Quality and Risk Profiles

1. Quality and Risk Profiles Richard Hamblin October 2009

2. QRPs • What are they? • Who’s doing them? • What will they do – for registration and beyond? • What do we need to do now to deliver? • (What will they look like?)

3. What are they? • A way of gathering all we know about organisation • so as to assess risk and thus prompt front line regulatory activity • And allow the judgements of this activity to be made robustly and add to the knowledge base • Critically, it builds over time and is never “perfect” • This is essential to support registration (or more specifically the ongoing monitoring of compliance following registration) but, because information can be used flexibly later versions could be focused on different issues

4. Three distinct things • Harvesting of different types of information; organising this according to a classification system relevant to purpose; and managing the flows. • A method for calculating risk and presenting findings in a way that front-line staff can use • A way for frontline staff to interpret the profile, use this to make decisions about what to do in response; make judgements and ensure that these are included in our knowledge base and are reflected in the profile.

5. Flow diagram of the QRP Direct data collection VFM Access Periodic Review Local Flavour IR QoL Experience Registration Safety Outcomes Inherent risk Decision Decision Data harvesting – passive /active, surveys, datasets, comments, infocab sweep Data from providers Q&RP system Significant compliance event Info from people with experience of service Info from stakeholders National information Surveys Comments Comments Findings Public ISAs Application Prompted Unprompted Monitoring declarations Variation Map to regs / outcomes / provider taxonomy The register Knowledge base Distillation Compliance risk by UoA Analysis Drill down Activity log & context Contains Intelligence system Public information website Concerns / regulatory plan Publication Additional local evidence/ intelligence CQC findings and judgements on quality Registration “core” of Q&RP Activities in response to view of risk Complex and hackneyed by use What does this really mean Decision audit trail Workflow support system

6. 1 – INFORMATION MANAGEMENT Data harvesting – passive /active, surveys, datasets, comments, infocab sweep Q&RP system Significant compliance event Info from people with experience of service Info from stakeholders National information Surveys Comments Comments Findings Public ISAs Prompted Unprompted Map to regs / outcomes / provider taxonomy The register Knowledge base Intelligence system

7. VFM Access Periodic Review Local Flavour IR QoL Experience Registration Safety Outcomes Inherent risk 2 Risk calculation and presentation Q&RP system Distillation Compliance risk by UoA Analysis Drill down Activity log & context Contains Concerns / regulatory plan Registration “core” of Q&RP

8. Decision Decision 3 Judgement framework The register Knowledge base Distillation Compliance risk by UoA Analysis Drill down Activity log & context Concerns / regulatory plan Additional local evidence/ intelligence CQC findings and judgements on quality Activities in response to view of risk Decision audit trail

9. Versioning • This a long term project to get to work effectively and its project should be at the heart of our information strategy • The demands of registration (its initial use) are much shorter term • The solution is versioning

10. Versioning • Version 0.1 and 0.2 – NHS registration (by January 2010) and IHC/ASC (BY April 2010) • Compendia of relevant previous judgements to support the process of initial registration and re-registration • Version 1.x – NHS ongoing monitoring – April 2010 • Draws heavily from existing data, systems and risk methodologies • “A proof of concept” • Version 2.x – Social care and IHC registration –October 2010 • More dependent on qualitative information • May need slightly different risk calculation • Issues of scalability Future developments • Version 3.x- 3.n – fully productionised system, other cuts of information (e.g. safety, dignity of care etc etc) from 2011 onwards

11. What do we need to do now to deliver?

12. 1 information management Mix of qualitative and quantitative data different for Social Care, NHS, and IHC Need for a different balance of IM and analysis skills Major task to identify available data and required data – and the gaps between! Data harvesting – passive /active, surveys, datasets, comments, infocab sweep Q&RP system Significant compliance event Info from people with experience of service Info from stakeholders National information Surveys Comments Comments Findings Public ISAs Prompted Unprompted The taxonomy is how we organise our information by defining to what it refers; to who it refers and whether it is good or not – this is the essential first step for managing our information and supporting risk assessment Getting qualitative data into the knowledge base requires some combination of manual and automated search, classification and tagging – potentially resource heavy Map to regs / outcomes / provider taxonomy The register Knowledge base Intelligence system We can build on existing COMPASS System to house knowledge base for version 1 – not clearly scalable for a huge number of providers

13. Using qualitative info in a model is complicated MaxQDA Source by Organisation • Qualitative to quantitative • Intelligent interpretation and coding • Key to patient experience • Developed excellent consistency and efficiency but resource intensive • Need a step change in analysis and sourcing Text of document read and code applied Code system InfoCab • Quantity to quality • Multiple potential sources • Large volumes of information • Requires intelligent answers for wide range of users • Hides significant complexity • Move from reactive to pro-active?

14. VFM Access Periodic Review Local Flavour IR QoL Experience Registration Safety Outcomes Inherent risk 2 Risk calculation and presentation This selection of cuts is purely illustrative Q&RP system • A method of calculating risk required • Can build on the “screening approaches • but the are alternatives which we • should investigate for version 2.0 onwards • (particularly if we have a majority of qualitative • data) Inherent risk refers to what a provider does, its particular conditions (e.g financial, managerial) and the nature of those they provide services to Distillation Compliance risk by UoA Analysis Drill down Activity log & context Contains Concerns / regulatory plan Registration “core” of Q&RP What the QRP actually looks like (design of the report) is critical to its Successful use and adoption

15. Decision Decision 3 Judgement framework Judgements in themselves form additional intelligence that need to be included in the knowledge base. They need to both a/ ‘turn off’ individual risk alerts and b/ be analysed to identify where alerts are consistently misleading and alter the risk model accordingly The register Knowledge base Distillation Compliance risk by UoA Analysis Drill down Activity log & context Concerns / regulatory plan Additional local evidence/ intelligence CQC findings and judgements on quality Activities in response to view of risk The QRP is designed to prompt action, NOT direct it – it requires a decision by front-line inspection staff about what to do in response Decision audit trail A judgement framework needs to be put in place to support consistent regulatory judgements

16. What will they look like?

17. Quality and Risk Profiles for Registration: First draft of potential format

18. Level 0: Corporate, drill down to unit of assessment (UoA) Provider: Melchester Hospitals NHS Trust Provider ID: AAA42 Services: Regulated activities: Provider level concerns: Something ORP like in this box??

19. Level 1: Registration summary for UoA Provider: Melchester Hospitals NHS Trust Service: Melchester Hospitals Maternity Service Provider ID: AAA42 Service ID: ZZ3456 Sites: Regulated activities: Registered 1/4/2010 Risk profile: Recent activity:

20. Level 2: Regulatory theme level Provider: Melchester Hospitals NHS Trust Service: Melchester Hospitals Maternity Service Personalised care, treatment and support

21. Level 3: Regulation level Provider: Melchester Hospitals NHS Trust Service: Melchester Hospitals Maternity Service Theme: Personalised care, treatment and support R22: Cooperating with other providers People using the service: • Receive safe and coordinated care, treatment and support when more than one provider is involved, or when they move between services. This is because providers who are compliant with the law will: • Cooperate and share information with others involved in the person’s care, treatment and support while having regard to peoples’ rights to confidentiality. This occurs when: – they are either sharing responsibility or transferring responsibility for care, treatment or support – they work together to respond to emergency situations – the person is supported to access the health and social care services they need. Performance Risk See full data set for R12 Uncertainty Risk

22. Level 4: Underlying data level Provider: Melchester Hospitals NHS Trust Service: Melchester Hospitals Maternity Service Theme: Personalised care, treatment and support R22: Cooperating with other providers Personalised Care Information etc