Putting the power of data to work for patients
A team of researchers and clinicians is helping analysts and decision makers in in the NHS to realise the power of data through statistical process control.
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The NHS has been working with partners to widen awareness and understanding about how to better use the power of data in performance and operational reports.
About the project
This project brought together a team of researchers and clinicians to widen awareness and understanding about how to better use the power of data in performance and operational reports.
The programme used the NHS guide on statistical process control (SPC), Making Data Count as a basis for the programme’s development. SPC is used widely in the NHS to understand whether change results in improvement. It is also used in other industries for quality control. The team wanted to explore applying this approach when considering performance and operational data.
The resulting guide provides strong evidence that better decisions are made when using SPC, rather than simpler techniques such as the long-established Red-Amber-Green (RAG) approach.
Through examples and prompts for discussion, the guide provides a step-by-step approach to the application of SPC in reading performance and operational data.
The team designed the guide for anyone reading, analysing and taking decisions informed by data. It requires no training or specialist skills in statistics.
Challenges
Shifting beyond two-point comparisons and RAG reporting
The project team recognised that traditional two-point comparison approach can lead to a number of pitfalls, including overreacting to natural performance fluctuations and overlooking the element of time. The long-established RAG approach can be overly simplistic and even misleading. A rating of green can provide false reassurance while red can mask changes that are the result of an improvement.
There can be significant risks from overreacting to data, such as instigating unnecessary and wasteful clinical audits and investigations. To avoid these pitfalls, variations in data need to be read in a way that fully considers the context in which they occur.
Embedded use of widely-trusted methods
Organisations often persist with tools like RAG because they are embedded in their ways of working. To encourage organisations to make both a cultural and system-wide shift to SPC, the team included exercises in the guide that encourage interactive, collaborative discussion between analysts and decision makers. In time, it is hoped this will foster closer, more holistic working between analysts and decision makers.
Making the case for use of SPC beyond quality improvement
Beyond the field of QI, the wider NHS can sometimes view SPC as a niche tool that is not applicable to their work. To challenge this view, the team identified specific reasons for using SPC in reading, analysing and making decisions based on performance and operational data, including:
- SPC alerts us to a situation that may be deteriorating
- SPC shows us if a situation is improving
- SPC shows us how capable a system is of delivering a standard or target
- SPC shows us if a process that we depend on is reliable and in control.
The role of data visualisation in decision making
To draw attention to the impact of data visualisation and the impact it can have, the guide includes an example of a data set presented first as a graph and then as columns of numbers.
This demonstrates how the same data presented in different ways can tell a strikingly different visual story, making it a key factor for NHS boards and decision makers to consider.
Results
Using the power of data for the benefit of patients
The NHS is seeing examples of how SPC can lead to startling discoveries about waiting lists for services such as mental health.
Dr Sally Morgan, a clinical psychologist at West London NHS Trust, used SPC in the Child and Adolescent Mental Health Team to understand why waiting lists were not coming down. SPC gave them much more insight into the data, including over time. By plotting the data points using SPC, the team discovered that referrals to the service had in fact doubled during the previous three years.
Statistical Process Control is absolutely benefitting the patient in the long run. As a result of that analysis, that that team has been redesigned and that waiting lists are coming down.
Establishing SPC champions to accelerate uptake
The team is now developing a network of skilled analysts, clinicians and managers to become Making Data Count Champions to increase the speed at which SPC is taken up across the NHS.
Champions will go through a training programme covering four areas:
- increase their knowledge and understanding of the approaches described in Making Data Count
- increase their confidence of using the tools referenced within the toolkit
- enhance their facilitation skills to enable each champion to facilitate local workshops and board education sessions
- provide them with tips and techniques for supporting effective data conversations, such as using hashtags on social media: #talkthedots
Getting analysts and decision makers to work together
The guide notes that analysts are well placed to identify how data can be presented so that it is both effective and meaningful, while decision makers are well placed to provide the wider operational context.
Too often, decision makers and analysts operate in isolation from one another, and the organisation does not benefit from their collective knowledge.
Working together, analysts and decision makers can share their insights and have a richer, more informed discussion that will lead to better outcomes.
Too often, decision makers and analysts operate in isolation from one another, and the organisation does not benefit from their collective knowledge.
By providing a set of tips on how to encourage collaboration, the guide supports decision makers and analysts to begin to work together effectively.
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