consultant outcome indicator programme mr k.w.o. thomson chief executive north west wales nhs trust
TRANSCRIPT
Consultant Outcome Indicator Consultant Outcome Indicator ProgrammeProgramme
Mr K.W.O. ThomsonMr K.W.O. ThomsonChief ExecutiveChief Executive
North West Wales NHS TrustNorth West Wales NHS Trust
Topics coveredTopics covered The Consultant ContractThe Consultant Contract
BackgroundBackground
The pilot projectThe pilot project
The Consultant Outcome Indicator reportThe Consultant Outcome Indicator report
The implementation processThe implementation process
Future developmentsFuture developments
The consultant ContractThe consultant Contract Several elements to the contract which differ slightly across the UK: Several elements to the contract which differ slightly across the UK:
Welsh ExampleWelsh Example
Job Planning The Working Week On Call / Emergency Work Pay and Pay Progression Commitment and Clinical Excellence Awards Disciplinary Arrangements Modernisation & Innovation Clinical Academics Private Practice Equal Opportunities
Part Timers Flexible Working
The Consultant ContractThe Consultant Contract The Job PlanThe Job Plan
Mandatory for all consultantsMandatory for all consultants
Set out consultant duties, responsibilities and Set out consultant duties, responsibilities and expected objectivesexpected objectives
Where consultants work for more than one NHS Where consultants work for more than one NHS employer, a lead employer will be designated and an employer, a lead employer will be designated and an integrated single job plan agreedintegrated single job plan agreed
The Consultant ContractThe Consultant Contract Annual job plan review, supported by the agreed appraisal system Annual job plan review, supported by the agreed appraisal system
and benchmarked information and benchmarked information
Objectives and outcomes will set out a mutual understanding of Objectives and outcomes will set out a mutual understanding of what the consultant and employer will be seeking to achieve over what the consultant and employer will be seeking to achieve over the next 12 monthsthe next 12 months
Expected outputs and outcomes may vary but the headings under Expected outputs and outcomes may vary but the headings under which they could be listed include: activity and safe practice; clinical which they could be listed include: activity and safe practice; clinical outcomes; clinical standards; local service objectives; management outcomes; clinical standards; local service objectives; management of resources; service development; multi-disciplinary team working; of resources; service development; multi-disciplinary team working; and quality of careand quality of care
BackgroundBackground The Welsh Assembly Government embark on negotiations re The Welsh Assembly Government embark on negotiations re
Consultant Contract Jan 2003-Nov 2003Consultant Contract Jan 2003-Nov 2003
North West Wales and Bro Morgannwg NHS Trusts named as Pilot North West Wales and Bro Morgannwg NHS Trusts named as Pilot Sites mid July – Sept 2003Sites mid July – Sept 2003
Pilot results audited by Audit Commission WalesPilot results audited by Audit Commission Wales
WAG ask North West Wales and Bro Morgannwg to develop WAG ask North West Wales and Bro Morgannwg to develop outcome indicators to make job planning more robustoutcome indicators to make job planning more robust
CHKS commissioned by both trusts to undertake a project to CHKS commissioned by both trusts to undertake a project to develop consultant-level outcome indicators involving both develop consultant-level outcome indicators involving both organisations for all specialtiesorganisations for all specialties
Pilot projectPilot project Conducted late 2003 / early 2004Conducted late 2003 / early 2004
Top led Bottom upTop led Bottom up
Consultants from over 30 specialities were interviewedConsultants from over 30 specialities were interviewed
Some other specialities made suggestions in writingSome other specialities made suggestions in writing
Reports were devised for 44 specialities although 59 have been Reports were devised for 44 specialities although 59 have been identified in totalidentified in total
Fed back to negotiating team inc. BMA for acceptance.Fed back to negotiating team inc. BMA for acceptance.
