1. IFMH Study day – 24 February 2011 Evidence-based Information on Cost & Quality: What is needed? Dr Mahmood Adil CertHEcon, DipHInformatics, MHSM, FRCP, FFPH Fellow & Improvement Faculty NHS Institute for Innovation & Improvement

2. Outline Information for the management of healthcare Need and existing barriers Pivotal role of information professionals Ideas and opportunities

3. Paediatrician Public health Consultant Improvement NHS Institute/IHI Fellow & Improvement Faculty Investigative Regulatory Yale Faculty Medical Director CQC Deputy RDPH (NW)

4. Business Case for Quality (M ADIL) Engaging, implementing and publishing to support the QIPP agenda in the NHS NHS Trusts + IHI (Boston) + KP Evidence gathering Pilot work & analysis Develop quality- cost frameworks & tools Disseminating & evaluate the impact I---------------------------------------------------I Phases completed

5. My knowledge journey...............

6. NHS Challenges Timeline: Free (1972) Effective (1992) Cost Effective (2002) Quality (2011) Value (2051)

7. Information needs to assess quality? Safety Experience Effectiveness Is the treatment or procedure safe? Any information on patients experience who received it in the past? Is it clinically and cost effective?

9. Changing times cont....

10. The “QIPP Gap” Expenditure Income Time £ The QIPP gap - £15 to £20 bn

11. Scenario

12. Typical cost and quality questions: Can we reduce the cost and improve the quality of care for cancer patients? How can we be more clinically and cost-effective in treating diabetes patients in primary care? How will the benefits of using this drug compared with using another drug improve the outcome for the patient while reducing costs, eg length of stay? How can the ward be cleaned effectively, while keeping the costs down?

13. PCT Scenario You are the lead for respiratory services for a PCT You have been tasked by the board to review the provision of COPD services within your health economy Neighbouring PCT, has undertaken a pilot reorganisation of services for COPD services The pilot has proven to have a considerable impact in reducing admissions for COPD patients and saving resources for the PCT Information Requirements?

14. Patient Story (July 09) Admitted with ankle fracture Discharge plan: 4 th July Fell 3 rd July while going to toilet – NOF fracture Discharged on: 18 th July Impact Quality of life £ 7K extra treatment cost

15. Nationally: NPSA data (E & W) 2008-09 284,438 falls 1390 fractures (840 #NOF) 83 deaths NHS In-Patient Fall Rate Average = 6 /1000 bed days Range = 3 -12 /1000 bed days

16. Stepwise approach to acquire practical information (knowledge) 1.Problem and its cost 2.Patient pathway 3.Effective interventions and their success rate 4.Cost to fix the problem 5.Applicability in clinical setting

17. £ enefits: costs of poor quality £ osts: costs of the improvement intervention £ ividends: the case for change Cost for Quality (Cost-spend-save model/theory)

18. Role of information Professionals informationKnowledge Improve outcomes

19. Barriers Cultural Technical Human

20. WAY FORWARD

21. Information Professional – the future Traditional Reactive/passive Paper-based Subject based location & time bound More information less knowledge Literature based Innovative Active (Specific & timely) Electronic (push technology) Web 2.0 Tools/models Quantitative data Building capacity Tapping the tacit knowledge Key guides

22. Take Home Points: Components for your success 1.Relentlessly raise the awareness of your skills and offerings (in particular on cost front) 2.Find practical knowledge on the key issues faced by the organisation (board papers) 3.Join the clinical improvement teams 4.Build the skills among clinician and managers (trainee rotations) 5.Be a custodian of knowledge systems

23. “Learning & Leadership are indispensible to each other.” John F Kennedy

24. Thank you Mahmood.adil@institute.nhs.uk