HQIP will be following NHS England pre-election guidance for the National Clinical Audit and Patient Outcomes Programme (NCAPOP) workstream which is in part funded by NHSE.
As such we will pause publications from the 25 May 2024 to 05 Jul 2024 (00:01) or until the date at which a new government is formed. Clinical Audit Awareness Week (CAAW) will continue as business as usual. The NCAPOP nine-month publication reschedule is here.
Data relating to maternity and perinatal care has been published on HQIP's benchmarking site, NCAB.
Tender: Child Health Clinical Outcome Review Programme (CH CORP)
20 May 2024
Applications closing date: 20 Jun 2024 12:00
The Healthcare Quality Improvement Partnership (HQIP) is seeking to commission an organisation that will support the delivery of the Child Health Clinical Outcome Review Programme (CH CORP).
The programme will initially be delivered for NHS-funded care in England, Wales, Northern Ireland and Jersey but may later extend to include Guernsey, Scotland Isle of Man and other Devolved Nations/ Crown Dependencies.
Further details can be found on the tenders webpage.
Data relating to maternity and perinatal care has been published on HQIP's benchmarking site, NCAB.
Tender: National Audit of Dementia
17 May 2024
Applications closing date: 14 Jun 2024 12:00
The Healthcare Quality Improvement Partnership (HQIP) is seeking to commission an organisation that will support the delivery of the National Audit of Dementia.
The programme will initially be delivered for NHS-funded care in England, Wales, Jersey and the Isle of Man but may later extend to include Guernsey, Scotland, Northern Ireland and other Devolved Nations/ Crown Dependencies.
Further details can be found on the tenders webpage.
Data relating to maternity and perinatal care has been published on HQIP's benchmarking site, NCAB.
New resource published May 2024
14 May 2024
We are pleased to announce that the following NEW resource has been published:
National Diabetes Foot Care Audit (NDFA) – State of the Nation Report 2018-2023
This report is available to view and download, along with all other reports, on our dedicated reports webpage.
Stay up to date: Join our mailing list to receive notifications when new reports are published.
Data relating to maternity and perinatal care has been published on HQIP's benchmarking site, NCAB.
Amended NHS England Quality Accounts List 2024-25 available from HQIP website
14 May 2024
The NHS England Quality Accounts List 2024-25 has been amended. The revised version of the List, dated May 2024 is available on our website, along with further information and guidance.
Data relating to maternity and perinatal care has been published on HQIP's benchmarking site, NCAB.
Avoiding ‘lost in translation’
4 May 2024
Using national healthcare data to support meaningful change
Jill Stoddart, Director of Operations (National Clinical Audit and Patient Outcome Programme), HQIP
What keeps you awake at night? When I worked in clinical practice, questioning whether I’d provided the very best care for patients kept me awake. Now I commission national clinical audits and other patient outcome programmes, this is still a primary concern – but the focus is on whether the data we collect supports the best care for patients. How can we ensure that evidence derived at a national level is well received and implemented at Trust level? And, critically, are we really making a difference to patient care?
I understand the pressure and challenges that Trusts face with increasing demand, financial constraints, bed shortages, recruitment freezes and preparing for winter pressures – all in addition to national and regional scrutiny. Against this backdrop, it can be extremely difficult to make sense, and practical use, of the vast array of national healthcare data available. Between April 2022 and March 2023, the National Clinical Audit and Patient Outcome Programme (NCAPOP), commissioned by HQIP, published 64 reports and 368 recommendations alone. Factor this up across the national clinical effectiveness landscape – including National Institute for Health and Care Excellence (NICE) guidance, Getting It Right First Time (GIRFT) reports, Healthcare Safety Investigation Branch (HSIB) investigations and multiple other national enquiries – and we can safely say that Trusts are awash with reports and recommendations.
Widely disseminate information about both negative and positive outliers – share the learning!
This is why, in 2023, HQIP reshaped its outputs. We undertook discussions with policy makers and healthcare providers, which identified a need to reduce the burden and increase the timeliness of data, culminating in:
Shorter user-friendly ‘state of the nation’ reports
Quality Improvement (QI) resources, replacing local recommendations in reports
A focus on approximately ten metrics, and
Near real-time dynamic reporting, refreshed at least quarterly.
However, while these changes were welcomed by healthcare providers, we know that information provision alone does not change behaviour. It takes much more than knowledge to leverage change. The starting point for transformation at a Trust level is to continually question the quality of care provided. Questions are vital, they do not mean resistance and should be actively encouraged. These questions can take many forms, and can help to clarify understanding.
Questions that healthcare organisations can ask themselves about their performance* were highlighted in the 2023 edition of CORNERSTONE by Mirek Skrypak (pages 22-23) and are worth reiterating here, since they are the starting point for a Trust:
Do we know how good we are?
Do we know where we stand relative to the best?
Do we know where, and understand why, variation exists in our organisation?
