NHS Digital Data Release Register - reformatted

Civil Eyes Research Ltd projects

HES data application

116 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).

HES data application — DARS-NIC-35166-B5Y7P

Type of data: information not disclosed for TRE projects

Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant, No (Does not include the flow of confidential data)

Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(2)(b)(ii), Health and Social Care Act 2012 - s261 - 'Other dissemination of information'

Purposes: Yes (Research)

Sensitive: Non Sensitive, and Sensitive, and Non-Sensitive

When:DSA runs 2019-08-26 — 2020-08-25 2017.06 — 2024.01.

Access method: One-Off, Ongoing

Data-controller type: CIVIL EYES RESEARCH LTD

Sublicensing allowed: No

Datasets:

Hospital Episode Statistics Admitted Patient Care
Hospital Episode Statistics Accident and Emergency
Hospital Episode Statistics Critical Care
Hospital Episode Statistics Outpatients
Emergency Care Data Set (ECDS)
HES-ID to MPS-ID HES Accident and Emergency
HES-ID to MPS-ID HES Admitted Patient Care
HES-ID to MPS-ID HES Outpatients
Hospital Episode Statistics Accident and Emergency (HES A and E)
Hospital Episode Statistics Admitted Patient Care (HES APC)
Hospital Episode Statistics Critical Care (HES Critical Care)
Hospital Episode Statistics Outpatients (HES OP)

Objectives:

Civil Eyes Research is a leading benchmarking organisation working with clinicians and managers to use information to understand the metrics of quality and productivity within health services.

Civil Eyes Research work with large and small organisations seeking to align complex datasets and collect information to enable decision making and to improve healthcare.
Currently Civil Eyes Research offers three leading edge benchmarking programmes which are managed as clubs by the participating hospitals:

• Valuing Medical Resources – twenty teaching hospitals across the UK have joined together to work on productivity issues
• Pathology benchmarking – looking at improving the impact of laboratory medicine disciplines on efficiency and quality within hospitals and the wider health economy
• The Specialist Children’s Hospitals network working on shared data and developing specialist benchmarks

The overall objective of Civil Eyes Research is to provide aggregated analysis and interpretation of performance and quality issues within healthcare to doctors, clinicians and managers of NHS and Social Care providers using benchmarking of HES data alongside the deployment of Civil Eyes Research’s own accumulated healthcare expertise over thirty years.
Civil Eyes has been working with HES data over the past twelve years to support and improve the provision of patient care across the NHS throughout the UK. Civil Eyes Research has two principal directors who have long and significant track records within the healthcare sector where they have held a range of roles. They joined Civil Eyes Research in 2005 to provide services whereby doctors and managers could use data to understand service provision and effectiveness.

Civil Eyes Research is commissioned by Chief Executives and Medical Directors of NHS trusts specifically to provide analysis and advice in order to promote discussion and action on efficiency, productivity, effectiveness, quality and access to services. Engagement with doctors and managers results in higher commitment to better coding, improved understanding of case mix and more robust use of information in the health service.

Civil Eyes Research benchmarks HES activity with trusts to provide insights into their service profiles, performance and outcomes.

Civil Eyes Research only works with health services in the UK and does not, and has no plans to, work in other sectors or outside the UK. Any such work would be subject to an application for an amendment to their agreement.

HES data are held only in pseudonymised form and are never directly linked with other datasets which could allow re-identification of HES data.

Reports are only issued to clinicians and managers of NHS organisations. No record level data is provided to any third party organisation in any format.

Civil Eyes Research has not and will not use HES data to undertake sales and / or marketing activities to the healthcare or any other sector.

Client engagements are either long-standing from Civil Eyes Research’s inception, as a result of their previous work within healthcare services, or have occurred by “word of mouth” recommendation.

Civil Eyes Research has developed three Benchmarking Clubs or “purposes” where hospitals work together to review and understand the data and performance and plans to carry on with these three clubs using the 2016/17 HES data.
The three clubs are:
(A) Medical productivity within NHS organisations
(B) Pathology networks (with Keele University)
(C) Specialist Children’s Hospitals
(A) Medical productivity within NHS organisations

Over the past twelve years, Civil Eyes Research has worked with 30 teaching hospitals and 25 district general hospitals (DGHs) scattered across the country and developed methodologies to analyse and present HES data to portray admitted care, outpatient and A&E activity by specialty across the full range of secondary care activity. The specialty list requested by hospitals Acute and Emergency Medicine, Anaesthetics, Breast Surgery , Cardiology, Cardiothoracic Surgery, Care of the Elderly, Colorectal Surgery, Dermatology, ENT, Gastroenterology, Gynaecology, Haematology, Hepatobiliary Surgery, Intensive Care, Maternity, Nephrology, Neurology, Neurosurgery, Oncology, Operating Theatres, Ophthalmology, Oral & Maxillofacial Surgery, Plastic Surgery, Radiology, Respiratory Medicine, Rheumatology, Trauma & Orthopaedics, Upper GI Surgery, Urology and Vascular Surgery.

Civil Eyes Research organises national workshops for service managers and lead clinicians at specialty or function level. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Service managers and lead clinicians are then invited to submit their recommended service changes to their local management teams.

