September 2011
Using the ESR Data Warehouse to reduce the pay costs whilst maintaining quality and safety – a Case Study from NHS Portsmouth
Introduction NHS Portsmouth is one of four commissioning PCTs in the NHS South Central region of England who are now working as the NHS SHIP1 Cluster. With an annual budget of approximately £330m NHS Portsmouth commissions services from a range of hospitals and treatment centres for approximately 190,000 people. Background to the project The SHIP Workforce planning and Development team, lead by Oliver Anderson was set up to help the four commissioners in the SHIP area of the South Central SHA region fulfil their Operational Plan requirements and ensure that they met the Workforce requirements of World Class Commissioning. Oliver explains: “These tasks included a workforce risk assessment involving benchmarking; working with system reform boards to ensure quality and productivity weren’t adversely affected with workforce reductions, training commissioning managers in workforce information, implementation of productivity and efficiency opportunities within provider organisations and producing the workforce elements of the QIPP agenda. Early on in the project it was clear that the first iteration of provider and commissioner QIPP plans were not aligned and furthermore there was very little in the way of local help or modelling to support providers modelling through changes to meet QIPP targets. The rationale for the project was therefore to create one overall model that could support the benchmarking needed for the risk assessment and system reform work, identify productivity and efficiency opportunities for the system reform work and QIPP, and develop a tool that commissioning managers could use to inform them of best practice in terms of skill mix when tendering services”. How the Benchmarking Tool works One of the main drivers behind the initial idea and the development of the model was the vast amount of significant research evidence linking staff numbers and 1
NHS SHIP Cluster consists of NHS Southampton City, NHS Hampshire, NHS Isle of Wight and NHS Portsmouth PCTs working together
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staffing skill mix with patient outcomes across many different specialties. “The tool we have developed is, therefore, the first of its kind that we are aware of that actually tries to work with those relationships instead of just trying to observe whether they exist.” “The tool allows the user to benchmark for ideas or best practice then model through skill mix changes and scenarios and observe the effect those changes have on the quality and productivity metrics being looked at. While workforce numbers and workforce cost are linked by agenda for change bands, the relationship between workforce numbers and each of the selected quality and productivity metrics is much more complex. To make these relationships we have used advanced statistical regression modelling to generate mathematical models that relate the levels of staffing in each agenda for change band within a specialty to the quality or productivity metric being used. The models are based on historical staffing levels within the region and the resulting quality or productivity metric recorded. Similarity scores, a methodology developed in sport to evaluate players and transfer risk, have been developed to compare how similar each organisation in the NHS South Central region is against one and other. This counteracts the argument that you can’t compare one Trust to another like for like. The model compares a number of categories e.g. staff in post, budget, admissions, beds, Trust type and creates a score out of 100 between two organisations to give a better idea of how statistically similar they are and how appropriate they are for comparisons. Using the ESR Data Warehouse we extract workforce wte by pay band by specialty and by NHS organisation. For quality and productivity a range of metrics are collected including re-admission rates and length of stay that have been shown to have a significant relationship to staff skill mix. All quality and productivity metrics are collected from NHS Comparators which is a national, standardised data source that includes Foundation Trust data. The model introduces local benchmarking across the region so that Trusts can benchmark their own performance and also look at high performing organisations”. How the model is delivering QIPP The model provides Trust’s with the opportunity to see how they can make the staffing reductions and skill changes needed to meet saving targets but do so in a way that the quality and productivity of patient care is not adversely affected and remains of a high standard. The model is therefore able to help providers save money (through planned staffing reductions and skill mix changes) and become more efficient, whilst enabling Trust's to improve or maintain patient outcomes such as length of stay, re-admission rates, % emergency admissions with no overnight stay etc. The rationale for the model was to create one overall model that could support the benchmarking needed for QIPP and subsequent provider reform to help create sustainable system reform that involves removing activity, money and workforce, without adversely affecting quality and productivity. For those reasons the model had to include elements that could be benchmarked with each other,
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that related to QIPP as well as enabling some functionality to work through the effects of planned changes on quality and productivity. By using the data available within ESR and linking it to other databases we are able to answer questions about how workforce data relates to other areas of healthcare e.g. quality and productivity. The Benefits • • • • • • • •
Local Benchmarking; Option to add National data to benchmark with high performing organisations; Specialty level comparisons to engage with clinical leads and frontline staff; Collaborative working between Commissioners and Providers to facilitate discussions around skill mix, pathways and best practice; Standardised approach to workforce reform; The model is being used for planning purposes in all of the Acute Trusts within the region which aides consistency and quality of data; Improved the level of engagement between management and HR staff with clinical leads and frontline staff; Stimulates debate/challenge.
In addition the benefits listed above, the model has been used by providers to help with their QIPP planning to meet challenging targets. This has been facilitated by individual Trust modelling days as well as system based workshops looking at QIPP intentions in detail and modelling through scenarios. The model has been used to help inform both a Trauma and Orthopaedic and a Paediatric service review within one of the Regions providers and one Trust has observed that they can make a saving of £250k, improve length of stay by 2.2 days and reduce re-admissions by 0.3% in Trauma and Orthopaedics just by skill mixing alone and not reducing the total wte. Lesson learned and advice for other organisations The data within the ESR Data Warehouse relies on the data quality practices of the Trusts within the region, so the better the data cleansing and quality practices of the Trusts the better the data in the warehouse and the more accurate the analysis and outcomes using that data can be. Additionally, occupation codes give specialty information but that might not necessarily give all staff (even at that specialty) within departments and teams. Unlike the live ESR systems at Trust level the Data Warehouse does not drop down to a department or team level. The future The model currently looks at workforce numbers, workforce costs, quality and productivity measures. The project team are planning to add quality measures to help improve patient safety compliance relating to the CQC registration for Essential Standards for Quality and Safety.
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The team is also exploring whether by extracting additional data from the ESR Data Warehouse the model could be used across other SHA regions. Oliver adds: “In terms of the data within the ESR Data Warehouse we are keen to see a directorate or department level added to give extra information to build up the range of comparative tools and models. Across the South Central region we have received encouraging feedback from our Trusts, but more importantly we are now able to provide the Department of Health with the assurance they require that patient quality and safety is not being affected by any changes in workforce, which is hugely important in terms of maintaining patient confidence�. The tool was listed as one of the innovations in NHS South Central for the National Innovations Expo in March 2011 and in June 2011 it was highly commended in the innovation in human resources category of the 2011 HPMA Excellence in HRM Awards. Many Trusts across England have already expressed an interest in using the tool, which for the team at NHS Portsmouth provides them with a great opportunity to share their knowledge and develop the tool further. For more information If you are interested in learning more about the QIPP Benchmarking tool using ESR, please contact Oliver Anderson, Head of Workforce and Development at oliver.anderson@ports.nhs.uk or call 023 9268 2581.
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