Quality improvement, using NICE tools and resources
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This document discusses how the Healthcare Quality Improvement Partnership (HQIP) supports quality improvement through various programs and tools. HQIP manages the National Clinical Audit Programme which includes 34 national audits across different clinical areas. It also oversees other national programmes focused on specific topics like learning disabilities. HQIP helps align quality improvement programs with NICE guidance and standards. Tools like clinical audits and the Quality Standard Service Improvement Template help providers assess current practice against standards and plan improvements. NICE guidance and quality standards can support quality improvement when implemented using these resources.
Quality improvement, using NICE tools and resources
- 1. Healthcare quality improvement partnership (HQIP) Quality improvement Kirsten Windfuhr, Associate Director, Quality and Development
- 2. • What is HQIP and what do we do? • What is quality improvement (QI)? • Quality improvement in action: the importance of alignment between QI programmes and NICE guidance/standards • How else do HQIP support QI?
- 4. National Clinical Audit Programme 34 national audits covering: • Acute • Cancer • Children and Women's Health • Heart • Long-term Conditions • Mental Health • Older People Other National Programmes National Learning Disability Mortality Review Programme National Mortality Case Record Review Programme National Perinatal Mortality Review Programme Child Death Review Database Project Clinical Outcome Review Programmes 4 national programmes: • Maternal, Newborn and Infant • Medical & Surgical • Mental Health • Child Health Programme National Joint Registry Collects joint replacement information, monitoring implant, hospital and surgeon performance
- 5. ‘Clinical audit: a quality improvement cycle measuring effectiveness of healthcare against standards, & taking action to bring practice in line with these standards.’ New Principles of Best Practice in Clinical Audit (HQIP, January 2011)
- 6. HQIP audits, NICE Guidance, and Quality Improvement
- 11. …and more quality improvement
- 12. Source: https://improvement.nhs.uk/uploads/documents/BPT_Additional_Infor mation_-_FINAL_WITH_IRB.pdf “A BPT is a national price that is designed to incentivise high quality and cost-effective care. The aim is to reduce unexplained variation in clinical quality and to encourage best practice. The price differential between best practice and usual care is calculated to ensure that the expected costs of undertaking best practice are reflected and to create an incentive for providers to shift from usual care to best practice.” Best practice tariff (BPT)
- 16. Quality Improvement, using NICE tools and resources to support improved outcomes.
- 17. Where to find the Quality Standard Service Improvement Template? https://www.nice.org.uk/About/What-we-do/Into-practice/Measuring-the-uptake-of-NICE-gui dance
- 18. Quality standards for quality improvement • Prioritised areas for quality improvement • Focus on areas where there is a variation in care • Cover topics across health, public health and social care Who are quality standards for? • Anyone wanting to improve the quality of health and care services. You can use them for: • Contracts • Audits (local/national) • Benchmarking • Evidence for regulators such as the Care Quality Commission.
- 19. Assess current practice, plan change and measure improvement • Quality Standards Service Improvement Template • Provides instant access to quality standards from NICE • Allows selection of up to 10 topics for quality improvement • Helps produce a baseline assessment and an action plan for each topic of quality improvement • Automatically populates an audit spreadsheet • Automatically charts your progress as you input data
- 20. Select your quality standard(s) for example: QS75 Neonatal infection Select the quality statement of interest • statement 1: Pregnant women whose babies are at risk of early-onset neonatal infection are offered intrapartum antibiotic prophylaxis and given the first dose as soon as possible
- 21. How does the current service compare?
