1. Big action please, not big data informatics event
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8 December 2016

2. Welcome and introductions
David Clayton-Smith – Chair, KSS AHSN

3. David Clayton-Smith – Chair, KSS AHSN
What?
Bringing people together who are passionate about Informatics in health and social care
To improve performance within health and social care
Why?
Improve data led decision making
Create closer working relationships
And not!!
to keep central government informed about historical performance
surviving simply on experience and gut feel
David Clayton-Smith – Chair, KSS AHSN

4. David Clayton-Smith – Chair, KSS AHSN
How?
Use of data, not the creation of data
Information management not Information Technology
Ultimately transform data into intelligence and action
Creating a community of best practice amongst informaticians, analysts and anyone interested in healthcare analytics
David Clayton-Smith – Chair, KSS AHSN

5. Setting up communities of practice and professionalising analytics Richard Lee-Wright - Head of Informatics, KSS AHSN Amanda Grindall – Director, KSS Leadership Collaborative

6. The Role of Generalist Analytical Practitioner
Paul Stroner
Head of Analytical Research
8 December 2016
Title slide with embedded images

7. There is nothing more important
"A person without data is just another person with an opinion” or
“Without data, you’re just another person with an opinion”
WH Demming
“Without analytics you are just another person with data and an opinion”
PL Stroner

8. Analyse this • Accounting analyst, • Business analyst, • Cost analyst,
• Financial analyst,
• Industry analyst,
• Marketing analyst,
• Quantitative analyst
• Chemical analyst
• Colour analyst
• Handwriting analyst,
• Intelligence analyst,
• Mathematical analyst,
• News analyst,
• Psychoanalyst
• Public analyst,
• Public policy analyst,
• Systems analyst
• Web metrics analyst

9. Define the role The term analyst is too generic to have any meaning
We need a better way to describe what we do
We have tried before
Please do not describe me as an Informatician
We need to break out of the “Admin and Clerical” perception

10. Some useful definitions
Analytics helps decision makers to determine risk, weigh outcomes, quantify cost and benefits associated with decisions
Analytics is the use of skill, technologies and practices to explore and investigate performance, gain insight and drive decision making
Operational Research (OR) is the use of advanced analytical techniques to improve decision making. It is sometimes known as operations research, management science or industrial engineering.

11. What’s in a name? Analyst Data Information Statistician Economist
Accountant
Operational Researcher
Management Scientist
Data Scientist
Sub–specialisations of
General Analytical Practitioner

12. Career Pathway ?

13. Skills and Competency Framework
NHSE have been leading on a piece of work to create a nationally recognised skills and competency framework;
This has been developed with input from a number of ALB’s;
PHE
NHSD
HEE
NHSI
AphA also involved

14. NHS E commitment to analysts
The senior team has already agreed:
50 hours CPD in work time for every NHS Analyst
CPD should be logged routinely
CPD will increasingly become part of delivering the work programme
Location of vacancies will be actively considered rather than assumed on advert.

15. What the aspiration is
Becoming a professional workforce that can clearly demonstrate capability and articulate what it means to:
Be an analyst in the NHS
Be an analyst of a particular pay band
Be a subject matter expert
Have the skills that add the most value to the organisation we are in
Influence and support evidence based decision making

16. Framework – what the skills are
There are a mix of core skills, optional skills and specialist skills
Example core skills – critical thinking, quality assurance and describing data
Example optional skills – knowledge of commissioning process and incorporation of that knowledge into the analytical work programme (other options are policy and strategy development and provider development)
Example specialist skills – NHS Informatics (UKCHIP) government skills frameworks, public health analytics
1 Context &
Strategic skills
2 Data skills
3 Quantitative
skills
4 Qualitative
5 Consultancy
6 Innovative /
Anticipative
Skills
core
optional

17. Where the lines are drawn
Describing a skill set obviously means saying
We’d expect certain skills at certain levels
Generally the progression is
Working under direction
Working with supervision
Working applying own judgement
Being able to mentor or coach others
Being able to manage and deliver
Being able to lead and place work and resources strategically
We also need to articulate what it is to be an subject matter expert and being able to reward specialist knowledge and skills as something separate from management responsibility

18. A glimpse into the future
Who has heard of Big Data?
Who knows what it really is?
Business think “big data” means data analytics. It has nothing to do with the size of the data.
Technologists think “big data” means data that is too big to be processed by a normal computer.
Who employs any data scientists?

