{"id":4695,"date":"2016-05-07T08:01:27","date_gmt":"2016-05-07T07:01:27","guid":{"rendered":"http:\/\/www.saasoft.com\/blog\/?p=4695"},"modified":"2016-05-07T08:01:27","modified_gmt":"2016-05-07T07:01:27","slug":"the-nhs-cockpit-dashboard","status":"publish","type":"post","link":"https:\/\/hcse.blog\/?p=4695","title":{"rendered":"The NHS Cockpit Dashboard"},"content":{"rendered":"

A few weeks ago I raised the undiscussable issue that the NHS feels like it is on a downward trajectory … and that what might be needed are some better engines …\u00a0<\/em>and to design, test, build and install them we will need some health care system engineers (HCSEs) … and that\u00a0we do not have appear to have enough of those. None in fact.<\/p>\n

The feedback shows that many people resonated with this sentiment.<\/p>\n

\n

This week I had the opportunity to peek inside the NHS Cockpit and look at the Dashboard … and this is what I saw on the A&E Performance panel.<\/p>\n

\"UK_Type_1_ED_Monthly_4hr_Yield\"<\/a><\/p>\n

This is the monthly aggregate A&E 4-hour performance for England (red), Scotland (purple), Wales (brown) and Northern Ireland (grey) for the last six years.<\/p>\n

The trajectory looked alarmingly obvious to me – the NHS is on a predictable path to destruction – a controlled flight into terrain (CFIT).<\/em><\/p>\n

The repeating up-and-down pattern is the annual cycle of seasons; better in the summer and worse in the winter. \u00a0This signal is driven by the celestial clock … the movement of the planets … which is beyond our power to influence.<\/p>\n

The downward trajectory is the cumulative effect of our<\/strong> current design … which is the emergent effect of our collective beliefs, behaviours, policies and politics … which are completely within our gift to change.<\/p>\n

If we chose to and if we knew how to – which we do not appear to.<\/p>\n

Our collective ineptitude is not a topic for discussion. It is a taboo subject.<\/p>\n

\n

And I know that because if it were for discussion then this dashboard would be on public view on a website hosted by the NHS.<\/p>\n

It isn’t.<\/p>\n

\n

\"George_Donald\"<\/a>It was created by George Donald, a member of the public, a disappointed patient, and a retired IT consultant. \u00a0And it was shared, free for all to see and use via Twitter (@GMDonald).<\/p>\n

The information source is open, public, shared NHS data, but it takes a lot of work to winkle it out and present it like this. \u00a0So well done George … keep up the great work!<\/p>\n

\n

Now have a closer look at the Dashboard Display … look at the most recent data for England and Scotland. \u00a0What do you see?<\/p>\n

Does it look like Scotland is pulling out of the dive and England is heading down even faster?<\/p>\n

Hard to say for sure; there are lots of signals and noise all mixed up.<\/p>\n

\n

So we need to use some Systems Engineering tools to help us separate the signals from the noise; and for this a statistical process control (SPC) chart is useless. \u00a0We need a system behaviour chart (SBC) and its handy helper the deviation from aim (DFA) chart.<\/p>\n

I will not bore you with the technical details but, suffice it to say, it is a tried-and-tested technique called the Method of Residuals<\/em>.<\/p>\n

\"Scotland_A&E_DFA_02\"<\/a>\u00a0Exhibit #1 is the DFA chart for Scotland. \u00a0The middle 4 years (2011-2014) are used to create a ‘predictive model’; \u00a0the model projection is then compared with measured performance; and the difference is plotted as the DFA chart<\/em>.<\/p>\n

What this “says” is that the 2015\/16 performance in Scotland is significantly better than projected, and the change of direction seemed to start in the first half of 2015.<\/p>\n

This evidence seems to support the results of our Mark I Eyeball test.<\/p>\n

\"England_A&E_DFA_02\"<\/a><\/p>\n

Exhibit #2 – the DFA for England suggests the 2015\/16 performance is significantly worse<\/strong> than projected, and this deterioration appears to have started later in 2015.<\/em><\/p>\n

Oh dear! I do not believe that was the intention, but it appears to be the impact.<\/p>\n

\n

So what are England and Scotland doing differently?
\nWhat can we all learn from this?
\nWhat can we all<\/strong> do differently in the future?<\/p>\n

Isn’t that a question that more people like you, me and George could reasonably ask of those whom we entrust to design, build and fly our NHS?<\/p>\n

Isn’t that a reasonable question that could be asked by the 65 million people in the UK who might, at any time, be unlucky enough to require a trip to their local A&E department.<\/p>\n

So, let us all grasp the nettle and get the Elephant in the Room<\/em> into plain view and say in unison\u00a0“The Emperor Has No Clothes!”<\/em><\/p>\n

We are suffering from mass\u00a0ineptitude and hubri<\/em>s<\/a>, to use Dr Atul Gawande’s language, and we need a better collective strategy.<\/p>\n

\n

And there is hope.<\/p>\n

Some innovative hospitals have had the courage to grasp the nettle. They have seen what is coming; they have fully accepted the responsibility for their own fate; they have stepped up to the challenge; they have looked-listened-and-learned from others, and they are proving what is possible.<\/p>\n

They have a name. They are called\u00a0positive deviants<\/strong><\/a>.<\/p>\n

Have a look at this short video … it is jaw-dropping … it is humbling … it is inspiring … and it is challenging … because it shows what has been achieved already.<\/p>\n

It shows what is possible. Now, and here in the UK.<\/p>\n

Luton and Dunstable<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

A few weeks ago I raised the undiscussable issue that the NHS feels like it is on a downward trajectory … and that what might be needed are some better engines …\u00a0and to design, test, build and install them we will need some health care system engineers (HCSEs) … and that\u00a0we do not have appear … <\/p>\n

Continue reading “The NHS Cockpit Dashboard”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17,22,35,48],"tags":[],"class_list":["post-4695","post","type-post","status-publish","format-standard","hentry","category-examples","category-healthcare","category-reflections","category-trust"],"_links":{"self":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/4695","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4695"}],"version-history":[{"count":0,"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/4695\/revisions"}],"wp:attachment":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4695"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4695"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4695"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}