- 22. Monitor change for structure, process and outcome measures. Structure: Evidence of local arrangements to ensure that pregnant women whose babies are at risk of early-onset neonatal infection are offered intrapartum antibiotic prophylaxis and given the first dose as soon as possible. Process: Proportion of pregnant women whose babies are at risk of early-onset neonatal infection who receive intrapartum antibiotic prophylaxis. • The number in the denominator who receive intrapartum prophylaxis • The number of pregnant women whose babies are at risk of early onset neonatal infection Outcome: Rates of early onset neonatal infection
- 23. Planning to implement NICE guidance • The NICE resource planner
- 24. The resource planner: • Excel document, published monthly • Lists all forthcoming guidance • Provides the indicative resource impact (costs or savings) for England based on draft guidance (current and future financial years) • Summarises the resource implications of published guidance that organisations may still be implementing (current and previous financial years)
- 25. The resource planner: • Profiles costs and savings over 5 years • Several functions including ability to filter by cost category • Example: cost saving guidance
- 26. Filter by cost saving guidance Steady state resource impact for England (£000s) Resource impact for England (£000s) Publication date / Anticipated publication date Guidance short title Type of guidance Potential resource impact areas (costs or savings) Potential resource impact Costs (a) Savings (b) Total resource impact (a-b) 2016/17 2017/18 2018/19 2019/20 2020/21 May-16 PlGF based testing to help diagnose suspected pre- eclampsia Diagnostic Technology Implementation of the guideline may lead to a reduction in bed days and may increase available clinical time. Current estimates indicate that national savings of around £7.3 million may be possible in year 5. The savings are not anticipated to be cash releasing. Cost saving 0 7,300 -7,300 -£1,200 -£3,000 -£4,800 -£6,100 -£7,300 Jun-16 GreenLight XPS Photoselective Vaporisation of the Prostate (PVP) in benign prostatic hyperplasia Medical Technology The Medical Technology guidance document gives details of when the case for adopting GreenLight XPS 180 W for treating benign prostatic hyperplasia is supported. Resource impact work indicates that savings will be possible as a result of implementing the guidance. Savings range from £1.3 million when 36% of procedures with GreenLight XPS are done as day cases, to as much as £3.2 million when 70% are done as day cases. Based on 53% of GreenLight XPS procedures being done as day cases, the guidance is estimated to save the NHS around £2.3 million per year (or £4,200 per 100,000 people). Cost saving 0 2,270 -2,270 -1,135 -2,270 -2,270 -2,270 -2,270 Potential resource impact Cost saving Cost saving
- 27. Filter by cost saving guidance Steady state resource impact for England (£000s) Resource impact for England (£000s) Publication date / Anticipated publication date Guidance short title Type of guidance Potential resource impact areas (costs or savings) Potential resource impact Costs (a) Savings (b) Total resource impact (a-b) 2016/17 2017/18 2018/19 2019/20 2020/21 May-16 PlGF based testing to help diagnose suspected pre- eclampsia Diagnostic Technology Implementation of the guideline may lead to a reduction in bed days and may increase available clinical time. Current estimates indicate that national savings of around £7.3 million may be possible in year 5. The savings are not anticipated to be cash releasing. Cost saving 0 7,300 -7,300 -£1,200 -£3,000 -£4,800 -£6,100 -£7,300 Jun-16 GreenLight XPS Photoselective Vaporisation of the Prostate (PVP) in benign prostatic hyperplasia Medical Technology The Medical Technology guidance document gives details of when the case for adopting GreenLight XPS 180 W for treating benign prostatic hyperplasia is supported. Resource impact work indicates that savings will be possible as a result of implementing the guidance. Savings range from £1.3 million when 36% of procedures with GreenLight XPS are done as day cases, to as much as £3.2 million when 70% are done as day cases. Based on 53% of GreenLight XPS procedures being done as day cases, the guidance is estimated to save the NHS around £2.3 million per year (or £4,200 per 100,000 people). Cost saving 0 2,270 -2,270 -1,135 -2,270 -2,270 -2,270 -2,270 2016/17 2017/18 2018/19 2019/20 2020/21 -£1,200 -£3,000 -£4,800 -£6,100 -£7,300 -1,135 -2,270 -2,270 -2,270 -2,270 Resource impact for England (£000s)
- 28. Filter by cost saving guidance Steady state resource impact for England (£000s) Resource impact for England (£000s) Publication date / Anticipated publication date Guidance short title Type of guidance Potential resource impact areas (costs or savings) Potential resource impact Costs (a) Savings (b) Total resource impact (a-b) 2016/17 2017/18 2018/19 2019/20 2020/21 May-16 PlGF based testing to help diagnose suspected pre- eclampsia Diagnostic Technology Implementation of the guideline may lead to a reduction in bed days and may increase available clinical time. Current estimates indicate that national savings of around £7.3 million may be possible in year 5. The savings are not anticipated to be cash releasing. Cost saving 0 7,300 -7,300 -£1,200 -£3,000 -£4,800 -£6,100 -£7,300 Jun-16 GreenLight XPS Photoselective Vaporisation of the Prostate (PVP) in benign prostatic hyperplasia Medical Technology The Medical Technology guidance document gives details of when the case for adopting GreenLight XPS 180 W for treating benign prostatic hyperplasia is supported. Resource impact work indicates that savings will be possible as a result of implementing the guidance. Savings range from £1.3 million when 36% of procedures with GreenLight XPS are done as day cases, to as much as £3.2 million when 70% are done as day cases. Based on 53% of GreenLight XPS procedures being done as day cases, the guidance is estimated to save the NHS around £2.3 million per year (or £4,200 per 100,000 people). Cost saving 0 2,270 -2,270 -1,135 -2,270 -2,270 -2,270 -2,270 Potential resource impact areas (costs or savings) Implementation of the guideline may lead to a reduction in bed days and may increase available clinical time. Current estimates indicate that national savings of around £7.3 million may be possible in year 5. The savings are not anticipated to be cash releasing. The Medical Technology guidance document gives details of when the case for adopting GreenLight XPS 180 W for treating benign prostatic hyperplasia is supported. Resource impact work indicates that savings will be possible as a result of implementing the guidance. Savings range from £1.3 million when 36% of procedures with GreenLight XPS are done as day cases, to as much as £3.2 million when 70% are done as day cases. Based on 53% of GreenLight XPS procedures being done as day cases, the guidance is estimated to save the NHS around £2.3 million per year (or £4,200 per 100,000 people).
