CHI delivers “must do better” verdict on information use

CHI’s verdict is contained in a summary report on what it has found in acute services.  It is effectively a farewell note from the commission which hands over its responsibilities to the new super-regulator, the Commission for Healthcare Inspection and Audit, on 1 April.

On the whole, the report paints a positive general picture of improving acute services, though in her foreword, the CHI chair, Dame Deirdre Hines, notes: “Whilst, on the whole, the quality of services has improved, there’s a worrying variation in the quality of service provision.

“At a strategic level trusts are beginning to embrace public and patient involvement.  Key issues relating to risk management are being addressed and we have seen improvements in multi-disciplinary audits.  However, trusts do need to improve the collection and use of good quality information.”

In a more detailed examination of information use at board level CHI notes that board members tend to see information about waiting times and financial performance, but  there is generally insufficient value placed on information by senior staff.

The report says:“They [senior staff] are often unable to explain the reasons behind whether they have met, or have failed to meet, targets set.  In our investigations we found that lack of effective performance management to be a contributory factor to service failure.  Boards have a responsibility to understand trends and patterns in service performance, and the reasons for these, in all areas of trust activity.”

Clinical teams fare no better in their information use, according to the report.  It says CHI teams have frequently found problems with the accuracy and quality of data, particularly with patient administration data, such as incomplete and inaccurate coding, missing data sets and double entries.

“Inaccurate data makes it difficult for the trust itself, as well as outsiders, to ascertain a trust’s performance and to understand the reasons behind it.  Inaccurate data can occur due to a number of reasons including poor IT infrastructure, lack of access to IT, inadequate training for staff using information systems and lack of understanding of the importance and value of good quality data,” says the report.

CHI has consistently highlighted use of information as an area where trusts perform badly, says the report.  However, it concludes that many of the problems could be overcome through encouraging a good information culture and by encouraging staff to collect reliable and valid data and put it to good use.

There is praise for IT systems which have helped to improve patient complaint systems, though CHI laments the obstruction of genuine patient and public involvement in some organisations due to lack of leadership, information and opportunities for involvement.

The report is critical of the abuse of information in “gaming measurement” where systems used to collect data or the data itself are manipulated to meet targets.

“Gaming measurement may mean patients do not receive the care they need; it distorts the system, leading to unfair comparisons between trusts and, by undermining a good information culture, can result in demoralisation of staff,” the report says.

“On balance, our assessment is that too many acute trusts take a mechanistic approach to achieving targets, rather than redesigning services supported by high quality information systems that achieve high standards of care, as well as high standards of performance,” the report concludes.