In addition Civil Eyes is asked to visit hospitals to share workshop analysis for in-depth review with local management teams. For instance, a hospital wishing to change practice will ask to see local comparisons, selected peers or best in class across England.

Civil Eyes Research uses national data to:
• Examine the mix of case types that are treated in specialist hospitals and non-specialist hospitals. When looking at the activity of a particular provider, it is necessary to understand the pattern of care at neighbouring hospitals as this will affect the volume, case mix and clinical characteristics (such as length of stay, day case rate or readmission rate) of the presenting healthcare activity at that provider. An example would be in the northeast where the large Ophthalmology service at Sunderland affects the Ophthalmology workload at South Tees and Newcastle. Another would be the profile of Plastic Surgery at University Hospital Coventry & Warwickshire which is affected by the provision of relatively more straightforward clinical activity at the two district general hospital trusts elsewhere within Warwickshire.
• Review shared care arrangements with specialist centres and local DGHs. An example would be looking at hub and spoke care models between teaching and district general hospitals, where, for example, cancer patients treated at a teaching hospital may re-present in any other hospital or specialty or mode (such as outpatients or A&E) at DGHs. This analysis helps clinicians and managers to understand and review the pattern of care given to patients and enables identification of improvements in efficiency and service quality.
• Determine “best in class” performance across England. An example would be the operation rate on the day of admission for elective activity, where “best in class” has varied over time and specialty and provider. Using such benchmarks helps spur on clinical performance at other trusts and improves efficiency and importantly the quality of service for patients.
• Review length of stay on a system-wide basis as opposed to that seen on a discrete provider basis (we look at length of stay on a “super-spell” basis (for example, for elderly fractured femur patients) and look for Hospital A’s discharges re-appearing within other hospitals within a short time period – we find that discharged patients have subsequent admissions at a large number of other hospitals; clinicians and managers see this as a more acceptable way of looking at lengths of stay).
• Provide peer groups to hospitals – clinicians and managers of particular hospitals may require comparator peer groups of any other hospital in England.
This club comprises 25 trusts this year, 25 the year before and is expected to comprise 25 trusts in the following year.

(B) Pathology networks (with Keele University)
Starting January 2014, Civil Eyes Research has been working with Keele University Benchmarking Service to look across the UK at potential impact areas of Pathology work including the overall levels of Cellular Pathology, Clinical Biochemistry, Haematology, Immunology, Microbiology & Virology activity, patient pathways, infections, diabetes, anaemia, speed of patient turnaround in Accident & Emergency and proxies for one-stop arrangements in outpatients. Civil Eyes use the HES data to calculate national rates of activity across England and Keele University provides a national service to Pathology departments.

The Keele University Benchmarking Service has been delivering the Pathology Laboratory Benchmarking programme to NHS organisations in the UK for over 20 years. It is the only organisation in the UK to collect and provide such information. The Keele University Benchmarking Service is peer reviewed and guided by specialty panels in each discipline, all of whom represent professional bodies including the Royal College of Pathologists and Institute for Biomedical Science. The recent Carter Review of Pathology services called for benchmarking and review of Pathology information. The Keele programme meets those objectives but the Review called for Pathology to be seen in the wider hospital context. Keele and Civil Eyes Research are working together to provide that wider perspective. Pathology networks can now see their performance in the wider hospital context through the use of HES data.

Keele University Benchmarking Service has been historically strong at showing performance within Pathology laboratories, while Civil Eyes is using HES data to show potential impact areas of Pathology within the hospital and community context.
Keele University Benchmarking Service collects contextual information (for example overall workload, staffing, test turnaround times and type of laboratory) from Pathology laboratories that Civil Eyes incorporates into analysis for the national workshops and local hospital meetings. Civil Eyes does not share record level data with colleagues in Keele. The HES data are solely managed by Civil Eyes, and Keele staff only see the same level of aggregated data as is present in the analyses received by client hospitals.
Civil Eyes Research organises national workshops for service managers and lead clinicians. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Workshop participants are then invited to submit their recommended service changes to their local management teams.
In addition, Civil Eyes is asked to visit hospitals to share workshop analysis for in-depth review with local management teams.

Keele University is the only university with which Civil Eyes Research works. Keele University is the only third party with which Civil Eyes Research has a relationship for delivering services to clients.

This club comprised 30 laboratories in 2016, 20 the year before and is expected to comprise 30 laboratories in 2017. The 30 laboratories cover 40 trusts as a number of laboratories provide services to a network of NHS trusts.