- 29. Link to published resource impact tools Steady state resource impact for England (£000s) Resource impact for England (£000s) Publication date / Anticipated publication date Guidance short title Type of guidance Potential resource impact areas (costs or savings) Potential resource impact Costs (a) Savings (b) Total resource impact (a-b) 2016/17 2017/18 2018/19 2019/20 2020/21 May-16 PlGF based testing to help diagnose suspected pre- eclampsia Diagnostic Technology Implementation of the guideline may lead to a reduction in bed days and may increase available clinical time. Current estimates indicate that national savings of around £7.3 million may be possible in year 5. The savings are not anticipated to be cash releasing. Cost saving 0 7,300 -7,300 -£1,200 -£3,000 -£4,800 -£6,100 -£7,300 Jun-16 GreenLight XPS Photoselective Vaporisation of the Prostate (PVP) in benign prostatic hyperplasia Medical Technology The Medical Technology guidance document gives details of when the case for adopting GreenLight XPS 180 W for treating benign prostatic hyperplasia is supported. Resource impact work indicates that savings will be possible as a result of implementing the guidance. Savings range from £1.3 million when 36% of procedures with GreenLight XPS are done as day cases, to as much as £3.2 million when 70% are done as day cases. Based on 53% of GreenLight XPS procedures being done as day cases, the guidance is estimated to save the NHS around £2.3 million per year (or £4,200 per 100,000 people). Cost saving 0 2,270 -2,270 -1,135 -2,270 -2,270 -2,270 -2,270
- 31. Resource impact tools • Resource Impact Report – Microsoft Word document – National estimate of resource impact for England – Shorter version when resource can not be estimated or is likely to vary locally • Resource Impact Statement – Resource impact not considered to be significant • Resource Impact Template – Microsoft Excel document – Users can amend NICE assumptions to calculate local impact – Based on population of England but CCGs and LAs can select their own population
- 33. Forthcoming guidance • Lists all forthcoming guidance for 2016/17 and 2017/18 • Latest estimates of costs or savings associated with implementing guidance • Colour coded cost categories (cost saving, cost neutral, low cost, medium cost, high cost) • Hyperlink to latest guidance documents and background information
- 34. Where to find the resource planner • https://www.nice.org.uk/about/what-we-do/into-practice/resource-impact- assessment Where to find the QSSIT? • https://www.nice.org.uk/About/What-we-do/Into-practice/Measuring-the- uptake-of-NICE-guidance
- 35. Questions…
Editor's Notes
- #4: HQIP is an independent, not for profit charitable organisation that was established in 2008. It is governed by the AoMRC, the RCN and National Voices. HQIP acts under contract to NHSE to deliver the NCAPOP programme. Our vision is to enable and support those who commission, deliver and receive care to measure and improve services
- #6: Go through principle of audit Unique piece is that this programme gives you a national benchmarked picture of what is going
- #7: So why do we do the job. Many are NHS clinicians both nurses and doctors and we all firmly believe that NCA and Confidential Enquiries can help to support the delivery of better care and improved outcomes for patients and their families.
- #12: So why do we do the job. Many are NHS clinicians both nurses and doctors and we all firmly believe that NCA and Confidential Enquiries can help to support the delivery of better care and improved outcomes for patients and their families.
