Notes for Trust Turnaround through Business Intelligence

Introducing . . .

Donna Kelly twenty years business intelligence experience . . . • Provided best practices in Data Warehouse Architecture to NHS National Programme in Leeds

(NHS Spine/Secondary Uses Services)• Created greenfield technical architecture for Acute Trust (WWL)• Programme Manager and Enterprise Architect (combined business architect and technical

architect) for greenfield Commissioning Support Service in support of 30 London Primary Care Trusts; brought organisation from empty offices to fully operational business intelligence status.

• Business Intelligence Programme Manager at Queen Elizabeth Hospital NHS Trust in King’s Lynn; created programme framework including infrastructure, organisation design and staffing, security , and methodology, in a total greenfield setting. Acted as Enterprise Architect, and created Theatre Business Intelligence for the Trust

• Consultant to Greater Manchester West Mental Health Trust, instrumental in moving the Trust to a strategic business intelligence framework. Provided both business and architectural consulting services, as well as coaching staff and delivering product.

• Interim Head of Quality, Performance and Business Intelligence for Vale of York Clinical Commissioning Group, managed relationship with York and Humber Commissioning Support Unit

• Interim Programme Manager for Cardiff University, performed review and reset of the programme, created new programme, provided architecture and methodology and brought home product delivery to the University. Role incorporated Enterprise Architect (combined business architect and technical architect).

http://www.redwing-bi.comhttp://[email protected](781) 380-0181

1

Trust Turnaround with Business Intelligence

© Redwing Business Intelligence 2002-2015

I’m not the person you need for a steady-as-she-goes situation. That’s not what I do. I’m a strategic

consultant by trade, having worked all over North America, and for every part of the NHS here in

England.

That includes:

• Business Intelligence Architecture for Wrightington, Wigan and Leigh NHS FT.

• Programme Management and Architecture for The London Commissioning Support Service and

the Primary Care Trusts of London; brought the organisation from an empty office to fully staffed

and operational business intelligence status; she worked at all levels from the infrastructure to the

boardroom.

• Best Practices Consulting for Secondary Uses Services and the National Programme in Leeds

• Programme manager for the Queen Elizabeth Hospital Foundation Trust in Norfolk; created the

programme framework including infrastructure, organisation design and staffing, security , and

methodology, in a total greenfield setting.

• Business Intelligence Consultant for the Greater Manchester West FT; creating the foundation,

bringing together Incident, Patient, Financial, and Staff data together to provide enterprise

business intelligence.

I make things work, then hand over to long-term permanent staff. Often, it’s me who recruits my

substantive replacement.

2



This was the situation in an Acute Trust I was invited to give this presentation to, in early 2013.

3



The immediate first-aid has been applied. The left hand side listed the key actions the Trust has already taken. They were mainly around cost-cutting.

Now the requirement is for a strategic approach to stabilising the situation and putting the Trust on the road to recovery and long-term health.

The right-hand column listed the key items I felt were now mandatory.

4



In this next section, I’m going to talk briefly about

1. Specific functional areas of the hospital

2. How enterprise business intelligence using multiple sources of data can make a difference to the bottom line

Cost savings may be found in HR and related areas. Typically, the initial requirement is to ensure that front-line management staff are provided with understandable, easily accessible, and useful information. This will enable them to do things like targeting action to address sickness hot spots. With such information in their hands, it would be reasonable to expect sickness absences to reduce by 10 – 15 %.

Agency staff spend is another fruitful area for cost reduction. The need is to first understand where agency staff spend has occurred, then the need is to understand why it has occurred, and then to work with the Divisions to seek to reduce it though mechanisms such as addressing gaps in rotas and recruitment to vacancies.

(The picture is from an A&E monitoring system we developed in London)

5



In A & E, there have recently been record attendances (one day in Dec 2012 - in the Trust in question - there were well over 300 as against norm of 200).

Whilst there’s always a requirement to manage patient throughput at the case level, there’s also a need to step back and look at how attendance levels are changing over time, and projecting those trends into the future.

Patient case must not be compromised. As changes happen, the Friends and Family surveys will ensure that quality of care is maintained.

Are patients aware of alternatives to A&E? Are the alternatives used?

Is ESR data combined with A&E data to get a proper picture of staffing levels and requirements?

