Transforming patient experience annual conference 2012 Revalidation measuring and regulating to ensure excellent patient care Ben Bridgewater
What do patients expect from us? www.scts.org
What do patients expect from us? We would expect the surgeon would have a good reputation with their colleagues and, if we needed unusual surgery we would expect the surgeon to have that sub-specialist expertise and, if not, that they would refer us onwards to someone who did. We would assume that they would have up to date knowledge, and would expect that the profession would make assessments to ensure that was so. Finally we would expect a transparency in all dealings, and an ability to independently check any claims made would be key to earning and maintaining Trust. We would expect the professional societies responsible for the practice of surgery under consideration to set clear standards of care, monitor those standards, and use the data to drive quality improvement. We would also expect them to have a strategy for getting information to patients about the relevant disease and treatments, as well as providing comparative clinical outcomes, to help us become an informed partner in any decision making process. David Geldard MBE, SCTS patient representative
What do I think patients want? Outcomes are measured Action is taken if results are below standard Knowledge is assessed Patient experience is measured All these activities are transparent and checkable Are we trustworthy?
Outcomes measurement SCTS database 500,000 patient records Patient characteristics Operative details Post operative outcomes Long term mortality tracking
Data published By hospital since 2001 Dr Foster/Times SCTS By surgeon since 2005 Guardian SCTS/CQC
Mortality proportion Mortality proportion 0.02 0.04 0.06 0.08 0.10 Clinical outcome measurement Observed Expected Actual Overall average Trend O:E = 0.73 O:E = 0.37 2002 2004 2006 2008 2010 Time
History 2006-2009 published on CQC website Hospital Surgeon Decision made that this is not in line with their portfolio SCTS held meetings with various organisations for hosting outcomes data Working towards publication on SCTS website Final stages of preparation for publication of 2008-2011 data
By hospital
By surgeon Multiple and flexible risk models
Analysing and publishing clinical outcomes data Not easy Needs high level clinical input Needs high level analytical input Needs detailed data validation processes Quite decision dependent IT and dissemination strategies not yet optimal Not yet widespread
5 stages of governance Defining standards Developing and supporting infrastructure to measure to those standards Defining unacceptable variance Investigating possible instances of poor performance Making judgments on poor performance Professional Society Professional society +/- others Professional society Professional society +/- others (Trusts/RCS/CQC/NCAS/ GMC) Trusts/RCS/CQC/GMC
Measuring patient experience Picker/SCTS/UHSM collaboration
Patient experience measurement Discriminate to individual practitioners Improve overall quality of experience Detect unacceptable practice Drive culture of patient-centredness Routine part of clinical practice
Publication for patients Clinical outcomes Patient experience Training and practice profiles Other
Information About Doctors Tim Hooper, consultant cardiac surgeon Tim is a full time consultant surgeon practising adult cardiac surgery. He trained in medicine at Manchester and underwent postgraduate training in Manchester, London and Detroit, Michigan. As well as undertaking the full spectrum of cardiac surgery, Tim has a particular interest and specialist expertise in mitral valve repair and complex redo-valve surgery GMC number 3166114. Revalidated by GMC November 2012 What does he do? In the 3 years to the end of March 2011 Tim undertook 390 open heart operations His overall mortality was 2.8%, compared to a predicted mortality for his case mix of 3.2%
Success Rates of Treatment What operations does he do? Coronary artery surgery Aortic valve surgery Mitral valve surgery Other complex surgery His results are as expected
What Do His Patients Think? Sample
What Do His Patients Think? Sample See also https://www.uhsm.nhs.uk/patients/cardiacs/pages/default.aspx
For more info see www.scts.org www.ucl.ac.uk/nicor/ Demonstrating Quality Maintaining Patients Trust Programme of work Detailed technical information Research publications