1. The Healthcare Quality Improvement Plan for Wales Dr Cerilan Rogers National Director NPHS / Interim CEO Wales Centre for Health

2. What are we trying to do? “by 2015 Wales will have minimised avoidable death, pain, delays, helplessness and waste.” “create world class health and social care services…….”

3. Key Issues • Consistent, evidence based care provided to agreed standards • System supports continual improvement • Strong leadership and governance arrangements • A patient-centred care approach • Lessons learnt from mistakes • Good practice sustained and spread

4. Quality Domains • Safety • Effectiveness • Patient Experience • Timeliness • Efficiency

5. System Level Improvement Measures for NHS Wales (SLIM) Action 2 of the QuIP: By March 2008 identify and begin collection of the high level indicators …..to assess the quality of the NHS…….The key measures will be run in shadow form through 2008/09 • Small set of high-level, system-wide indicators • Complementary to larger set of highly specific measures • Map to Welsh healthcare standards and 5 quality domains • Designed with care providers

6. Project Structure • Project Board (chaired by WAG) • Project Director (Cerilan Rogers) • Project Manager (Jonathan Gray) • Project Team (NPHS, WCfH, HSW) • Technical and Policy Reference Groups • Task and Finish Group (Stakeholders)

7. Original Indicators DimensionNumber Safety 34 Effectiveness 167 Efficiency 5 Equity 2 Timeliness 34 Staff/Patient experience 37 Total indicators considered: 279

8. SLIM Project Filter Is the measure Attributable to the NHS (provider)?NoDiscard Yes Will the measure have a significant impact on patient’s health?NoDiscard Yes Is this a high level system level measure?NoDiscard Yes Is background info available for this indicator? NoDiscard Yes IMSCaR proforma for assessing measures Is the system measure scientifically sound/‘Fit for purpose’? NoDiscard Yes Technical Team Selected

9. Checks and Balances • Technical Reference Group: scientific robustness • Policy Reference Group: work done consistent with WAG policy • 37 indicators presented to Task and Finish Group, which recommended final set of 16 to Project Board

10. Priority System Level Indicators March 2007 Emergency readmission Acute Cardio respiratory hospital mortality rate Staff absence due to illness Delayed transfer of care Risk Adjusted length of stay Hospital Standardized mortality Patients with health needs Patients with health needs met Functional results Process for providing services Patient satisfaction Access Clinical Results Elective surgery EmergencyAmbulance Waiting time Survival following diagnosis of cancer Patient satisfaction Costs A & E GP Operation cancelled Rate of C. difficile infection Rate of MRSA Percentage generic drug prescribing = Indicator

11. SLIM 1B: March to Present • In 2nd phase of project (SLIM 1B), technical team piloted technical definitions, levels of analysis • Findings discussed with Chief Executives • Close links maintained with policy and frontline staff • Final recommendations put to the Project Board on 22 November 2007

12. Priority System Level Indicators March 2007 Emergency readmission Acute Cardio respiratory hospital mortality rate Staff absence due to illness Delayed transfer of care Risk Adjusted length of stay Hospital Standardized mortality Patients with health needs Patients with health needs met Functional results Process for providing services Patient satisfaction Access Clinical Results Elective surgery EmergencyAmbulance Waiting time Survival following diagnosis of cancer Patient satisfaction Costs A & E GP Operation cancelled Rate of C. difficile infection Rate of MRSA = Proposed Indicator Percentage generic drug prescribing = Omitted Indicator

13. How we will use the indicators • Pyramid of investigation for special cause variation • Investigation should start with data and end with individuals Individual Process of care Structure Case-mix Data Richard Lilford, Mohammed A Mohammed, David Spiegelhalter, Richard Thomson, ‘Use and misuse of process and outcome data in managing performance of acute medical care: avoiding Institutional stigma’, Inpatient Safety III