Quality and Risk Profiles (QRP)

December 2009

Quality and Risk Profiles (QRP)

1. Introduction

What are QRPs

What they are not

Information flow ideals and getting the best out of information

The vision?

2. What’s Happening Now

Versioning and timelines

V0s for NHS, ASC, IHC

V1 for NHS

3. Future

Introduction

What are they?

1. A way of gathering all we know about organisation

2. So as to assess risk and thus prompt front line regulatory activity

3. Allow the judgements of this activity to be made robustly and add to the

knowledge base

4. Critically, it builds over time and is never “perfect”

5. This is essential to support registration (or more specifically the ongoing

monitoring of compliance following registration) but, because information

can be used flexibly later versions could be focused on different issues

What they are not

• QRP produces an automated initial risk estimate – it does not produce judgements

• The QRP is designed to prompt action, NOT direct it – it requires a decision by front-line inspection staff about what to do in response, tempered by local knowledge and guided by the judgement framework

• One size does not fit all – the types and scale of data for NHS, independent health care and adult social care are entirely different.

Three distinct QRP activities

1. Harvesting of different types of information; organising this according to a classification system relevant to purpose; and managing the flows.

2. A method for calculating risk and presenting findings in a way that front-line staff can use

3. A way for frontline staff to interpret the profile, use this to make decisions about what to do in response; make judgements and ensure that these are included in our knowledge base and are reflected in the profile.

Map to regs / outcomes / provider taxonomy

Data from providers

Application

Monitoring declarations

Variation

Info from people with experience of service

Info from stakeholders

National information

Knowledge base

The register

Periodic Review

Local Flavour

Registration

IR

OutcomesSafety

QoL

AccessVFM

Experience

Decision

Public information website

Workflow support system

Direct data collection

Data harvesting – passive /active, surveys, datasets, comments, infocab sweep Q&RP system

Intelligence system

Significant compliance

event

Activity log& context

Compliance risk by UoA

Concerns / regulatory

plan

Surveys Comments

Prompted Unprompted

Comments Findings Public ISAs

Flow diagram of the QRP

Drill down

Registration “core” of Q&RP

Contains

Distillation

Analysis

Inherent risk

PublicationAdditional

local evidence/

intelligence

Decision

Activities in response to view of riskDecision audit trail

CQC findings and judgements on quality

Turning information into evidence

NHS LA, PEAT and ALE already used in this way for Core Standards Assessment of the NHS

Care Quality Commission – Quality Profile Anywhere NHS Foundation TrustInherent Risks

Registered in 2010 with 0 conditions imposedProvides general and acute services including emergency surgery and specialist services including Cardiac surgery.For further details click here

Summary: Amber

Situational RiskA relatively small Cardiac Surgery department compared with national averages but no consultants operating below College GuidelinesFor further details click here

Summary: Green

Population RiskA more deprived, older population with generally poorer CAA ratings for local areaFor further details click here

Summary: Red

Uncertainty Risk5 interactions in last 12 months. Data flows from trust judged good

Uncertainty judged LOWEST

Surveillance dataThere is currently 1 live alertThere are 4 closed alerts – all were data anomalies

Summary: Green

Current Intelligence April 15 2012

Historic PerformanceStar Rating. AHC and Periodic review performanceSpecial ReviewsPatient Surveys

Summary: Amber

Registration outcomes5/21 judgement categories show highest level of risk of poor outcomes for patientsSee all screening + reports

Summary: Red

Regulatory InformationRisk Summits show widespread concerns about joint working with social services and PCTs; handling of patient complaints and clinical leadershipSee all regulatory information

Summary: Red

Written IntelligenceInspector interviews reveal common themes ofDignity and respect (poor) Patient safety (mixed)Hygiene and cleanliness (good)Patient pathways with social care (poor)

LINKs report no concerns with this TrustWe have 294 comments received on our website73 (25%) relate to Maternity services, the majority are positive

Summary: Amber

What’s happening now ?

