The Devil is in the Data

With more and more LOCs choosing to set up a Primary Eyecare Company (PEC) to bid for extended primary care services, the Clinical Governance & Performance Lead role (CGPL) is becoming a vital position in local eyecare services; responsible for analysis of the real-time data to the PEC and CCG.

Interpreting the data and relating that in a meaningful way is part of the art of being a successful CGPL.

As part of his participation in the Leadership Skills for Optical Professionals, Mark Simpson (pictured right) from Primary Eyecare Company Cheshire (PECC), has studied the role of the CGPL as a transformational character who must be able to interpret the data and communicate it to practices and in a constructive way.

In this LOCSU Blog, submitted in an essay as part of the Leadership Module, Mark explains how he transferred elements of the learning to improve his performance as a CGPL and, in turn, the running of the Primary Eyecare Company and the delivery of the service to the CCG and patients.

Introduction

The NHS is changing and moving towards more Step-Down Care to provide care closer to home for patients (NHS England, 2017). With this in mind, Local Optical Committees (LOCs) across the country have realised the great position they are in to deliver this model.

To prepare themselves for tendering for extended NHS services, many LOCs have been forming Primary Eyecare Companies . This has resulted in a range of new roles, one of which is that of a Clinical Governance and Performance Lead.

I have now been a CGPL for Primary Eyecare Cheshire (PECC) for two years. According to LOCSU, a CGPL is responsible for day-to-day monitoring of all aspects of service provision and delivery including mobilisation, clinical governance, information governance, auditing and performance monitoring of the service. Read the full role description on the LOCSU website.

The main primary care service in West Cheshire is the Glaucoma Repeat Reading Service (GRRS). For this we are funded to perform repeat readings on patients with elevated IOPs and/or suspect glaucomatous visual fields in the presence of no other glaucoma related findings (i.e., normal looking optic nerves and open anterior chamber angles). The service is managed using an IT platform produced by Webstar Health called OptoManager. This IT platform allows us to:

  • Offer managed services to Commissioners, including administration, data collection and performance reports
  • Provide easily accessible, secure and simple platforms for practice staff
  • Collect robust audit data to showcase to commissioners the value of the services we provide.

However, one of the roles of the CGPL is to undertake the data analysis. It’s vitally important that the data is analysed properly for a variety of reasons:

  • Spotting outliers in the service
  • Showing Clinical Commissioning Groups (CCGs) that Key Performance Indicators (KPIs) are being met
  • Presenting the data to PEC in an easy to understand way so they can appreciate how the service is running
  • Encourage practices to stay on top of KPIs

Analysis of Data and Leadership

There are two main sets of data made available to the CGPL. One is an online OptoManager admin platform that allows access to real-time data for the service. This allows visualisation of all historic and active patient episodes. The other set, which arrives quarterly by email, is the tabulated audit data based on the CCGs KPIs for the service. 

One of the KPI targets set out from the CCG stated that 90% of patient episodes should be completed within four weeks from the initial eye examination. To keep track of this it’s important to check the real-time OptoManager data to see if any patient episodes are overdue (this process is outlined Appendix 1). In my case, after discovering that certain patient episodes were over the four-week KPI target, I would then contact the practices to find out the reason for the delay. However, these delays continued to occur. I began to get the impression that the message wasn’t quite getting through to a number of practices. It is well known that motivating and engaging clinicians to take on new guidelines is an ongoing challenge in healthcare (McKeown et al., 2016). One study (Murray and Richardson 2003) suggested that 20% of employees actively support change, 70% remain uncommitted and 10% oppose change as a matter of principle. 

Burns (1978) described leadership as a form of relationship that encourages followers to pursue joint purposes that represent the motivations of both parties. Nicol et al. (2014) stated that, to develop into a successful healthcare leader, individuals need the ability to take an inclusive approach, while understanding the system and themselves. So, in order to help the NHS reach their £20 billion efficiency saving target, all stakeholders need to work together (NHS England, 2017). To help with adapting to changes in healthcare provision organisations require transformational leaders that focus upon changing aspects of an organisation. Transformational leaders strive to adjust the existing structure and influence people to buy into a new vision and new opportunities (Tucker and Russell, 2004).

Murray and Richardson (2003), stated the importance of communication in leadership roles to help develop a shared understanding between all employees of what lies ahead. In addition, Kotter (1995) takes the view that communication needs to be sustained over a period of time, so that people don't return to their previous ways of working. Written communication, such as newsletters are emails) is a useful form of communication to support the ongoing process of change (Scott and Jaffe 1989).

