health information exchange, and system reliability. Conversely, at baseline, short-term and long-term follow-up, perceptions of productivity, ability to provide better care with the EHR, and satisfaction with available resources, were lower at both short- and long-term follow-up compared to baseline. Persistent dissatisfaction with productivity and resources was identified. Addressing determinants of dissatisfaction may increase full adoption of EHRs. Further investigation in larger populations is warranted.
Ruth Thorlby: capturing patient and staff thoughts in evaluation Nuffield Trust
Ruth Thorlby, Acting Director of Policy at the Nuffield Trust, presents reflections on the challenges of capturing patient and staff thoughts in evaluations
Current clinical electronic health record systems do not provide accessible information for quality assurance and research purposes. Furthermore, data entry is limited due to inappropriate and/or insufficient fields.
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
Professor Kamlesh Khunti - Introduction to CLAHRC East MidlandsCLAHRC-NDL
Professor Kamlesh Khunti, Director of NIHR CLAHRC East Midlands - Introductory presentation given at CLAHRC East Midlands launch event, 14 February 2014, Loughborough.
Making your improvements last ckmf 2015 Laura Lennox
Presentation for the Canadian Knowledge Mobilisation Forum 2015. Theme of the session was sustainability and this presentation detailed work done to develop a reflective tool for improvement teams to influence their projects sustainability and create lasting impact on patient care.
Let's Talk Research Annual Conference - 24th-25th September 2014 (Professor M...NHSNWRD
"Engaging with the work of North West Coast and Greater Manchester Collaborations for Leadership in Applied Health Research and Care": Professor Mark Gabbay and Sue Wood's presentation provided an overview of the work of the two CLAHRCs within the NW and provided an opportunity for delegates to explore how they can engage with their work.
Nhs innovation accelerator understanding how and why the nhs adopts innovationHugh Risebrow
Thanks Nael Clarke for highlighting Wessex AHSN report on adoption of innovation in the NHS. Innovation is difficult in any organisation, but why is it so much harder in the NHS than in say Apple, Amazon or most private businesses: My views:
1. Organisational success. In private b2c companies, success results from attracting and retaining customers through delivering innovative services which meet their needs better than competition. In the NHS, success is much more about achieving arbitrary political targets, and patients have limited choice.
2. Organisational incentives. Many innovative companies set divisional objectives around the proportion of income from new products.
3. Individual and team incentives. In successful b2c businesses, financial and career recognition/ promotion rewards are often linked to innovation. There is recognition that innovation may need a few reiterations to succeed. In the NHS, few get fired for preserving the status quo, but many lose out of they innovate and it fails first time round, and there are no individual or team incentives.
Many in the NHS seek to innovate in order to deliver better care at a lower cost. They are often faced with organisational resistance or at least inertia, and excessive bureaucracy.
Lesson 101 in management s that you get the behaviours that you incentivise. (How) should the NHS change the incentives? Is there scope for more NHS owned 'spin-outs' which allow private sector type financial incentives for staff, and greater freedom from NHS bureaucracy and governance?
Professor Cindy Farquhar
Cochrane Menstrual Disorders & Subfertility Group
NZ Cochrane Branch of the Australasian Cochrane Centre
New Zealand Guidelines Group
National Women’s Health
University of Auckland
High-level analysis of NIHR research impact derived from REF2014 case studiesAdam Kamenetzky
This presentation is based on an analysis of 248 impact case studies citing support from the UK's National Institute for Health Research (NIHR) submitted to REF2014. It provides a high-level view of the features of this research, and categorises a number of levels at which they provide evidence of wider societal impacts.
Effect of Financial Incentives on Incentivised and Non-Incentivised Clinical Activities: Utilising Primary Care Databases to answer clinical, policy and methodological questions
Interventions to reduce unplanned hospital admission, a study from NHS Bristo...Emergency Live
This review represents one of the most comprehensive sources of evidence on interventions for unplanned hospital admissions. There was evidence that education/self-management, exercise/rehabilitation and telemedicine in selected patient populations, and specialist heart failure interventions can help reduce unplanned admissions. However, the evidence to date suggests that majority of the remaining interventions included in these reviews do not help reduce unplanned admissions in a wide range of patients.
How Community Engagement Fits Into The Mission Of The National Center for Adv...SC CTSI at USC and CHLA
Christopher Austin, MD, Director of the National Center for Advancing Translational Sciences (NCATS) shared his thoughts on how community engagement fits into the mission of NCATS at the recent CTSA Community Engagement Key Function Committee (KFC) conference. He proposed a revision of NCATS' mission: "To catalyze the generation of innovative methods and technologies that will enhance the development, testing and implementation of interventions that tangibly improve human health across a wide range of human diseases and conditions." Learn more about NCATS http://www.ncats.nih.gov/
Effectiveness of the current dominant approach to integrated care in the NHSNuffield Trust
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Lisa Annaly, Head of Provider Analytics at the Care Quality Commission, discusses lessons learned from the CQC as they have worked to monitor care quality over time.
