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ISD Scotland better information, better decisions, better health

National Benchmarking Project

Better Quality Better Value

NHS National Services Scotland ISD Scotland & NHS National Services Scotland

Better Quality Better Value

The purpose of the Better Quality Better Value (BQBV) tools is to highlight productive opportunities based on variation in clinical productivity at NHS Board and Hospital level. There are four separate components to the BQBV toolkit, each focussed on reducing variation and, therefore, identifying productive opportunities, for a wide range of process and clinical measures:

BQBV Indicators:
Identifies variation from benchmark performance in a number of key process measures including Average Length of Stay, Outpatient DNAs and Pre-Operative Stay.
Ambulatory Care Conditions:
Identifies the potential for a range of clinical conditions (identified by the Directory of Ambulatory Emergency Care for adults) to be treated in an ambulatory emergency care setting rather than being admitted to hospital, resulting in reduction of time spent in a hospital bed.
British Association of Daycase Surgery (BADS) Procedures:
Identifies variation from clinical guidelines for the daycase rates across a range of procedures.
Procedures of Low Clinical Value:
Identifies variation from benchmark performance in the number of hospital admissions for a selection of procedures that may be treated with a safe clinical treatment other than surgery

In each of these components, a cost opportunity is calculated based on a reduction in variation.

Potential Productivity Opportunity Methodology

The potential productivity opportunities are estimated by calculating the cost opportunities that could be achieved, if NHS Boards/hospital sites moved to perform at the benchmark performance (e.g. Scottish mean/upper quartile or appropriate clinical guideline). The productivity opportunities are measured in occupied bed days for ALOS, pre-op stay, BADS and Ambulatory Care; in reducing DNAs by saving new outpatient appointments and by reducing the number of low clinical value procedures carried out.

Cost opportunities are then calculated using the following methods:

Patient Level Costing Method (PLICS)
For those tools where the productivity opportunity is based on a reduction in length of stay or bed days (i.e. ALOS, pre-op stay, Ambulatory Care & BADS) the Patient Level Costing Method Download PDF file is used. The methodology apportions hospital site and specialty specific direct costs to individual patient records on admission, per day, for theatre time and specific high cost items e.g. prosthetics. Various direct cost unit tariffs, e.g. pharmacy costs per day, medical costs per admission, are calculated from the direct cost pools in the NHS Costs Book and activity totals; after adjusting costs for any high cost items that are applied separately. These direct cost unit tariffs can then be applied to individual patient records using the appropriate activity measure e.g. length of stay. One of the direct costs calculated in the methodology is the 'Delayed Discharge cost per day'. Given that most of the productivity opportunities in BQBV are based on a reduction in excess bed days then this particular direct cost is the most appropriate to use.
Scottish National Tariff
For the procedures of low clinical value tool, the average costs per procedure identified in the Scottish National Tariffs are used to determine the cost opportunities in reducing the number of admissions for these procedures.
Cost per Outpatient Attendance
The appropriate cost per outpatient attendance from the Cost Book is used as an approximation of the costs associated with reducing DNAs.

It is important to note that any cost opportunities identified by reducing variation and aspiring to achieve benchmark performance may be realised as opportunities to reinvest, address new demands but, not necessarily, as cash releasing savings.

Accessing Better Quality Better Value

The BQBV dashboards are accessed via Level 1 of the NSS Discovery system. For more information on Discovery and how to request access, please visit the NSS Discovery web page.

If you would like further information on the Better Quality Better Value tools, please contact

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