The usual NHSHealth chat health warning here – these are my views and reflections. They may differ from yours if you were there, watched on Periscope or will view later. If you want to see the whole chat, for free, please click though here.
(it is free to watch)
Data is good! Data is King? Well, Samantha Riley head of Improvement Analytics at NHSI was described by Roy Lilley as the ‘data doyenne’. Her passion was and is data and using it. She is a bit of a standard bearer for a possibly misunderstood set of skills. And she had a very interesting back story – which is Mr Lilley’s tried and tested way of us getting to know the person behind the job title. We often need that, as job titles very seldom tell you about the day to day, and the long term aims.
Let’s get my preconceptions out of the way. A science head, a people and strategy heart and MBA biased towards information use. So I arrive at the Periscope recording of this session with these thoughts ringing in my ears:
- “What gets measured gets done”. A quote from the seminal treatise “In Search of Excellence”, (Peters and Waterman, 1982))
- We tend to measure what is easiest to measure, not what is going to give us the best information set to inform decision making and action
- Data is useless unless you turn it into usable information
- Having got useful information, what do people do with it? Does it actually inform decision making and create an action plan that is put into being?
- How does Sam Riley’s team make sure the data and information they feedback to people isn’t just met with stony faced blank resistance?
I remember my Uncle Fred’s job at Plessey in Liverpool. He was a Time and Motion Engineer. So, a pawn of management, and hated by the workers! The ultimate middle management position. The aim was fine. Gather data, work out what it means, and use it to create an action plan to improve processes in both efficiency and effectiveness (which are different, of course). He still remained the punch bag and source of panic and fear. And as soon as they knew they were being watched, people did things differently. I suppose experience taught him to look past that. But the job feels so similar in problems as Sam’s does now!
Let’s look at career highlights:
- A women in a mans world – computer Science degree. One of two women on the course that year. More interested in people than machines, so moved on. Majored on visual presentation of data.
- Charity role – Concern Worldwide. Ethiopia. Definitely people focussed! Co-ordination of all Admin. Good old spreadsheets!
- Into NHS. Research Co-ordinator at a London hospital. Many clinical trials happening. Ostensibly looked on as an income stream, from Pharma companies. Her data found they were bleeding costs, mainly due to the extra burden on lab testing. Data meant they could argue for more money from the pharmaceutical companies. Result…
- Joined the famed Management Training Scheme within the NHS. Other luminaries? Simon Stephens. Mark Britnell. There are more….and if it creates visionaries like that, who stay loyal within the NHS, who cares if it is inward looking and NHS originated?
- Modernisation Agency. Placements at St Georges. Community Trust. Data showed they could keep people in hospital for a shorter time. Push them out ASAP. Unintended consequence? They burst the community budget.
- Brighton Acute Trust. CEO, Dame Marie-Anne – described as very inspirational. A ‘management by walking around’ advocate. Firm and Fair. Much team building and spending time together. Team pub on Friday Lunchtime. Working lunch. Back to office then stayed late. Head of Patient Access.
- Improvement Partnership for Hospitals. A new three letter acronym. Statistical Process Control – SPC – more in a mo!
A couple of Sam’s core values emerged during this, which I think are key. She found new recruits though interviewing for attitude and team fit. She then trained them for the required knowledge and skills. It is too hard to train attitude – some would say impossible. Amen to that. Secondly, the focus on team work and team worth. If you didn’t fit, you didn’t stay. Simple.
As you can see, a lot of the jobs had ‘improvement’ actively in the title, or as a core aim of the role.
We did have the usual sparring. Inspection is useless intoned Roy. A politicians answer from Samantha. She didn’t answer at all. But I tend to agree with Roy. “Targets are all out of the window now aren’t they?” Again, ignored. That wasn’t in her bailiwick, so didn’t need to be answered. “Now we’re getting to it. The Friends and Family test. What a waste of time.” Sam answered this time. No, she said, the data was very positive, but the patient comments were amazingly powerful as staff motivators, far beyond the occasional note and box of chocolates. I thought that was possible, but not as instant as a thank you and note – and chops from the patient and family. Roy told us as a Trust Chairman, they found it easy to fiddle the results. Ask the patient immediately after their successful procedure, preferably when still woozy with anaesthetic, you always got positive results.
And I suppose that’s the problem. If you have targets, that’s what gets done. Even if 4 hours blanket target for getting through A&E is plainly daft as every condition is different in its level of emergency need. Would we have so many people in ambulances waiting to get into the department if the clock didn’t start until they cross the threshold? Targets create inappropriate unintended consequences. End of.
I did get a bit lost in a plethora of TLA’s. I suppose all industries have them. But when you put together an IT and informatics led support function and the NHS itself, you really are in TLA heaven! Or hell…(three letter acronym, in case you had forgotten).
But SPC got me. I’m not going to define or go into detail. Samantha didn’t. And doesn’t when she or her team are presenting the results of their research. It’s the numbers and info that count not the how they got them. But here’s the difference, and her aim in life now. Red Amber Green – the RAG system is very widely used. Saw it last night on BBC report on this years purported winter crisis in hospitals. RAG against targets, which are externally imposed in a simplistic way, and not based on patient outcomes. Most of them are simplified to two points on a graph. You can only draw a straight line between two points. And people respond to the Reds because that’s ‘the cosh they are under’ – as Roy said. Sam’s mission is to get more data so that we have proper graphs. That’s my essence reading of SPCs. 7 points means you have a proper graph, and you can then be controlled and step back and do much less firefighting and more real fixing? If I’m wrong Sam, please tell me! It does feel like it makes SPC a more reliable early warning system because it fixes on trends rather than one off blips.
Yes, it’s not easy. All along Sam kept telling us how people take the data personally. As we are talking, for example, named clinician patient outcome data here, I am not surprised? But let’s look at their method. When presenting to a board they are never judgemental. No fingers are pointed. It’s up to the board to use the information. And they will support them.
It’s all about giving the boards and others a better understanding of the data, to make better use of it to make proper action plans that will make a trans-formative difference.
Her mission includes training boards and NEDs and others how to make better use of the data. My biggest concern is this is a great start. But Sam’s team are too thinly spread. They can analyse, present, train a bit, but then they have to move on. I’m not sure they help with action planning from that data, and defining the outcomes that will show the strategy has succeeded? Maybe there is an obvious link to The Fab NHS forum of great practical ideas that are already proven to work? We don’t need to reinvent the wheel. Samantha Riley’s team can present the results to show where people are now. The boards can then seek ideas for actions from the likes of FabNHS.net.
My opinion? Perhaps we just need to move from data being created to feed the National offices beast. To interrogating it to inform our strategies. We are overwhelmed and drowning in usable data. What we need is for more of it to be turned into usable information. That to me needs not to be poisoned by targets. It needs to be led by patient outcomes.