Taking these ideas on board, I have presented a new case at a PECC board meeting. In the first two years of the GRRS there were no regular updates and advice to sub-contractors and optometrists. I felt if everyone involved in the service was made aware of the CCGs KPI targets and the benefits of hitting these they may be more on board with ensuring the service runs smoothly. I wanted to send an email out to everyone explaining this, stating that if we were shown to run this service efficiently, then we were more likely to gain other extended primary care services in the future. This type of approach is backed up by Tracey and Hinkin (1998) who discuss motivating people by appealing to higher ideals and moral values and setting out a positive vision of the future. Following this, I also advised that I would send out quarterly practice specific updates to inform them how they were performing relative to their targets (Appendix 2).

To help with the data analysis and to make it easier to compare how individual practices were performing, I created multiple stacked bar charts based on the CCG KPIs. Our CCG KPIs include:

  • 90% of patients to be seen and completed within four weeks of being referred into the service
  • A hospital eye service (HES) referral defection rate of 70% or more
  • 40% or more completion of recommendation questionnaire
  • 90% or more recommendation from the questionnaire

Individual practice data can easily be pulled off from the quarterly tabulated data provided by OptoManager (see Appendix 3). Two examples of the stacked bar charts are shown in Appendix 4. The quarterly charts include:

  • Total number of 1st IOP repeats, 2nd IOP repeats and total field repeats
  • Total number of IOP deflections and referrals
  • Total number of repeat field deflections and referrals
  • Total number of complete and incomplete questionnaires

After creating the charts, I decided only to present these to PECC, sending individual data to each of the participating practices as shown in an example in Appendix 5. The reason for this is that there are multiple providers in Cheshire who are competing for the same primary care services, so it was important that this data doesn’t get into the wrong hands where it could be used against us in a rival tender.

Since introducing these extra communications in West Cheshire there has been a significant improvement in performance with respect to KPIs. Most notably, participation in the friend and family questionnaire, which has always been historically low, increased by about 30% to 88.5% completion (Appendix 6).

By providing the communications in this way, it has been significantly easier to approach practices that appear as outliers. This is backed up by Swinburne (2001), who demonstrated that delivering constructive feedback at regular intervals helped to reduce the need to challenge and discipline employees. Stacked bar charts also allow easy identification of other outlier scenarios. For example, practices with:

  • high levels of IOP repeats were advised to calibrate their NCT machine
  • low deflection rates for repeat IOPs were advised to calibrate their Goldmann tonometer
  • high levels of repeat fields and a high deflection rate for fields were asked to reconsider their field screening method (i.e., Changing from a full threshold test to a supra-threshold)
  • low levels of participation were offered support with training.
  • high levels of second repeats for IOPs alongside a high deflection rate were advised that they were doing more second repeats than other practices

It is vitally important for all new CGPLs to understand the importance of their role in ensuring services are running as efficiently as possible. To do this they must get to grips with the OptoManager platform. It is great having all this robust data, but unless the operator fully understands how to interpret it and arrange it in a way that reveals hidden trends then you will not get the full benefit from it.

Those who are not familiar with how the different aspects of OptoManager work should be encouraged to request a webinar with the Webstar Health team.

To help CGPLs in the future there should be some continuing education and networking. This could be achieved via interactive online platforms (for example forums) and peer-review discussions, so that ideas can be shared and lessons can be learned from the experiences of others.

The biggest lesson I’ve learned in my role is that if you don’t carefully communicate your aims and ideas with frontline colleagues on a regular basis then the service will not run to its full potential.

For more information about becoming a CGPL visit the dedicated page of the LOCSU website. The National Optical Conference hosts an annual CGPL workshop. Visit the NOC page to see the workshop content and full programme. For more information about the Leadership Module for Optical Professionals, visit the LOCSU website Leadership Skills page.

For more information about his blog and essay, you can email Mark at marksimpson_4@hotmail.com

References

Burns, J.M. (1978), Leadership, Harper and Row, New York, NY.

Kotter, J.P. (1995) Leading change: why transformation efforts fail. Harvard Business Review. Vol 73, No 2. pp59-67

LOCSU. (2017). Clinical Governance & Performance Leads. Available: http://www.locsu.co.uk/. Last accessed 10th June 2017.

