Improving quality in Indepdent Healthcare
News and updates from today’s conference looking at improving quality, and delivering outstanding practice in independent healthcare.
Improving information and transparency in private healthcare
Andrew Vallance-Owen, Chairman, Private Healthcare Information Network (PHIN)
In 2014, the Competition and Markets Authority (CMA) appointed the Private Healthcare Information Network (PHIN) as its Information Organisation. The CMA mandated all private hospitals and NHS pay bed units to submit standardised data to PHIN which has a duty to analyse and publish this data as information to help patients make informed choices. Eleven datasets will be collected from hospitals ranging from simple activity levels and patient satisfaction/outcome scores through to quality and safety measures; the first three were published at the end of April and more will follow over the coming months. PHIN is required to start publishing individual consultant data from April 2018 and consultant fee information from April 2019. The presentation will describe the process including the data requirements and give an update on progress so far.
In his presentation Andrew made the following points/observations:
- PHIN, patients and consumers are our core focus
- PHIN Online portal; consultants have 6 month opportunity to use portal and check accuracy of data before it’s published in April 2018
- PHIN website; very important that GPs know about our website to help make decisions about referrals
- Great thing about PROMs data is that it shows benefit
- We encourage consultants to use the 1st PROM, can be a clinical tool not just data collection, use to improve outcome
- NHS ‘pay beds’ are hard to engage in data collection
- Publication of fees on PHIN website by December 2019, huge job here. How to present fee data in a standardized way.
- Let’s concentrate on the positives to demonstrate our sector in delivering excellence
- Why don’t we collect data on waiting times?
Improving the investigation of deaths
Dr Gerry Morrow, Medical Director and Editor, Clarity
Monitoring hospital mortality using Retrospective Case Record Review (RCRR) is being adopted throughout the National Health Service in England. A standardised national method for such reviews will be introduced later this year, with mandatory reporting. This presentation describes the experience of reviewing the care records of inpatients who died during or within 30 days of admission to hospital in the North East of England.
• It is feasible to carry out large numbers of case record reviews and to link them locally to other governance processes including investigations of Serious Incidents.
• Case record review estimates of rates of avoidable death are subject to ‘denominator’ effects.
• Internal reviewers, in our experience, report lower rates of preventable mortality than the published literature.
• Sharing information about deaths between providers means solving important IG issues. There are technical issues to overcome – but the NHS Number could be used. Ideally we would use one system across a region.
• If Medical Examiners are introduced across England by April 2018 we will need to be open to the major advantages that will bring to involve families in a timely manner.
In his presentation Dr Morrow made the following points/observations:
- Mortality Review at South Tees, need to look at our deaths to drive improvements in patient care
- Numbers are important, Data is power
- If someone dies in hospital that is just a snapshot of their overall healthcare
- Review system, not necessarily looking for consensus, looking for a considered view of what happened
- We are now looking to use process for serious incidents, not just deaths
- We think introduction of medical examiners will make a big difference to families as a direct point of contact
Delivering services that are well led
Dr Kamal Ahmed, Medical Director, The London Bridge Hospital, and Dr Jenny Davidson, Head of Governance, London Bridge Hospital
In this joint presentation Kamal will share his own journey and that of the hospital from 1986 to date to deliver exceptional care by exceptional people. He will focus on the essential components that have led to the outstanding rating by the CQC which includes, but is not limited to, clear vision, clinical and non-clinical leadership, cohesive and collegiate consultant body all of which underpinned by strong and well embedded clinical governance framework/structure.
Jenny will focus on the quality management processes, the development of the role of the board in quality improvement, patient safety and assurance and the delivery of a well led organisation from board to ward.
In their presentation Dr Ahmed & Dr Davidson made the following points/observations:
‘London Bridge Hospital was rated outstanding by the CQC’ ‘Our mission statement is – ‘We are committed to excellence and quality through the provision of specialised healthcare services’
‘Our current Vision - Exceptional People delivering exceptional care’
‘Its all about the employees - it’s all about the people that lead to quality care’
‘Leadership – You must listen and you must act’
‘Ward to Board – we created a flow chart so people at all levels in the hospital know how their concern is going to get to the board’
‘Employee Engagement is very important, Its not just about pushing out information, its about getting information back’
Delivering Outstanding Quality
Prof Mark Whiteley, Consultant Vascular Surgeon, The Whiteley Clinic
The Whiteley Clinic was set up to be a centre of excellence for the research and treatment of varicose veins and other venous diseases, including venous leg ulcers. As the NHS has been withdrawing from this area of medicine over the last 2 decades, the clinic had to be set up in the independent sector.
Mark Whiteley developed an interest in venous disease as a junior vascular surgeon as it became clear to him that although arterial surgery appeared more heroic in terms of saving lives and limbs, the long term health benefits for treating venous disease, and the long term complications of poor treatment, far outweighed those of arterial surgery. He built a team around him that shared the same goals – clinical excellence through research and innovation.
Mark developed “The Whiteley Protocol”, a standardised protocol for investigating and treating patients with venous diseases. This protocol was developed using the research from The Whiteley Clinic, mixed with appropriate research acquired from other researchers in the field. It is a “living” protocol, and is regularly reviewed and updated as different research studies, techniques or devices are developed or reported.
By the critical appraisal of the optimal techniques for diagnosis and treatment, and by the regular audit of results and complaints through a regular CGP meeting and formal audits of cohorts of patients treated up to 18 years previously, we can ensure that The Whiteley Protocol represents the current optimal management of venous patients.
All doctors, clinical vascular scientists (formerly called “vascular technologists”) and nurses agree to investigate and treat all patients by The Whiteley Protocol as part of their terms of employment or as part of their practising privileges. All are trained in The Whiteley Protocol and are assessed before being allowed to see patients on their own in the clinic. The non-clinical staff are also given clinical tutorials so that they are aware of The Whiteley Protocol and what it entails. This allows them to be able to converse with clinicians and also help patients to understand the processes of investigation and treatments from a lay viewpoint.
The Whiteley Clinic has an intranet and e-mail cascade where any updates to The Whiteley Protocol are posted and any queries answered. The Whiteley Clinic hosts an annual “Academic Day” where all members of The Whiteley Clinic, clinical and non-clinical (including all administrative staff) meet to be formally updated as to what is going on in the clinic.
In addition to our regular clinical audits, we encourage feedback at all of our clinics and have an automated feedback booth in our Guildford clinic. We have been running patient satisfaction surveys on all patients who we have seen since 2001, and now have made this electronic. We publish the results on our website. We encourage questions through our website and have self-assessment pages for venous disease and pelvic venous congestion. We also have open discussions on social media, particularly through our Facebook page.
Source of information:
Future events of interest:
Measuring, Understanding and Acting on Patient Experience Insight
Measuring & Monitoring Clinical Quality
Complaints Handling, Investigating, Resolving and Learning for Clinicians and Managers in Health and Social Care
Clinical Audit for Improvement
Improving Ward Round Process and Practice
Improving Patient Flow Masterclass
Driving Improvement: Learning lessons and sharing good practice from Trusts who have demonstrated significant improvement through CQC Inspections
National PROMs Summit 2017
Monday 11 December
De Vere West One, London
10 July 2017