Improving theatre efficiency by highlighting clinical performance

Frimley Health NHS Foundation Trust uses CRAB Medical and CRAB Surgical modules to monitor clinical performance at consultant level and improve efficiency.

Background

Frimley Health NHS Foundation Trust’s acquisition of Heatherwood and Wexham Park Hospitals NHS Foundation Trust presented the board of Frimley Park with a due diligence challenge. Heatherwood and Wexham Park Hospitals NHS Foundation Trust had been failing to meet national targets, the Care Quality Commission (CQC) had raised concerns about quality of care and the organisation was in financial deficit. Having discovered that CRAB was being piloted by professor Sir Mike Richards at the CQC, the organisation decided that it would help to investigate mortality and morbidity at consultant level and use this as the basis for wider improvement.

Consultant-level investigation leading to quality and efficiency improvement

As well as helping Frimley Health NHS Foundation Trust gain a better understanding of mortality and morbidity at Heatherwood and Wexham Park Hospitals NHS Foundation Trust, CRAB revealed a number of other safety issues. Dr Timothy Ho, Medical Director, says that this insight was helpful in terms of being a good starting point for discussion with clinical colleagues about these wider safety issues. “Once we could see how CRAB was able to provide this level of insight, we decided to use it at Frimley Park to review performance at consultant level,” he says.

NHS Frimley Health is now using CRAB across its three main sites and Dr Ho says the benefits are tangible. “I’m able to get a whole suite of reports giving me an overview of consultant level performance. The team then produces individual reports which we can use to highlight issues with individual practice.

“Peer comparison means we can have those difficult conversations with consultants. You can’t start this conversation by saying the data shows you are underperforming, because that individual will simply question the data. It takes time to show that performance is a concern.”

By moving beyond anecdote and relying on an analysis of data that can be trusted by clinicians, the organisation has found that it is able to begin a dialogue with consultants whose performance is deteriorating, or where clinical practice needs to be challenged. This in turn has led to improvements in efficiency, particularly in theatre usage.

Future quality improvement

Going forward Dr Ho says having CRAB is enabling it to take part in national initiatives such as sepsis prevention. “The morbidity metrics are linked to acute kidney injury so we can start to make comparisons and measure performance. We have recently carried out a trust-wide intervention in sepsis which we wouldn’t have been able to do without insight from CRAB.”

“CRAB is generating trusted data which we can use to flag up areas of concern. From there we are able to take action in a much more sophisticated way that we have in the past.”

SUMMARY

CRAB helped Frimley Health NHS Foundation Trust gain a better understanding of mortality and morbidity at Heatherwood and Wexham Park Hospitals as well as wider safety issues

Frimley Health NHS Foundation Trust is now using CRAB across its three main sites and the benefits are tangible

A suite of reports provides an overview of consultant level performance, while individual reports highlight issues with individual practice

CRAB data is trusted by clinicians which means the organisation can begin a dialogue with consultants whose performance is deteriorating