- #13: NHFD is used to provide data to support NHSEs best practice tariff. The tariff offers additional payments to hospitals when the NHFD records that a patients care meets the agreed standards listed above. Since the start of BPT is 2010 there has been a steady increase in participating hospitals, cases submitted and cases meeting tariff standards
- #14: NHFD is used to provide data to support NHSEs best practice tariff. The tariff offers additional payments to hospitals when the NHFD records that a patients care meets the agreed standards listed above. Since the start of BPT is 2010 there has been a steady increase in participating hospitals, cases submitted and cases meeting tariff standards
- #16: Over the past year HQIP and the CQC have been undertaking a joint project to help maximise the use of national clinical audit data to help inform the CQC intelligent monitoring pre inspection packs which CQC inspectors use as pre inspection intelligence prior to undertaking a Trust inspection as well as supporting quality improvement measures/clinical governance committee and board level reporting at Trust level. Every audit within the NCAPOP Programme has chosen 5 measures (as well as a case ascertainment measure) which they believe can be used as overall markers of care delivery. A dashboard approach helps to benchmark individual Trusts.
- #18: So today I am going to tell you about a tool that we have developed to help you make an assessment of your service compared with NICE Quality standards. I will tell you more about Quality Standards and the tool in the next slides. On the webpage shown you can also find links to our uptake database containing audit results measuring the uptake of NICE guidance and or submit your own local audit results measuring uptake of guidance or standards. NICE has a large website and so we will provide the link again at the end of the presentation. Can be found by following the link above or from the Into practice link at the bottom of the NICE homepage and selecting view uptake data.
- #19: QS are based on NICE Guidelines or NICE accredited guidance. Topics are referred from NHSE, DH or Dept. Education During the development process committee members and stakeholders are asked to identify key areas for QI and provided examples of published information on current practice e.g. variation in care, safety concerns, evaluation of compliance with guidance. Quality standards consider the complete care pathway, from public health to health and social care. They will be relevant to variety of different audiences and this will vary across the topics. Although some QS are area-specific and may just cover clinical care etc., there will often be significant overlap across areas and this is considered during development of the standard. New QS 5-6 statements (areas for quality improvement) and older versions 13-15. Could have several measures per statement. The purpose of quality standards is to ‘drive and measure priority quality improvements’. I’ll show you how, using the quality standard service improvement template
- #20: We have developed an Excel spreadsheet that enables users to select statements from any of the current 128 QS (August 2016). There are over 3000 measures, or an average 25 measures per quality standard, and as a result It’s a large spreadsheet. This is the only document where all the quality standards, statements and measures are available in a single resource. Don’t worry the measures are automatically populated for each of the selected quality statements. The template enables you to select statements and measures that are relevant to your practice. Complete a baseline assessment for each of the selected QS statements (MAX 10) Since QS are published throughout the month the template is updated on the last Wednesday of each month. You’ll need to download a new template each month to make sure that you have the latest quality standards.
- #21: So now I am going to take you through the baseline assessment and then through monitoring change over time tab. Using the assessment and action plan tab select the quality standard and statements of interest (A maximum of 10). Selecting a quality standard in the first column automatically populates the associated statements as can be seen in the dropdown box. Since this is a wide spreadsheet I’ve shown the initial assessment and action plan in the next slide. New QS 5-6 statements and older versions 13-15. Could have several measures per statement. The source guidance for this statement is: Antibiotics for early-onset neonatal infection (2012) NICE guideline CG149, recommendations 1.3.1.1 (key priority for implementation) and 1.3.1.2.
- #22: So on the right hand side of the spreadsheet the initial assessment and action plan columns are shown. The assessment and action plan tab separated out and a series of questions are asked. How does the current service compare with the statement? In this case “Pregnant women whose babies are at risk of early‑onset neonatal infection are offered intrapartum antibiotic prophylaxis and given the first dose as soon as possible” What is the source of evidence to support this? If captured it could be activity data or audit? What are the risks associated with not making these improvements? Increased rates of early-onset neonatal infection Has this statement been prioritised for quality improvement? Action(S) to meet the statement, date action decided, person responsible, deadline for action, progress, change stage (not yet actioned, in progress, completed). Plan, Do, Act, study model
- #23: Monitoring change tab (ten tabs in total): The monitoring change tab is used to capture and present data and so it wouldn’t fit on the slide! There are 10 tabs for each of the selected quality statements. The statements for each measure are automatically populated and can be selected from dropdown boxes For each statement a maximum of: 3 structure (yes no) , 3 process (numerator and denominator) and 3 outcome measures can be selected. Fewer outcome measures since an outcome can not always be attribute to a single statement and of those very few have a numerator and denominator (so no charts). Ability to monitor change over time (maximum of data points) and for process measure the data are automatically shown in a line chart. Gary Shields will talk you about the NICE resource planner.