Advancing quality in the North West

The company’s president, Rick Norling, formerly a healthcare manager in Minnesota and California, says it has delivered clear improvements in care and outcomes.

He tells HSJ: “In the beginning perfect care was being provided on average 73 per cent of the time. Over three years, the hospitals are all above 90 per cent. It got to the point where we found there were substantial improvements for the patients. Mortality rates reduced significantly and so did readmissions.”

He says doctors were keen to take part: “It has a strong evidence base and most clinicians just assumed this stuff always happened. When they started looking, they said, ‘We need to be engaged in making sure this happens every time.’”

Turning rhetoric into action

“This takes the rhetoric on quality and turns it into action,” was how NHS North West chief executive Mike Farrar described the launch of the region’s Advancing Quality scheme.

It was conceived well over a year ago and has increasingly been seized on by health minister Lord Darzi as an example of good practice.

In October, every acute trust in the region - although the scheme is described as voluntary - began reporting against a series of clinical process and outcome measures for five high-volume procedures: coronary artery bypass graft, acute myocardial infarction, congestive heart failure, hip and knee replacement and community acquired pneumonia. Each comes with a checklist of required processes.

Score cards

Data is sent to US company Premier and returned in the form of scores against each measure and overall results for each procedure.

The first results will be published next year and are expected to quickly draw attention to areas where care is not meeting standards.

Particularly likely to focus minds are figures for the proportion of patients receiving “perfect care” - when each required process is carried out. Trials suggest that in some cases “perfection” is delivered to fewer than half of patients.

Based on outcome and efficiency improvements seen in the US, it is estimated Advancing Quality will prevent 141 avoidable deaths and save£17m each year. Results will be publicly reported in 2010 - in time for the first round of quality accounts.

The region is looking at extending the system into other areas, including mental health and primary care.

Bold incentives

Another bold feature of the North West project is its incentive scheme. In 2008-09,£2.5m pooled by PCTs will be paid in rewards for top performers. In 2009-10, this will rise to£5m, with cash also going to fast improvers.

The approach contrasts with CQUIN (commissioning for quality and innovation), the approach outlined in the next stage review, which would take part of all trusts’ tariff uplifts and redistribute to the best.

Mr Farrar says: “We think you should start off by incentivising, then in the second or third year, where there has been a failure to improve, you can look at potential penalties.”

Advancing Quality’s success also suggests the importance of the regional level in measurement.

Central Lancashire PCT chief executive Joe Rafferty, NHS North West director of commissioning until last month, says: “If you disaggregate it too far, you lose that ability to cross compare. If you aggregate too high, you lose local ownership.”