6



Can we ensure that Length of Stay matches or betters national averages?How to we plan to track quality and ensure it remains high?What about reportable delayed discharges? Are we ensuring that the necessary pre-discharge paperwork has been completed –in coordination with Social Services where necessary?Are delayed discharges matched with ESR to ensure that Patient Services staffing is not an issue?(We developed a CQUIN at Vale of York around delayed discharges.)

Can we track and project admissions numbers? And very importantly, re-admissions. (This is a vital Care Quality indicator)Will these be matched to PbR results and patient ‘profitability’ through Service Line Reporting?

The Countess of Chester Acute Trust reports that provision of information to clinicians on the ‘profitability’ of services:• Allowed effective decision making based on accurate, clinician-focused information→The appointment of a 9thConsultant Gynaecologist→The move to a single knee prosthetic →A review of Sexual Health services to understand why they are ‘losing’ money→To minimise the risk of service changes→Targeted cost reduction based on peer comparators• Will improve corporate governance through better business information

7



Example of patient-focused care that we did: the report for Queen Elizabeth Hospital on op list patients cancelled by hospital multiple times previously

A high level of reporting within an organisation indicates a better safety culture: the more aware staff are of safety problems, the more likely they are to report.

The level of reporting from mental health organisations in England and Wales has significantly improved.

However, the NPSA is aware that not all incidents are reported both within organisations and to the NPSA.

All mental health organisations have implemented a system for collecting data on patient safety incidents. This enablesorganisations to:• analyze the type, frequency and severity of incidents;• respond to incidents in a timely manner;• escalate incidents depending on their severity and nature;• use this information to develop corrective strategies and to improve systems and clinical care;

The pictures are taken from our RAVEN Rapid Analysis of Events Integrated Governance and Incident Analytics system.

8



All of these are important indicators, and the most important aspect of them is how – and how fast – they change over time.They need to be expressed graphically, with trend analysis and projections. They also need to be expressed against targets. Key Performance Indicators = Actuals against Targets

The source for this list is the Audit Commission (various papers) and a joint report by the Audit Commission and NHS Confederation: Good Governance: Good Financial Management. Note the list in the slide begins with Ensuring Clinical Involvement.

Here are some quotes:‘We were burying our head in the sand. We’d lost our feedback loop – we knew we’d lost it but there was so much going on. The choices had to be made. It was a fair and open process, and now we’re getting a better handle on clinical information too –what we’re spending the money on.’ Associate Medical Director, NHS trust.‘The mood of the organisation has moved from denial, “we’re not overspent, but under funded”, to constructive engagement in the recovery plan process. Clinical chiefs are represented on the Recovery Plan Steering Group and recently volunteered their own perspective and new ideas, so demonstrating their complete commitment to the process.’ An acute NHS trust Service and Financial Recovery PlanCost awareness – and actual cost control – is vital.

9



A few years ago, Redwing developed a prototype of a comprehensive financialbudgeting, planning, and forecasting system. It was aimed at Commissioners, and it was for contract management. It was called CONCERTO, and the slide shows a sample report.

Here are some comments from the summary document:

• Drillable graphs and numeric/tabular reporting come as standard with CONCERTO.

• Secure reporting can be provided through Excel read-only Excel Reports; more generally, reporting is web-based and easily accessible.

• The basic suite of reports can be modified and extended by any developer familiar with these standard Microsoft tools. The heart of the database is a series of SQL Server Analysis Services cubes, which can easily be interrogated using a wide variety of methods.

• In the future, the data contained with CONCERTO could form the main data feed for performance management dashboards, to be presented as the primary monitoring tool to Executive Management. If this is done, zero integration problems are foreseen.

10



Getting technical for a moment:

PerformancePoint Services in Microsoft SharePoint Server 2010 enables us to create and use powerful dashboards. This includes a Balanced Scorecard.

A Balanced Scorecard provides a high-level view of organizational performance at a glance.

In PerformancePoint Services, a Balanced Scorecard consists of a dashboard page that contains a scorecard and a corresponding strategy map.

In the example, the scorecard and the strategy map show performance information for key performance indicators (KPIs) across four main areas or perspectives.

For the Acute Trust in question, the KPIs are well defined:• Financial Performance• Patient Value – how they see us, how we treat them• Clinical Quality Improvement

We did not develop this scorecard – I copied it off the Web.

11



Donna Kelly

Director, Redwing Hospital Performance

http://www.donnapkelly.com

0(781) 380-0181

12




© Redwing Business Intelligence 2002-2015 13

Healthcare

Notes for Trust Turnaround through Business Intelligence