Monitoring quality of care: making the most of dataNuffield Trust
Chris Sherlaw-Johnson, Senior Research Analyst at the Nuffield Trust, introduced the Monitoring quality of care conference and gives an overview of some of the approaches that we've been using at the Trust to identify where care quality has been improving, especially for frail and older people.
New Models of General Practice: Practical and policy lessonsNuffield Trust
Nuffield Trust policy researchers Rebecca Rosen and Stephanie Kumpunen present findings from our upcoming report on large scale general practice models.
Dr Mark Spencer, Co-Chair at the New NHS Alliance, shares initial findings from Collaborate, a partnership aiming to support primary care leaders to deliver to new models of care.
Extended Primary Care Access in Southwark Nuffield Trust
Dr Lauren Parry, Improving Health; Rebecca Dallmeyer, Quay Health Solutions and Hayley Sloan, NHS Southwark CCG present on their Extended Primary Care Access programme.
Has clinical commissioning found its voice? GP perspectives on their CCGsNuffield Trust
This slide deck presents the fourth and final year of results from an annual survey of GPs and practice managers in six CCGs across the country. The survey – conducted as part a joint project with The King’s Fund – explores how GP attitudes towards clinical commissioning have evolved since their launch in 2013.
Revolutionising the workforce for child health services - Hilary CassNuffield Trust
For the Nuffield Trust Health Policy Summit 2016, Hilary Cass talks about how we need to reconsider health services for children in the UK and what implications that may have on the workforce.
ACOs and vanguards: Reflections from the USA - Mark LeenayNuffield Trust
Mark Leenay from Optum in the US presents to the Nuffield Trust health policy summit on accountable care organisations and what lessons they may have for vanguards in the UK.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Providing actionable healthcare analytics at scale: Understanding improvement measures
1. Providing actionable healthcare analytics at scale:
Understanding improvement measures
Thomas Woodcock, Improvement Science Fellow, Imperial
College London
2. NIHR CLAHRC
Northwest London
Collaboration for Leadership in Applied Health Research and Care
Northwest London
The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Northwest London
is hosted by Chelsea and Westminster Hospital NHS Foundation Trust and academically led by Imperial College London, in partnership with North West London
Understanding Improvement
Measures
Dr Tom Woodcock
Programme Lead Information Intelligence
Health Foundation Improvement Science Fellow
3. NIHR CLAHRC
Northwest London
To achieve this: Develop a comprehensive systematic approach to
improvement which is transferable and generalizable across the NHS
3
Primary aims
Translate research into practice
Improve health outcomes and patient experience
Deliver value locally and to the wider NHS
Working in collaboration with: Patients, communities, health and care
services, healthcare professionals, academics, universities, third sector,
industry…
4. NIHR CLAHRC
Northwest London
Collaboration for Leadership in Applied Health Research and Care
Northwest London
The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Northwest London
is hosted by Chelsea and Westminster Hospital NHS Foundation Trust and academically led by Imperial College London, in partnership with North West London
Measurement for Improvement
6. NIHR CLAHRC
Northwest London
Measurement for Improvement
A few simple and specific measures,
linked to your objectives and aims, and
available in real time
to demonstrate whether changes are
making improvements.
NHS Institute for Innovation and Improvement
7. NIHR CLAHRC
Northwest London
Measurement in, and of,
Improvement
• Are changes happening in the way health
care is delivered?
• Are these associated with improvements
for patients, carers & the public?
• Are these changes causally linked?
• How can we reproduce this improvement
elsewhere?
8. NIHR CLAHRC
Northwest London
The measurement cycle
1 Decide aim
2 Choose measures
3 Confirm collection
6 Take appropriate
action
5 Analyse & present
8 Repeat
steps
4-6
4 Collect data
7 Review measures
5 Analyse & present
Adapted from a slide by Mike Davidge
9. NIHR CLAHRC
Northwest London
What to measure?
Aim Concept Measure
Operational
Definitions
Data
Collection
Plan
Data
Collection
Analysis Action
R. Lloyd. Quality Health
Care: A Guide to
Developing and Using
Indicators.
11. NIHR CLAHRC
Northwest London
Enumerative vs Analytic Study
On Probability As a Basis For Action, W E Deming,
The American Statistician, Vol. 29 No. 4 1975, pp. 146-152
(and previously in ‘42 and ‘50)
“An enumerative study has for its aim an estimate
of the number of units of a frame that belong to a
specified class.