Civil Eyes Research uses national data to:
• Calculate national rates of activity (volumes of diagnoses and procedures, outpatients and A&E activities) across England for use within the benchmarking of Pathology services which, with Keele University, are provided to all Pathology departments.
• Determine “best in class” performance across England. An example would be length of stay for a particular condition such as diabetes for non-elective activity, where “best in class” has varied over time and specialty and provider. Using such benchmarks helps spur on clinical performance at other trusts and improves efficiency and quality of service for patients.
• Pathology services are organised on a network basis, quite often resembling counties, or combinations or counties, and do not map conterminously to NHS trusts. One laboratory may provide Pathology services to a number of NHS organisations including a number of quite small healthcare entities and the data for the small organisations is required to complete the picture of the services to which the Pathology activity relates. An example is an organisation called Empath which provides Pathology services to hospitals across Leicestershire and Nottinghamshire in the East Midlands including the independent treatment centre at Nottingham.
(C) Specialist Children’s Hospitals
Civil Eyes Research uses HES data to provide analysis of clinical performance and benchmarking information to a group of 20 specialist children’s hospitals scattered across the country covering areas such as lengths of stay, day case rates, readmissions, same day operations, depth of clinical coding and clinical performance within specialties.
This group comprised 20 hospitals last year, 20 the year before and is expected to comprise the same number in the coming year as this is, by and large, a fixed sector within the NHS.
Civil Eyes Research organises national workshops for service managers and lead clinicians at specialty or function level. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Service managers and lead clinicians are then invited to submit their recommended service changes to their local management teams.
In addition, Civil Eyes is asked to visit hospitals to share workshop analysis for in-depth review with local management teams.
Civil Eyes Research uses national data to:
• Examine patient pathways between national centres (e.g. Great Ormond Street Hospital) and other hospitals throughout England. An example would be enabling clinicians and managers to understand and review the splits of care between the thirteen specialist paediatric Nephrology centres across the UK and the other hospitals which they work alongside.
• Review length of stay, patient activity and mode of treatment on a system-wide basis as opposed to that seen on a discrete provider basis. For example, patients with a chronic illness such as Crohn’s disease may attend their local hospital for clinical management and care but sometimes at “flare up” of their disease they will visit a specialist centre. Clinical networks are being established wherein patients attend, for example, Manchester Children’s hospital and also may visit their local hospital in Burnley or Morecambe Bay. NHS England is moving towards reimbursement of care for patients on a year-wide payment and care mechanism with the active support of the Royal Colleges. National data is necessary to see the entirety of patients’ encounters with health services.

Yielded Benefits:

