“Serious mistakes by hospital staff that put patients at risk are on the rise, despite the government’s drive since the Mid Staffs scandal to make care safer, official NHS figures reveal.”
The Guardian (12-Dec-2016)
The Mid-Staffs débâcle was a catastrophe. The Berwick report published in August 2013 made a promise to learn, alongside making a commitment to act to improve patient safety.
We understand how to improve patient safety. We recognise that we need to:
- Look at our organisations as a whole
- Identify where we need to improve . . . as well as identifying areas of best practice from which we can learn
- Put focus on the least-well performing areas
- Understand what actually happened
- Address the problem issues
- Repeat the cycle
This is classic continuous improvement best typified by the Deming cycle of Plan-Do-Study-Act.
However, there was a huge gap in the cycle. The ability to perform deep analysis of the data across the organisation did not exist. There wasn’t a mechanism to analyse the data, to mine it, to create trends and predictions from it, and to measure actual improvements as they were delivered. Hence the compelling impetus to create this service, to address that desperate need.
At that time Redwing was working with Greater Manchester West Mental Health NHS Foundation Trust, assisting them in the creation of a greenfield Business Intelligence programme. Patient safety was a central part of that work. We saw a huge database gathering dust. It was available and ready for mining. We extracted the data and fed it into the Redwing Data Warehouse ready for reporting. Later we took what we had learned, created powerful algorithms and analytics, and expanded it into a Cloud Service called Rapid Analysis of Events, or RAVEN for short. Managers and executives can Know How We're Doing.
More recently, at South West Yorkshire Partnership NHS Foundation Trust, Redwing is providing a full implementation of RAVEN. This is part of our creation of a total greenfield Business Intelligence programme for the Trust.
We couldn't have done all this alone, of course. We gained Executive support, worked with the clinicians, spent time on the wards, had many workshops with clinical staff who work directly with patients, worked with Information Governance and the other stakeholders.
We used Evolutionary Development Methodology® to deliver the system in an incremental and iterative manner, fixing our mistakes as we went. To wrap it all up, we worked with management to ensure that RAVEN reporting is comprehensive, accurate, and precisely as required.