An analytic study has for its aim a basis for action
on the cause-system or the process, in order to
improve product of the future”
12. NIHR CLAHRC
Northwest London
Enumerative vs Analytic Study
Analytical studies: a framework for quality
improvement design and analysis, Lloyd P Provost
BMJ Qual Saf 2011; 20 (Suppl. 1) doi:10.1136/bmjqs.2011.051557
“Because of the temporal nature of improvement, the
theory and methods for analytical studies are a
critical component of the science of improvement.”
Analogy: pond vs river
13. NIHR CLAHRC
Northwest London
SPC: Origins
• Dr. Walter Shewhart: physicist & engineer,
Western Electric and Bell Laboratories,
1920s. Quality in manufacturing.
• Dr. W. Edwards Deming extended
Shewhart’s work, developing and
explaining applications (U.S. Then Japan
after WWII, worldwide in the 80s and 90s).
• Increasingly seen in healthcare – but
applied with varying degrees of rigor and
success.
14. NIHR CLAHRC
Northwest London
Understanding variation
Everything we can measure will vary
Statistical Process Control separates out Special Cause
from Common cause (routine variation)
– Common: inherent to the process, none dominant
– Special: due to a specific reason, dominant
Distinguishing between the two is crucial for good decision
making
SPC provides tools to make this distinction
– run and control charts
15. NIHR CLAHRC
Northwest London
Collaboration for Leadership in Applied Health Research and Care
Northwest London
The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Northwest London
is hosted by Chelsea and Westminster Hospital NHS Foundation Trust and academically led by Imperial College London, in partnership with North West London
An Example QI Initiative
17. NIHR CLAHRC
Northwest London
Physical health and severe and
enduring mental illness
“Adults with serious mental illness represent the
greatest and least recognized health disparity...
reflected in a 13- to 30-year reduced life expectancy.
The primary cause... is cardiovascular disease
associated with disproportionately high rates of
obesity and tobacco use... the greatest current
challenge to providing appropriate mental health
services is not a knowledge gap, but an
implementation gap.” Bartels, Am J Psych, 2015
21. NIHR CLAHRC
Northwest London
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Run Chart - Percentage of Admissions with BMI Recorded
A MENTAL HEALTH WARD IN NORTHWEST LONDON
Percentage with BMI recorded
Baseline Median (21%)
Baseline Median - Extended
New process median (61%)
Baseline audit
(247 admissions)
Intervention period
(311 admissions)
22. NIHR CLAHRC
Northwest London
Collaboration for Leadership in Applied Health Research and Care
Northwest London
The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Northwest London
is hosted by Chelsea and Westminster Hospital NHS Foundation Trust and academically led by Imperial College London, in partnership with North West London
Additional Examples
24. NIHR CLAHRC
Northwest London
0%
5%
10%
15%
20%
25%
30%
Percentage ED
attendances admitted
Seasonalised
Average
Seasonalised Lower
Process Limit
Seasonalised Upper
Process Limit
Monthly % ED Attendances Admitted; England 2011-2014
0
0.1
0.2
0.3
0.4
0.5
0.9
0.92
0.94
0.96
0.98
1
1.02
1.04
1.06
1 2 3 4 5 6 7 8 9 101112
RangeChart
AverageChart
Month
Average and Range Chart for Monthly
Seasonal Factors
Average
Grand Average
Lower Average
Limit
Upper Average
Limit
25. NIHR CLAHRC
Northwest London
Collaboration for Leadership in Applied Health Research and Care
Northwest London
The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Northwest London
is hosted by Chelsea and Westminster Hospital NHS Foundation Trust and academically led by Imperial College London, in partnership with North West London
What next?
27. NIHR CLAHRC
Northwest London
We conclude that
although informal theory is
always at work in
improvement, practitioners
are often not aware of it or
do not make it explicit.
The germane issue for
improvement practitioners,
therefore, is not whether
they use theory but
whether they make explicit
the particular theory or
theories, informal and
formal, they actually use.
28. NIHR CLAHRC
Northwest London
Safer Clinical Systems
Evaluation findings (http://www.health.org.uk/publication/safer-clinical-systems-
evaluation-findings)
29. NIHR CLAHRC
Northwest London
Collaboration for Leadership in Applied Health Research and Care
Northwest London
The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Northwest London
is hosted by Chelsea and Westminster Hospital NHS Foundation Trust and academically led by Imperial College London, in partnership with North West London
Plan
Explore
Design
Test and Scale
Up
Spread
MeasurementPlanning
SupportTool
Measurementfor
ImprovementSupportTool
SPCPublication
Standards
WISH
MeasureDefinition
Process
MeasurementTraining
(inc.QI4U)
Technicalsupport
30. NIHR CLAHRC
Northwest London
Measurement for Improvement -
Summary
• Goal is improvement – analytic study
• Methodology required is different – SPC
• Not an excuse to sacrifice rigour!
• QI methods support good practice – if used
correctly
• Further research required – how to reliably
achieve good measurement
• More support and guidance is needed for QI
teams