Quality and Safety in

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Quality and Safety in Private Healthcare
Andrew Vallance-Owen Group Medical Director
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Quality The Target
Appropriate, cost-effective care and
treatment whose outcomes will benefit the patient
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Quality The Target
Where appropriate means

• The right treatment
• At the right time
• Managed by the right person
• In the right place

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The Cochrane Principle

• Best clinical practice often represents
• best financial value in healthcare

Cochrane AL (1999) Effectiveness and Efficiency.
Random Reflections on Health Services. March.
3rd Edition. Royal Society of Medicine Press,
London. ISBN 1-85315-394-X
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Professor Jack Wennberg and Professor Elliott
Fisher Dartmouth Medical School

• Compared with the lowest use areas, people in the
  highest use areas get ten times as many prostate
  operations, six times as many back operations,
  seven times as many coronary angioplasties and
  ten times as many hospital days if they have
  heart failure
• What predicts the rate is the number of
  specialists per capita. The more doctors, the
  more consultations
• High use did not mean better quality of care and
  outcomes. In fact, for many measures, quality and
  outcomes were best in the low-use areas

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National Institute for Health and Clinical
Excellence(NICE)

• An independent organisation responsible for
  providing national guidance on the promotion of
  good health and the prevention and treatment of
  good health
• Guidance is developed using the expertise of the
  NHS and the wider healthcare community, including
  NHS staff, healthcare professionals, patients and
  carers, industry and the academic world.

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NICE Produces Guidance in Three Areas

• Health technologies - including new and existing
  medicines, treatments and procedures
• Clinical practice - appropriate treatment and
  care of people with specific diseases and
  conditions
• Public health - guidance on the promotion of
  health and the prevention of ill health

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Implementation of NICE Guidance

• Once NICE publishes clinical guidance, health
  professionals and the organisations that employ
  them are expected to take it fully into account
  when deciding what treatments to give to people.
• To develop NICE interventional procedures
  guidance, NICE reviews evidence and collects and
  analyses information. By providing guidance on
  how safe procedures are and how well they work,
  NICE makes it possible for new treatments and
  tests to be introduced into the NHS in a
  responsible way.

A Guide to NICE 2006
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Speciality networksDriving the Quality agenda
forward
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BUPAs Role

• BUPA seeks to be at the forefront of developments
  in quality based contracting
• We have a responsibility to set and monitor
  standards. This is in the members interests
• We have built the credibility to challenge

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Approved Cancer Hospitals

• BUPA spends 35m AUD per year on the diagnosis
  and treatment of breast and bowel cancer
• BUPA was the first UK insurer to develop a
  national network of quality assured hospitals for
  breast and bowel cancer
• Currently over 130 BUPA Approved Breast and 120
  BUPA Approved Bowel Cancer Hospitals

10/05
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Why is BUPAs accreditation process for cancer
units important?

• A study in the British Journal of Cancer states
  that
• Local recurrence rates were 57 lower and the
  risk of death from breast cancer was 20 lower
  for women treated in specialist unitsthe
  surgical management in specialised breast units
  is more often adequate, local and regional
  recurrence rates are lower, and survival is
  correspondingly better.

Of those who applied to be an approved cancer
hospital just 64 have been able to meet the
standards we seek
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Case Management

• Nurses micro manage treatment work with
  providers to ensure delivery of appropriate, cost
  effective care
• 32 experienced nurses and 29 expert advisors
• Manage complex care diseases and cases
• critical care
• cancer care
• rehabilitation
• back pain
• medical cases psychiatry
• BUPA Initiatives do change clinical practice
• Wisdom Teeth Extraction
• Hysterectomy

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Supported Decisions - BUPA Healthline

• 24 hour health Information Service made up of
• A team of specialist nurses, available 24/7
• Supported by research based health information
• Confidential service
• Triage via a comprehensive symptom assessment
• Information on specific health topics Travel
  advice
• Self help groups Fact sheets
• Home Treatments
• Advice on medications

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Patient Satisfaction Survey

• Monthly survey to approx 5,000 randomly selected
  members who have had an inpatient or day case
  episode of care asking them for feedback about
  their hospital stay.
• Key themes below
• 85 of members rated the overall service provided
  by the hospital as excellent or very good
• 94 of members said that the overall service met
  or exceeded their expectations
• 74 of members rated the overall level of comfort
  as excellent or very good
• 84 of members rated the hospital as very clean
• 80 of members rated the nursing staff as
  excellent or very good for each of the five
  questions relating to them (e.g.
  attitude/efficiency)

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Clinical improvement cycle
Compare Practice with standards
Set Standards
Peer Review
?
Improve Standards
Measure Outcomes
Improve Practice
Peer Review
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Functional Outcome Measurement
Why SF-36?

• Thoroughly validated and reviewed
• Suitable for most surgical, medical and
  psychiatric treatment
• Measures physical and psychological health status
• Risk-adjusts
• Reliable process for collecting data
• Does not impose extra work on clinicians

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The SF-36 Survey Process

• The baseline questionnaire is completed by the
  patient at admission
• A follow-up questionnaire is sent to the patient
  at twelve weeks after the treatment
• The participation of the patient is entirely
  voluntary
• Patients cannot be identified by their doctors

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Professor Sir Cyril ChantlerChairman, Great
Ormond Street HospitalMedicine used to be
simple, ineffective and safenow its complex,
effective, and potentially dangerous
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BUPA
Vision Caring for the lives in our hands
Mission To help our customers liver longer,
healthier and more productive lives