Intelligent Improvement

Transcription

1 Intelligent Improvement A Business Intelligence Strategy for Healthcare Improvement Scotland ( )

2 Contents Foreword 3 1 What is business intelligence and why do we need it? 4 2 Where are we now? 6 3 Where do we want to be? 8 4 Next steps 11 2

3 Foreword I am delighted to set out Healthcare Improvement Scotland s Business Intelligence Strategy for This strategy sets the direction for the work that Healthcare Improvement Scotland will carry out to gather, process, and share data so that it becomes meaningful information that it then uses to support business operations. Improving the way we capture, understand and interpret data will help drive Healthcare Improvement Scotland forward, and will be a critical success factor in our mission to improve outcomes for patients. There are two key strands to our business intelligence work. The first focuses on processing, sharing and using data about other organisations that provide frontline patient care - and this strand addresses some of the key issues from the Francis Inquiry report. The second focuses on the data about Healthcare Improvement Scotland that the organisation gathers internally and uses to support continuous improvement in our aim to become a high performing organisation. This strategy takes its direction from the 20:20 Vision for Health and Social Care in Scotland, and delivering the Business Intelligence Strategy will contribute to the successful implementation of our organisational strategy (Driving Improvement in Healthcare, ). The ultimate aim of our Business Intelligence Strategy is to ensure that Healthcare Improvement Scotland, working with partner organisations, is making best use of data and information to help make care better for patients. Dr Brian Robson Executive Clinical Director Healthcare Improvement Scotland 3

4 1 What is business intelligence and why do we need it? Business intelligence is a set of theories, methodologies and technologies about gathering and processing data so that it becomes meaningful information that enables an organisation to make better informed business decisions. Vision Our vision for our business intelligence work is to effectively utilise data and information to achieve our organisational goals, and better support front line service provider organisations in the delivery of safe, effective and person-centred care throughout Scotland. External and internal focus Healthcare Improvement Scotland interacts with all parts of the healthcare system, including organisations that provide frontline health and social care. To reflect this there are two complementary aspects to our business intelligence work that needs to be taken forward. 1. External: this focuses on Healthcare Improvement Scotland, working with partner agencies, gathering, sharing and using data about frontline health and social care provided by other organisations. The aim of this is to inform the work Healthcare Improvement Scotland and other national bodies carry out to drive improvements in care. This work will be aligned with the National Information and Intelligence Framework for Health and Social Care in Scotland and the ehealth strategy. It also addresses some of the key issues from the Francis 1 Inquiry report, for example recommendations on use of information for effective regulation and also the need to share information between regulators. 2. Internal: this focuses on enabling Healthcare Improvement Scotland itself to become a high performing organisation, and the data about our own organisation that need to be gathered and used internally to support this. This approach will provide the necessary operational information to support business improvement activity, notably our internal Driving Improvement programme. Why do we need a Business Intelligence Strategy? In order to understand the current state of business intelligence in Healthcare Improvement Scotland, an internal consultation and engagement process was undertaken in There was consensus that there are opportunities for improvement about how the organisation gathers, shares and uses data about our own organisation and about other organisations that provide patient care. This is unsurprising given Healthcare Improvement Scotland is still in its relative infancy with evolving structures, processes and systems - and different parts of the organisation using ad-hoc tools (for example, Excel, Access, Word and narrative notes). However, there is scope to develop more systematic approaches across the organisation that would result in the production of more consistent, timely and accurate 1 Mid-Staffordshire NHS Foundation Trust Public Inquiry. Report of the Mid-Staffordshire NHS Foundation Trust public inquiry [cited 2014 Feb 27]; Available from: 4

5 reports that would satisfy multiple information requirements. This would reduce duplication of effort in creating several similar reports for different audiences, and minimise organisational risk created by dependency on unsupported ad-hoc systems and on key individuals. The rationale for developing our business intelligence function is given further weight by the recent Francis and Keogh 2 Reports, and also the recent review of quality and safety in one NHS Board 3 which was led by Healthcare Improvement Scotland. The Francis Inquiry report highlights that there were numerous opportunities for early identification of problems at one NHS Trust. These wisps of smoke when put together should have given clear identification of significant problems. Enhanced business intelligence is required to help safeguard healthcare against systemic failures and to identify potential areas of good practice where learning can be applied across the whole healthcare system. Business intelligence will be an enabling function supporting Healthcare Improvement Scotland to achieve its corporate objectives. For example by making better use of intelligence, the organisation will be enabled to target specific scrutiny and improvement interventions more effectively. Business intelligence models exist to support organisations assess their capabilities and areas for development. A business intelligence model will be used to guide and assess growth in Healthcare Improvement Scotland. Our organisation is currently at a level where we have recognised the need to use management information in supporting tactical decision making, however this information is largely held in silos. Our aim is to integrate business intelligence into critical business processes, by March To illustrate: key metrics at strategic and operational level would be in place, for the organisation s delivery functions (evidence, improvement, scrutiny) and support functions (including finance, HR, IT). For example, these metrics would include data on the impact of/customer satisfaction with our work, and also on our progress against key delivery targets. Data quality for these metrics would be defined and monitored, to ensure the data are trusted and acted upon. Healthcare Improvement Scotland s business intelligence work will take its direction from the 20:20 Vision for Health and Social Care in Scotland and might dovetail with the ehealth strategy. In particular, while an initial focus of our external facing work will be on acute services, this will evolve to consider integrated health (primary and secondary care) and social care. 2 Keogh B. Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report [cited 2014 Feb 27]; Available from: esources/nhs_lanarkshire review.aspx. 5

