I was hugely encouraged and I think you have done a great job of thinking through the key issues. I was especially pleased to see the thoughtful approach to different levels of measurement (national, regional, local etc) and how we will need different kinds of measures for different purposes; similarly, the attention to different kinds of analytic work and evaluation was great. I also very much like the clear implication that part of the role of the unit is to think about what safety measurement and monitoring should look like, how it will relate to other measures and so on. I really hope the unit will provide much needed leadership in this area. Charles Vincent
Since its inception we (UCLPartners) have found members of the (Patient Safety Measurement Unit (PSMU) to be receptive and responsive to our views and queries and also supportive in relation to specific measurement and data queries we have had around safety. They have been instrumental in supporting the development of patient safety metrics bringing a wealth of knowledge that was needed. Catherine Dale, Programme Director - Patient Safety and Patient Experience, Health Innovation Network
In 2008 Charles Vincent and colleagues posed the question in the BMJ ‘Is health care getting safer? Their conclusion was that despite numerous initiatives to improve patient safety, there was still little idea whether they have worked. Nearly 10 years later, whilst there had been various attempts at voluntary reporting there still was not the systematic measurement system for safety that they had advocated.
Further work into the safety of patients in England carried out by Don Berwick, and published in August 2014, outlined a set of recommendations and led to the creation of 15 Patient Safety Collaboratives (PSCs) across the country. The PSCs empower local patients and healthcare staff to work together to identify safety priorities and develop solutions. The PSCs are hosted by Academic Health Science Networks (AHSNs) and include a requirement to set up local measures and measurement strategies to evidence their impact and understand variability. To deliver the capacity for the high quality measurement and analysis needed, NHS Improvement (NHSI) set up a Central Measurement Unit (CMU). SCW won the contract to deliver this CMU, known as the Patient Safety Measurement Unit (PSMU), starting in April 2017.
As part of the PSC programme three national workstreams were implemented in September 2017 in which all PSCs participate. These are:
- Safety culture
- Deteriorating patients
- Maternal and neo-natal
The objective for the PSMU was to create high level programme measures designed to enable a review of quality and impact. The PSMU would have access to national data sets and utilises this on behalf of all 15 PSCs, supported by qualitative work enabling them to fill any identified gaps in data or assess impact more appropriately.
- Safety culture
SCW are delivering the national patient safety measurement unit on behalf of NHSI providing data and measurement support to inform local PSC improvement, identify how patient safety changes over time and assess the overall impact of the programme. It is not designed as a means of comparison, benchmarking or for performance management.
The programme has two main elements:
1. Patient Safety Measurement Unit - The operation of the national PSMU and the provision of high quality data and analysis for measurement to support improvement. As well as the provision of data the PSMU provides a key strategic role in supporting the PSCs and NHSI.
- SCW designed and delivered the measurement
frameworks to understand what needed to be measured on a national basis. This involved identifying what could already
be measured. Outputs included support for data collection, developing
dashboards and deep dive analyses. The gaps in measurement were identified and
strategies developed to gather the required information through new data
collection, developing tools to deliver this where needed.
- Working with our strategic partners to deliver
high quality measurement for improvement, training and learning across the 15
- NHSI are keen to share learning and provide thought leadership on measuring patient safety both in the UK and around the world, and the PSMU facilitates this by collating and sharing learning from the project.
2. NHS Safety Thermometer – a major safety measurement toolkit. The PSMU is also responsible for the provision of national patient safety thermometers. SCW provides hosting and technical development services for the safety thermometers which include Medication, Mental Health, Maternity, and Children and Young Peoples thermometers as well as the Classic version, together with the full range of support services:
- A responsive service desk – SCW’s team of
dedicated staff respond to e-mail and telephone enquiries about the safety
thermometers in a fast and efficient manner.
- A new website for the Safety Thermometer which displays analysed data with a much quicker response time and has an improved facility to upload the data.
- Consistent reporting between the Classic and
Next Generation Patient Safety Thermometers.
- Full documentation of metric and metric design
- The creation of a suite of Apps to allow data entry via mobile devices.
- SCW designed and delivered the measurement frameworks to understand what needed to be measured on a national basis. This involved identifying what could already be measured. Outputs included support for data collection, developing dashboards and deep dive analyses. The gaps in measurement were identified and strategies developed to gather the required information through new data collection, developing tools to deliver this where needed.
- NHSI and NHSE were looking for
the PSCs, to provide assurance of how patient safety has improved. In undertaking this each PSC had used their
own local approaches such as workshops, deep dives etc. to assess.
- SCW established what needed to be measured and
has undertaken the measurement and aggregated the data into a coherent national
narrative. In developing the measurement
framework SCW ensured that the data collected was right for developing a
- The NHS Safety Thermometer forms a key part of
local safety measurement. It receives approximately 500 submissions covering
160,000 patients per month across the health economy with data coming from
hospitals, community, mental health, nursing homes and private hospitals
treating NHS patients. Its helpdesk
manages 400 queries per month with 98% closed within 24 hours.
- The PSMU provides more than one single
solution. SCW were able to add value by
not only bringing the data together but also providing interpretation into a
coherent narrative. Outputs included not
just the data but also cases studies, evaluations and stories.
- Taking this forward SCW, on behalf of NHSI, will
be supporting the PSCs as the three national programmes progress and in developing
‘measurement for improvement’ capability across the country.
- Investigations are also underway to assess how
the data from the PSMU could be used to support changes across STPs through
linking parts of the system. Initial suggestions include early recognition of
deterioration in the community, sharing early warning scores from ambulances to
emergency department, and providing evidence of how earlier interventions in
primary care prevent patients further deterioration.
- NHSI and NHSE were looking for the PSCs, to provide assurance of how patient safety has improved. In undertaking this each PSC had used their own local approaches such as workshops, deep dives etc. to assess.