Nathaniel van Gulck, Business Intelligence Solutions Architect at IT services group Trustmarque, thinks lessons learned from the private sector can help save time when it comes to NHS use of Business Intelligence (BI)
It’s well established that the NHS is facing a budget crisis to the tune of a £30bn deficit and, in order to continue caring for the British people, the service is being asked to find huge amounts of savings and cost reductions. Last October, for example, NHS Chief Executive Simon Stevens pledged to reduce the deficit to £8bn by making £22bn-worth of efficiency gains. Against such a backdrop, the NHS needs to make the most of every tool available to it.
If the NHS is to hit its efficiency targets, then making effective use of technology and Business Intelligence (BI) will be critical - not just because of the need to find savings, but because of the legislative imperative based on recommendations from the Francis Report; following incidents at Mid-Staffordshire NHS Foundation Trust, the Francis Report mandated that data should become more accessible and more easily shared. If NHS Trusts implement BI projects successfully, it can be the glue that holds together all key information sources to help create continuous service improvement and support the ultimate aim of the NHS – excellent patient care.
More Than Just 'Status Reports'?
Given the funding crisis, the NHS must ensure that every penny spent represents value – therefore BI projects need to represent a smart ROI. However, typically BI projects have been a challenge for the NHS and businesses generally, with Gartner estimating that around 70% have been unsuccessful in achieving their goals. It’s inevitable that there will be some obstacles, especially in an organisation as complex, large and important as the NHS. But this failure rate is also down to a fundamental disconnect between the IT teams implementing these ambitious BI projects and the rest of the organisation. Too often, IT teams are looking to incorporate data from all departments, clinicians and staff, to carry out wide-scope analyses across the entire Trust.
This desire to make sure that no data is missed out, while well-intentioned, can lead to IT teams carrying out huge, expensive back-end transformations, for example, a large-scale data warehousing project, which ultimately doesn’t produce the information that clinicians need to improve patient outcomes. These projects are time consuming, disruptive and result in BI being used more as a way of producing snapshot status reports to compare actuals against pre-set targets, rather than using BI for improvement by thoroughly examining processes to identify trends and uncover actionable insights that lead to ongoing service transformation opportunities.
Making the most of BI
There is no question that NHS Trusts employing BI for status reporting is a positive stepping stone. Such reports can identify wasteful practices and overspending, that can in turn help Trusts to ensure medical equipment order sizes are correct and to benefit their argument in contract negotiations.
However, in order to really maximise the value of BI, clinician requirements should be at the heart of any project as well as having a clear business case based on patient outcome. For example, rather than keeping patient data on paper and risk missing important information, clinicians can record data digitally; self-service BI tools then allow meaningful clinical process performance benchmarks to be set and time-tested statistical techniques to be applied as part of deliberate improvement initiatives.
Through this ”BI for improvement” approach, outcomes can be greatly improved, for example, by raising ‘early warning scores’ about dangers such as sepsis, ultimately reducing the length of hospital stays and saving lives.
Therefore, communication between IT and the rest of the organisation is key. This can be achieved by focusing on the quick wins, i.e. tightening the scope of BI projects to address specific issues or targets in particular departments. Due to the fact that these projects have a smaller scope, they are more manageable and can be continuously reviewed in order to identify areas where the service could be improved. At the lower end of the scale, these improvements may only save 30 minutes a day for each clinician, but these savings soon mount up.
Moreover, the more time that is freed, the more time that can be given back to clinicians to spend caring for patients.
The multiplier effect
Even beyond freeing up the time for patient care, properly implemented BI projects can empower clinicians to make their own improvements. Provided they have the right technology and the ability to review data on the move, staff can review and amend processes to improve successful outcomes. For example, take outpatient appointments – staff could review the data to identify the optimal times to book in patients, thereby helping improve appointment attendance rates.
One such outpatient department carried out this kind of analysis and discovered a high number of missed appointments on a Saturday for patients under 25; the department was then able to address this imbalance and avoid allocating appointments to younger patients at times they were less likely to attend.
This type of actionable data insight could help NHS Trusts address the costly issue of missed appointments, which the NHS estimates currently costs it £700 million per year. Additionally, BI can support other NHS aims such as the drive towards Electronic Health Records (EHR).
EHRs are the foundation of effective BI projects, so embracing and implementing BI will encourage Trusts to push forward with adopting EHRs. As an additional benefit, these two things together will help meet the paperless directive which the NHS hopes to achieve by 2018, estimated to save Trusts an approximate £1m a year.
Success results in improved patient outcomes
In order to have a chance to meet the targets set by Simon Stevens and guarantee patients have the best possible treatment and experience, Trusts need to ensure that they are using BI to enable service transformation and cost-saving measures. A key factor in making sure that this happens is eliminating the disconnect between IT, statisticians and clinicians by connecting IT systems to statistical processes and techniques.
This will allow Trusts to embrace the next generation of BI and analytics, where the right data is available to staff at the right time. Successful BI projects will enable service transformation, help resolve the serious budget crisis that the NHS is facing, and ultimately and most importantly, improve patient outcomes.