6 2 Where are we now? Business intelligence in Healthcare Improvement Scotland is still in its relative infancy. There remain some key challenges around identifying and prioritising business intelligence requirements. In relation to these requirements there are a number of challenges relating to data collection, processing, reporting and information governance as well as ensuring we have dedicated human resources with the appropriate skills. Our Corporate Management Team is responsible for prioritising our business intelligence requirements, and actively managing the various challenges in relation to these. In 2013 we committed to make business intelligence a core part of our work by creating our Data, Measurement and Business Intelligence Team. This team is now in place, and working across the organisation to develop and support our focus on the use of data to support our corporate, evidence, improvement and scrutiny functions. This team will continue to have a leading role in working with the other parts of Healthcare Improvement Scotland to identify and support our business intelligence requirements and priorities and deliver the work to address these. In 2013, we also made significant progress in the externally focused work we are carrying out to gather, share and use data about frontline patient care. This is a top priority for the organisation for 2014 and beyond, and the Business Intelligence Strategy provides a context for progressing this in a coherent and structured way. For example development and delivery of the Business Intelligence Strategy includes work currently in progress on the sharing intelligence agenda a joint enterprise involving Healthcare Improvement Scotland, Public Health and Intelligence, NHS Education for Scotland, Care Inspectorate, and Audit Scotland. It is critical that the complementary roles of these national organisations in relation to the intelligence sharing agenda are more clearly defined. There are also significant challenges in relation to sharing and using data across different organisations. In addition, the organisation recently led a review of the quality and safety of acute care provided by one NHS Board. This work highlighted the opportunities to improve the data and intelligence required when seeking to assess the breadth or quality and safety of healthcare. Further work is now being carried out to explore approaches to identifying potential areas of concern or risk to the public, allowing proportionate, targeted and timely deployment of Healthcare Improvement Scotland resources. This could be based upon data available to Healthcare Improvement Scotland such as patient experience surveys, patient complaints, inspection reports, mortality metrics, quality indicators, hospital and national programme performance measures, healthcare associated infections, patient safety incidents/indicators, adverse events, whistleblower referrals, staff surveys, media mentions and social media. Turning to the internal focus, in 2013 Healthcare Improvement Scotland established a substantial internal business improvement programme, Driving Improvement. There are natural dependencies between this improvement work and our business intelligence as, for example, our Corporate Management Team requires timely, accurate information and data to further improve efficiency and effectiveness of our work programmes. 6

7 Supporting information, communication systems The IT systems landscape at Healthcare Improvement Scotland is evolving; some areas have robust enterprise systems 4, but many are still using out-dated, ad-hoc systems. For example the finance and HR departments are transitioning to new systems as part of the shared services agenda, and the planning department has developed its own database for tracking progress in relation to the Local Delivery Plan. However there are opportunities to improve how the outputs of these systems are better integrated. 4 An enterprise information system is a central computing system that deals with large volumes of data to allow an organisation (enterprise) to integrate and coordinate its business processes. It ensures information can be shared across all functional levels and management using a standard data structure to reduce fragmentation caused by multiple information systems. 7

