Dr Foster Intelligence | Case studies

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Success stories

The improvements in data quality have led to improved relationships and highlighted the importance of accurately coding our activity. Clinicians will more readily accept analysis if it is based on accurate data.

Keith Soper Associate Director for Quality

Striving for excellence

St Mary's NHS Trust began using Dr Foster Intelligence's Practice and Provider Monitor (PPM) and Real Time Monitoring (RTM) tools in 2004. They are used to identify areas for further review and analysis, as part of a general trend in improving care. Cardiac surgery was brought to the trust's attention following a regular review of alerts generated by the tools.

Questions around the accuracy of the department's coding emerged and, since both management and clinical teams wanted to improve coding and clinical data collection across the trust, the report from Professor Keogh was commissioned.

The trust wanted to make substantive improvements to its patient care and so fully supported the report's recommendations concerning processes and facilities.

Mortality Graph

[more info] RTM shows trusts their performance trends and can also benchmark trusts against other similar organisations.

Solution:

In May 2005 St Mary's formed a Cardiac Surgery Working Party chaired by the trust's director of operations, to review, design and implement service improvements addressing the recommendations in the report.

The working party, which met regularly between May 2005 and January 2006, was made up of a team of experts ranging from retired surgeons to theatre staff and a general manager. Since the group was going to focus on the cardiothoracic department, all members of that team were given reduced hours to ensure their full involvement in the improvement programme.

One of the group's first decisions was to establish clear areas of responsibility for individuals, departments and multi-disciplinary teams. Accountability also became clearer, as these areas of responsibility were identified.

Staff were empowered by seeing the direct links between their individual areas of responsibility and overall trust performance. Clear lines of accountability also increased their sense of involvement.

Teamwork within the trust was another area identified as essential to improving performance. In order for coding responsibilities to be genuinely shared, departments needed to work together to identify problem areas and formulate solutions that were supported and supportable.

For Keith Soper, the trust's associate director for quality and risk, it was the improved relationships and data accuracy that made the biggest difference to his trust's performance.

"The improvements in data quality have led to improved relationships and highlighted the importance of accurately coding our activity," he says. "Clinicians will more readily accept analysis if it is based on accurate data."

To reinforce the importance of regular data reviews and reports, information is shared monthly between clinicians, the management team and the strategic board.

Outcome:

One of the largest projects spearheaded by the working party was the creation of a new cardiac recovery unit. Situated near intensive care and the surgical wards, the unit is staffed by a dedicated team of nurses who are supported by a full cardiac team, including surgeons, when needed.

Skill development was also identified as needing work across the trust and so a nurse rotation programme was introduced. Nurses now rotate through high-dependency areas to give them a broader experience of providing emergency and intensive care.

In order to tie together all the new processes, team structures and information use, a data manager was appointed to manage the new trust database. Clinical information is now linked to a central cardiac audit database, making it easier for clinicians and managers to compare their results against other teams and double-check the data they are already using from the PPM and RTM tools. Tools are checked weekly for alerts and results are fed into the reporting and planning systems.

Strategic thinking remains important for the trust, even in the midst of all the work being done on review and analysis. Pioneering research is supported by monthly clinical governance meetings. The highest standards in quality and safety are pursued, supported by groundbreaking work such as the trust's innovative robotic cardiothoracic surgery.

Tool or service

Practice and Provider Monitor and Real Time Monitoring