CHIRAD Masters COURSE ELEMENT : NATIONAL SERVICE FRAMEWORKS and BENCHMARKING

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CHIRAD MastersCOURSE ELEMENT NATIONAL SERVICE
FRAMEWORKS and BENCHMARKING

• 1100-1230 Sunday 21st April
• jean_at_hcjean.demon.co.uk

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AGENDA

• Terms and concepts
• Origination
• What they contain
• How to use them
• Exercises
• Further information

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OUTLINE AUDIT TO PROVE GOVERNANCE
GUIDANCE / BENCHMARKS
contains
inform
described by
STANDARDS
inform
addressed by
AUDIT PROCESS
monitor
measured by
CRITERIA FOR SUCCESS
define
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WHY?

• National imperative (The New NHS and A First
  Class Service) measures to raise quality and
  decrease variation
• National Service Frameworks are one aspect
• Then The NHS Plan stressed the role of NSF in
  delivering the Modernisation Agenda

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FUNDAMENTAL QUESTIONS

• An ISSUE been identified (national or local) via
• area of concern
• opportunity presented by new health technologies
• agreed campaign target
• pressures
• Where are we
• Where do we want / need to be
• How are we going to get there

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SUPPLEMENTALS TO SET CONTEXT

• Are we that bad relative to others
• What (if anything) makes us different
• What would good / success look like
• What do we have that we can use to help us
  achieve success
• What might inhibit us from progressing towards
  our goal

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STANDARDS (including National Service Frameworks)

• What the great and the good think should be
  achievable
• could be collected wisdom or evidence-based
  (Helen will deal)
• could be a level already achieved by the best or
  an aspiration (professionally or externally set)
• set to raise quality and decrease variations

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TARGETS

• Local goal (quantified and measurable)
• Improved treatment for ltxgt
• 5 reduction in ltYgt
• Better care for the elderly
• Needs LOCAL information to describe properly

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NATIONAL SERVICE FRAMEWORK

• Sets a national standard and defines service
  model(s) for a defined service (childrens) or
  care group (cancer patients)
• Establishes strategies to support implementation
  (of the model(s))
• Defines performance milestones against which
  progress within an agreed timescale will be
  measured

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TO DATE

• Cancer
• Mental Health NSF (09.99)
• CHD NSF (03.00)
• Older Peoples NSF (03.01)to come (at one / two
  per year)
• Diabetes
• Renal, Childrens, long term neurological
  conditions

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WHAT SHOULD BE DONE WITH THEM

• Plans for addressing them should be in the LIS
  within 6/12 of their issue
• including actions and resources

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BENCHMARK and AUDIT
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BENCHMARKING - a structured approach to sharing
and comparing practice

• To answer the fundamental question-
• what is the best and what actions do we need to
  take to (remedy poor practice) and achieve it
• Similar structure to auditing (addressed later)

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BENCHMARKING PROCESS

• 1. Agree focus
• 2. Set baseline
• 3. Describe best practice
• 4. Assess current position
• 5. Compare (and share to reach consensus on
  target)
• 6. Determine Action Plan
• Review and revise
• 7. Tell everyone

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SCORING A BENCHMARK
WORST
BEST
PRACTICE
PRACTICE
STEPS TOWARDS BEST PRACTICE
E D C
B A 1 2
3 4 5
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PROCESS

• Consider your own practice / opinion on the
  organisations way of currently addressing the
  issue
• Give your reasons
• Compare scores and discuss reasoning
• Agree consensus score
• Discuss Action Plan
• Set review date / conditions

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EXERCISE (hypothetical)

• CUSTOMER CARE
• what 5 main areas of issue might be covered
• how do you think the organisation is currently
  doing on them
• what actions could be taken to address the issues
• when would it be feasible to come back and review
  the situation

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EXERCISE 2

• So the organisation might have a problem?
• How would you set its performance into context?

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PUTTING BENCHMARKING INTO NHS CONTEXT

• Can be done at many levels
• practitioner
• team
• Trust
• Strategic Health Authority
• Regional
• National
• International

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Ah but, risk plays a part ...
Low LLH LHH High
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QUANTIFYING RISK

• Determine your Action Plan
• Identify weaknesses and risks
• impact / effect, likelihood, cost to fix
• Things that happen frequently, have little
  impact, but are low cost to fix
• Unlikely events which cost much to fix, should
  you insure by putting expensive contingency in
  place?

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COSTS EXERCISE

• What are the effects of not having computer
  system for half a day
• What are possible effects of not having a full
  patient history

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COMING BACK TO NSFs

• There are costs attached to achieving them
• Resources are limited
• Performance targets have an importance
• Qualitative and quantitative issues for
  consideration
• THE HARD STUFF IS THE SOFT STUFF

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The Quality Framework
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Context Aims of NSFs
Prof Keith Wilson NSF Dec 5 NICE Conf

• NHS Plan Care Standards NSF

• NSFs to drive up quality reduce variation

• 3 pronged approach NICE - NSF - CHI

• 5 underpinning strategies finance, workforce,
  information, RD, clinical decision making

• Other NSFs

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Purpose of NSFs

• Drive up quality
• Reduce variations
• Help deliver The new NHS, Modernising Social
  Services and Saving Lives Our Healthier Nation.

