Case Study

This initiative is part of a broader initiative that won the commissioning Penna award. 2014 details can be found here: http://www.nhsiq.nhs.uk/news-events/events/pen-awards-webinar-series/pen-award-winners-webinar-6th-october-2015.aspx. The initiative is supported by MLCSU and implemented by SOTCCG and NSCCGS in partnership with local providers, GP surgeries and patients. It takes disparate sources of data across patient experience, clinical effectiveness and safety data and aggregates under standard data sets so that themes and trends can be identified. All data is then reviewed under a subgroup of the quality committee and actions agreed with providers. The success of this initiative has been the engagement from all members of staff across the various organisations embracing the feedback from patients and repointing to it in a spirit of partnership and learning. Its innovative approach is groundbreaking, the clinical leadership across organisations has been inspirational, the outcomes are patient focused and have been aggregated over time, it is sustainable via its process and procedures and the buy-in from staff and patients, and it is eminently transferable as the dissemination from the Stoke on Trent pilot shows. It started in one CCG with 54 practices and transferred to 113 CCGs and over 600 practices as well as other organisations.

To provide an opportunity for GPs and practice staff to provide feedback from a clinical and safety perspective on services delivered by local providers and to triangulate this data with patient experience information to create themes and trends to be used or improvement activities and learning. This initiative originally came from the initial enquiry from a commissioning perspective from David Colin Thome into the failures at Mid Staffs in 2009. The Insight database provided by MLCSU had been set up for 12 months, and the CCGs wanted to extend the data from just patient experience to include the other two tenets of quality, clinical effectiveness and safety. In April 2013, the 54 GP practices in Stoke on Trent took part in a pilot that allowed them to feed information directly into a database which would give them access to real-time data triangulated against patient experience so that any themes and trends could be identified. This pilot was then extended to the 33 GP practices covered by North Staffordshire CCG and through this work the local providers of acute, mental health and community care were then engaged in a healthy economy basis to share in the identified themes to action improvement activities.

The implementation with the GP surgeries and the first CCG involved a face to face meeting that explained the quality strategy and approach and then took the practices through the physical entry into the system. This was then followed up by a face to face on-site session and backed up by phone helpline support. The data was reviewed and calibrated for accuracy, and then the first review meeting took place. Work then began on the implementation at the second CCG and via the practices. From here work commenced with the local providers in engaging them in the learning and improvement ethic and this included acute care – University Hospitals of North Midland, mental health – Combined Healthcare Trust community and social Care – Staffordshire and Stoke on Trent Partnership Trust and parallel work was undertaken with the patient congress to recruit patients to review the data so that there was a full managerial patient and clinical perspective. The appointment of a sustaining sponsor to work with the GP practices was key to the implementation process.

The initiative has resulted in many changes to practices and has been measured both in terms of numbers of data entered, changes effected as well as changes to culture from the partnership working. Data North Staffs CCG:

• Events, clinical effectiveness and safety – total number of records 813 from 06/08/12 to 02/12/15
• Outcome recorded 353 (44%)
• Action recorded 532 (65.4%)
• Feedback- patient experience total number of records 1988 from 13/3/12 to 2/12/15
• Outcome recorded 1951 (98.1%)

Stoke CCG:

• Events – Clinical effectiveness and safety – total 1563 records from 28/02/2013 to 01/12/2015
• Action recorded = 1207 (77.2%)
• Outcome recorded =966 (61.8%)
• Feedback total �patient experience – 2425 records from 02/04/2012 to 30/11/2015
• All 2425 records have an outcome

Year on year increases in reporting numbers and actions

Areas identified for improvement activities include:

• Radiology
• Obstetrics and gynaecology
• District nursing
• Ears syringing in the community
• Implementation of gold faxes
• Changes to policies on missed appointment
• Referral issues
• Notification of patient deaths
• Changes to blood testing procedures

Consistently the areas of reporting are emergency admission and discharges, and the sub-themes are medications, safe, high quality care. Culture – The establishment of a subcommittee of the quality committee to review the data, agree actions and feedback to the individual practices ensures ongoing staff engagement. The actions are then reported directly to the board by the PI lay members. All providers have their own login to the system and can update directly on RCAs, action plans improvements and all of the information is auditable via the system. Each month the CCG quality lead and the governance manager from the acute hospital review the themes and trends and any outstanding actions. The community providers review every incident and patient experience feedback that is reported, and they feedback within 24 hours and the mental health provider reviews all incidents at the time for reporting, although the relative numbers for mental health are low. The change from assurance to learning has also meant that the providers have now started to report back issues from a primary care perspective. Consistently 60% of the 85 practices report on a monthly basis, and the average reporting is 300 per month.

• It is a holistic approach to collating, aggregating and triangulation of the three tenets of quality to identify opportunities to improve and make services better for patients
• It has a reach across 85 GP practices, condition support groups and three main providers
• It is partnership between MLCSU, SOTCCG, and NSCCG working in partnership across the health economy with the providers of all main services including NHSE
• It is led by staff from each of the partner organisations who all bring a slightly different perspective to the review process
• Patients are integral to the review process
• It implements many of the approaches recommended within the Francis report
• It listens and responds to the concerns of staff and patients
• It involves working in partnership with patients to identify what they require from involvement and how the existing structures could be incorporated to ensure the maximum effect
• It involves working closely with commissioning managers and clinical leads to ensure that the involvement meets the requirements and is embedded from practice to board level and throughout the commissioning cycle
• The potential for creating a cross health economy approach to insight and involvement which overcomes the perceived barrier between patient involvement with commissioner and provider
• The divide between commissioner and provider is a myth, we all interact and need the feedback of the same patients in order to take a patient centred approach
• Communication is key at each stage of the implementation in relation to changes in practice, process and procedure

• Good clinical leadership � engage with the practices and work with them to find benefits for them
• Appoint an initiating sponsor at the start of the work programme who can authorise and endorse the process
• Back up your initiating sponsor with a sustaining sponsor who acts as a champion, engaging the people who embrace the process and helps unblock any issues, real or perceived
• Make sure that your database and your technical team are customer focussed and will work with the customer to co-produce solutions
• Engage with your providers and ensure that they are able to learn from the feedback and work with a quality improvement approach
• Providers and commissioners can work in partnership with patients to make changes and implement learning
• Reviewing the data with GPs, nurses, safeguarding leads, managers and patients to give everyone the opportunity to have an input and shape the outcomes.
• Providing systemic feedback to providers in a systematic way ensures changes for patients.
• Commitment and tenacity
• Clear outcomes and realistic timescales
• Obtaining the input of the staff that will use the data to codesign the system
• Making use of systems that are already in place and amending them to suit the needs of the project
• Exploring the places where soft intelligence is available and providing an intuitive system to allow multiple inputs in a simple way
• Tackle a big project one step at a time, communicating along the way.