All CER workshops within each benchmarking club are evaluated and delegates are asked to share action points following the meeting. A selection of actions is included below which show clear benefits for the NHS and patient outcomes – they are a sample of the action points documented. (A) Medical productivity within NHS organisations • Clinical Lead: Achieve a better balance in patient flows between elective and emergency activity and admissions & discharges • Senior Matron: Seek to reduce admissions on night before surgery • Matron: Continue to work on delayed discharges • General Manager for Critical Care.: Develop concept of Day of Week Surgeons to improve throughput and patient flow • Consultant Radiologist: Explore reasons why high there is a high proportion of CT scans per A&E attendance and MRI scans per inpatient • Acute Pathway General Manager: Review reasons for delays - possibly look at 2.5 theatre session days • Data Manager: Implement text reminders / follow-up calls in advance of surgery in order to cut down issue of patients not fit for surgery • Acute Medicine Consultant: Create more streaming for common medical conditions presenting to A&E through ambulatory care • Performance Manager: Look into option of shadow / reserve list of patients when calling patients week before appointments and look at telephoning patients two days before • Consultant: Explore options to improve trauma repatriations to district general hospitals • Operations Director, Clinical Support Health Group: Explore why our close peers have a lower admission rate from the Emergency Department • Consultant: Explore whether delayed discharge adversely affects mortality after critical care • General Manager, Theatres & Anaesthesia: Investigate high number of cancelled operations for patient contraindications • Service Manager: Review readmissions for unselected take medical admissions Feedback comments included: • Divisional Clinical Director: As ever I enjoyed the session • Specialty General Manager Critical Care: Data was helpful and can be shared with teams • Service Manager: Helpful analysis will be used to prompt discussion with the clinical team • Project Manager -Service Line Management: Liked the team review at the end of the meeting and feedback at the end - interesting how everyone's focus was slightly different • Deputy Divisional Operations Director - Surgery: Many thanks - another useful and enjoyable session! See you next year Civil Eyes Research elicit feedback about the value of shared practice within the workshops – 95% of workshop attenders rated this as very good or excellent. The “returning customer” rate, at organisational level, for the Medical Productivity benchmarking club was 90%. (B) Pathology networks • Consultant Microbiologist and Assistant Care Group Director for Pathology: A&E timeliness and discharge • Pathology Service Manager: ED timeliness and the contribution of Pathology diagnostics • Pathology Manager: Review patient pathway for infections • Microbiology Operational Manager: Positive pathogens reported – explore the process • Blood Sciences Manager: Explore impact on re-investment on cost per test • Microbiology Service Manager: Explore possible repatriation of Pathology send away tests • Trust Lead Healthcare Scientist & Head of Pathology: Review total costs and skill mix • Microbiology Operational Manager: Investigate increase in molecular tests to drive infection control and sepsis availability – potential saving to patient length of stay • Blood Science Service Manager: Review reasons for high level of anaemia bed days at peripheral hospital • Cellular Pathology Manager: Investigate potential impact areas for Pathology and cost savings for the trust • Head of Pathology Services: Blood cultures – review the sepsis pathway • ‎Laboratory Manager Microbiology: Blood cultures, time of receipt and reporting • Blood Sciences Manager: Explore reasons for increased BNP tests and impact on heart failure metrics • Blood Science Service Manager: Readmission rates and lengths of stay • Cellular Pathology Operations Manager: Review turnaround data against other trusts and look for similarities / differences - how can we improve? • Head of Pathology Services: Review Vitamin D demand management and fT4: TSH testing rates • Microbiology Manager: Sepsis - look at Biochemistry activity and laboratory processing times especially at the weekends - what are other hospitals doing right? Feedback comments included: • Consultant Biochemist and Speciality Lead for Clinical Laboratory Sciences: Excellent - as ever! • Trust Lead Healthcare Scientist & Head of Pathology: Excellent discussions - wide-ranging and thought-provoking • Director of Pathology Operations and Development: Hoping to identify where Pathology has successfully reduced costs in any of the marker conditions • Blood Sciences Manager: Very useful and thought-provoking meeting • Cellular Pathology Service Manager: Well organised, informative and friendly 96% of workshop attenders rated the value of shared practice within the workshops as very good or excellent. The “returning customer” rate, at organisational level, for the Pathology benchmarking club was 91%. (C) Specialist Children’s Hospitals • Consultant & Clinical Lead: Availability / analysis of data to assess outpatient operational efficiency • General Manager: Develop a waste reduction workstream based on KPIs drawn from the benchmarking • Consultant Paediatrician and Child Health Clinical Lead: Develop electronic room booking and scheduling system • Business Manager: Do outpatient room audit and examine actual start and finish times • Children's Matron: Moving more surgery to day cases - hypospadias, ENT and children aged under one • Clinical Services Manager, Hospital Paediatrics : Examine pre and post theatre stays • Service Manager: Explore extending the outpatients afternoon session • Information Manager, Evelina London Neonatal Unit: Review our staffing against activity • Service Manager, Paediatric Outpatients: Adding appointment cancellations to our outpatient scorecard • Divisional Director for Newborn Services: Explore opportunities for early discharge into the community and tube feeding • Nurse Consultant: 24/7 community nursing services and effect on hospital stays • Chief of Service: Admitted but not operated patients - small numbers but impact on patients / families - need to understand why it happens for operational issues • Service Manager: Coding and co-morbidities for elective activity and outpatients • Deputy Divisional General Manager - Children's & Women's Division: Review Continence pathways • Children's Matron: Explore reasons for surgery being cancelled on the day • Deputy Head of Nursing: Explore the option of crisis mental health support within the children's hospital and children's ED • Consultant Paediatrician: Out of hours assessment of children following deliberate self-harm without hospital admission Feedback comments included: • Clinical Director & Consultant Psychologist: As always I have a very long to do list but I will keep working on this! I think it would be great to get you down to our trust for a local workshop • Child & Adolescent Psychiatrist: Extremely useful to discuss the variety of practices around the country and to brainstorm what we might be able to adopt • General Manager: It was a really good day and an excellent opportunity to meet some of the people from the other centres • Consultant Neonatologist and Deputy Service Lead: Thanks for bring neonatal professionals from different hospitals together - good to take away learning points from our peers • Service Manager: Useful opportunity to network with colleagues across children's hospitals - sharing experience and ideas very beneficial • Head of Outpatients - Division of Medicine: Very informative - good sharing of what's worked well and what's not Civil Eyes Research elicit feedback about the value of shared practice within the workshops – 95% of workshop attenders rated this as very good or excellent. The “returning customer” rate, at organisational level, for the Specialist Children’s Hospitals benchmarking club was 100%. Continued use of Hospital Episode Statistics data will enable Civil Eyes Research to continue to provide similar benefits to the healthcare organisations that opt to use its benchmarking and analytical services. The future benefits are expected to continue working with the same and additional organisations and will consist of identifying opportunities for improved use of NHS resources and potential improvements in the quality, patient-centeredness and timeliness of patient care. That NHS organisations have opted to use services from Civil Eyes Research over twelve years shows that the services provided are valued by chief executives, medical directors and managers in helping with the management of healthcare and the improvement of efficiency, quality and timeliness in patient care. The outputs or analysis are ultimately delivered to improve patient care, pathways, healthcare services and value for money. The benefits provided are: • An improvement in patient care due to increased clinical productivity and the reduction in variability across the healthcare system in England. • Enhanced efficiency within clinical services improving capacity and access to services for patients. • Evaluation and benchmarking of NHS organisations helping to increase quality and outcomes for patients. • Providing insights and evidence to support providers in developing local services to provide the best care possible for their patients. • Better use and understanding of information within the NHS for all disciplines, specialties and hospitals with which Civil Eyes Research works.

Expected Benefits:

Analyses are used by trust boards, directorates, clinical directors, managers and specialties to improve performance and quality and increase efficiency.

Civil Eyes Research is acutely aware that its benchmarking activities need to result in demonstrable impact and improved value for the NHS. This is important for three reasons: to justify access to HES data, to demonstrate the value of the benchmarking services to NHS clients, and to improve the quality and efficiency of services for patients.
To address this, all CER workshops within each benchmarking club are evaluated and delegates are asked to share action points following the meeting.

A selection of actions is included below which show clear benefits for the NHS and patient outcomes – they are a sample of the action points documented. They show the role of the hospital clinician or manager and the action point arising from the benchmarking workshop and analysis.