8 3 Where do we want to be? By March 2017 we are aiming to integrate business intelligence into critical business processes. As already described this will include key metrics at strategic and operational level being in place, relating to the delivery and support functions/departments. Data quality for these metrics would be defined and monitored, to ensure the data are trusted and acted upon at Executive level and operational management level. To achieve this, key success factors include strong sponsorship, right skills, technological infrastructure and clear roles and responsibilities. In addition we will adopt an incremental and iterative approach (develop, test, spread methodology), and not a big bang approach. The strategy for our organisation, Driving Improvement in Healthcare, emphasises the critical importance of the different parts of Healthcare Improvement Scotland being better integrated in order to maximise the public value we add. As stated in the Improvement Guide 5 ultimately, the success of an organisation will depend on integration, not the performance of the individual parts. This was a key finding from the stakeholder consultation for the Business Intelligence Strategy. This does not mean that every piece of work needs to go through each of our evidence, improvement and scrutiny functions. Instead, this is about different parts of the organisation working together in a planned way in order to produce results not obtainable by any of the parts independently. As already stated, an initial priority of our external facing business intelligence work is on different national organisations better sharing and using data about acute services to inform scrutiny functions. A phased approach will be taken to subsequently include data on primary care and social care, and also to support our evidence and improvement functions. In terms of the internal facing work, an initial priority is on developing standardised central reporting, and also recording recent and forthcoming interactions between the organisation and other NHS Boards. This includes identifying the core data set and ensuring the information technology is in place to enable the collection of these data items. Implications for our workforce This is a complex and substantial programme of work, and will involve significant input from the Healthcare Improvement Scotland workforce to fully implement. This will have implications for workforce development in making sure we have the skills and capacity to deliver the business intelligence work. The intended outcome is organisational enablement with Healthcare Improvement Scotland benefiting from improvements in business processes from making information more readily available to staff across the organisation. The implications for the workforce across the organisation are likely to be substantial in terms of competency development, changes in priorities, and work patterns. This programme of work will be overseen by a Business Intelligence Implementation Group, which will include members of the Corporate Management Team. This group will be chaired by the Executive Clinical Director and report to the Executive Team, who will provide strong sponsorship to ensure the workforce are engaged and supported and return on investment is maximised. 5 Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers;

9 A robust business intelligence function encompassing the people, processes and systems required will be developed to facilitate this desired state. Data from inside and outside the organisation will be gathered, processed and used to inform business decisions and drive actions that add value. This is known as the business intelligence value chain, see figure 1. It is important to note that it is only by acting on this insight and intelligence that added value is created. Figure 1 business intelligence value chain A fundamental component of the business intelligence function is the existence and accessibility of the underlying data needed to serve to the business intelligence requirements. These data will be derived from numerous sources from within and out with 9

10 the organisation. It is common that some systems development and reengineering may be required in order to effectively record data required for business intelligence purposes. Adhoc systems and data sources may be used to satisfy interim requirements but should be moved over to the business intelligence function at the earliest opportunity. Specialist systems are required to extract the data from the varied and disparate sources where they are currently held, and affect the transforming, cleaning and enriching of data via the application of Business Rules. Significant automation of this process can support frequencies of refreshing the data of up to near real-time. Analysing, visualising and using our data This intelligence can be presented in a variety of different ways to a variety of different users, from highly aggregated graphical dashboards to very low-level tabular analysis, and everything in between. Summarisation (e.g. into a RAG categorisation) with the opportunity to drill-down into the detail (e.g. the raw data or the original inspection report) allows for analysis at an appropriate level and awareness of potentially useful but previously unrecognised data, together with enforcing integrity and consistency of the data a single version of the truth. Different data for different purposes It is important to understand that different items of data are collected for different purposes, and are reported/published in a variety of ways. Specifically much of our data is based on local data for improvement, studying variation and trends over time. These data are not intended for use for performance assessment or performance management. It is essential that Healthcare Improvement Scotland has access to both types of data and has clear agreements in place with local providers, Scottish Government and others to avoid misuse of these data. Our business intelligence work will therefore be underpinned by clear agreements and protocols in terms of what data are shared, for what purpose, together with plans for reporting and publishing such information. There are a range of information governance matters that will be addressed as the strategy is implemented. We will access field experts in using data for improvement externally to supplement and support our internal team, including NHSScotland Improvement Advisers and business intelligence experts internationally. 10

11 4 Next steps A proven strategy for implementing business intelligence in NHS organisations is incremental and iterative ensuring that value is added at each step, progressing towards the desired state. This delivery model moves away from the big bang approach which can often result in a failed system having to be withdrawn or redesigned, with resulting loss of time, money and staff buy-in. The philosophy will be familiar to Healthcare Improvement Scotland, being closely allied to the small test of change approach within the Model for Improvement 6 We will adopt this develop, test, and spread methodology for our business intelligence work. A Business Intelligence Implementation Group, which will include members from the Corporate Management Team, will be established in May The group which will be chaired by the Executive Clinical Director, reporting to the Executive Team who will provide strong sponsorship. In parallel with this, the Corporate Management Team will agree our business intelligence priorities and a full business case will be prepared by June We anticipate that a top priority for our business intelligence work for is using the above methodology to progress work on different national organisations sharing and using data to inform scrutiny activities. Once our initial priorities have been agreed, a review of our current human resources and IT systems will be carried out. In , we will review progress and learn lessons from the work carried out on our top business intelligence priorities. This will be used to inform the roll out of a more substantial programme of work. In , we will assess the implementation of the Business Intelligence Strategy. 6 Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers;

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