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NSF will need to respond to change
Information through technology
Expectations skills
Roles of care professions
Attitudes to private care
Older People 2011
Older People 2001
NSF
Public attitudes to age
Medical Developments
Assistive technologies
Govnt policies
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NSF IMPLEMENTATION FRAMEWORK
The How -planning Best Value HImPs/PCIPs LMRs
local delivery plan SaFFs
The How-levers Modernisation Money Performance
Management Clinical Gov Workforce Training IT
The What The NSF standards models milestones
The Who Implementation Teams
Local Regional National
Implementation
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CHIs aim

• To bring about demonstrable improvement in the
  quality of NHS patient care throughout England
  and Wales

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CHIs principles

• patient centred
• independent, rigorous and fair
• developmental
• Evidence based
• open and accessible
• apply the same expectations to ourselves

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Assessment framework

• use of information
• patient involvement
• clinical risk management
• clinical audit
• research and effectiveness
• staff and staff management
• education training CPD
• patient experience
• strategic capacity

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Conventional HISS Architecture
Laboratory
Radiology
Interface Facility
Pharmacy
Clinical and Audit Systems
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Summary vs. Detail
Mental Health
Gen Surgery
Elderly Care
Cardiology
Neurology
Therapies
Diabetes
Cancers
AE
Patient Master Index
Summary
Patient Demographics
EHR
Past Medical History
EPR
Problems Assessments
Investigations
Detailed Activities
Detail
Detailed Data Collection
Detailed Actions
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IMS Systems at Cornwall
Protocol Manager / Case Based Reasoning
Information Tools (Business Objects / Cognos /
Comshare etc)
Integrated Care Pathways (Proactive)
Integrated Care Pathways (Passive)
External Agencies
AE
Cardiology
General Surgery
Spinal Injuries
Diabetes
Rheumatology
Lung Cancer
Breast Care
Colo-rectal
Prostate
Palliative Care
Mental Health
Neurology
Neurophysiology
Colposcopy
Flexible Cystoscopy
Physiotherapy
Occupational Therapy
Chiropody/Podiatry
Theatres
Neonatal
Obstetrics
Gynaecology
Elderly Care
Head Neck
GPs
Core Cancer
Clinical Image Management
Document Imaging
Electronic Drug Prescribing
Results Reporting
Order Entry
Scheduling
Social Services
Admissions, Discharges and Transfers
General Assessment
Document Management
Past Medical History, Family History, Allergies,
HCPs, Lifestyle, Special Registers
Referrals Management
PAS
Laboratory
Radiology
Pharmacy
ANO
ANO
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NATIONAL SERVICE FRAMEWORK

• Coronary Heart Disease (CHD)

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CHD NSF - the 12 STANDARDS

• reducing heart disease (12)
• prevention in high risk patients (34)
• heart attack other acute coronary syndromes
  (5,6,7)
• stable angina (8)
• revascularisation (9,10)
• heart failure(11)
• cardiac rehab (12)

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STANDARD ONE

• The NHS and partner agencies should develop,
  implement and monitor policies that reduce the
  prevalence of coronary risk factors in the
  population, and reduce inequalities in risks of
  developing heart disease
• DISCUSS INFORMATION IMPLICATIONS
• quantification of targets
• setting baseline
• measuring and monitoring

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PRIORITIES

• Smoking cessation clinics (April 2001)
• Rapid Access Pain Clinics (April 2001-)
• reduction in call to needle time for thrombolysis
  (ambulance response, AE to April2003)
• better use of effective medication (aspirins,
  betablockers statins, by April 2002)
• increased nos of revascularisation (April 2002)
• Start systematic approaches to delivery of care
  (by October 2000)

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CHD NSF information processes

• Obligation is for (virtual) registers
• established CHD
• evidence of non-cardiac arterial disease
• Heart failure plus
• CHD risk factors
• Information Strategy addresses
• patients, carers and the public
• health professionals delivering care
• clinical governance, performance mgt, service
  planning, public health

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INFRASTRUCTURE TO SUPPORT CARE FOR PATIENTS WITH
CHD

• HIP for CHD www.hipforchd.org.uk
• PRIMIS www.primis.nhs.uk
• practice-based register development
• PRODIGY www.prodigy.nhs.uk
• introduction of Rapid Action Chest Pain Clinics

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Practical example of CLINICAL GOVERNANCE -HIP
for CHD

• Flexible framework for action for primary
  healthcare, which supports the clinician in the
  consultation
• to measure the effectiveness of their care
  delivery
• to meet the milestones and standards set in the
  NSF for CHD
• Covering patient agenda, professional education,
  technical toolkit for systems, community
  partnerships, organisational learning

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INFORMATION SOURCES
NHS Direct 0845 464748 NHS Direct Online
www.nhsdirect.nhs.uk www.NHS.uk NeLH for CHD
www.wish-uk.org/znelh (temporary) CHD Zone
www.nelh.nhs.uk/heart/ -- a virtual branch
library www.givingupsmoking.co.uk www.nelh.nhs.uk/
heart/racpcs/dataset/ - dataset for clinics is
under devo www.doh.gov.uk/consent/ Guidance on
questions for patients to ask before consenting
to treatment www.jr2.ox.ac.uk/Bandolier/ -
internet journal on EBM by specialty ?access
through BIOME also www.show.scot.nhs.uk/sign/clini
cal.htm - Scottish Intercollegiate Guidelines