QlikView Business Discovery in use at Addenbrooke’s. Credit Phil Mynott
When thoughts turn to technology in the NHS, people generally think of the much-maligned National Programme for IT (NPfIT), but there are innovative uses of technology at organisations that are making a real difference to day-to-day operations.
CBR has reported in the past about St Helens & Knowsley Teaching Hospitals NHS Trust switching to electronic patient health records and the use of digital dictation systems at Guy’s and St Thomas’ NHS Foundation Trust.
Recently CBR was invited to see how Cambridge University Hospitals NHS Foundation Trust is using business intelligence software to improve performance and efficiency throughout Addenbrooke’s Hospital.
"Hospitals are large, complex organisations. Apart from running it like a 1,200 bed hotel, which is difficult enough, most of the patients that are here have their own individual problems. It’s incredibly difficult to efficiently and effectively manage a budget of £550m and 7,000 staff and around 500 doctors, all with their own subspecialty," Dr Gareth Goodier, chief executive of Cambridge University Hospitals NHS Foundation Trust told CBR.
"Without having help to understand what’s going on at a micro level you are lost," he added. "The NHS has been managing blind for a very long time and it’s only in the very recent years that we’ve started to understand how we spend all that money."
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Help has come in the shape of a BI (or business discovery, as it is being called here) platform from QlikView that enables workers – from bosses down to Ward managers and nurses – to view staff performance and patient satisfaction from across the hospital.
"To me this approach represents a huge step forward in enabling both the management and the clinical management – the doctors and nurses that lead the teams – to be able to understand where the potential improvements can be, whether that’s the patient care, the experience or the outcomes," Dr Goodier said.
QlikView Business Discovery pulls information from a number of different sources throughout the hospital and presents it to staff from a single dashboard, customisable depending on what data the user needs to see. It uses in-memory and compression technology to ensure the data is displayed as quickly as possible.
It can display information on patient satisfaction, ward cleanliness, the number of sick days taken or just about any other metric bosses need to access.
Dr Goodier used the example of cataract operations to demonstrate exactly how the technology is being used. Using data from 2007 the Hospital discovered a wide variation in the number of patients being treated as day cases, ranging from 26% for one surgeon to 95% for another. Keeping patients in overnight is expensive, so the Hospital wanted to get as many in and out in a day as possible.
"You have to know where every individual consultant’s performance is," Dr Goodier explains. "So after a bit of feedback the surgeon that was at 26% went up to 85%. How do you manage that if you’re dealing in paperwork? Most Trusts have this information but they can’t get into this level of detail because it’s all on paper."
This view was backed up by Deborah Spencer, Divisional Nurse at Addenbrooke’s. "It used to be done on paper and from lots of different places so the information you’d work with was often out of date and irrelevant. Now it’s done in real-time," she said.
It took around 18 months for members of staff to become familiar and comfortable with the system and to trust the results it produced, Dr Goodier claimed. Eventually, however, clinicians at the hospital voted to include names against results, which meant their colleagues could compare figures against their own. This was, Dr Goodier suggests, an example of the cultural change the software has produced.
"It’s been a five year process to get every senior staff member engaged and involved," he told CBR. "On every ward now there is a board that shows various scores that the public can see. It holds the staff to account for the performance of that team. The hope is that the team is driven to improve performance because of the shame of having the wrong numbers up there."
Using this sort of technology has saved the Trust the equivalent of 25% of its bed capacity – meaning that beds can be backfilled, removing the need to build a new hospital, Dr Goodier said. He reckons that wide-spread adoption of this sort of data sharing technology could save the NHS £5bn over five years.
"The software itself doesn’t [make the change], but it highlights where you should put the effort to drill down and focus," Dr Goodier concluded.
