Presentation for Directors

International Review Use of Information for the regulation of health and social careBarbara Foley, PhD Tracy OCarroll Health Information and Quality Authority26th September 20141Presentation overviewPart 1BackgroundMethodologyUse of information for regulationPart 2Quality indicatorsTools to inform quality of careReporting

2ObjectiveConduct international review to identify how regulators and health improvement agencies use data to improve health and social care.

About HIQATo drive continuous improvements in the quality and safety of health and social care in IrelandSetting StandardsSupporting ImprovementMonitoring Quality and Safety in HealthcareInspecting Social ServicesHealth Technology AssessmentHealth InformationTechnical StandardsHealth Information QualityBusiness Intelligence

Jurisdictions reviewedNew ZealandOntario, CanadaEnglandNetherlandsDenmarkScotlandWales / N.Ireland (summary)Consultation with key individuals JurisdictionOrganisationNameTitleNew ZealandHealth and Quality Safety CommissionRichard HamblinDirector of Health Quality and EvaluationNew ZealandMinistry of HealthCaroline BoydManager, Strategy and PolicyOntario, CanadaHealth Quality OntarioGail Dobell Director of Evaluation and ResearchOntario, CanadaHealth Quality OntarioWiser Haj-AliManager - Performance Measurement & ReportingEnglandCare Quality CommissionNeil PrimeHead of AnalyticsEnglandCare Quality CommissionDavid HarveyTeam ManagerNetherlandsInspectie voor de Gezondheidszorg (IGZ)Perry KoevoetsAdvisor Research & InnovationDenmarkDanish Health and Medicines AuthorityAnne Mette DonsHead of Supervision and Patient Health ScotlandHealthcare Improvement ScotlandDr Brian RobsonExecutive Clinical DirectorScotlandHealthcare Improvement ScotlandDonald MorrisonBusiness Intelligence DivisionStructures in placeCountry RegulationQuality Improvement New ZealandMinistry of Health (HealthCERT)The Health Quality and Safety Commission (HQSC) OntarioMinistry of Health and Long-Term CareHealth Quality OntarioEnglandCare Quality Commission (CQC) Care Quality CommissionNetherlandsInspectie voor de GezondheidszorgQuality Institute ; CBODenmarkThe Danish Health and Medicines AgencyDanish Institute for Quality and Accreditation in healthcare (IKAS). ScotlandHealthcare Improvement ScotlandThe Care Inspectorate

Healthcare Improvement Scotland (HIS) WalesHealthcare Inspectorate Wales (HIW) Care and Social Services Inspectorate Wales (CSSIW)

NHS Wales and Welsh government.Northern IrelandRegulation and Quality Improvement Authority (RQIA)RQIAKey findings(www.hiqa.ie)

1. Vision/StrategyAll the countries reviewed had strategic approach in place for the use of information to improve health and social careInformation being used as both regulatory and quality improvement toolChanging profile of regulation increased emphasis on information /intelligence2. Defining the informationQuantitativeQualitativeSurveysPatient/staff experienceStructured/unstructuredSocial mediaComplaints/whistle-blowingTypes of indicator data Focus on existing datasets

3. Applying Business IntelligenceClear vision/ action plan around Business IntelligenceKey strategic approach to Information and IntelligenceOutsourcing of analysis - Data PartnersCentralised structurePresentation of information intelligently - interactivity of information / web-based

Use of Information - Regulation

England (CQC) - New Intelligent Monitoring/ Surveillance model for NHS Acute Trusts

Netherlands (IGZ)- Risk-led supervisionProactive - analysis of information provided routinelyReactive incident-led; complaints etc14Intelligent Monitoring (CQC)Previously Quality and Risk Profiles (QRPs) for acute hospitalsadvanced statistical modellingNew model - Intelligent monitoring informs programme of inspections (Sept 2013)Clarity about indicators they will prioritise, rather than a model that claims to scan all information all the timeUses local and national information sources

Indicators Intelligent MonitoringAvoidable infections (e.g. MRSA)Notifications of deaths, severe and moderate harm and abuseNever eventsMortality ratesYour Experience form CQCPatient and staff surveysComplaints

Dutch model for risk-led supervision

Dutch Healthcare InspectorateInspectorate Risk detection System (IRiS)Intelligence data sourcesCare-related indicatorsCorporate - Management and finance indicatorsIncident reports (incidents and near-misses)External signalsOwn observations/info from other regulatorsSummary Part 1Intelligent monitoring informs programme of inspectionsPart 2:IndicatorsQualitative data tools to inform qualityReporting and publishing of information

Key Performance Indicators (KPIs)Specific and measurable elements of practicethat can be used to assess quality of care.

Indicators are measures of structures,processes or outcomes that may becorrelated with the quality of care delivered.Indicators allow flags of healthcare quality using a 3 part model:Structures buildings, equipment, specialist personnel and financesProcessess what is done for service user and how it is doneOutcomes state of health of the individual as a result of their interaction with the healthcare system

19KPIs are not intended to be direct measuresof quality but instead act as alerts to warn usof opportunities for improvement in the process and outcome of service-user care.JCAHO

Joint Commission on Accreditation of Healthcare Organisations in the United States.

