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Building capacity and leadership to identify unwarranted variation and how technology can support this.

Stacey McCann, Assistant Head of Commissioning, NHS England20 April 2016

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• What is ‘unwarranted variation?’

• How can technology enable nursing, midwifery and care staff to identify unwarranted variation?

• What is our leadership role?

Three key questions:

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‘Variation in health care delivery that does not add value to an individual’s health care, for example:• Variation in readmission rates amongst patients

discharged at weekends.• Variation in lengths of stay.• Variation in maternity care.• End of life – variation in quality of care between

geographical areas and medical conditions.• ..and so on.

What is unwarranted variation?

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- Better experiences for individuals.

- Better outcomes for individuals.

- Better use of available resources.

Triple aim outcomes.

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Commissioning for value

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The primary objective for Right Care is to maximise value:

• the value that the patient derives from their own care and treatment

• the value the whole population derives from the investment in their healthcare

RightCare - Commissioning for Value

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Five Key Ingredients:

1. Clinical Leadership

2. Indicative Data

3. Clinical Engagement

4. Evidential Data

5. Effective processes

1 key objective + 3 key phases + 5 key ingredients = COMMISSIONING FOR VALUE

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OBJECTIVE - Maximise Value (individual and population)

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What should we do?

• When faced with variation data, don’t ask: How can I justify or explain away this variation?

• Instead, ask: Does this variation present an opportunity to

improve?

• How can we utilise information technology to reduce unwarranted variation?

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‘Nurses, midwives and care staff need to integrate information and information technology into routine practice and embrace opportunities to manage care in new ways.’ (Cooper A, Hamer S (2012) Nursing Times)

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In autumn 2012 the Nursing Technology Fund was launched, dedicated capital investment was made available to support nurses, midwives and care staff to make better use of digital technology in all care settings.

The aim was;• to support staff to give safer, more efficient

and more effective care, and• to empower care professionals to engage with

technology in meaningful and helpful ways.

Nursing Technology Fund 2012

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• Electronic observation systems that allow nurses and clinicians to record clinical data at the bedside on electronic devices in real time.• Provides real time data which can support

commissioners to identify unwarranted variation in care giving.

• Digital pens for community, district nurses and midwives, which allows for captured data to be integrated into back-office patient systems.• Supports timely data collection in a formalised

way which enables comparison of like services.

Examples of new technologies:

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• Marie Curie Cancer Care - £1m to enable mobile access to digital care records, digital capture of clinical data at the point of care, and resource-scheduling software. • Provides data to support better experience,

better outcomes and better use of resources.• Devon Partnership Trust - £204K for video

consultations and remote consultations in a community mental healthcare setting.• Reduces unwarranted variation in access to

services by offering a universal service remotely.

Technology fund support:

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‘The innovation that telemedicine promises is not just doing the same thing remotely that used to be done face to face, but awakening us to the

many things that we thought required face to face contact, but actually do not.’

David D Asch MD, Perelman School of Medicine, University of Pennsylvania

Airedale and partners Enhanced Health in Care Homes

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But technology alone won't improve outcomes. For that to happen, we need nurses, midwives and care staff to lead the use of technology to support reduction in unwarranted variation.

Nursing Technology Fund 2012

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• We have a central role to play in transforming NHS services; making best use of digital solutions is a key component of this.

• As system leaders, how do we use technology to understand and reduce unwarranted variation?

What is the leadership role for nursing, midwifery and care staff?

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• We need better, more integrated and preventative person-centred care.

• As system leaders, the role of commissioning nurses is to promote the utilisation of peer comparability linked to population outcomes and demonstrate value for money in service re-design and transformation.

What is the leadership role for nursing, midwifery and care staff?

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• We need to support people in their communities and homes, reducing the need for hospital care, technology is a key enabler to make this happen.

• We must use technology to generate information, that helps us compare the triple aim outcomes with peers and embark on quality improvement and optimal pathway design in collaboration with clinicians and individuals.

What is the leadership role for nursing, midwifery and care staff?

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• We need to offer care in new ways that were not possible a decade ago and continue to support improved working practices with the potential to transform care.

• The responsibility of system leaders is to be role models and lead partners in service transformation whilst make best use of resources, enabling better outcomes and experience for individuals.

What is the leadership role for nursing, midwifery and care staff?

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• In a world where information and technology is more available than it has ever been before, we have integrated much of this technology into the way we live day to day, online banking, searching information online and planning our holidays and shopping.

• But – to meet the triple aims of better outcomes, experience and better use of resources, we need to lead the use of all available technology to reduce unwarranted variation through optimal care pathway design.

Think!