(A) Medical productivity within NHS organisations

Ten District General Hospitals have been involved in working together to seek to understand medical productivity. Using some of the methodology initiated within the Valuing Medical Resources project, Civil Eyes Research has created a network of DGHs across the country focusing on consultant-level information using programmed activity (PA) data alongside published clinical activity.
The early stages of work have been conducted in Trauma & Orthopaedics, Radiology and Acute & Emergency Medicine. The scoping days and workshops have been designed for clinical directors and specialty managers. The group is now seeking to widen the project scope and move forward to address emerging themes within the selected hospital group and cover more specialties.
The project is managed by a steering group which meets in the Spring to evaluate the work programme and consider further topics for subsequent workshops.

The selected action points have been grouped under the headings of efficiency, productivity, improved performance, and safety and quality outcomes.

Efficiency
• One marker of benefit is the degree to which hospitals have attended multiple workshops over the course of the past year – this is an indicator that the participants had considered the outputs beneficial to their work in the NHS. The workshop topics vary across the year so one would not expect the same people to attend all workshops. The “returning customer” rate, at organisational level, for the Medical Productivity benchmarking club was 90%.
Director of Services / Paediatric Surgeon: Improve admissions through surgical assessment unit for better theatre throughput
• Clinical Lead for Anaesthetics: Explore recruitment above establishment in order to minimise agency spend
• Service Manager: Review in detail A&E workload and impact of Radiology activity by modality
• Deputy Head of Operations: Improve weekend medical resources and senior input in order to promote earlier discharge and reduce lengths of stay
• General Manager for Critical Care: Develop concept of Day of Week Surgeons to improve the management of non-elective patients across all seven days

Productivity
• Directorate Manager: Apply a scheduling tool as implemented at other trusts to generate an apply operating time per Consultant and procedure
• Performance Manager: Consider extended job plan hours to better match with patient workload
• Chief Radiographer / Radiology Services Manager: explore reasons for low rate of MRI activity per scanner
• Head of Operations: Map Emergency Department resources to both attendance and time spent within the department
Improved performance
• Directorate Lead Nurse: Starting first operative patient in theatres on time assuming that a bed will later become available to facilitate flow of cases through theatres
• Clinical Lead for Anaesthetics: Implement extended hours and seven day working
• Deputy Head of Operations: Increase ambulatory care throughput - look at pathways for toxicology patients in order to reduce length of stay
• Operational Manager: Review frailty model in medical assessment unit and explore the feasibility of a “no limits” model
• Consultant Orthopaedic Surgeon: review the musculoskeletal pathway for non-operative patients
• Deputy General Manager: Seek to manage and forecast elective cases requiring Critical Care admissions

Safety and quality outcomes
• General Manager, Theatres & Anaesthesia: Focus on day cancellations and seek to reduce
• ED Business Support Manager: Improving frequent attender figures in A&E e.g. introducing fast track area for better Psychiatry access
• ED Business Support Manager: Review acute frailty CQUIN - should we be removing the age requirement (70+) and offering the service to those who actually need it?
• ED Admin Manager and Symphony System Lead: Explore the introduction of a mental health flow out from the A&E department
• Senior Nurse for Acute Medical Unit: Investigate potential improvement in rate of weekend discharges
• Consultant: Add occupational therapy and physiotherapy to the rehabilitation team in Critical Care outreach to improve patient care
Civil Eyes Research also receives feedback about the value of the workshops from individual delegates and a very much shortened set of comments is shown below:
• Operational Manager: As always very interesting session that has provided food for thought
• ED Business Support Manager: Excellent data analysis and facilitators enthusiastic to offer further data
• Modern Matron: Good to see how you compare with other units and where you can learn from them
• Consultant Acute Medicine: Good workshop and discussion. New ideas to take back.
• Patient Access Co-ordinator: Informative and thought-provoking, thank you
• General Manager, Theatres & Anaesthesia: Informative, useful & thoroughly enjoyable
• Consultant: Thanks for a great day - some provocative thoughts
• Divisional Manager: Thanks for a thought-provoking day. I found it very positive to have such a high quality of debate and to hear from others trying to make sense of the now and grappling with the uncertainty ahead. Keep up the good work
• Consultant Orthopaedic Surgeon, Clinical Director for Trauma: Thanks for organising the day, it was very interesting and provided much food for thought!
• Service Manager, Anaesthesia, Theatres and Critical Care: Useful session, worthwhile discussions and will generate discussion among local team
• General Manager: Very interesting and informative. Well delivered. Has provided the team with a lot of ideas in ways to improve patient pathways and performance
• Clinical Director: Very relevant and helpful workshop
• Director Medicine & ED Operational Lead: Well structured, great analysis and discussion
Civil Eyes Research elicit feedback about the value of shared practice within the workshops – 93% of workshop attenders rated this as very good or excellent.