Pilot project – examples of researchPilot project – examples of research Much research was conducted – examples include:Much research was conducted – examples include:
Pioneers in Patient Care: Consultants leading change, British Pioneers in Patient Care: Consultants leading change, British Medical AssociationMedical Association
British Association of Urological Surgeons (BAUS), Section of British Association of Urological Surgeons (BAUS), Section of Oncology, Cancer Registry, Analysis of 2002 data, October 2003Oncology, Cancer Registry, Analysis of 2002 data, October 2003
Changing the Way We Operate, The 2001 Report of the National Changing the Way We Operate, The 2001 Report of the National Confidential Enquiry into Perioperative DeathsConfidential Enquiry into Perioperative Deaths
Good Surgical Practice, Royal College of Surgeons of England, Good Surgical Practice, Royal College of Surgeons of England, September 2002September 2002
Knee Replacement, A Guide to Good Practice, British Orthopaedic Knee Replacement, A Guide to Good Practice, British Orthopaedic AssociationAssociation
Categories of clinical practitionerCategories of clinical practitioner
Practitioner: Services are delivered primarily by Practitioner: Services are delivered primarily by consultants or members of their teamconsultants or members of their team
Leader of multi-disciplinary team: Consultant is the Leader of multi-disciplinary team: Consultant is the strategic director of a multi-disciplinary team, of which strategic director of a multi-disciplinary team, of which there is onethere is one
Member of department: Entire department works as a Member of department: Entire department works as a single teamsingle team
Key considerationsKey considerations Evolution of Indicators. The field of clinical information is Evolution of Indicators. The field of clinical information is
fast-evolving field with many dynamicsfast-evolving field with many dynamics A phased implementation of the indicatorsA phased implementation of the indicators The reports represent a feasible start-point and further The reports represent a feasible start-point and further
iteration and development of the indicators may take place, iteration and development of the indicators may take place, such as patient-captured outcome indicatorssuch as patient-captured outcome indicators
Some local investment in data capture is likely to be Some local investment in data capture is likely to be requiredrequired
A bias towards “modernisation” has been includedA bias towards “modernisation” has been included The reports will show that consultants work under different The reports will show that consultants work under different
variable resourcing arrangements variable resourcing arrangements
Specialisms coveredSpecialisms covered Accident & EmergencyAccident & Emergency Acute MedicineAcute Medicine Adult Mental IllnessAdult Mental Illness AnaestheticsAnaesthetics Breast SurgeryBreast Surgery CardiologyCardiology Care of the ElderlyCare of the Elderly Chemical PathologyChemical Pathology Child & Adolescent Child & Adolescent
PsychiatryPsychiatry Clinical HaematologyClinical Haematology Clinical OncologyClinical Oncology Colorectal SurgeryColorectal Surgery Community PaediatricsCommunity Paediatrics Critical CareCritical Care DermatologyDermatology
EndocrinologyEndocrinology ENTENT Forensic PsychiatryForensic Psychiatry GastroenterologyGastroenterology Genito-Urinary MedicineGenito-Urinary Medicine General Medicine General Medicine General SurgeryGeneral Surgery Gynaecology Gynaecology OncologyOncology HistopathologyHistopathology Learning DisabilitiesLearning Disabilities Medical OncologyMedical Oncology MicrobiologyMicrobiology NephrologyNephrology Obstetrics & GynaecologyObstetrics & Gynaecology
Old Age PsychiatryOld Age Psychiatry OphthalmologyOphthalmology Oral Surgery (including Oral Surgery (including
Maxillo-Facial)Maxillo-Facial) Paediatric DentistryPaediatric Dentistry PaediatricsPaediatrics Pain ManagementPain Management Palliative MedicinePalliative Medicine RadiologyRadiology RehabilitationRehabilitation Respiratory MedicineRespiratory Medicine RheumatologyRheumatology Trauma & OrthopaedicsTrauma & Orthopaedics Upper GI SurgeryUpper GI Surgery UrologyUrology Vascular SurgeryVascular Surgery
The Consultant Outcome Indicator ReportThe Consultant Outcome Indicator Report Annual report per consultantAnnual report per consultant
Developed in conjunction with consultantsDeveloped in conjunction with consultants
Specialty specific indicators Specialty specific indicators
Uses contract minimum data setUses contract minimum data set
Utilises other data sourcesUtilises other data sources
Data entry Data entry
Programme includes on site support and implementationProgramme includes on site support and implementation
The Consultant Outcome Indicator ReportThe Consultant Outcome Indicator ReportMain HeadingsMain Headings
SummarySummary
Activity, Safe Practice and Clinical StandardsActivity, Safe Practice and Clinical Standards
Quality of Care and Clinical OutcomesQuality of Care and Clinical Outcomes
Local Service RequirementsLocal Service Requirements
Management of resourcesManagement of resources
Modernisation Modernisation
The The Consultant Consultant Outcome Outcome Indicator Indicator ReportReport
The Consultant Outcome Indicator ReportThe Consultant Outcome Indicator Report
The Consultant Outcome Indicator ReportThe Consultant Outcome Indicator Report
Dynamic processDynamic processIndicator selection should beIndicator selection should be
Regularly reviewed to remain relevantRegularly reviewed to remain relevant
which could lead to the indicator being: which could lead to the indicator being:
RefinedRefined
RevisedRevised
ReplacedReplaced
RemovedRemoved
RelocatedRelocated
