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WMQI

WMQI. Measuring and improving quality in neonatal care. Talk. Who are we? What we have been doing? Why we are doing it? The future. “ We can only be sure to improve what we can actually measure” Lord Darzi, High Quality Care for All, June 2008. Origins of the quality observatories.

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WMQI

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  1. WMQI Measuring and improving quality in neonatal care

  2. Talk • Who are we? • What we have been doing? • Why we are doing it? • The future

  3. “We can only be sure to improve what we can actually measure” • Lord Darzi, High Quality Care for All, June 2008

  4. Origins of the quality observatories • “There is clear local support for quality improvement. A new ‘Quality Observatory’ will be established in every NHS region to inform local quality improvement efforts.” • “We will also ask each SHA to establish a formal Quality Observatory, building on existing analytical arrangements, to enable local benchmarking, development of metrics and identification of opportunities to help frontline staff innovate and improve the services they offer. “ High Quality Care For All

  5. Approach and principles • Clinically championed Indicators • No measure about me, without me • Bottom up development not top down • Developmental not regulation • Metrics not targets • Helpful benchmarking and comparison • Helping clinicians to set their aspirations • Helping patients to compare different providers

  6. Goal • Building clinician championed metrics is an expensive investment • Takes time to build consensus • Benefit build local engagement with the data • Closes feedback loop • Why do I both spending time entering the data, never see any results? • Understanding your performance is crucial

  7. As Sherlock Holmes says in the Legend of the Copper Beeches: "Data! Data! Data!... I can't make bricks without clay."

  8. Quality Indicators: clinician championed • Vascular Surgery • Orthopaedics • Urgent care • General Surgery • Mental Health • Learning Disabilities • Care of the elderly • VTE • Cardiovascular

  9. Neonatal Indicators

  10. The team • WMQI Analyst based at UHBFT • Guided by a group of interested clinicians from across the West Midlands • Consultants • Nurses • Specialised Commissioners • Supported by the Staffordshire, Shropshire and Black Country Newborn and Maternity Network Co-ordinator

  11. Journey • Process kicked off in October 2010 with presentation to Partners In Paediatrics • Neonatalogy • Paediatric Surgery • Paediatrics • Blank sheet of paper! • Global search for metrics • Literature and internet • Refined during 2011 in a series of meetings

  12. Building consensus • Workshop held in November • Over 30 from almost all of the Neonatal units • Reviewed the metrics • Are these indicators clinically useful? • Are there any issues with the data required to measure these indicators? • How would you like these reported back? • Are there other things that you would like measuring and reporting on in the region?

  13. Top 3 Priorities • Mortality • 2 year outcome • Infection/CVL • Morbidity • NEC with surgery • ROP with surgery • Discharged home on O2 • Clinical Pathways • Transfer • Data Quality • Capacity • Staffing (medical & nursing) • Temperature

  14. First set of metrics • Discharged home on O2 • NEC with surgery • ROP with surgery • Piloting on 5 trusts • Data quality • Complete, Accurate, Precise • Statistical model of casemix adjustment • Review process and results with the steering group for confirmation before processing

  15. Badger Dataset • Your Clinical dataset • Opportunity to track most interventions on a neonate • Drawbacks are • In the ability to track patients once they are discharged from Neonatal care unit • No access to complete regional or national dataset • Opportunities are huge for embedding quality metrics into their dashboards

  16. Going beyond Badger • WMQI has access to the fully linked national dataset • Birth, A&E, Admission, Outpatient, Death • Provides opportunity to track routinely: • Survival • On going care post neonatal care • Elective • Emergency • Technically simple • Challenge is information governance

  17. Transition • End of SHAs • Reinforcement of the provider-commissioner split • Where next for NHS supported development of metrics • Provider sponsored? • Commissioned focused? • Still to find out! • For us means focusing on delivery and sustainability

  18. Summary • Developing clinician championed metrics takes time to build consensus • Goal of WM work is to build local engagement with data • Challenge is to complete the work • Align to other work streams at NDAU/NNAP and national dashboard • Build sustainability through quality dashboard on Badger

  19. WMQI • Email: WMQI@westmidlands.nhs.uk • Contact • Richard: 0121 213 1987 • Jag: 0121 695 2460 • Follow us at @wmqi • Register at the website for updates and news of events www.wmqi.westmidlands.nhs.uk

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