(B) Pathology networks (with Keele University)

The selected action points have been grouped under the headings of efficiency, productivity, improved performance, and safety and quality outcomes

Efficiency
• Quality and Governance Manager, Cellular Pathology: Use the analysis showing Haematology / Oncology cases to demonstrate activity to support business case for additional staff
• Microbiology Operational Manager: Urine process review with the aim of reducing the number of cultures and unnecessary costs
• Consultant in Medical Microbiology and Infectious Diseases: Understand why there are higher costs for patients with infections than at other hospitals
• Operations Manager, Pathology Business Services: Explore whether there is scope for a cross-trust Pathology cost improvement related to the hospital testing rate
• Cellular Pathology Operational Manager: Continue review of Microbiology and implement changes in follow ups, impact of new technologies, new ways of working on infection control and length of stay

Productivity
• Consultant Histopathologist: Review training of senior biomedical scientists to have a greater role in cut-up and reporting of simple specimens
• Blood Sciences Manager: Review scope and practice of band 4 associate practitioners - particularly overnight
• Senior BMS, Microbiology: Look at advanced practitioner roles and see how they might be utilised in a growing department and / or as a source of staff training
• Consultant in Medical Microbiology and Infectious Diseases: Individual job plans of all the infection team to be reviewed as one team
• Pathology Centre Manager: Develop automation opportunities in Microbiology
Improved performance
• Service Manager, Molecular Services: Share slides with colleagues and senior managers to prompt discussions regarding rapid changes
• Quality and Governance Manager, Cellular Pathology: Review rate of blocks and slides - extremely high compared with everyone else
• Consultant Biochemist: Investigate A&E turnaround times and the interaction with both Biochemistry and Haematology
• Clinical Scientist: Explore how Blood Sciences can support Diabetology in reducing length of stay in the way we have for acute kidney injury
• Head BMS, Cellular Pathology and Microbiology: Seek to expand the working day in Microbiology and introduce Saturday working in Cellular Pathology to reduce length of stay

Safety and quality outcomes
• Pathology Business Development Manager: Review process for diagnostic biopsies to ensure reporting within seven days
• Consultant in Medical Microbiology and Infectious Diseases: Review why bed day levels for infections and sepsis are so high
• Pathology Business Development Manager: Look at the use of Procalcitonin for under 16s to reduce numbers of admissions with infection diagnoses
• Head BMS: Investigate Vitamin D to Na ratio compared to deprivation profile
• Head BMS Blood Sciences: Develop guidelines for GPs to improve appropriateness of requesting

Civil Eyes Research elicit feedback about the value of shared practice within the workshops – 95% of workshop attenders rated this as very good or excellent.

One marker of benefit is the degree to which hospitals have attended multiple workshops over the course of the past year – this is an indicator that the participants had considered the outputs beneficial to their work in the NHS. The workshop topics vary across the year so one would not expect the same people to attend all workshops. The “returning customer” rate, at organisational level, for the Pathology benchmarking club was 88%.

(C) Specialist Children’s Hospitals

The selected action points have been grouped under the headings of efficiency, productivity, improved performance, and safety and quality outcomes

Efficiency
• Specialty General Manager: 47% of outpatients discharged at first attendance – review the appropriateness of referrals and look at GP postcode areas with high referral rates
• Paediatric Renal Nurse Coordinator: Look into capturing unplanned activity including telephone advice and liaisons and the most effective way to record this for the benefit of the service
• Head of Service - ENT: see how to improve follow-up rates in clinic and explore the introduction of virtual clinics
• Consultant in Paediatric Respiratory Medicine: Other units have four transitional care beds for Long Term Ventilation patients, we need to try to do this to reduce bed blocking - consider use of technology dependent area within a ward
• Head of Nursing for Surgery and PICU: Improve theatre productivity – consider the introduction of theatre escorts and an admission lounge

Productivity
• Service Manager: continue to review and improve wording of clinic letter templates - e.g. emphasising to come to appointment / cost of appointment / arrive early if having tests
• Project Manager - Outpatient Productivity: Consider extended weekday hours versus seven day working in clinic re-structure plans
• Service Manager: Continue to explore / record telephone clinics / SKYPE / alternative clinics
• Matron: Develop Clinical Nurse Specialist role to release Consultant time
• Service Improvement Manager: Introduce procedure room to increase theatre utilisation
• Head of Operations: Explore nurse-led, protocol-driven discharge across the specialties

Improved performance
• Directorate Operations Manager: Review the process for issuing sleep study equipment during clinic appointment and the necessity for bringing patients back to the day ward to give out equipment on a separate occasion
• Matron: Review Cardiology and Urology bringing in patients the night before a surgical procedure
• Consultant Paediatric ENT Surgeon: Seek to improve clinical coding for HRG4+ - improve the engagement between clinicians and coders
• Outpatient Manager: Consider outreach clinics versus travel distances for patients and their families
• Service Manager: Review transitional care and the possibility of a transitional care unit versus high dependency care for our new hospital build

