Measurement and data: the Hard Truth

Today, the government published Hard Truths, its response to the recommendations of Sir Robert Francis, following his inquiry into the failures of care at Mid Staffordshire NHS Foundation Trust. It’s good to see that the response recognises the complexity of safety and, in particular, how to measure it. The proposal to publish data, ward by ward, on key safety issues could be a real driver of improvement if the data are developed and used in the right way. 

Providing guidance on how to interpret the data will help. But what really matters is that the right data are collected. Our recent report on measuring and monitoring safety highlights that focusing on data about specific past harms – such as pressure ulcers and falls – can only ever be partially helpful in predicting how safe care is likely to be in the future. We also need to collect real time and forward-looking data that tell us how safety is being managed day to day and how future risks are minimised.

But there’s more. This isn’t just about getting an accurate picture of safety. Who owns the data and how it is used also has an impact on its potential to support safer care.

An organisation that is leading in this area is Salford Royal NHS Foundation Trust, where they measure staffing levels in real time at ward level and respond accordingly. I believe that ward based reporting will be a positive part of an organisational culture that embraces the need to constantly challenge itself to improve safety. This transparency will also help patients and the public to understand quality of care and how it can be improved.

I do wonder, however, whether the key to Salford’s success has been that it owns the data and that it is part of their day-to-day management of safety. The government’s proposal for a new website, where healthcare providers post safety data, has advantages – it will give the public easy access and makes sure it is independent – but it is less likely to build a sense of local ownership of the data, any issues with care that it highlights and the need to improve.

If measures are felt to be an externally imposed requirement, a tick box exercise on top of already busy jobs, then staff could become disengaged and the accuracy of that data may also suffer.  

I hope that, as the government develops its plans for the website, they make sure that local engagement is part of the strategy so that staff, patients and the public are energised by transparency to improve care. 

Penny is an Assistant Director at the Health Foundation,www.twitter.com/PennyPereira1