Over time, where are the gaps in our practice that indicate a need for change?
In our efforts to improve, what’s working?
Alongside asking key questions about clinical effectiveness performance, all Trusts need to also invest time in building an open and transparent data and quality improvement culture. NHS England’s approach to improvement is outlined in their NHS IMPACT (Improving Patient Care Together) programme. It includes five components which form the ‘DNA’ of all evidence-based improvement methods, and which underpin a systematic approach to continuous improvement:
Building a shared purpose and vision
Investing in people and culture
Developing leadership behaviours
Building improvement capability and capacity, and
Embedding improvement into management systems and processes.
NHS England also makes a wide variety of useful improvement resources available to health and other care providers. These include good practice pathways and guidance documents as well as cross-cutting workstreams such as GIRFT, intensive support and national clinical audit.
The starting point for innovation and change at a Trust level is to continually question the quality of care provide
So, what difference can clinical audit make? The audit cycle includes taking action to bring clinical practice in line with evidence based standards, to improve the quality of care and health outcomes. Healthcare providers need to consider the link between the evidence base, national policy, national clinical audit and local implementation. This can take many forms, but here are some top tips that are useful when considering how best to use data intelligently and achieve change at a local level:
Share information widely across the Trust, understand variation, make data available and transparent but don’t stop there – discuss it and agree the changes required. Widely disseminate information about both negative and positive outliers – share the learning!
Report by exception to the relevant assurance committees and Board – ensure regular Board airtime is given to discussing the data, its meaning and the required QI actions.
Remember the 80:20 rule (Pareto Principle) – 80% of outcomes (or outputs) result from 20% of causes (or inputs) for any given event.
Always set deadlines and agree who is responsible for delivering actions, following up on progress. Set regular small milestones – these are much more likely to be successfully implemented.
Action plans need to be robust and identify system actions which remove the reliance on individuals. Where possible, use standardised and permanent (physical or digital) designs to eliminate human error, sometimes referred to as ‘forcing actions’ (as cited in the Perinatal Mortality Review Tool (PMRT)’s infographic relating to their 2022 annual report).
Be aware of national clinical audit publication schedules – and make plans to receive reports and data as they are published.
Monitor your own internal Trust data and take actions to unpick and explore early, using NHS England Making Data Count resources.
Make an explicit Trust link between data and Quality Improvement (QI) and avoid silo working.
All seemingly obvious and sensible. But, in fact, it’s easy to get this wrong. The Kirkup report on maternity services at the East Kent University NHS FT was published in October 2022. It highlighted several important points when it comes to understanding variation, and presenting and interpreting data, stating “The unit-level information that is available tends to be presented in the form of ‘league tables’… These serve to conceal the variation between different units, with no indication of whether one or more units are outliers”. To address this, Kirkup noted two requirements:
1. From Section 6.9: The first [requirement] is the generation of measures that are:
meaningful – that is, related clearly to outcomes
risk adjustable
available – they are available from data already routinely collected
timely.
2. From Section 6.10: The second requirement is that the measures:
are analysed and presented in a way that shows both random variation and trends
use sound, statistically based approaches to detecting the signal among the noise
are presented graphically to show variation, significant trends and outliers in the form of statistical process control charts and funnel
plots are extended to clinically relevant outcome measures.
These, and many other messages in the Kirkup report, can be extrapolated and applied across Trusts and other healthcare providers. Data are everywhere, often difficult to interpret, can be complex and, at times, additional information is required to get a clear picture of what is happening. As such, it can be difficult for Trusts to understand where they need to improve. The following tools offer a suggested approach:
Questions for Trusts to ask themselves about how they use data
1. Is there evidence that the Trust is aware of the requirement to participate in NHS England’s Quality Accounts (QA) List of clinical audits / programmes?
Limited and sporadic use of data. Data are reviewed but only when a problem has occurred.
Pockets of data used across the Trust, clear QI peer leaders – the Trust is on a journey, but work is needed to embed a culture of data use across all workstreams.
Commitment to improving patient care and active understanding that clinical audit is a key element in that process. Consistent and regular use of high quality data, both qualitative and quantitative, with data triangulation across all directorates, and with a proactive approach where ideas are shared collaboratively.
2. Is there evidence that the Trust is aware of the requirement to participate in NHS England’s Quality Accounts (QA) List of clinical audits / programmes?
Limited understanding of the NHS Contract requirement to participate in national clinical audit. The Trust has no comprehensive and accurate record of the audits it has / hasn’t participated in, with no plan to address this.
The Trust is aware of the QA List but: does not participate in all of the relevant listed audits / programmes has poor case ascertainment. Has a plan but lacks annual achievement, and lacks ability to move forward with the plan to full implementation.
There is a Trust clinical audit plan in place that is aligned with the annual national publication date of the QA List, with evidence of Trust Medical Director support that demonstrates: 100% participation in all relevant QA List audits 100% case ascertainment. There is a Trust annual clinical audit report where progress is discussed quarterly at the relevant Quality Committee and reviewed annually by the Trust Board (with an indication of whether the Board is assured or not assured).