Safety and quality outcomes
• ENT Consultant: Consider day case tonsillectomy discharge within four hours and the weight limit criterion for children’s day case surgery
• Clinical Services Manager, Hospital Paediatrics: Consider GP referral patterns by area and relate to need for improved GP education
• Consultant Respiratory Paediatrician: Seek to establish a more formal multi-disciplinary meeting (including Palliative Care) for certain patients being considered for long term ventilation / tracheostomy
• Senior Physiotherapist: Investigate rapid response service to avoid unnecessary admissions as at other trusts
• Directorate Operations Manager: Readmissions for paediatric ENT within two days quite high despite lower day case rates - review causes of readmission
• Divisional Operations Manager: Tongue-tie surgery rate at our trust is second highest nationally - need to pursue discussions about clinical appropriateness
Civil Eyes Research also receives feedback about the value of the workshops from individual delegates and a very much shortened set of comments is shown below:
• General Manager, Surgery & PICU: Constructive, well facilitated workshop that has set my to-do list for 2017/18!
• General Manager for Children's Surgical Services and PICU: Data benchmarking - priceless!
• Operations Manager: Excellent, relevant, well presented, knowledgeable presenters
• General Manager - Medical Specialities and NICU: Good breadth of information, interesting discussion and peer learning
• Radiology Professional Manager: Good opportunity to benchmark and network with peers
• Sister for Outpatients Department: Great overview of outpatients and work of other trusts
• Head of Operations and Delivery for Acute Child Health: Group discussion around practice very helpful
• Consultant in Paediatric Respiratory Medicine: Helpful to put local service in a national context
• Matron / Service Improvement Lead: Informative and intriguing day, brilliant data presented
• Lead Nurse: Really interesting and valuable - thank you - lots to take back and discuss with colleagues
• Paediatric Renal Nurse Coordinator: Reiterated importance of benchmarking to address gaps in service delivery and expansions - I found the meeting very helpful
• Service Manager: The workshop provided a comprehensive understanding of the service, challenges and how to progress
• ENT Consultant: Very meaningful and thought-provoking data
• Senior Paediatric Radiographer: Very useful to see comparisons and meet other staff from paediatric hospitals, as well as hearing how they work and how we could change to make improvements

Civil Eyes Research elicit feedback about the value of shared practice within the workshops – 94% of workshop attenders rated this as very good or excellent.

One marker of benefit is the degree to which hospitals have attended multiple workshops over the course of the past year – this is an indicator that the participants had considered the outputs beneficial to their work in the NHS. The workshop topics vary across the year so one would not expect the same people to attend all workshops. The “returning customer” rate, at organisational level, for the Specialist Children’s Hospitals benchmarking club was 100%.

The participating hospitals are committed to working together in a mutually beneficial way by:
• Working collaboratively, the hospitals have the opportunity to understand why sister organisations operate differently.
• Examining best practice and likely service trajectories enabling the group to explore opportunities in the context of each member hospitals.
• Addressing key questions such as: what lies behind the information? Why do we code differently? What can we learn from this example and can we apply it to our local situation?
The steering group meets each February to evaluate the work programme and consider further topics for subsequent workshops.

Continued use of the HES data will enable Civil Eyes Research to continue to provide similar benefits to the healthcare organisations that opt to use its benchmarking and analytical services.

The future benefits are expected to continue working with the same and additional organisations and will consist of identifying opportunities for improved use of NHS resources and potential improvements in the quality, patient-centeredness and timeliness of patient care.

That NHS organisations have opted to use services from Civil Eyes Research over ten years shows that the services provided are valued by chief executives, medical directors and managers in helping with the management of healthcare and the improvement of efficiency, quality and timeliness in patient care.

The outputs or analysis are ultimately delivered to improve patient care, pathways, healthcare services and value for money.

The benefits provided are:
• An improvement in patient care due to increased clinical productivity and the reduction in variability across the healthcare system in England.
• Enhanced efficiency within clinical services improving capacity and access to services for patients.
• Evaluation and benchmarking of NHS organisations helping to increase quality and outcomes for patients.
• Providing insights and evidence to support providers in developing local services to provide the best care possible for their patients.
• Better use and understanding of information within the NHS for all disciplines, specialties and hospitals with which Civil Eyes Research works.

Outputs:

Outputs are set out below for each of the three benchmarking clubs.

(A) Medical productivity within NHS organisations

The outputs will be in the form of PowerPoint slides used at specialty and topic-specific workshops which are attended by senior doctors, nurses, other clinicians and managers from the hospitals involved. Civil Eyes model is that they use data to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide. The encounters are workshops, not lectures, with typically between 20 – 30 attendees. The aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS trusts the scope for better use of resources, for example how specialties could treat more patients if they achieved peer levels of productivity.

The PowerPoint outputs will be produced and disseminated over the course of the 2017/18 year and issued to doctors, nurses, other clinicians and managers of healthcare organisations. Civil Eyes will also use the slides in local meetings with the hospital where they share the messages of the analysis and the workshop with senior members of the hospital management team.

In the Medical productivity programme, the specific outputs last year consisted of benchmarked analysis in PowerPoint slide form of a range of specialties and functional areas covering Anaesthetics, Breast Surgery , Cardiac Surgery, Cardiology, Care of the Elderly, Colorectal Surgery, Dermatology, ENT, Gastroenterology, Gynaecology, Haematology, Hepatobiliary Surgery, Intensive Care, Maternity, Nephrology, Neurology, Neurosurgery, Oncology, Ophthalmology, Oral & Maxillofacial Surgery, Plastic Surgery, Radiology, Respiratory Medicine, Rheumatology, Trauma & Orthopaedics, Upper GI Surgery, Urology and Vascular Surgery. The specific outputs this year will comprise the same topic areas. Civil Eyes expect to cover similar areas next year.

(B) Pathology networks (with Keele University)

The outputs will be in the form of PowerPoint slides used at topic-specific workshops which are attended by senior doctors, other professionals, clinicians and managers from the hospitals involved. Civil Eyes model is that they use data to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide.

