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2 May 2012
Reform roundtable seminar introduced by Dame Julie Moore, Chief Executive, and Dr David Rosser, Medical Director, University Hospitals Birmingham NHS Foundation Trust, on Tuesday 1 May 2012.
Despite the advances in medical science and clinical best practice, poor quality still persists in parts of the NHS. The challenge of how to maintain and improve quality will exercise policymakers for much of this Parliament, with the long awaited Francis Inquiry on Mid Staffordshire hospital due to be published in October. While there is no single and all-encompassing solution to better quality, there are proven tools, such as the effective use of data and technology. To explore these issues we convened a lunch with Dame Julie Moore, Chief Executive of University Hospitals NHS Birmingham Foundation Trust and the Medical Director, Dr David Rosser. The lunch was held under the Chatham House Rule, but these were the headline points.
University Hospitals Birmingham has high quality outcomes. The Trust has reported a 16.9 per cent reduction in 30 day mortality, the equivalent of 100 lives saved per year, a reduction not seen in the rest of England. Key to this achievement has been UHB’s philosophy of reducing errors. Rather than connecting errors to outcomes and focusing on significant mistakes and errors in clinical practice, the Trust took the view that all errors are important. Consequently IT systems were designed to reduce all errors.
One of the key programmes that UHB has introduced has been the Prescribing Information and Communication System (PICS), a decision support tool for front line clinicians. The system has over 4,000 registered users, manages 25,000 new prescriptions and 125,000 drug administration events a week. Clinicians use the tool through 450 handheld tablets. Each and every decision made by clinicians working in wards is run through an “error filter”, which screens the decision made, such as changing a patient’s therapy, ordering tests or discharging. The system automatically records the decision and either confirms the order, warns the clinician of the potential error, requires the clinician to re-enter their password in the knowledge they take responsibility for the order, or stops the order. Medication errors were cut by 66 per cent, preventing up to 450 individual errors a day.
However information systems alone are not sufficient to improve quality. The Trust had to combine measuring data on clinical performance with rigorously enforced clinical accountability. This requires strong leadership to shift the culture towards excellence and hold senior clinicians to account. UHB addressed poor performance in its hospital by effectively managing clinical teams that were not meeting the necessary standards. Unfortunately, in this it is the exception rather than the rule. There is no “quick fix” to achieve better quality, but for doctors and nurses responsibility must accompany power.
The freedom to pursue excellence has been important, while my impression is that central diktats have been a distraction. Rather than waiting for the National Programme for IT in the NHS to bring IT to the Trust, UHB went alone in investing in a purpose built in-house system. Commissioning and quality incentives have not been able to drive improvement by providers. Too often the system has failed to generate the incentives for Trusts to invest in effective IT systems. UHB had to take responsibility on itself to deliver better quality. All of this means that we need a permissive system that allows more experimentation, that encourages high performing trusts to excel, that encourages new entrants to challenge existing models, and that recognises and deals with failure when it occurs.