From scoping to defining data packs
Each GIRFT report combines novel analyses on Hospital Episode Statistics (HES) with publicly available information, other relevant registry or professional body data, and the results of a questionnaire which is issued to all the trusts being reviewed. The reports look at a wide range of factors, from length of stay to patient mortality, and individual service costs through to overall budgets. The GIRFT breast surgery programme is led by Miss Fiona MacNeill and Miss Tracey Irvine, Consultant Breast Surgeons at the Royal Marsden NHS Foundation Trust and Royal Surrey County Hospital NHS Foundation Trust. Fiona says: “GIRFT is our opportunity to minimise unwanted variations in care and raise the quality of breast surgery to the very best that can be provided.” Dr Foster was involved in the scoping phases of the project which helped to define the contents of the data packs down to individual metric level. This required a firm grasp of what can and can’t be done with HES data, but also a good understanding of what the clinical leads are interested in and the questions about clinical practice they are trying to find answers to. Tracey says: “The aim is to produce a report with metrics which are specific to each specialty. In some cases, this means developing new metrics, but also understanding what existing ones are telling us, for example, day case rates for certain procedures. It is a very collaborative process.”
Creating clinician-defined coding groups
Many of the questions can be answered by looking at the HES data (e.g. admissions, attendances, DNAs and length of stay). Dr Foster worked closely with the breast surgery team to investigate the quality of coding in the data. Where it wasn’t possible to obtain a defined outcome, the use of proxy measures was explored. For some metrics, multiple HES datasets needed to be analysed concurrently to link patient events between care settings and over time. The benefit for the GIRFT specialty team was that large numbers of bespoke diagnosis and procedure coding groups were defined in collaboration with clinicians.
Data validation and inclusion in data packs
Following scoping of the procedure groups, Dr Foster worked with clinicians to sense-check initial results to give them confidence in the data packs. Clinicians’ input ensured the output met their needs and, where necessary, coding groups were refined. Ensuring clinicians had confidence in the data was essential, noted both Fiona and Tracey, because it was the starting point for driving clinician-led conversation during deep-dive visits to the NHS trusts involved. Dr Foster’s technical expertise in data helped it develop data packs that aligned with the existing GIRFT report format and also supported a narrative to fit with each individual specialty. For the breast surgery packs in particular, it added bespoke data visualisation as a result of clinicians’ requests. Tracey explains that now the data packs have been produced, the programme is at the stage where she and Fiona are visiting 132 individual trusts discovering some amazing examples of best practice and significant and surprising variations in activity and outcomes. Dr Foster analysts have joined the clinical leads in order to gain a deeper understanding of how the data are interpreted and challenged, and how the structure of the data packs are received by clinicians in direct discussion.
Fiona says: “We have seen clear benefits from working with Dr Foster especially when it comes to the team’s expertise and experience with NHS data sets: the Dr Foster analysts depth of understanding of HES's strengths and limitations allowed us to use HES to ‘see’ and interpret complex clinical pathways. Their ability to translate our ‘wish-list’ into something clinically tangible and meaningful was impressive.”