The encounters are workshops, not lectures, with typically between 20 – 30 attendees as the aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS organisations the scope for better use of resources, for example how different patterns of Pathology testing could avoid hospital admissions or reduce bed day use.

The PowerPoint outputs will be produced and disseminated over the course of the 2017/18 year and issued to doctors, other professionals, clinicians and managers of healthcare organisations. Civil Eyes will also use the slides in local meetings with the hospital where we share the messages of the analysis and the workshop with senior members of the hospital management team.

In the Pathology benchmarking programme, the specific outputs last year consisted of benchmarked analysis in PowerPoint slide form of areas on which Pathology disciplines can have beneficial impact in terms of increased efficiency and improved quality. These areas comprised Accident & Emergency, infections, inpatient sepsis, diabetes, cellulitis, pulmonary embolism, deep vein thrombosis, acute kidney injury, anaemia, readmissions and outpatients. The specific outputs this year will comprise the same topic areas. Civil Eyes expect to cover similar areas next year.

(C) Specialist Children’s Hospitals

The outputs will be in the form of PowerPoint slides used at topic-specific workshops which are attended by senior doctors, nurses, other clinicians and managers from the hospitals involved. Our model is that we use data to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide. The encounters are workshops, not lectures, with typically between 20 – 30 attendees as the aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS organisations the scope for better use of NHS resources and opportunities to improve the quality and timeliness of services provided to patients.

The PowerPoint outputs will be produced and disseminated over the course of the 2017/18 year and issued to doctors, nurses, other clinicians and managers of healthcare organisations. Civil Eyes Research will also use the slides in local meetings with the hospital where we they will share the messages of the analysis and the workshop with senior members of the hospital management team.

Civil Eyes Research issues to doctors, nurses, and managers of Specialist Children’s Hospitals an annual database in password-protected Excel file format of aggregated performance information covering length of stay, day case rates, same day operations, cancelled operations, depth of diagnosis coding and readmissions. The level of data is hospital, specialty and Healthcare Resource Group.

In the Specialist Children’s Hospitals benchmarking programme, the specific outputs last year consisted of benchmarked analysis in PowerPoint slide form of a range of clinical and functional areas. These comprised Accident & Emergency and General Paediatrics, Clinical Immunology & Allergy, readmissions and cancelled operations, Paediatric Radiology, general performance review of length of stay, same day operations and day cases, Outpatients, Paediatric Nephrology, Paediatric Surgery and Urology, Paediatric Trauma & Orthopaedics, Paediatric Gastroenterology, Paediatric Ophthalmology and Paediatric Oncology. The specific outputs this year will cover most of the same areas with the addition of Paediatric Respiratory Medicine, Paediatric ENT and Paediatric theatres. Civil Eyes expect to cover similar areas next year.

In addition to the national workshops, Civil Eyes Research undertakes meetings and visits with individual hospitals at both executive team and departmental level. These meetings vary in format, but typically are collaborative events where we work in more detail with the hospital to emphasise the messages from the benchmarking analysis with the aim of stimulating beneficial change. For example, in the Pathology benchmarking programme, a common meeting format consists of sessions with the individual disciplines within the Pathology department – Microbiology, Cellular Pathology and others – and also with the hospitals’ executive team in order to increase their awareness of both the performance of the laboratory and to explore ways in which the disciplines can improve efficiency and quality within the wider hospital and the health economy .

Processing:

Civil Eyes Research will be only requesting data items that are required for their analytical purposes - the data requested is pseudonymised and not sensitive and do not identify clinical activity at a patient level.

Outputs from data processing and analysis are only issued to clinicians and managers of NHS organisations. No record level data is provided to any third party organisation in any format.

England-wide data is used to see the entirety of patients’ encounters with health services within a healthcare network, to look at patterns of care across providers such as readmissions and extended lengths of stay, to provide peer groups and to derive comparative provider and population-based performance measures.

Civil Eyes Research is required by clients to:
• Provide evidence of national best practice
• Provide performance within a national or local context
• Provide information on patient flows to tertiary, regional or national services and centres
• Provide local market reviews of comparable provider

Civil Eyes Research will group the pseudonymised HES data to the latest Healthcare Resource Group (HRG) software and analyse the data at organisation, hospital, specialty, HRG, diagnosis and procedure level.

The data is held on a prime database server dedicated to the sole use of Civil Eyes Research; the server is not connected to a network. The data will be stored and processed at the single address specified.

The processing activities are the same for all three Benchmarking activities.

All individuals with access to the record level data are substantive employees of Civil Eyes Research.

Civil Eyes Research provides details of the programmes and datasets used throughout the website http://www.civil-eyes.com/ and is highlighted on the Home Page. Further details of any of these activities or more information, can be requested by contacting Civil Eyes Research by writing to info@civil-eyes.com.

Civil Eyes Research uses a range of healthcare data to provide information to hospitals, clinicians and managers about clinical performance, quality, efficiency and productivity with the aim of helping to achieve improvements in these areas. These data include Hospital Episode Statistics information as well as data collected directly from healthcare organisations around the UK.

All data is pseudonymised.

Civil Eyes Research will not link HES data to other datasets.

All outputs are in aggregate form with small numbers suppressed in line with the HES analysis guide.