Dec

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10

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-10

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10

Jul-1

0

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-10

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11

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Apr

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May

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11

Jul-1

1

Aug

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Sep

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Mar

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Apr

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Aug

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QRP Version 0.NHSsupports NHS registration for transitional orgs.

QRP Version 0.IHS and Version 0.SC support Independent health sector and Social Care registration for transitional orgs.

QRP Version 1.NHS supports ongoing monitoring for transitional NHS organisations and newly registered NHS organisations

QRP Version 1.IHS and Version 1.SC support ongoing monitoring for transitional organsiations and newly registered organisations.

QRP Version 1.Third tranche supports ongoing monitoring for newly registered ambulance service, independent midwifery, prison health and dental practices.

QRP Version 1. GP supports ongoing monitoring for newly registered GP surgeries

QRP Version 2 supports ongoing monitoring for NHS, IHS, SC and third tranche

QRP Version 3 is built on an interactive platform and fully supports ongoing monitoring for all sectors

Time lines and versioning

V0.NHS – Delivery January 2010

Delivered January 2010Sector NHSPurpose Support registration Format Compendium of existing key

information and judgementsContents up to 20 data sources identified

from CQC and partner bodies – up to 200 items available will finalise a smaller subset)

Delivery CRMPlan In placeTraining Designed – delivery in

December 2009Users Assessors, RIEOsUnit NHS trust (i.e. super location)Risk model SimpleInherent risk Minimal, contextual info

Version 0.IHC is designed to allow initial registration to take place.

V0.IHC – Delivery April 2010

Delivered April 2010Sector Independent HealthcarePurpose Support registration Format Compendium of key information

for locations mapped to GaC requirement where possible, not

using GaC sector as for NHSContents 9 data sources identified Delivery CRMPlan In placeTraining To be designed – delivery as

part of registration tranche 2 training package

Users Assessors, RIEOsUnit Location (i.e. current registered

entity)Risk model Minimal – identification of

information which shows “concern”Inherent risk Minimal, contextual info

Version 0.IHC is designed to allow initial registration to take place.

V0.ASC – Delivery April 2010

Delivered April 2010Sector ASCPurpose Support registration Format Compendium of judgements against NMS

regs mapped to GaC outcomes and other key information not mapped to GaC outcomes

Contents NMS judgements, notification and safeguarding data, potentially others including skills for care data, but the overwhelming majority of information available is that gathered by inspectors

Delivery tbd Nov 2009 but likely to be dynamic rather than a stand alone report

Plan tbd Nov 2009Training To be designed – delivery as part of

registration tranche 2 training packageUsers Inspectors, RIEOsUnit Location (i.e. current registered entity)

with provider “TOP SHEET”Risk model Minimal – identification of information

which shows “concern”Inherent risk Minimal

V1.NHS – Delivery May 2010

Delivered May 2010Purpose Ongoing monitoringFormat Granular data with information mapped

to outcome level; risk model tbd but minimum being aggregated at GaC section level {to provide a section risk assessment} designed to prompt regulatory action

Sector NHSContents 30 different data sources with 94 data

streamsDelivery CRMPlan In placeTraining to be designed by Dec 2009 –

implemented Jan – April 2010Users Assessors (compliance inspectors),

RIEOsUnit tbc {Location}Risk model Included– will develop in later versionsInherent risk Included modelFeedback Mechanism to feedback inspector

included precise approach tbd

Future beyond these versions

1. NHS: Updated v1.NHS- As new data become available we will add additional data sources

as the year progresses. Initially likely release QRP at set points (but no one big bang). Eventually develop into a ‘live’ document.

Version development – v1.1- 1.n expected throughout 2010 and beyond, as we see it in action, test its efficacy, develop risk model and expand information collation and presentation in the QRP beyond registration outcomes

2. IHC and ASC: Development and delivery of version 1s - primary focus of 2010 in these sectors

3. Designing and developing efficient information flows, feedback loops ect

4. QRPs for other sectors? GPs, dentists, private ambulances etc