Measuring improvement in the quality of care after reconfiguration of NHS services

I asked a question at a public meeting of our local Health Overview and Scrutiny Committee. They have a slot for questions from the public.  I asked if the PCT and hospital would provide a baseline from which to measure the improvement in care promised as a result of the centralising of services on one hospital site.   

I have posted a couple of stories about the difficulty I have had in getting an answer to this relatively simple but important question:  "Like getting blood from a stone" & "What is a 'benefits realisation'?".  I finally arranged a meeting with the hospital managers who are delivering the data. It is really important to talk to the right people.

They were very helpful and, despite being busy implementing the changes, they spared an hour of their time to talk with me about how they are measuring the quality of care.  They reassured me that they have plenty of quantitative data, such as re-admission rates, length of stay, avoidable admissions and mortality rates from before the changes and they will be collecting similar data from the newly reconfigured services.   Now that is good news.

They will not be publishing the data until they have the first set of new data so that there can be a comparison made between the old and the new.   This data will be collected routinely and published regularly. More good news.

We had a discussion about how to present the results in a form that the patients and public can understand.  Not an easy problem to solve. 

We also talked about using qualitative data from the patient experience to complement the hard numbers.  Now I think that the patient experience is a really good test of quality.  The government thinks so too because the 'Friends and Family' test depends on patients feeling they had a 'good' experience in a hospital.  I am not sure that any time spent in hospital can be considered good though.  This sort of data is more difficult to get and use but we agreed that it is important as the patient can have a different perspective compared to a healthcare professional or a manager. 

The hospital has been collecting this sort of information for some years and they said that they will be using it in the baseline measure as well as in the future. 

So my question has been answered at last and I feel reasonably certain that they have the data, both quantitative and qualitative, to measure the quality of the services in some way. 

What will be more interesting is what will the patients and public make of it?  Do they care about tables and charts showing that the number of people re-admitted within 28 days has been reduced by 5%?  Will they care that 95% of patients in a recent survey said that they had a satisfactory experience in the hospital?  Will they use this data to compare the quality of different service providers? Will quality information from other providers be comparable? 

Only time will tell.

What is a 'Benefits Realisation'?

In the summer I asked some questions at our local council Health Overview and Scrutiny Committee about how would the public know that the planned reconfiguration of services at our two local hospitals would benefit patients and what were the baseline measures for the specific services being changed.

The answer I got from the PCT was "in relation to the Better Healthcare in Buckinghamshire programme, a benefits realisation performance dashboard was being developed".

At the time this went straight over my head and all I could think about was that they had not answered my question on baseline measures.  I have described my effort to get the information in a previous blog (Like getting blood from a stone).

Recently there was a twitter discussion (#NHSchange) on measurement for improvement and someone used the phrase 'benefits realisation' in a tweet.  I complained about the use of jargon but was challenged to find some alternative wording.

I had to think a bit but did come up with some suggestions for a patient friendly version.

"Is my experience as a patient better now than it was before the change/redesign/reconfiguration?"

"Is my outcome (better health, less pain, ability to work, feel better) improved as a result of the change in service provision?"

I also did a bit of research and even went back to a PCT paper on benefits realisation.  In the document it said "Better Healthcare in Buckinghamshire will begin the development of a business case from which the benefits realisation plan can be further developed". However I could find no trace of such a plan in the public domain.

The paper also said that it was important to set current baseline against which to measure benefits.  This is, of course, what I was asking about in my question to the scrutiny committee. But it did not appear to have been done.  Luckily I have a meeting with the Trust to discuss this issue in a few days and I can use this information in my discussions with them.  I will report on what happens at the meeting.

As part of my research I googled 'benefits realisation' and first up was the NHS Institute for Innovation and Improvement's (NHSIII) website where they have a paper on the topic. It is interesting and worth a read. http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/benefits_realisation.html

In their view a benefits realisation is

"a tool to make sure you actually get the intended benefits originally planned for your project". 

I like that! Clear and concise.

Further on it says

"A benefits realisation should be a fundamental part of any improvement project running from the projects beginning to the end and beyond".

Now that confirms my view that you need to know the baseline so you can measure the effects of the change you are implementing. It seems so obvious.

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So if you are running an improvement programme and you want to know if it has worked I suggest you read the NHSIII paper and make sure you have a benefits realisation framework established at the beginning of the project.