How CRAB has helped an award-winning trust on its improvement journey by monitoring clinical performance, benchmarking quality and identifying surgical trends

St Helens and Knowsley Teaching Hospital, highly commended at the 2016 Patient Safety awards, began its improvement journey several years ago and started using the CRAB surgical module to monitor clinical performance and benchmark against peers.


Sunjay Kanwar, Consultant General/Upper Gastrointestinal Surgeon was instrumental in introducing the CRAB surgical module and raising its profile, as part of an initiative to assess consultant performance which he viewed as being of critical importance to improving quality of care.

Quality improvement

CRAB is being used to look for trends and outliers which in turn affords the organisation greater vigilance and oversight in outcome measures. Mr Kanwar believes the success has been down to getting buy-in early on. “Once my colleagues understood it can be used as a performance management tool they were happy to use it,” he says.

“CRAB enables you to look at longer period of time which usually means a spike in reporting returns to normal range,” says Mr Kanwar. “This is very useful as we can look at a trend over six months to two years. In this way you can see if a spike in mortality or morbidity is a blip. However, it also means we can monitor the situation and look at ways of preventing a recurrence.”

Identifying variation and changing practice

Mr Kanwar welcomes the insight CRAB provides. He says: “It offers a level of vigilance we didn’t have before and most of our consultants have accepted it. Their attitude is if I’m not good at something, tell me what I’m doing and I’ll fix it.”

By providing clinicians with their own reports they are able to highlight what the issues are underlining the data. Mr Kanwar says: “We can critically appraise performance and feedback to our divisional lead. We then assess whether there is an issue. It needs to be clinically led because we aware what the real world of surgery is like and offer us more credibility with our colleagues and managers.”

Benchmarking against peers

CRAB is being used for setting and meeting benchmarks. Mr Kanwar says: “Comparison with other trusts is the key and we are able to find a peer group and look into comparative audit.” This allows for comparative analysis within departments, but also between institutions, set against national standards. Individual reports can be used to support consultant appraisal and institutional data fed into the Quality Account.

The organisation hopes to widen its use of CRAB and establish the programme in other departments. Representatives from the anaesthetic team have been so impressed with CRAB they are keen to use the next tool COMPASS to help with pre-admission risk assessments and care planning as well as highlight which patients require a higher level of care, as well as supporting a more informed consent process.


CRAB is playing an integral part in the improvement journey at a highly-commended NHS trust

Clinicians have bought into the improvement initiative because CRAB is trusted by them to present a true picture of surgical practice

The organisation is able to make inter-department and inter-organisation comparison to find areas where improvement needs to be made and surgical practice changed

The organisation has greater vigilance and oversight in key outcome measures

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