Addressing clinical variation across the NHS: Standardisation offers light at the end of the tunnel

By David Bolton, global industry solutions director for the public sector and healthcare at Qlik

In this article, David Bolton, global industry solutions director for the public sector and healthcare at Qlik, examines how reducing the clinical variation caused by surgeons or physicians behaving differently when performing the same procedures, could help the NHS to reduce costs and improve finances while still improving quality and access to care

It has long been clear that the NHS is facing a serious funding crisis.

Amid rising treatment costs, an ageing population, and a social care crisis, the NHS only just manages to stay above water.

The service ran a deficit of £930m between April and June of last year. And, while the situation may look bleak, standardising the way that NHS trusts operate could offer a light at the end of the tunnel.

Lord Carter of Coles recently announced that the NHS could release a total £5billion a year by reducing variation in the way operations and treatments are carried out. The report found that there was a 20% variation in the average cost of inpatient treatment between the most-expensive trusts and the least expensive.

Insight and engagement with data can highlight best practice and lead to more-standardised use of the most-effective clinical practices

This type of clinical variation is usually the result of surgeons or physicians behaving differently when performing the same procedures – meaning variation exists in the cost, length of stay, and clinical outcome.

Consider, for example, the cost of knee replacements across an NHS trust.

Digging into the data, you’ll find some surgeons ‘cost’ more than others. Looking at knee replacements in an NHS hospital, the average cost of the procedure varies by more than £1,000. Perhaps surgeons are using different techniques, or prescribing different drugs, or their patients need to be readmitted – there are a number of things which impact the overall ‘cost’ of the procedure. These variations often make procedures, and the care around them, more expensive than they need to be. It is something that happens a lot across healthcare organisations and yet, with the right data analysis systems in place, these discrepancies can be directly addressed.

The key is to identify the reasons for variation and uncover the best practice for all surgeons to adopt. Experience shows that clinicians will naturally reduce variation and adopt best practice if the data is presented in a meaningful, trusted, and accessible format. While this can save costs; fundamentally, it also helps improve patient care. Adopting best practice helps clinicians reduce complications and allows patients to be discharged more quickly.

Key for the NHS right now is to maximise the impact of the money that is currently available

It’s a method that many other healthcare systems have adopted. Sahlgrenska in Sweden, for example - one of the largest hospitals in Northern Europe - has recently worked on a value-based care programme that specifically uncovered variation in orthopaedic care.

By identifying anomalies and variation, the hospital was able to reduce adverse events by 18%, reoperation by 17%, and increase the number of surgeries by a staggering 44%. As a result, waiting times were reduced by more than 40 days for hip and knee replacements. This was only possible by engaging clinicians with data, uncovering variations, and dispelling widely-held myths.

This example shows how insight and engagement with data can highlight best practice and lead to more-standardised use of the most-effective clinical practices. This frees up beds and, in turn, reduces waiting times, enables quicker emergency admission, reduces costs, and improves patient care.

But this can only happen with timely access to good-quality information from a multitude of clinical and operational systems. Clinicians will only engage if the data is trusted, delivers the whole story, and is easy to work with. The crucial factor is to ensure that clinicians are involved and engaged from the conceptual stage of the project. It’s important to create visualisations and dashboards to present the data that are intuitive and easy to use, but that contain data which will drive better patient care. The challenge is finding the right tools and the right mind set - something that is hard to create.

It’s not just about clinicians behaving differently and the associated cost of care. Reducing variation in procurement will also help trusts to save money. A group of eight NHS trusts, for example, recently managed to save money by pulling procurement data from each trust into one single application. This quickly allowed them to see where variation existed in the spending patterns of each trust and the types of products the trusts were purchasing.

This can be something very simple – for example, different surgeons may prefer different types of gloves, but they might cost double the amount. While alone these things might seem negligible, this approach enables trusts to clearly see where they could cut costs or negotiate better deals with suppliers. Over a two-year period, they have been able to save over £30m.

Combining data from all the clinical and operational systems is fundamental to understanding variation. Historically, however, data quality and data volume has been a real challenge for the NHS. With so many different clinical and operational systems that record information related to variation in care, it has been a struggle to see the whole story across these data sets and deliver them in a way that clinicians can engage with.

If healthcare organisations can make sure they're getting clinical performance right across the board - those wasted finances will take care of themselves

The opportunity to use data on a more-national scale and really understand where data can support in decision-making to improve quality of care and outcomes is critical.

Some of the national programmes that are underway, such as care.data when it gets off the ground, will have a big impact on the NHS’s ability to do that.

Key for the NHS right now is to maximise the impact of the money that is currently available.

If healthcare organisations can make sure they're getting clinical performance right across the board - those wasted finances will take care of themselves.

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