Outcome indicator principlesOutcome indicator principles Participation in professional body and local audit Participation in professional body and local audit
Volume of sentinel cases within the specialismVolume of sentinel cases within the specialism
Complication ratesComplication rates
Efficient use of resourcesEfficient use of resources
Management of the interface with other clinical areas as appropriateManagement of the interface with other clinical areas as appropriate
Multi-disciplinary practice where appropriateMulti-disciplinary practice where appropriate
Presence of specialist facility or arrangementPresence of specialist facility or arrangement
Extended professional roles within the specialismExtended professional roles within the specialism
Demand management where appropriateDemand management where appropriate
Sample generic indicatorsSample generic indicators Process in place to ensure awareness of and adherence to Process in place to ensure awareness of and adherence to
requirement to seek permission to undertake new interventional requirement to seek permission to undertake new interventional procedureprocedure
NICE Guidelines implemented April – May 2004 across England, Scotland and WalesNICE Guidelines implemented April – May 2004 across England, Scotland and Wales
% Day case overstays% Day case overstays Risk adjusted mortalityRisk adjusted mortality Risk adjusted readmissions Risk adjusted readmissions Risk adjusted complicationsRisk adjusted complications % DNA out-patients% DNA out-patients Risk adjusted length of stayRisk adjusted length of stay Out-patient new to follow-up ratioOut-patient new to follow-up ratio
Specialism specific indicatorsSpecialism specific indicatorsBreast SurgeryBreast Surgery
Number of breast surgery procedures for patients with breast Number of breast surgery procedures for patients with breast cancer cancer
% Breast conservation procedures for breast cancer patients% Breast conservation procedures for breast cancer patientsGuidance on Cancer Services, Improving Outcomes in Breast Cancer, manual Update (Aug 2002)
Colorectal SurgeryColorectal Surgery
Contribution to and use of the Association of Coloproctology of Contribution to and use of the Association of Coloproctology of Great Britain and Ireland colorectal cancer databaseGreat Britain and Ireland colorectal cancer database
Specialism specific indicatorsSpecialism specific indicators
NephrologyNephrology Adherence to the nutritional and biochemical standards for Adherence to the nutritional and biochemical standards for
patients on haemodialysis and peritoneal dialysis is patients on haemodialysis and peritoneal dialysis is monitoredmonitored
Audit of all late referrals Audit of all late referrals Treatment of adults and children with renal failure, Renal Association (August 2002)Treatment of adults and children with renal failure, Renal Association (August 2002)
Genito-urinary MedicineGenito-urinary Medicine Waiting times for access to GUM clinic are monitoredWaiting times for access to GUM clinic are monitored
Specialism specific indicatorsSpecialism specific indicatorsOphthalmologyOphthalmology % Cataract procedures that were Phako cataract extractions% Cataract procedures that were Phako cataract extractions
Paediatric MedicinePaediatric Medicine % Activity aged < 1% Activity aged < 1 Individual appointed to lead on children's issues and represent them Individual appointed to lead on children's issues and represent them
on the Boardon the Board Processes in place to ensure that no child about whom there are Processes in place to ensure that no child about whom there are
child protection concerns are discharged from hospital without a child protection concerns are discharged from hospital without a plan in place to ensure their safetyplan in place to ensure their safety
National Service Framework for Children, Standard for Hospital Services (April 2003).National Service Framework for Children, Standard for Hospital Services (April 2003).
% Emergency admissions that had a primary diagnosis of asthma % Emergency admissions that had a primary diagnosis of asthma
The implementation processThe implementation process
Liaison with individual trusts to explain process and key Liaison with individual trusts to explain process and key taskstasks
Validation with trusts of a Consultant List and confirmation Validation with trusts of a Consultant List and confirmation of consultant characterisationsof consultant characterisations
Entry of data and interface with IT systemsEntry of data and interface with IT systems
CHKS produces and disseminates reports CHKS produces and disseminates reports
CHKS presents reports to individual trustsCHKS presents reports to individual trusts
Programme managementProgramme management
Programme Steering GroupProgramme Steering Group
Programme Technical GroupProgramme Technical Group
Establishment of ad hoc groups as necessaryEstablishment of ad hoc groups as necessary
Trust level project team potentially including Medical Director, Trust level project team potentially including Medical Director, Business Managers, Information Manager and CHKS consultant Business Managers, Information Manager and CHKS consultant
Future developmentsFuture developments Expand the number of specialities to include those not present at Expand the number of specialities to include those not present at
the pilot truststhe pilot trusts
Extending the coverage of the reports to all types of indicatorExtending the coverage of the reports to all types of indicator
Using the reports to monitor the ongoing modernisation of clinical Using the reports to monitor the ongoing modernisation of clinical carecare
Keeping the reports up to date to reflect clinical developmentsKeeping the reports up to date to reflect clinical developments