NEW: Outliers guidance 2024

Published: 05 Jan 2024

HQIP is pleased to share our revised guidance, Outliers 2024. The result of extensive consultation with NHS England, the CQC and other stakeholders, this is a revision of a policy that has been in existence for well over a decade and is an important part of benchmarking. It is the core policy from which our audit and other providers develop their own policies, bespoke to their particular circumstances.

“Benchmarking in healthcare is far more than mere comparison. It is a powerful tool that can support healthcare providers to identify opportunities for improvement and improve patient care.” Excerpt from an article on benchmarking from HQIP’s Quality Improvement publication, CORNERSTONE (pages 9-11)

Outlier analysis is a valuable approach to benchmarking, where assessment of the performance of healthcare providers can identify organisations with unexpectedly extreme values for particular aspects of care. This is important for deepening understanding when patient outcomes fall significantly outside of the norm of what is expected, either positively or negatively; and this is why it is a key component of the analysis carried out during many national clinical audits.

Outliers was necessarily set aside during the height of the COVID pandemic. This gave us time to reflect on the policy and work on it with others across the sector, to deliver robust guidance that will lead to even greater insights and improved care,” Professor Danny Keenan, HQIP Medical Director.

Measurement of outliers has traditionally been considered primarily a quality assurance activity. However, an outlier policy also provides opportunities for national clinical audits to support quality improvement. As such, HQIP has recently updated its guidance around outlier management for national clinical audits and programmes, which is produced to support NCAPOP provider organisations to support the development of their own outlier strategies.

The result is a ‘softer approach’ which retains the principles of benchmarking, and includes:

  • The introduction of a ‘non-participation category’ so that Trusts that should be contributing data towards national audits but are not, will be regarded as outliers.
  • Changes to the notification of significant outliers. For key predetermined audit metrics, the highest level outliers will be notified directly to the CQC and NHS England. Other metrics with outlier results will be available for review when annual reports are published as part of the national audit cycles.
  • NHS England, as part of their approach to quality management, also receiving first-hand notification of such outliers, as they also have an important role, as commissioners, to assist in the management of quality improvement falling out of the outlier process.

It is expected that this revision to our guidance will help audit colleagues, through benchmarking, to continue their important work to assure our services but also to drive the quality improvement agenda.

The revised guidance can be read in full here.