19. Sexiest job in the 21st Century
The Hot Job of the Decade
Hal Varian, the Chief Economist at Google, is known to have said, “The sexy job in the next 10 years will be statisticians. People think I’m joking, but who would’ve guessed that computer engineers would’ve been the sexy job of the 1990s?”
“Data analytic talent is not new. Statisticians, database marketers, and PhD quantitative analysts have long been a staple of sophisticated marketing organizations and have played critical roles in financial engineering. But all too often these same individuals have been relegated to the side-lines.”

20. Data Science

21. Analytical Maturity

22. Applications in Oncology
Is Big Data analytics the secret to improving cancer treatment?
The American Society of Clinical Oncologists believes that advances in cancer treatment will only emerge if oncologists and researchers can access, search, and utilize all of the information that exists on the disease. To achieve this goal, ASCO teamed with SAP to create CancerLinQ, a rapid learning health system for oncology.
Monitoring clinical quality measures in real time - continually tracking performance to prospectively improve the quality of care
Considering trends that could improve care - gaining insights from de-identified data on thousands of patients
Identifying groups of anonymous patients with shared characteristics - making it possible for physicians to understand how other patients similar to theirs were treated
Making better use of EHRs - by creating, for example, a personalized patient timeline that provides a visual snapshot of a patient's treatments, side effects, and outcomes

23. Applications in Cardiology
Case study: Big data improves cardiology diagnoses by 17%
Big Data in Cardiology: A Paradigm Shift?

24. Big Data in health will help…
prediction of risk and resource use, i.e. readmission and costs of care
population management - monitoring, case finding, might be able to detect e.gg who would develop diabetes and heart failure, even earlier
drug and medical device surveillance - better job at detecting safety signals
precision medicine and decision support - ‘-omics’; dec support, prescriptive, specific drug for specific patient
quality of care and performance measurement - casemix, real time
public health - health behaviours
research applications - methods, validation - still much to be done on better methods and approaches cannot understate validation

25. Can we do it?
The NHS needs Big Data analytics to survive so what is stopping us doing it?
We have a lot of data BUT do we have a lot of the right data ?
Trust of the public
Care.data has not helped
Lack of recognition of the potential value that it can bring
Lack of appropriate skills in the public sector
NHS is naturally conservative in the adoption of new technologies or approaches
No centralised NHS analytical function

26. Refreshment break

27. Informational led operational change Marc Farr, Director of Information, EKHFT Ben Rosling, Emergency Care Programme Director, Croydon University Hospitals

28. LEARN. ENJOY. DO GOOD.

29. “Information led operational change”
Why is it important?

30. INFORMATICS VERSUS OPERATIONS

31. WE BELIEVE -IN THREE LAYERS OF INFORMATION
Real-time mobile push alerting
Business Intelligence Layer
Analyst Resource
Executive
Operations
External

32. Information Ecosystem
Mobile
Automated Report Dissemination
Self Service Business Intelligence Tools
Analytical Support, Report Writing & National Uploads
PAS Source Tables & Data Entered on PTL
Push
Alerting
Framework
Directing

34. LEARN. ENJOY. DO GOOD.

35. “The Edgecombe Unit Case Study”
Ben Rosling
Emergency Care Programme Director
CHS NHS Trust

36. SETTING THE SCENE High attendance for a DGH (350- 400/ 24hrs)
High conversion rates of attendance to inpatients episodes (>29%)
Reactive bed management
Inappropriate use of the Acute Medical Unit beds
Large numbers of day 0 and day 1 LoS admissions
Poor patients experience
Poor clinical outcomes
High volume of reattenders and readmissions

37. BACKGROUND
Can’t get to the Edgecombe Unit without talking about the Acute Medical Unit and historical “front end” flow
Previously an Out-lying ward run by staff grade doctors
Resulting in late patient reviews
poor care, increased patient morbidity, long LOS, poor out-of-hours care and some serious incidents
Poor education for juniors and falling staff morale
Bed modelling and internal waits
Clinical vision

