As part of the HTN Data and Analytics Channel, we spoke with Geoff Bick from Civil Eyes Research.
The company uses a range of healthcare datasets to provide information to hospitals, clinicians and managers about clinical performance, quality, efficiency and productivity with the aim of helping to achieve improvements in these areas.
We asked Geoff a few questions about benchmarking in the NHS during COVID, and to hear about some of the learnings from recent projects and the role of technology in the process.
How has benchmarking evolved during COVID?
The normal way to apply benchmarking was through face to face meetings, so we have taken our approach online like many other services. The principles have remained the same; it has been important to understand how something compares elsewhere and to facilitate sharing of best practice. The problems and challenges are largely similar, so benchmarking helps take a step back and understand what’s good and what could improve.
At the moment it’s about coping and reacting. It has been really important to learn and share recovery strategies, and how others have approached similar challenges.
Some of the elements we have focused on have ranged from understanding approaches to the emergency department, predicting future demand, approaches to non-elective pathways and technology to service recovery. It is good to think what others have done and what you can copy and learn from.
Could you take me through some of the learnings from the recent sessions?
The move to virtual outpatient attendance has supported a redesign and that has sparked great discussion for its use going forward and how and when it will be used. It’s been really important to draw from data and insight to support discussions and planning.
We focused on one hospital that launched a trust-wide emergency workload stream to look at pathways and flows. Another hospital had some concern about the lack of single rooms in PICU and was looking at building these.
Most of the hospitals were generally anticipating that the winter will be hard to cope with and were expecting all sorts of infections that would need to be managed as suspected Covid patients.
We discussed service recovery as well where some providers are starting day unit work and like many, virtual clinics were encouraged where possible, but it was felt that cardiac and orthopaedic departments needed to see patients face to face.
Most were introducing big time slots to reduce waiting which had taken much negotiation with clinicians. Staff were stationed at the entrance to the children’s outpatient’s area, policing attendance and checking that there was an appointment; if the wait was over 15 minutes, the patient/family were sent back to wait in the car park or outside. Overall it was felt that the outpatient process had been carried out reasonably well, and lots of changes have taken place.
Technology adoption…
There have also been some great examples where previously areas or teams would have resisted the change to technology. At one hospital, the vetting of tertiary referrals was previously a paper-based process, but has now quickly adapted to an electronic process.
One centre had a link with the local women’s hospital and was using robot to robot telehealth technology where the video quality was sufficient to allow surgeons to direct operations.
At another centre, all MDTs became virtual while teams and consultants who were previously reluctant to go electronic have now realised how useful it can be.
In general, things which were previously difficult to do are now happening quicker – there was a sense of increased agility.
Why is benchmarking important at a time like this?
A characteristic of high performing entities is that they are willing to entertain the stimulus of benchmarking and to take the positives from it, to question why they are doing what they are and to see whether anything can be done better.
Unfortunately, the hospitals that have experienced major shortfalls in clinical quality over recent years have tended to be the more remote and distanced organisations – a common characteristic is a closed culture that mitigated against open-minded self-examination or self-criticism.
Over many years, we have found no such thing as the perfect – or model – hospital. Hospitals are complex systems with many moving parts, with different cultures and histories, located within differing geographical situations and dealing with different patient demographics.
