As the Chief Medical Officer of Britain’s largest private international healthcare company from 1994 until my retirement in 2012, I was responsible for the safety and quality of care of Bupa’s customers around the world. In the late 1990s I started the routine collection of patient reported outcome measures across our network of 30 hospitals. This was achieved through objective clinical performance survey forms that patients filled out before their treatment and then again three or six months after their treatment. This proved to be a successful method of driving quality improvements in the hospitals.
Due to the successful nature of our work in facilitating patient generated performance data, I was invited to Chair the advisory group for the National Health Service’s (NHS) pilot programme for Patient Reported Outcomes Measures (PROMs), a programme that assess the health gain or benefit delivered to NHS patients from the patient perspective. After my retirement from Bupa, I took on my current role as Chair of PHIN, which is a UK-based independent organisation that sets the information standards for private healthcare, ensuring that data is consistently collected and thoroughly checked by hospitals.
Overcoming the hurdles of collecting quality data
The UK’s Competition and Markets Authority (CMA) recently conducted a study of the private sector and decided that private patients didn’t have enough information available to them to make informed healthcare decisions. This resulted in a legal mandate which required all private hospitals and NHS pay bed units to submit a collated standardised data set and submit it to my organisation, PHIN.
Before the mandate it was a difficult to publish standardised quality private healthcare data because, although there was support in principle, we had to rely on hospitals that were enthusiastic and who would voluntarily share data, and then hope that other hospitals would follow suit. Even though it’s since been mandated, it’s still proving to be a difficult task for hospitals and doctors because they are worried about how accurate their data is and how they will be portrayed.
Another big challenge is getting a standardised consensus of definitions of certain data sets, and then collecting it. So even though private hospitals and NHS pay bed units have always collected data on infection rates and mortality rates, for example, they need to change the way they are collecting their data so that everybody is collecting exactly the same data.
Accessing quality data improves the quality of healthcare
It’s important for patients to have data to help them make informed decisions. However, it’s worth noting that in the UK 80% of patients still want to check with their GP first before making a medical decision. And in fact from what we’ve seen, due to their competitive nature, it is often the doctors who actually use the data to drive improvement in patient outcomes.
For example, during my time at Bupa we published the hospital network’s hip replacement results based on the outcomes from the patient reported data. Some hospitals were, of course, below the average which led to their orthopaedic surgeons asking why that was the case. Sometimes the reason would be that one of their occasional operators wasn’t doing enough operations or getting good results, which dragged their overall score down. The surgeons then took action and agreed they would stick to their different procedure expertise and refer other patients to more appropriate surgical experts to ensure better patient outcomes overall.
Another well-known example from New York was when cardiac surgeons had to publish their mortality rates; the objective being for patients to be able to review and decide where they wanted to go for their treatment. As it turned out, many patients weren’t really interested in making decisions on the basis of death rates; however, there was a reduction in mortality rates which was seen as the result of the surgeons not wanting to be seen as offering an inferior service compared to their colleagues. So while publication of mortality data may be a good incentive for doctors, I believe that patient reported outcomes covering health gain and improvement in quality of life has more meaning for patients in helping them choose the best medical care.
Facilitating easy access to data
At PHIN, our primary stakeholders are the patients, potential patients and their general practitioners. Therefore via our website we will provide them with both clinical and patient reported outcome data and other important information about private providers of healthcare, such as how many beds they have, etc. From April 2018 PHIN will also start publishing patient data on individual consultants that will focus on their activity, such as how many certain operations they do and their clinical outcomes. Although most of that data collection is already being done in the NHS, we are going to expand on that work by collecting 12 different patient reported outcome measures across the sector to show differentiation between hospitals and, in due course, consultants.
Insurers are also very interested in the sort of data we are collecting because although they collect data on their members, we have data across the whole market that gives a much broader view of hospital and clinical performance.
Publishing standardised quality data in the private sector
The UK experience has demonstrated the necessity of having an enforcing body to initiate the process of private hospitals collecting quality, standardised data. Since the mandate we have made progress in collecting data; however getting agreement and full compliance across different hospitals with different systems and different definitions of things takes a great deal of good will, commitment and money.
During the HASA 2017 Conference I look forward to sharing some of my experiences regarding the process for the publication of standardised quality data in the private hospital sector in the UK. Even though South Africa and the UK have different health systems, I believe quality data is a crucial component in the delivery and continuous improvement of patient-centred care.
The HASA 2017 Conference will feature a number of international and local speakers who will together explore how to respond to the global healthcare puzzle through integrating healthcare. The world-class conference and exhibition will take place from Monday, 25 September to Wednesday, 27 September 2017 at the Cape Town International Convention Centre (CTICC). More information about the event can be found here.