38. THE PROBLEM AND PROVING THE PROBLEM
Data collection (CERNER)
Proving cost
Demonstrating true activity
Weighting man hours spent
Pathway vs Process
Service already being delivered

39. IDEA FOR THE EDGECOMBE UNIT
Co-location of existing services to improve use and patient experience
Expansion of AECU ( Ambulatory emergency Care Unit) – due to increasing number of referrals and pathways
Development of a new services in the form of:
RAMU – Rapid assessment Medical Unit
ACE Unit – Acute Care of the Elderly Unit
Re-location of CRT (Croydon Respiratory Team)

40. THE EDGECOMBE UNIT

41. THE ETHOS OF EDGECOMBE (RAMU)
Create a Unit for review and assessment prior to senior medical decision to admit
Take patients directly from GPs rather than board them in ED
Early decision on which ward is appropriate for which patient
Ensure AMU is used as a Short stay ward to create daily capacity and flow
Appropriate specialty input early to facilitate early discharges
Increased Consultant activity with increased hours to 9am to 9pm to match ED patient attendance
Direct referrals from clinical streamer in ED for patients referred by GP who attend ED
Direct GP access to Medical Consultant via mobile to discuss patient admission

42. THE EDGECOMBE UNIT

43. PATIENT FLOW THROUGH THE UNIT
GP referral
Telephone Triage by AEC Consultant
9am – 6 pm
Accepted
Ambulatory patient
Medically accepted for admission/assessment (on call team)
AEC
Ambulatory care pathway
Unstable patients
A&E/AMU/HDU/ITU for on-call team assessment
RAMU or ACE unit
Advice

44. THE EDGECOMBE VISION
The vision was that rapid review and decision making will:
Ensure early decision about outcome and hence appropriate ward destination
Ensure early discharge with appropriate specialty f/up
Increase use of ambulatory processes to reduce in-patient bed needs
Reduce LOS in the medium/ long term
Improve patient experience

45. SO THE SUCCESS Since opening:
Over 28,000 patients have visited the unit
57% of patients have completed their pathway within the unit
Circa 20% reduction in the number of medical admissions (12-18 per day)
Best performing NHS Trust against the 4hr target in London on 17 occasions
On a national scale, top quarter for initial 10 months, 2 years ago = bottom 10

46. LENGTH OF STAY Trustwide LoS 5.4 days 2015/16 4.5 days 2016/17
Medical LoS
6.7 days 2015/16
5.4 days 2016/17
Care of the Elderly Los
4.6 day reduction within 1st year

47. IMPACT
Ambulatory Care activity up 100%
20% reduction in medical admissions
39 unfunded bed reduction
Stabilised performance, currently at 93.72% against trajectory
We only admit patients that need to be admitted
We ensure that patients are treated in the right place and first time
Quality of care and access to senior decision makers
Managing Winter:
“This winter was the safest pressure period we have faced from a clinical perspective for our patients since I have worked in the Trust“

48. WHAT HAS UNDERPINNED THE TRANSFORMATION?
“A clinical vision driven by”
# data into action

49. LEARN. ENJOY. DO GOOD.

50. Breakouts Adrian Flowerday, MD Docobo
Session 1
Utilising applications and hardware to drive improvement
Adrian Flowerday, MD Docobo
Showcasing the power of data in the use of risk stratification tool and telehealth
solutions in improving health and social care
Session 2
Case studies for utilising information to create operational improvement
Ben Rosling, Emergency Care Programme Director, Croydon University Hospitals
Case study: Croydon Healthcare Services. Implementation of live ED reporting across a large Cerner site in south London, covering inpatient metrics as well as Emergency Department metrics.

