Data and analytics from “ward to board”
Wrightington, Wigan and Leigh NHS Foundation Trust serves 320,000 patients, specialises in orthopaedics, is the location of world’s first full hip replacement operation in 1960. Without experiencing a particular problem but wanting to increase the data literacy and understanding of data in the workforce, in 2009 the decision-makers at the trust bought QlikView for service level reporting.
This would be the initial step in the trust’s journey towards data-driven healthcare. Mark Singleton, acting associate manager of IM&T at the Foundation Trust, said that unfortunately, many clinicians would not engage with the technology.
"People wanted the information to make a difference."
A few years later between 2012 and 2013 the Trust brought in two programmes; one to champion data quality and the second to improve staff engagement and morale. The Quality Champions programme taught the staff how to use data and it empowered them to look for ways in which data could improve things in the organisation, while the engagement programme introduced self-assessment that was underpinned by psychology.
Singleton said that these two programme created an overwhelming hunger for more data. “People were enthusiastic, they wanted to make a difference and they wanted the information to do that.”
In 2013 they developed a Qlik application that allowed budget-holders to see their budgets in real time, instead of having to meet with people from finance once every three months with numbers on a big piece of paper.
“Budget holders could drill all the way down to an invoice level, they could see what income was coming out, where the expenditure was, their staffing cost and that was a real game changer.” Singleton added that the app was very visual and easy to use.
Between 2014 and 2017, the Trust decided to restructure its business intelligence team and moved the ‘gurus’ from the finance teams merging them with the analysts and developers who were producing clinical applications and reports. The aim of this was to maximise its investment in Qlik.
One of the apps that was developed by the reconfigured team was for the accident and emergency department, which was used to predict patient demand in that department in the days, weeks and months ahead. In the past, a lot of money was spent on agency staff as the people creating the rotas didn’t know which days would be busiest.
However with the Qlik app, using R and taking into account historic data and weather data, they were able to better predict demand. It now influences how they shape the workforce and which services they operate.
“It's been really successful. We're the top performing trust in Greater Manchester for A&E.”
Another application was developed to maximise the efficient use of the operating theatre, which Singleton described as the most expensive commodity in healthcare, as well as one to support staff working on hospital wards.
The aim of the ward app was to enable nurses and doctors to subjectively evaluate the quality and efficiency of care provided on the ward, by pulling in data from different systems in the organisation.
The trust also introduced Comm Cells or communications cells where teams would gather around a visual and tactile display of information. “With the touch screens and the apps they can still pose those questions but they can get answers to them there and then. That was another key step in our journey and learning about how to make sure information was transparent and accessible as possible.”
“We have a culture where the number is the number, no argument.”
Singleton said that the Trust also introduced the concept of a single version of the truth, to avoid figures becoming fuzzy with different people in the organisation quoting different figures and arguing about what the number is. “With applications like the theatre dashboard or the A&E dashboard, we’ve removed any other sources of similar reporting, so the application becomes the single version of the truth.”
This new way of working means that time can be spent on what really matters. Singleton said: “We have introduced a culture where the number is the number and there is no argument. And they can spend their time looking at what that number means and how can we act on it."
To make that information more portable, QlikSense was introduced so that bed managers and member of the executive team access the data on a tablet or mobile and not be tied to a desktop or laptop. QlikSense also allowed the three developers, whose workload had increased significantly, to spend more time analysing data instead of producing it.
Andrew Foster, the chief executive of Wrightington, Wigan and Leigh NHS Foundation Trust, has a dashboard in his office with data about the organisation updated in real time, rather than a week or month later. One day when the trust was aiming for 100% efficiency, Foster saw on the dashboard that there was a hold-up in the A&E department. He rushed over and found out that one patient was waiting for a cardiology opinion.
He said: “The medical director of the trust is a cardiologist. So I rang him up, he agreed to come straight to the A&E dept, saw the patient and was able to discharge him, so that was an example of using the app in real time to meet the target.”
The effect of introducing a culture of data literacy to the healthcare organisation can be seen in monetary terms as well as efficiency. Singleton stated that with a £900,000 per year investment in BI resource and £100,000 per year on Qlik support and maintenance, the trust was able to make savings of £2 million in improved theatre utilisation, between £3 million and £5 million in penalty avoidance, approximately £5 million in improved budget management, and £500,000 in improved procurement. So with an investment of £1 million, the hospital was able to save between £10.5 million and £12.5 million.
What is harder to quantity but key to the essence of a health facility is the quality of care that staff are able to offer patients, but Singleton is adament that the care has improved as a result of better data literacy. “Our staff have been able to go the extra mile for patients in the last few days of their life because they are not sat at a computer and they are not tied down producing reports."
Mark Singleton was speaking at Big Data LDN.