Health Informatics – Francis, Berwick, Keogh et al

1. Health Informatics – Francis, Berwick, Keogh et al Paul Curley Mid Yorkshire Hospitals NHS Trust

2. Aims • 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..

3. Keogh Review process • 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

4. Costs • 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

5. Panel • 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

7. HSMR Funnel Plot

8. Activity

9. Demographics

10. Demographics 2

11. Demographics 3

12. Selection of 14 Trusts

13. SHMI vs HSMR

14. SHMI Tree

15. SHMI Gen Med breakdown

16. HSMR Tree

17. HSMR Tree breakdown

18. LOS / Readmission rates average/low

19. Patient Experience (inpatient survey)

20. Staffing Challenges

21. Staff Engagement

22. Key Findings • 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

23. Most Useful Indicators • 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

24. Surgeon Level Outcomes • Published June/July 2013 • Several specialties • Vascular – AAA, CEA • Tables non-risk adjusted

25. Florence Nightingale 1863 • "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.

26. Weekly Bills of MortalityLONDON week ending 31st January 1634The Diseases and Casualties this week Abortive 2 Aged 36 Bedridden 1 Bloody flux 1 Bruised 1 Cancer 1 Chilbed 3 Chrisoms 19 Consumption 77 Convulsions 44 Cough 2 Dropsie 1 Executed 33 Feaver 10 Flox and smallpox 5 Found dead in the street (an infant) 1 French pox 1 Gripping in the guts 13 Jaundies 1 Infants 18 Killed with a fall 3 Murthered 1 Overlaid 2 Quinsie 1 Rickets 8 Rising of the lights 8 Scowering 1 Scurvey 2 Stillborn 9 Stone 1 Stopping of the stomach 3 Suddenly 6 Teeth 16 Winde 3 Worms 1 Males 107 Christened Female 109 In all 216 Males 213 Buried Females 196 In all409 Plague 0 Decreased in the buriels this week - 63 Parishes clear of the plague - 130 Parishes infected - 20

30. Raw vs Risk-Adjusted data

31. Information / Data • Pennine Acute Hospitals NHS Trust 266 • 4308472 89 3 86 0.0% • 4187787 * * * * • 3643174 84 11 73 2.4% • 3560031 50 14 36 2.0% • 6090793 * * * *

32. Coronary PCI • Primary – STEMI • Planned – angina, NSTEMI etc • 2 models : • Centralised (Leeds, Newcastle) • Distributed • Good data submission • Is “geography/service model” an issue ?

33. HSMR Mortality Funnel Plot

34. Information hidden in data !

36. Conclusions • 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

37. Conclusions • 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

39. More Paedophiles and murderers reside in Wakefield than any other city in UK • Wakefield Prison – category A • Highest concentration of Sex offenders and Murderers in Prison population

40. Fatality from Burns higher in Wakefield than Leeds, Bradford, Hull, Huddersfield and Halifax combined • Only major Burns Centre in Yorkshire based in Pinderfields

41. As for IT Projects ! • Document Management • PAS replacement • Outsourced letter printing • EDsM • Order Comms • PACS/RIS • PMI duplicates • Managed networks • VoIP/Mobile voice/Faraday cage construction