Quality and Risk Profiles by sdfwerte

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									Quality and Risk Profiles



 Richard Hamblin October 2009
                  QRPs
• What are they?
• Who‟s doing them?
• What will they do – for registration and
  beyond?
• What do we need to do now to deliver?
• (What will they look like?)
                What are they?
1.   A way of gathering all we know about organisation
2.   so as to assess risk and thus prompt front line
     regulatory activity
3.   And allow the judgements of this activity to be made
     robustly and add to the knowledge base
4.   Critically, it builds over time and is never “perfect”
5.   This is essential to support registration (or more
     specifically the ongoing monitoring of compliance
     following registration) but, because information can be
     used flexibly later versions could be focused on
     different issues
          Three distinct things
1. Harvesting of different types of information;
   organising this according to a classification
   system relevant to purpose; and managing the
   flows.
2. A method for calculating risk and presenting
   findings in a way that front-line staff can use
3. A way for frontline staff to interpret the profile,
   use this to make decisions about what to do in
   response; make judgements and ensure that
   these are included in our knowledge base and
   are reflected in the profile.
                                                                                                                   Direct data collection
Flow diagram of the QRP
  Data harvesting – passive /active, surveys, datasets, comments, infocab sweep                                         Data from                           Q&RP system
                                                                                                                        providers
      Significant         Info from people with              Info from            National
      compliance          experience of service            stakeholders         information
        event
                       Surveys        Comments            Comments   Findings   Public   ISAs                                                               Periodic   Local
                                                                                                                        Application                         Review     Flavour




                                                                                                                                               Experience




                                                                                                                                                                                     QoL
                                  Prompted   Unprompted
                                                                                                                                                                   IR
                                                                                                                        Monitoring
                                                                                                                        declarations                          Registration

                                                                                                                        Variation
                               Map to regs / outcomes / provider taxonomy
                                                                                                                                                                                 Inherent
                                                                                                                                                                                   risk

                                      The                 Knowledge
                                    register                                                                        Compliance
                                                            base                                                    risk by UoA

                                                                                                Drill down
                                                                                                                    Activity log
                                                      Intelligence system                                                              Contains
                                                                                                                    & context
                                                                                Public
                                                                                                                    Concerns /
                                                                                information
                     CQC                                                        website
                                                                                                                    regulatory              Registration “core” of Q&RP
   Additional                                                                                                          plan
                 findings and                                Publication
      local
   evidence/
  intelligence
                 judgements
                   on quality

                                                                                                             Decision
                                                     Activities in
                       Decision                      response to                                        Complex and hackneyed by use
                                                     view of risk
                                                                                                        What does this really mean
                                                      Decision audit trail

Workflow support system
1 – INFORMATION MANAGEMENT




    Data harvesting – passive /active, surveys, datasets, comments, infocab sweep                Q&RP system

        Significant       Info from people with               Info from            National
        compliance        experience of service             stakeholders         information
          event
                                                           Comments   Findings   Public   ISAs
                         Surveys       Comments

                                   Prompted   Unprompted




                               Map to regs / outcomes / provider taxonomy


                                       The                 Knowledge
                                     register
                                                             base
                                                       Intelligence system
2 Risk calculation and presentation
                                                      Q&RP system




                                                      Periodic   Local
                                                      Review     Flavour




                                         Experience




                                                                               QoL
                                                             IR
                                                        Registration



                                                                           Inherent
                                                                             risk

                   Compliance
                   risk by UoA

      Drill down
                   Activity log
                   & context      Contains


                   Concerns /
                   regulatory        Registration “core” of Q&RP
                      plan
                                     3 Judgement framework




                                The        Knowledge
                              register                                              Compliance
                                             base                                   risk by UoA

                                                                Drill down
                                                                                    Activity log
                                                                                    & context

                                                                                    Concerns /
                                                                                    regulatory
                   CQC                                                                 plan
 Additional
    local      findings and
 evidence/
intelligence
               judgements
                 on quality

                                                                             Decision
                                         Activities in
                   Decision              response to
                                         view of risk
                                         Decision audit trail
               Versioning
• This a long term project to get to work
  effectively and its project should be at the
  heart of our information strategy
• The demands of registration (its initial use)
  are much shorter term
• The solution is versioning
                               Versioning
• Version 0.1 and 0.2 – NHS registration (by January 2010) and IHC/ASC (BY
  April 2010)
    – Compendia of relevant previous judgements to support the process of initial
      registration and re-registration