51. Lunch and networking

52. Graduates into Health: IM&T Graduate Pathway Programme
Louise Brennan, Programme Manager Health Innovation Network

53. Graduates into Health Successes to date: Working in partnership with…
NHS organisations benefitting…
Successes to date:
70 Graduates placements across the health & social care system
97% success rate from interview to appointment
96% retention rate

54. IM&T Graduate Pathway Programme
IM & IT recruitment- Graduate roles
Year 1: Band 4 / 5 Roles
CPD Apprenticeship Programme
Year 2/ 3: Band 6 Roles
CPD Apprenticeship Programme
Year 3/4: Band 7 Roles
CPD Apprenticeship Programme
replacement of contractors

55. The issue: “a successful digital strategy must be multifaceted, and requires workforce development”
Identified issues within NHS IM&T Workforce:
NHS struggles to recruit and retain the calibre and number of staff in information management and technology it requires to support service delivery leading to:
The lack of successful digitisation of healthcare
Recruitment challenges creating disproportionately high expenditure on agency staff costing NHS organisations millions every year
Organisations face cultural challenges with transient contractor staff. Transient teams create barriers to coaching and development opportunities so permanent staff lack access to clear, established career development pathways - a vicious cycle of managers not being able to recruit permanent staff and a continued reliance on contractors
Therefore, a key recommendation from Wachter review is:
“There is a need to strengthen and grow the CCIO field, others trained in clinical care and informatics, and health IT professionals more generally” (2016)

56. Health IM&T Graduate Pathway Programme – model and timeframes
Stage 1. Oct – Nov 16
Trust requirement gathering
Number & roles
Contract length
Training for each role established
Stage 2. Jan – Feb 17
Creation of an IT graduate pool
Career Fairs
Faculty engagement
Attending lectures
Stage 3. March - June 17
Recruitment of graduates
Advertising roles, assessment centres / interviews
Stage 4. July 17
Graduates in post across the system ( Band 4 / 5 )
Start new role with employer
Graduates start training plan ( after 3 month trial period )
Stage 5. July 18
Graduates upskilled though CPD plan promoted to Band 6
Stage 6. July 19 / 20
Graduates upskilled though CPD plan promoted to Band 7

57. Health IM&T Graduate Pathway Programme CPD element – apprenticeship
Apprenticeship programme – Data analyst Level 4 ( 24 months )
Typical Job Roles: Data Analyst, Data Manager, Data Scientist, Data Modeller, Data Architect, Data Engineer
Example Technical Competencies
Identify, collect and migrate data to/from a range of internal and external systems
Interpret and apply the organisations data and information security standards, policies and procedures to data management activities
Perform database queries across multiple tables to extract data for analysis
Use a range of analytical techniques such as data mining, time series forecasting and modelling techniques to identify and predict trends and patterns in data
Summarise and present the results of data analysis to a range of stakeholders making recommendations
Off the job training: 4 day induction, 5 day module 1, 5 day module 2, 3 day revision for End Point Assessment and Interview, 4 days EPA and One hour Interview with BCS

58. Where are we now and next steps
Trust & CCG appetite testing
Engagement to date:
South London
Kingston Hospital, Guys & St Thomas’, Lewisham & Greenwich CCG, Lewisham & Greenwich Trust, Oxleas, South London & Maudsley
Kent, Surrey & Sussex
Surrey and Borders Partnership NHS Foundation Trust
Expressions of interest from all organisations across London, and Kent Surrey & Sussex
Contact details:

59. Analytical Capacity and Capability in the NHS Professional Development in Analytics
Paul Stroner, AphA Chairman
The Association of Professional Healthcare Analysts is in part supported by the Health Foundation. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK.

60. Houston - we have a problem!

61. STATISTICAL ANALYSIS AND DATA RECONFIGURATION
THE PERCEPTION
STATISTICAL ANALYSIS AND DATA RECONFIGURATION
What is Chandler Bings job?
Its something to do with processing……
and numbers
He carries a briefcase
It has something to do with transponding
Oh oh oh he’s a TRANSPONSTER !!
EXECUTIVE
TRANSPONSTER

62. THE PERCEPTION Anyone can do information!
How hard can it be to drive a spreadsheet?
What is an analyst?
What skills do you need to become one?
Who dreamed about becoming an NHS information analyst?
If you are one – what does your career pathway look like?
Putting the anal into analysis

63. THE NHS ANALYST Highly Intelligent Master of their own environment
Struggles to succeed outside of it
Finds it difficult to communicate with human beings

64. Provision of False or Misleading Information is now a criminal offence

65. Validation & Regulation
PROFESSIONALISM
Practice
Standards
Behaviours
Ethics
Development
Registration
Developing Skills
Recording Skills
Proving Skills
Validation & Regulation
“Doing the Right Thing…
When No-one is Looking”
“You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.”

