NHS needs to be more transparent
Managing Director of healthcare performance management solutions MedeAnalytics UK, Paul Fitzsimmons, explains, there is no time for long drawn out debates and discussions about the right way forward; changes to clinical pathways, the removal of unwarranted variations in practice and rapid propagation of best practice will be key to realising the vision of the NHS over the next five years.
The leadership role of clinicians within the new NHS cannot be underestimated. But how can the NHS overcome the inherent disconnect between clinicians and managers to drive forward change and realise the vision of improved patient care? Simply cutting management heads and expecting clinicians to fill the gap cannot work without putting in place new processes and information resources to support these individuals.
So what is the route forward? The NHS has little time to introduce such change given the financial constraints. Promoting clinicians to full time, as opposed to rotation based–management roles is one option. And, as the E-Health insider campaign over recent months has demonstrated, there is a strong commitment across the NHS for dedicated Chief Clinical Information Officers (CCIO) to lead on IT projects and drive the increased use of information to support patient care.
But while CCIOs will have the respect of their clinical peers, these individuals cannot operate in an information vacuum. Despite the huge investment in information resources over the past decade across the NHS, too much of this information remains within the confines of finance departments. Outside finance there is limited understanding of the depth and quality of the current information available; leaving many clinicians lacking even basic insight into performance, and providing poor performing clinicians with the chance to argue information cannot be trusted.
Without adequate, trusted information, resources managers – even CCIOs – have simply no room for manoeuvre. How can any manager – clinical or otherwise – achieve effective change simply by telling a consultant or department that there is an overspend? Or by routinely disseminating an incomprehensible spreadsheet?
The key must be to combine the financial and performance information with clear insight into where the overspend is occurring and how practice compares with others – such as length of patient stay, post operative infections or level of complications; and to provide information in a manner that is relevant to clinicians, not finance or information experts.
Critically, the challenge is to create an environment that values information transparency, rather than one that fears judgemental performance evaluation. Information must be transparent and accepted by all parties, and organisations must engage in real debate on the pros and cons of existing clinical practice in order to realise improvements.
The good news is that there is a raft of information in place today that could, and should, be used by clinicians to support essential change. The challenge for CCIOs is not only to encourage finance and information teams to share that information with clinicians in both primary and secondary care, but also to put in place an education process that explains the data constructs around HRGs and how this is derived from their own patient treatment records. It is key to show how it influences funding to enable sometimes sceptical clinicians to better understand the value of the information they are the source for.
There has been too much emphasis in the past on creating a ‘perfect’ information resource. This is, simply, not possible. Data error will always occur at some point – even more so when clinicians responsible for recording that information can see no value from doing so.
By educating clinicians as to the data value, asking them to flag up clear errors, organisations can ignore the irrelevant and focus on the rest whilst also improving the overall data quality. This will provide invaluable insight into variations in performance and into best practice innovations that are delivering quantifiable value to patients and budget holder alike. If clinicians are also empowered to act on this information, changes to clinical practice in both primary and secondary care will deliver both budget reductions and an improvement in patient outcomes.
For example, enabling consultants to look at the duration of stay, complications and on-going treatment requirements of a group of post-operative patients, revealed that one consultant achieved consistently better patient outcomes and less post-operative bleeding. Discussing their treatment protocols together, these consultants discovered that the difference was simple – and cheap: prescribing a daily iron pill for patients for one month prior to operation. This practice was immediately embraced by the other consultants resulting in a rapid improvement in clinical outcomes.
No one is underestimating the challenges facing those tasked with healthcare provision in the UK – or any other country. The NHS delivers a broader and more expansive range of clinical procedures and treatments than ever before to continually increasing demand, yet within ever tighter financial constraints.
But if the NHS is to move forward, clinicians must be empowered to make decisions based on fact not anecdote. CCIOs clearly have a strong role to play, but they must be supported with access to trusted information. With this insight, managers and clinicians can together focus on variations in performance, looking at best practice to improve the overall quality of patient care, highlighting key problem areas, reinforcing accountability and focusing on quality as much as cost.