Published in 2015, the Carter Review was the latest independent review of NHS efficiency and productivity. Given the news headlines we are all now so used to seeing about the NHS, it's findings were not surprising - increased demand from an aging and growing population and a decrease in real-term funding means the NHS is currently going through its hardest ever times. Any opportunities the NHS has to save money on operational tasks that could instead be refocused on patient care should be taken. The report highlighted the places where the NHS could save significant amounts of such monies, and the importance of doing so at a time of unprecedented pressures on the NHS.
The subtitle to the Carter Review was Unwarranted variations. In this context what Carter meant by such unwarranted variation was the wide, unjustifiable cost disparities across acute NHS Trusts. Taking medicines costs as an example, the most expensive Trusts spends more than 2.5 times more on medicine than the least expensive Trust. The report states that, if the procurement and management of resources such as medicines, estates & facilities and the patient pathway become more standardized across Trusts, the NHS could save up to £5bn by 2021. At the same time, the report argues that such savings need not made by sacrificing the quality of patient outcomes
'There is strong international evidence that good hospital management can deliver both improved clinical outcomes and productivity.'
Those familiar with six sigma, lean and similar statistical process control based methodologies will understand that Carter's discussion about controlling for unwarranted variation has its roots in the US in the 1930s. The concepts of Walter Shewhart and his one-time student William Edwards Deming were key to the step-change in the efficiency and quality of manufacturing industry achieved by Japan in the post-war years up until the turn of the 21st century. Over the last 25 years Shewhart's and Deming's concepts have been steadily diffusing into the provision of clinical care. Protagonists such as Donald Berwick, President Emeritus at the Institute for Healthcare Improvement have led the way here, and are continuing to do so as quality assurance methods are increasingly embedded into standard ways of working across healthcare economies such as the NHS.
Carter discusses how digital technologies should be used to help NHS organisations embed the working processes that can reduce unwarranted variations and assure quality in outcomes
'...data and information is critical for managing quality and efficiency performance across the care pathway... To truly performance manage quality and efficiency on a regular basis, seamless real-time data is needed.'
The report alludes to the challenges the NHS in England has faced when it has attempted to 'join data across boundaries' to create integrated Electronic Health Records (EHR), stating the opportunities for managing quality and efficiency using digital technologies will be greatest when this happens across the whole of the NHS
At Anabasis we are passionate about using data and information to improve the quality of patient outcomes and the efficiency and productivity of healthcare organisations. We have expertise in gleaning the knowledge from healthcare data and information that can aid the decison-making required to achieve such outcomes. We also believe that such decison-making can be aided by digital technologies, and that these technologies can be a game-changer in healthcare - intelligent data-driven web applications can be embedded into hospital workflows and used to assure quality and optimise the utilisation of resources.
While the development and utilisation of data-driven applications will be significantly enhanced by the arrival of an integrated EHR in the NHS, there is no time like the present. Real-time data is flowing around the NHS. Operational management data such as that residing in Patient Administration Systems (PAS) can be further utilised within hospitals to aid planning and decision-making.
We were really excited to win an SBRI competition to work with the Northern Health and Social Care Trust in Antrim, Northern Ireland to develop a data-driven application - PEDRO. Driven off PAS and using a combination of predictive-analytics, clinical rules and quality standards, PEDRO intelligently deploys Pharmacists and Pharmacist technicians in hospitals. Using risk-stratification and simulation of patient flows, PEDRO enables the prioritisation of patients most in need of care and aids planning for resource optimisation. PEDRO ensures that Pharmacists and Technicians are in the right place at the right time, ensuring all patients in hospital receive the care they need. Real-time reporting enables the monitoring of the provision of this care - at times of high demand for care it is possible to drill-down and determine exactly where the bottle-necks are.
While PEDRO has been developed to work for Pharmacy services dedicated within hospitals, it is a data-driven app we have designed to be configurable and usable across clinical professions. If you would like us to come and demo PEDRO for you please get in touch.
Likewise, if Carter or other such research and reports have given you an idea for how you could improve your efficiency and quality in your hospital and you need help to develop technology to enable this to happen we would be keen to discuss.