66. Health & Social Care Informatics “Re-Energising the Profession”
Provides Leadership
Acts Independently
Representation
Reputation
Knowledge Base
Professional Standards
Personal Development
Code of Ethics
Publicly Open Register
Regulates Bad Practice

67. BACK TO THE FUTURE Big Data – its coming how do we react to it?
The Internet of Things is here;
Wearable devices, 24/7 monitoring;
Sensor-driven decision analytics in real time
The Intelligent House is here;
Remote monitored independent living
In the NHS today I can’t tell you how many people are in hospital with MS who were admitted for a (preventable) UTI.
“How it is we have so much information, but know so little”
Chomsky

68. NO MORE SHRINKING VIOLETS
The time has come for NHS analysts to up their game;
Need to be recognised as a professional group;
Need to be the masters of their own destiny;
Need to be making the case for having information specialists at the decision making table;
Need to convince those holding the purse strings that the investment is worth it.
“That’s the standard technique of privatisation; defund, make sure it doesn't work, people get angry and you hand it over to private capital” Chomsky

69. Who Are We?
An Association of public sector analytical staff who are working in the health care sector;
Formed in 2012 by a group of enthusiasts keen to promote the role and profile of health and social care;
We are an Association in out own right and are not attached or affiliated to any other organisation;
We have a membership of approx. 200, predominantly from the South West
Regional branches for
South West
South
East Midlands
Primarily funded by membership subscriptions, and a grant from the Health Foundation

70. What are we trying to achieve?
Support information specialists/analysts working across the healthcare sector;
Promote best practice and innovation amongst all NHS staff involved in analysis and interpretation of data;
Support professional and personal development;
To promote the highest standards in healthcare analysis;
To promote the development and recognition of healthcare analytics as a profession;
To develop links with other analytical professional bodies for mutual benefit and synergy;
Develop a truly nationally representative Association.

71. What Are The Benefits for Members?
Membership of AphA brings many benefits in the form of professional support and personal development through sharing of experience and knowledge to promote the highest standards in healthcare analysis.
Regional meetings – Meet with like-minded professionals to hear from guest speakers, share knowledge and develop networks;
Discounts – Attend annual conference at the member rate;
Website – aphanalysts.org – keep updated with news, book events, source material within the members area;
Newsletters – AphA members receive regular newsletters;
On-line resources – free access to members to SAS University edition, and a range of on-line training resources. You cannot get access to this anywhere else without buying SAS;
Workshops – AphA members to receive priority booking at technical workshops;
Awards – work and talent recognised via annual awards.

72. Website

73. “The breakout sessions were a great opportunity to learn more about how national organisations within the NHS family work and how their work impacts locally.”
“All the talks were really great and diverse. Good speakers. Having been to some (not AphA) with bad speakers, this is really important. I would recommend to colleagues.”
“The opportunity to network. The positive approach from the chair and other members to improve analysts throughout the NHS.”
“The whole day has been very useful - with key points from each of the speakers which I can apply back in workplace. Interesting and good presentations from all speakers.”
“I'm really interested in all the career development and accreditation/analyst registration information as I firmly believe this is the direction we HAVE to go in. Love the marketing - the dolphins and the badges.”

74. Its up to you Don’t be a benign recipient
Take responsibility for your own career
Create your own future
Only as good as the membership makes it
Establish a local branch

76. Knowledge Base - Setting the scene
Marc Farr, Director of Information, EKHFT

77. LEARN. ENJOY. DO GOOD.

78. Table discussion

79. What is the best way to set up an analytics community of practice in the South East?
Who should be involved and how do we get them involved?
What tools and knowledge base can be drawn upon?

80. low us on Twitter @KSSLWFL Kate Cheema - Quality Observatory
Plenary
low us on
Kate Cheema - Quality Observatory

81. Summing up and close Website http://www.kssahsn.net
@KSSLWFL