OUR APPROACH TO RTT DATA QUALITY AND VALIDATION PROGRAMMES. Barry Mulholland (MBI) Philip Calvert (MBI) Seeni Naidu (BHRUT)

Transcription

1 OUR APPROACH TO RTT DATA QUALITY AND VALIDATION PROGRAMMES Barry Mulholland (MBI) Philip Calvert (MBI) Seeni Naidu (BHRUT)

2 BACKGROUND CQC Quality Report 2 July 2015 Over 120,000 RTT pathways. No confidence what was real or if 120,000 were the correct / incorrect. Poor data quality and information systems Ongoing structural misalignment between demand and capacity Limited operational capability of waiting list management Insufficient and inexperienced operational managers Disempowerment of clinical body

3 DATA QUALITY WHERE SHOULD WE START? One of the most common questions we are asked is where to begin when facing something on this scale. Needs to be an understanding that no current PAS system can handle waiting list management: Poorly understood by system suppliers Complex Too many manual processes in place at different Trusts Data Quality 50% to do with IT systems and 50% to do with hygiene (human) factors around the IT

4 First place to start is with each waiting list coding (this bit is often left out) How can you plan anything until you are 100% sure the waiting lists are being correctly produced? Often poorly documented Often historic coding in place and relevant staff have left Often requires external expertise

5 WAITING LIST CODE TO CHECK? First place to start is with each waiting list code (this bit is often left out) Q. How many different waiting lists need to be checked?

6 First place to start is with each waiting list code (this bit is often left out) Non-admitted Admitted Planned Diagnostic Radiology Endoscopy Long-term follow-ups / active monitoring Others?

7 IT SYSTEMS WHAT ARE WE LOOKING FOR? That we understand each line of code and what it is for. Anything that is being excluded from the waiting list and why.

8 IT SYSTEMS EXCLUSIONS Good Exclusions Bad Exclusions

9 Good Exclusions Obstetrics and midwifery pathways treatment function codes 501, 560; Planned patients admission method 13; Referrals to services which are not consultant-led; Non-English commissioners; GUM this is no longer commissioned by the NHS and must be excluded; Direct Access; Emergency activity; Duplicate records; Bad Exclusions Specific clinics; Based on age; Diagnostics; Cancers; Based on previous referral specialty. If referred in under specially A but previously seen within B; Based on the time since the last referral in that specialty; Based on the number of attendances; Diagnostic patients referred from another hospital;

10 IT SYSTEMS USER ERRORS No matter how much training you do users will always make mistakes. Trick is to anticipate and track these. Q. What are the most common errors made by users in your organisations?

11 IT SYSTEMS USER ERRORS: OUR TOP Clock stops at first appointment per specialty for the last 12 months; 2. C2C referrals generating new pathways; 3. Ward discharges generating new RTT pathways; 4. Previous Outcome DNA with no future appointment booked; 5. Previous outcome Discharge with no future appointment booked; 6. Duplicate registrations in the same specialty; 7. On a planned WL with an open RTT clock; 8. TCI dates in the past; 9. Unknown clock starts; 10. Code 98 s & 99 s; 11. Patients on active monitoring who have not had an appointment in the last six months or an appointment booked in the next six months; 12. Unoutcomed clinic appointments > 24 hours;

12 HYGIENE FACTORS WHERE SHOULD WE START? As, if not more important than the IT systems

13 HYGIENE FACTORS OUTCOME FORMS Redesign Communications Clinical Ownership Launch Floorwalkers Tracking Feedback Loop

14 HYGIENE FACTORS CHRONOLOGICAL BOOKING Central booking office needs to be a focus Often some big departments outside of central booking Booking follow-ups and the role of the medical secretary Clinical booking often a challenge Think radically: mywaitingtime.com

15 HYGIENE FACTORS REPORTING Data Quality Dashboards

16 Management Information

17 HYGIENE FACTORS GOVERNANCE Critical that this process is enforced by the Executive Team Expectations and accountability need to be clear. Specialty PTL meetings should be patientfocussed and mirror the agenda of PIG Clear agenda which does not change with attendance mandatory

18 HYGIENE FACTORS TRAINING Using Toolkits RTT compliance toolkits will baseline training and development priorities; Capacity & Demand schedules will identify training needs; Toolkits are training products that can be held by all staff. Identify Key Staff Workforce classification and core training requirements; Link to re-validation and CEA awards; Appraisal sign-off. Tailored Programmes Key staff in operational roles will require individual programmes; REC members; Board Members; Non-Execs; Clinical Staff. Trustwide experts Capacity-Demand Experts; Policy and Rules for RTT; Pathway standards; Performance Triggers. Formation of an Expert Group reporting into FPI Committee.

19 HYGIENE FACTORS VALIDATION Pre May 15 May 15 - Oct 16 July 16- Current In house validation team In Source Group Cymbio In house validation team Director of Finance Head of Information Programme Director Data Quality Improvement IM & T Programme Director 1 WTE Band 7 Service Delivery Manager 1 WTE Band 6: Quality Systems Coordinator and internal auditor 3 WTE Band 5 Team Leaders 17.2 WTE Band 4 Validators

20 Patient Tracker Lists (PTLs) Medway front end (user entry) Excel PTL reports (user interaction) Validations Pre June 2016 Front-end database Various views including PTL view Business Intelligence database PTL scripts database

21 Automated web-based work flow

22 Intelligent Validation Database Pre populated errors and next actions Allows capture of patient factors Choice, co-operation, complexity Integrated audit and automated reporting Version controlled document management system Internal audit tool Integrated performance management tool Integrated root cause analysis tool

23 Intelligent Validation Database Predicts patient breaches; Report filtered by : WEEKS WAIT, Specialty, Validation status Report grouped by : Pathway status Drill down to patient level Export to Excel, word and pdf

24 Fully Paperless Solution Patient tracking entry from this page Patient validation entry from this page Export RAG rated patient breach possibility Future OP or IP appointment within breach time etc Fully paperless management of VALIDATION AND TRACKING

25 RTT DATA QUALITY STRATEGY Elimination of waste Validation Tracking Validation Tracking Validation of every pathway within the PTL by 31 March 2018 Audit 5 % of all validations 20% of clock stops audit Validate illogical pathways as they appear RTT Data Quality Accreditation: ISO : 2015 Information and Data Quality: Concepts and Measuring All appropriate staff within BHRUT to be trained in RTT rules by 31 March 2018

26 Barry Mulholland Philip Calvert Seeni Naidu