• Version 1.x – NHS ongoing monitoring – April 2010
    – Draws heavily from existing data, systems and risk methodologies
    – “A proof of concept”
• Version 2.x – Social care and IHC registration –October 2010
    – More dependent on qualitative information
    – May need slightly different risk calculation
    – Issues of scalability

Future developments
• Version 3.x- 3.n – fully productionised system, other cuts of information (e.g.
  safety, dignity of care etc etc) from 2011 onwards
What do we need to do now to
          deliver?
                                                1 information management
                                                                                           Mix of qualitative and quantitative data
Major task to identify available data                                                      different for Social Care, NHS, and IHC
and required data – and the gaps between!                                                  Need for a different balance of IM
                                                                                           and analysis skills


           Data harvesting – passive /active, surveys, datasets, comments, infocab sweep                                      Q&RP system

               Significant       Info from people with               Info from            National
               compliance        experience of service             stakeholders         information
                 event
                                                                  Comments   Findings   Public   ISAs
                                Surveys       Comments

                                          Prompted   Unprompted



                                                                                                          The taxonomy is how we
                                                                                                          organise our information
Getting qualitative data                                                                                  by defining to what it
into the knowledge                    Map to regs / outcomes / provider taxonomy
                                                                                                          refers; to who it refers and
base requires some                                                                                        whether it is good or not –
combination of manual                         The                 Knowledge
                                            register                                                      this is the essential first
and automated search,                                               base                                  step for managing our
classification and                                                                                        information and supporting
tagging – potentially                                         Intelligence system
                                                                                                          risk assessment
resource heavy                    We can build on existing COMPASS
                                  System to house knowledge base for
                                  version 1 – not clearly scalable for a huge
                                  number of providers
    Using qualitative info in a model is complicated
               MaxQDA
                                                 • Qualitative to quantitative
Organisation




                                                 • Intelligent interpretation and




                         Text of document read
Source by




                                                   coding




                         and code applied
                                                 • Key to patient experience
                                                 • Developed excellent
                                                   consistency and efficiency
                                                   but resource intensive
system




                                                 • Need a step change in
Code




                                                   analysis and sourcing
               InfoCab
                                                 • Quantity to quality
                                                 • Multiple potential sources
                                                 • Large volumes of information
                                                 • Requires intelligent answers
                                                   for wide range of users
                                                 • Hides significant complexity
                                                 • Move from reactive to pro-
                                                   active?
                         2 Risk calculation and presentation

                                                                                                This selection of cuts
                                                                                  Q&RP system
                                                                                                is purely illustrative


                                                                                  Periodic   Local
A method of calculating risk required                                             Review     Flavour
Can build on the “screening approaches




                                                                     Experience




                                                                                                           QoL
                                                                                         IR                          Inherent risk
-but the are alternatives which we                                                                                refers to what a
                                                                                    Registration
should investigate for version 2.0 onwards                                                                         provider does,
(particularly if we have a majority of qualitative                                                                    its particular
data)                                                                                                  Inherent    conditions (e.g
                                                                                                         risk
                                                                                                                          financial,
                                               Compliance                                                              managerial)
                                               risk by UoA
                                                                                                                   and the nature
                                  Drill down
                                               Activity log                                                          of those they
                                                              Contains
                                               & context                                                                    provide
                                               Concerns /                                                               services to
                                               regulatory        Registration “core” of Q&RP
                                                  plan



  What the QRP actually looks like
  (design of the report) is critical to its
  Successful use and adoption
                                           3 Judgement framework

Judgements in themselves
form additional intelligence
that need to be included in
the knowledge base. They
need to both a/ „turn off‟
individual risk alerts and b/
be analysed to identify                The        Knowledge
                                     register                                              Compliance
where alerts are                                    base                                   risk by UoA

consistently misleading and                                            Drill down
                                                                                           Activity log
alter the risk model                                                                       & context
accordingly                                                                                Concerns /
                                                                                           regulatory
                            CQC                                                               plan
            Additional
               local    findings and
            evidence/
           intelligence
                        judgements
                          on quality

                                                                                    Decision
                                                Activities in
                              Decision          response to
                                                                        The QRP is designed to prompt
                                                view of risk
                                                                        action, NOT direct it – it requires
                                                Decision audit trail
                                                                        a decision by front-line inspection
   A judgement framework needs to be put in                             staff about what to do in response
   place to support consistent regulatory
   judgements
What will they look like?
Quality and Risk Profiles for Registration:
       First draft of potential format
Level 0: Corporate, drill down to unit of assessment (UoA)
   Provider:
   Melchester Hospitals NHS Trust
                                                                       Provider ID: AAA42

