Meet the team: From RAGs to Riches
Head of Patient Safety Measurement Unit
South, Central and West CSU
- England - Kent, Surrey and Sussex
- England - London (South)
- England - Wessex
Consultant Anaesthetist, associate director of St Georges QI academy. Improvement lead of National Emergency Laparotomy Audit Chair RCoA Quality working group
St George's University Hospitals NHS Foundation Trust
- England - London (South)
- Samantha Riley, Head of Improvement Analytics, NHS Improvement
Most people accept that variation exists in their everyday life – whether this is your journey time to work or the time it takes to dry your hair. There are factors outside our control that we can do nothing about. In the quality improvement world we’re familiar with this concept.
But for many people, though, in their working lives they forget that natural variation exists. What is the result? Constant over-reaction to data which is simply normal. Whether it’s A&E performance this week being worse today than yesterday or the spend on a particular drug being higher this month than last. In many people’s working lives they regularly look at two data points and if the second data point has moved in the wrong direction, panic ensues. Investigations and action plans are demanded – and provided. A reason needs to be provided for that second number being ‘worse’. What if the answer is as simple as ‘the change in the data was due to natural variation’?
By acting in this way, valuable time is misdirected to ‘issues’ that do not exist and issues that require attention are often missed.
Similarly, the use of red, amber, green (RAG) distracts and misleads. ‘Green’ often provides false assurance that everything is ok whilst ‘Red’ can mask improvement.
The traditional ways in which the NHS uses data create a vast amount of wasted energy and effort. The use of Statistical Process Control as a way to look at data is well used in industry and is well established in quality improvement work in healthcare, but not in the wider NHS. It identifies when something unusual is going on which merits investigation – whether good or bad. It enables us to see whether the changes that have been implemented have made a positive impact, and identify opportunities for learning.
SPC enables us to understand which issues need to be understood and which issues truly merit investigation. It’s a brilliant tool to ensure we focus the time of busy people working in the NHS on areas that will improve the system and benefit patient care.
So, why don’t more people in the NHS use this technique? People may not be aware of SPC as an approach, or see it as being a tool ‘just’ for the quality team. Even if they are aware, they may not have access to the knowledge and tools to analyse the data in this way and make the correct interpretation. They may have seen so many reports with red, amber, green (RAG) over the years that they can’t imagine that there is a different (and more powerful way) to analyse data.
On 16th May, NHS Improvement published a new interactive guide : Making Data Count https://improvement.nhs.uk/resources/making-data-count/
This valuable resource helps people understand the pitfalls of two point comparisons and RAG reports and learn about the value of looking at data over time and using SPC. This guide gives people the knowledge and tools to be able to create and interpret SPC charts and encourages closer working between analysts and decision-makers in all sectors of the NHS. The intention is that Making Data Count supports more effective decision making in the NHS and makes a real difference to patients.
Whilst this is a brilliant guide, more is required to accelerate how the NHS in general can make the best use of data. This bid is proposing an approach to upskill keen analysts, clinicians and managers to become ‘Making Data Count Champions’.
‘Champions’ will be put through a programme which:
· Increases their knowledge and understanding of the approaches described in Making Data Count;
· Increases their confidence of using the tools referenced within the toolkit;
· Enhances facilitation skills to enable each champion to facilitate local workshops and board education sessions;
· Provides tips and techniques for supporting effective data conversations #talkthedots
A network of Champions will be created to share the experience of encouraging people within the NHS to make the best use of data. The feedback and experience from Champions will inform additional support offers developed and delivered at both a local and national level. There is already a huge appetite for this, and we would anticipate champions acting as key network weavers in the developing ‘Making Data Count’ revolution!
This bid has the potential to make a significant and long term positive impact on the decisions made by people working within the NHS to benefit patients. Part of the funding applied for will be used to evaluate the impact of the interventions outlined in this bid.
How you can contribute
- Think about how the Champions role could work in your locality/area of work
- Make suggestions with regards to what else can accelerate the adoption of best practice with regards to making the best use of data
NHS_MAKING_DATA_COUNT_FINAL (PDF, 5MB)
This is a great project because…
We know that using data for improvement is a top interest area for the Q community. This project addresses a systemic issue and offers great potential to engage beyond analysts and through Q reach organisations across the system. We like the two way iterative relationship between the centre and the members of the champion network.
By the time of the event we encourage the project team to think more about…
How the champions network will make the most of the interface with Q and how the work can be sustained.