Driving clinical quality through big data audit

Building internal audit and scrutiny tools in a clinical organisation can often be driven by service level agreements, key performance indicators and finances, when what matters most is the value provided by the patient’s treatment and recovery, writes our medical director, Alex Smallwood.

In fact the real proof of value is that when we change something it gives the desired outcomes. Through big data audit innovation, HCML now has a 3D picture of change and outcomes. We can measure real value.

We have gone through several evaluation cycles of the tools that we use to audit the success of a service. Now, when we use management dashboards to monitor a service, the intelligence gained from overlaying the specific dimension of clinical quality vastly improves its value. It also serves as a visible motivator and success indicator for a service.

I am not just talking about PROMs (patient reported outcome measures), which only report one dimension of a patient’s journey to recovery, but about using a tool that scrutinises the interactions between case manager and patient, patient expectations, goals, clinical advice, trajectory and patient satisfaction.

Over time, by doing this, we have been able to separate and champion excellence within teams and pinpoint areas of specialist knowledge or skill, to share with others. This can be from a regional approach correcting for differing social norms, or down to an individual with a specific strength looking at a complex co-morbid problem scenario.

The amount of data that can be collected using a digital tool is limited only by the resources used to do the checking, be it human or machine. A hybrid of high volume, low scrutiny checks alongside low volume, high scrutiny ones gives a balanced use of resources.

High volume, low scrutiny audits that can be identified as clinical indicators from standard coding and recording within clinical notes systems, provides a ready source of rolling quality across an entire open case book. Examples might include recorded and achieved goals, and their current status.

This is complemented by low volume, high scrutiny audits, which are more resource heavy, requiring validation of the work undertaken by a clinician with similar or more experience. This may include going through a checklist of areas of advice given, listening to a call, and comparing the advice against gold standards.

Combining both audit approaches has given us a unique, three dimensional picture of quality within our services, and also allows the early identification of change. Critically, it also gives very clear management intelligence that when you make a change, it has the desired and expected outcomes.

This approach is far more powerful at driving forwards the quality that patients need. We are delivering the real proof of value with our patients recovering quickly and leading useful and happier lives faster.