    Services:
      Maternity                                  Registered 1/4/2010
      A&E                                        Registered 1/4/2010
      Surgery                                    Registered 1/4/2010
      Diagnostics                                Registered 1/4/2010

   Regulated activities:
      Maternity and midwifery services
      Surgical procedures
      Diagnostic procedures
      Treatment of disease, disorder or injury

   Provider level concerns:
       Something ORP like in this box??
Level 1: Registration summary for UoA
  Provider: Melchester Hospitals NHS Trust
  Service:
                                                                                        Provider ID: AAA42
  Melchester Hospitals Maternity Service
                                                                                        Service ID: ZZ3456
   Sites:
      Melchester Hospital                 30 beds       1 Melchester Road, Melchester MC4 RR1
      Kingsbay                            10 beds       42 Kingsbay Ave, Kingsbay MC1 AA1
   Regulated activities:                                                                     Registered 1/4/2010
      Maternity and midwifery services

   Risk profile:
            Involvement and information             Personalised care, treatment and        Safeguarding and safety
                                                                support
             ●●●●○○○○○○                                                                  ●●●○○○○○○○
                                                        ●●●○○○○○○○
               Suitability of staffing                 Quality and management           Suitability of management


             ●○○○○○○○○○                                 ●●●●●●●●○○                       ●●●○○○○○○○
                   Inherent risk                             Situation risk                     Population risk


                       High                                       Low                                Low



   Recent activity:
       Inspection around Quality and management                                                       16/5/2011
       Annual compliance declaration received                                                         5/1/2011
       Application for removal of condition received                                                  23/11/2010
Level 2: Regulatory theme level
  Provider: Melchester Hospitals NHS Trust
  Service: Melchester Hospitals Maternity Service

   Personalised care, treatment and support                                         Personalised care, treatment and
                                                                                                support

                                                                                        ●●●○○○○○○○
                                                                                                                 View
                                             Judgement           Performance Risk      Uncertainty Risk          more

                                        What we said last time           What we think now
    R07: Care and welfare of
    people who use services
                                        Compliant                   ●○○○○                     Low

    R12: Meeting nutritional
    needs
                                       Almost met                   ●●●○○                   Medium

    R22: Cooperating with
    other providers
                                        Compliant                   ●●○○○                     Low
Level 3: Regulation level
   Provider: Melchester Hospitals NHS Trust
   Service: Melchester Hospitals Maternity Service
   Theme: Personalised care, treatment and support

    R22: Cooperating with other providers
     People using the service:
      • Receive safe and coordinated care, treatment and support when more than one provider is involved, or when they move between
      services.

      This is because providers who are compliant with the law will:
      • Cooperate and share information with others involved in the person‟s care, treatment and support while having regard to peoples‟ rights
      to confidentiality. This occurs when:
      – they are either sharing responsibility or transferring responsibility for care, treatment or support
      – they work together to respond to emergency situations
      – the person is supported to access the health and social care services they need.
                                                            Judgement                        Performance Risk              Uncertainty Risk
       R22: Cooperating with
       other providers
                                                      Compliant                                    ●●○○○                            Low

   Performance Risk
               Personalised care                                     Information                                       Risk Management

            ●●●○○○○○○○                                           ●●●○○○○○○○                                      ●●●○○○○○○○
       Prompt                                                                                                                Risk
       There are 2 items from Survey of NHS Staff relating to partnership working. Of these, 2 items (100%) are much
       worse than expected (using data from 2008 to 2009).                                                                   ●●○
       There is some triangulation between the 5 independent sources relating to partnership working, with 2 of them
       (40%) having at least one item that was much worse than expected (using data from 2007 to 2009).                      ●○○
                                                            See full data set for R12

   Uncertainty Risk
       The last inspection in this area was over two years ago                                                               ●●○
       There are 13 data items related to this area                                                                          ●○○
Level 4: Underlying data level
   Provider: Melchester Hospitals NHS Trust
   Service: Melchester Hospitals Maternity Service
   Theme: Personalised care, treatment and support

    R22: Cooperating with other providers
             Personalised care                         Information    Risk Management

           ●●●○○○○○○○                                ●●●○○○○○○○      ●●●○○○○○○○
    Personalised Care




   Information



            etc

								
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