3. Is there evidence that using data are included in relevant staff training / Learning and Development (L&D)?
The use of data is not incorporated into Trust L&D programmes. There is no evidence that the Trust is investing in data / QI skills and capabilities.
Training is in place but there is no carry through to staff objectives and appraisals.
The Board has evidence of an annual presentation by the Making Data Count NHS England team, and all relevant Trust staff are required to watch the Making Data Count virtual presentation as part of their mandatory training. The use of data is incorporated into relevant staff objectives and performance and personal development reviews. There is evidence of a commitment to develop the skills and capabilities for improvement across the Trust.
4. What data are used?
Scant use of national or local data.
Uses monthly dashboard ‘sound bite’ data with limited use of longitudinal trends from statistical process control charts. Limited data triangulation and lacks awareness of data sources available.
Understand and appropriately uses: National data that has been quality assured and risk adjusted (lacks timeliness given the linking and extra analysis required) Uses near real-time local data (timely but not risk adjusted) to watch for ‘smoke signals’ at a -2 standard deviation alert level and takes early proactive action to head off -3 standard deviation alarm outliers Proactively uses local surveillance data where this is made available by national audit providers Triangulates data Reacts rapidly to national data notifications (for example outlier status notifications from audit providers and/or the CQC) The HQIP ‘Directory’ is used to identify high level and key information for each work programme.
5. What format is the data presented in?
No distillation or synthesis of the data – huge amounts of confusing data are presented with no attempt to synthesis or interpret the findings, lacking focus.
Data are presented in a succinct, clear and meaningful way but there is limited discussion, with no conclusion drawn and no link to QI.
Data are presented where relevant using a combination of: Longitudinal trends in the form of Statistical Process Control charts (SPC) updated monthly Regional or national dashboards There is understanding and management of variation Data are clearly benchmarked Data are discussed, interpreted, and conclusions made with explicit links to QI.
6. How are the data interpreted?
Directorates work in silos with no clear allocation of lead responsibilities for the data interpretation, no triangulation of data, and no cross-fertilisation of QI ideas and activities. Does not act upon the data. Knee jerk reactions to isolated data points.
Understands which key metrics need to be reported but lacks clear roles and remits for monitoring, reporting and interpreting the trends – ‘data rich, information poor’.
There is a dedicated Trust data intelligence group who proactively INTERPRETS longitudinal trends for pre-agreed key Trust metrics / data outputs, with joined-up messages across workstreams, triangulation of data and an understanding of the bigger picture.
7. There is a clear audit trail from national clinical audit, longitudinal data interpretation, with active discussions and links with QI
There is limited use of data, and QI mechanisms are yet to be fully developed and implemented – there is no joined-up approach.
Data are available but there is no agreement about the key metrics, and data outputs are not linked to the Trust strategic objectives or QI initiatives. The Trust lacks a clearly articulated approach for using data and linking it effectively with QI.
There is a seamless, consistent, standardised, harmonised and coherent approach to data collection, interpretation and Quality Improvement. Information is actively shared across the Trust in relevant committees and the Trust Board.
8. The Trust Board reviews and discusses data
Trust Board receives ad hoc clinical effectiveness reports with limited discussion about the meaning and interpretation of data outputs. Not linked to QI and no indication in the Board papers about whether the Board is assured / not assured.
Clinical effectiveness issues and data are escalated to the Board by exception.
There is an agreed clinical effectiveness strategy linked to the Trust’s vision and objectives that describes how the Trust will intelligently interpret data and indicates how this data will be used across the Trust with seamless links to QI initiatives. Regular Board airtime is given to reviewing and discussing clinical effectiveness data. Quality improvement is a clear leadership priority for the Trust Board. The Board gives regular feedback with an indication of whether the Board is assured / not assured.
Trusts can either internally review these questions to judge where they might sit, or it may be helpful to ‘buddy’ with a peer Trust for independently reviewed opinions, such that a relevant professional team, external to the Trust / Board, provide ‘fresh eyes’ and an independent perspective. Translating national data into effective change at a local level isn’t easy. It may be littered with potential pitfalls and difficulties, but it is, of course, vitally important. So, I will leave you with just one takeaway thought, a lightbulb moment (neatly inspired by the inventor of the lightbulb, Thomas Edison): “I have not failed 700 times. I have succeeded in proving that those 700 ways will not work. When I have eliminated the ways that will not work, I will find the way that will work”. Here’s to continuing to work together, and supporting each other, to find the ‘right way’ to use national clinical data to support meaningful change at a local level.
Further information and resources
HQIP commissioned audit and programme reports (subscribe to notifications here)
Information and resources to support the use of the National Clinical Audit and Patient Outcome Programme (NCAPOP) to stimulate healthcare Quality Improvement (QI)