20Understanding Key Performance IndicatorsObjective:Improve the quality and safety of care provided

Effective:Clear definitions

Valid KPIs:Measure what they are intended to measure

Reliable KPIs:Consistently produce the same result regardless of who performs the measurement21

Health Quality and Safety Commission New ZealandThere are a total of 17 indicators, of which 12 either exist already or are easily sourced from routine data and five that require further work to define, and in some cases collect, the data.In addition, there are a further seven areas where we know we want an indicator of some description, but currently there is no plausible data available or we are uncertain about what would make a suitable measure.KeyGreen: fast-track An existing defined and tested indicator; there is likely to be good availability of data from existing collections. In some cases these will be collected as indicators, in others they will be derivable from existing data sets.Orange: under development Work underway to define indicator; further work required to understand availability of data.Yellow: placeholder Important area but significant further work required during next phase to develop indicator and derive data.

http://www.hqsc.govt.nz/assets/Health-Quality-Evaluation/PR/HQSI-Feedback-and-Engagement-document-July12-web.pdf22Health Care Ontario Primary Care KPIs

23Quality and Safety IndicatorsAvoidable InfectionsAdverse EventsNever eventsMedication SafetySurgeryHospital MortalityHospital ActivityDisease-specific outcomes

Patient experienceComplaintsMaternity IndicatorsSocial-care specificStructures

24Patient and Staff Experience

All Jurisdictionsall organisations should seek out the patient and carer voice as an essential asset in monitoring the safety and quality of care.A Promise to Learn a commitment to act. Improving the Safety of Patients in England

National Advisory Group on the safety of patients in England25NHS: EnglandNational Patient Survey Programme

The Picker Institute Europe, a private charity, coordinates patient surveys.National NHS Staff Survey in placePatient Experience New Zealand : Health Quality Safety CommissionLicense: use of Pickers inpatient survey questions, library of 250 questions4 domains: CommunicationPartnershipCo-ordinationPhysical and emotional supportAdopt an approach comparable with international best practice to allow international comparisons.

The National Danish Survey of Patient Experiences (LUP)LUP is conducted under an agreement between the Danish government and the Danish Regions. Survey is conducted by the Unit of Patient Perceived Quality. The unit carries out surveys, research and development projects concerning patient-perceived quality.

HEALTH QUALITY ONTARIO Launched pilot survey of patient experience in primary care in 2014

27Quality AccountsA report about the quality of services by the service ProviderDenmarkEnglandNew Zealand

A statement from the organisation detailing the quality of the services they provideSigned statement from the most senior manager of the organisationMandatory

28NHS: Quality AccountsSource: http://www.nhs.uk/aboutNHSChoices/professionals/healthandcareprofessionals/quality-accounts/Pages/about-quality-accounts.aspx

HQSC: Quality AccountsQuality Accounts A Guidance Manual for the New Zealand Health and Disability Sector

30Corporate and Governance Review NetherlandsAnnual Social Responsibility report: Management and Finance (liquidity, debt ratio)Personnel turnoverStaff absenteeism

The Annual Social Responsibility report is mandatory31Structured vs UnstructuredStructuredvs Unstructured

vs.

Image Number P1580 Object Number (TMS) NGI.19589 Title of artwork (TMS) The Castellated Rhine Constituents (All) (TMS) Artist: Joseph Mallord William Turner ,1775-1851 Classification (TMS) Drawings Date (TMS) c.1832 Medium (TMS) Watercolour and graphite on paper

32ReportsState of the NationNew Zealand, Ministry of HealthHealth and Independence ReportEngland, CQCThe state of health care andadult social care in Englandin 2012/13

ThematicLs mere i 'Forebyggelse af indlggelser synlige resultater' : Prevention of admissions visible results (IKAS)Performance indicators as an independant measure of the quality of hospital care (IGZ)Primary care summary( HQO)Childcare Statistics (HIS)Perinatal and maternal mortality review committee reports (HQSC)

IKAS Danish Institute for Quality and Accreditation'Prevention of admissions visible results'33Care Quality Commission: Reporting http://www.cqc.org.uk/provider/RTG#icon-keys

34Health Quality Ontario: Annual Report

HQO: AR 2013

35

Website and displaying information

InteractiveDynamicUser-friendlyTargeted

36New Zealand: Website and displaying information

37Health Quality Ontario: Website and displaying information

38CQC: Website and displaying information

39Danish Health and Medicines Authority Website and displaying information

Rich site summary40SummaryIt is only worth measuring if it changes your practice or the practice of service providers

Have clear definitions for indicators

Engage as many people as possible in the process

A business intelligence strategy is crucial

Publish intelligently

41New Zealanders live longer, healthier and more independent lives

GOVERNMENT GOALS

NZ TRIPLE AIM OUTCOMES

Services throughout the patient journey, across the health and disability sector

Improved quality, safety and experience of care

Best value from public health system resources

Improved health and equityfor all populations

Falls resulting in harm in hospitals

1. Cancellations of elective surgery by hospital after admission

Safety

Efficiency

SYSTEM-LEVEL INDICATORS

CONTRIBUTORY MEASURES

Healthcare associated infections

Patient experience

8. Health care cost per capita

Stratification of all measures across population groups

2. Amenable (preventable) mortality

Effectiveness

Equity

Access/Timeliness

Measure of surgical harm

Measure of safe medication management

3. Occupied bed-days aged 75+ admitted two or more times per year

4. Day case turns into overnight stay

5. Hospital readmissions

Hospital days during last six months of life

6. Eligible population up to date with cervical screening

7. Age- appropriate vaccinations for two-year-olds

Pressure injury acquired in hospitals

New Zealands economic growth is supported

Measure of adverse events

Measure of patient experience

Functional health outcomes scores

Measure of access to primary health care

Measure of workforce wellness

Stratification of all measures across population groups

9. % GDP spent on health care

Measure of cardiovascular disease management

Mental heath post-discharge community care