LOCSU. (2017). OptoManager. Available: http://www.locsu.co.uk/. Last accessed 10th June 2017.

Mckeown, S. Krause, C. Shergill, M. Siu, A. and Sweet, D. (2016) Gamification as a strategy to engage and motivate clinicians to improve care. Healthcare Management Forum 2016. Vol. 29(2) 67-73

Murray, E.J. and Richardson, P.R. (2003) Organizational Change in 100 Days: A Fast Forward Guide. Oxford: Oxford University Press

NHS England. (2017) NHS Five Year Forward View. Available at: https://www.england.nhs.uk/five-year-forward-view/. Last accessed 10th June 2017.

Nicol, E.D. Mohanna, K. and Cowpe, J. (2014) Perspectives on clinical leadership: a qualitative study exploring the views of senior healthcare leaders in the UK. Journal of the Royal Society of Medicine. Vol. 107(7) 277–286

Scott, C.D. and Jaffe, D.T (1989) Managing Organisational Change: A Guide for Managers. London: Kogan Page

Swinburne, P. 2001. How to use feedback to improve performance. People Management. 3 December.

Tracey,J. and Hinkin, T. (1998). Transformational leadership or effective managerial practices? Group & Organization Management. 23, 220- 236.

Tucker, B.A. and Russell, R.F. (2004) The Influence of the transformational leader. Journal of Leadership and Organizational Studies. Vol 10. No. 4


APPENDICES

Appendix 1 – How to spot overdue patient episodes on OptoManager Admin Platform


  1. Select ‘Download Data – Activity Report’ on the left hand side of the screen
  2. Put dates into the boxes from when the service commenced to present day
  3. Click the red download button

  1. This will download an excel spread sheet with all patient episode information on
  2. Click the option at the top ‘Enable editing’

  1. Select ‘Sort and Filter’ at the top right of the screen. Then select ‘Filter’
  2. This will then allow a tab drop down option on all column headings

  1. Select the column title ‘Sign Off Date’
  2. Deselect all column dates apart from the option ‘(Blanks)’ at the bottom
  3. After clicking ‘OK’ this will shrink your large table of data down to just the episodes that are active i.e. not signed off as complete by the practitioner. It is then just a case of looking at the initial sight test date and checking to see if the episode is over the 4 week KPI target.

Appendix 2 – Email sent to West Cheshire Practitioners 20/2/2017

Dear Subcontractors,

An integral part of maintaining current enhanced services and developing new ones is that we hit the KPI targets set out by our respective CCGs. To ensure these targets are being met practice data is being reviewed on a regular basis to ensure all performers are sticking to these KPIs. 

For the West Cheshire Glaucoma Repeat Reading Service this includes:

  • Patients have been completed and signed off for all repeat tests within 4   weeks of the initial eye test / when a practice receives an outside referral
  • Patient friends and family questionnaire completed and recorded on the OptoManager platform
  • An anticipated referral deflection rate for the service is being met
  • A high patient satisfaction level is being reached

If it is found that your practice is not hitting these targets I will inform you as it is in all our best interests for the service to run smoothly.

 I have carried out an audit on the service over the last 3 months, so I will be in touch shortly to let you know how your practice is performing for the KPI targets and how your repeat tests compare to average results from the other 16 practices participating in West Cheshire.

Kind regards

Mark Simpson 

CGPL GRRS West Cheshire


Appendix 3 – Examples of the quarterly tabulated audit data sent from OptoManager via email


Appendix 4 – Box chart examples

 


Appendix 5 -Example email from the 22/2/2017

Hi,

Hope all is well with you. Just thought I’d update you on how the GRRS is running compared to our KPIs at your practice. The data used is from a 3 month sample taken from Oct 2016 - Dec 2016 and is compared to the other 16 participating practices in West Cheshire.

 

Deflection rate for IOPs: 75%                          (Comparable to other practices)

Number of repeat IOPs carried out: 10            (Comparable to other practices)

Repeat fields deflection rate: 90%                                          (Above average)

Number of repeat fields carried out: 20          (Significantly higher than other) practices)

Completed friends and family questionnaires: 100% complete thank you :)

In respect to the fields part of the service, just need to check a few things with you. Which machine and program are you using for general field screening? Who do you perform fields on (everyone / certain patient groups)? How many spots need to be missed for you to generate a repeat?

Kind regards 

Mark Simpson CGPL GRRS


Appendix 6

 

ends

 

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