The aim of Clinical Profiles (formerly Surgical and Medical Profiles) is to stimulate reflective clinical practice and facilitate improvements in the care of patients, by making good use of existing Scotland-wide datasets.
Organisations/teams that provide clinical care cannot always guarantee good clinical outcomes for their patients. However, they should know what these outcomes are, and also use such information to reflect on - and guide improvements to the services they provide for their populations.
Clinical Profiles comprise a portfolio of collaborative projects led by Healthcare Improvement Scotland (HIS) and the Information Services Division (ISD) and are being developed in close collaboration with a number of clinical specialty groups in Scotland, the Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow are also linked in to the project.
Clinical Profiles aim to support the Healthcare Quality Strategy for NHS Scotland, which itself emphasises the critically important role of data/measurement in driving improvements in patient care.
A New Approach
The previous methodology involved the biennial production of either a medical or surgical profile (alternate years) containing a series of clinical indicators arranged according to specialty chapters. A key aspect of the work was the formal and structured dialogue with each NHS Board about how it was interpreting and using the data locally. There are examples of the profiles being used successfully to stimulate improvements in clinical care, data, and governance systems. The project's methodology, which was established in 2006, is being refreshed to ensure that it can continue to help make things better for patients while providing good value for public money. The National Clinical Data Advisory Group recommended that, instead of producing a fourth version of the surgical profile in March 2013 using the existing format, the project team should focus on more in-depth and continuous work with clinicians and specialty groups to develop indicators that are credible, timely and fit-for-purpose. Work in line with this new approach has already begun and is described below.
The operational definitions of all the indicators within each project described below have been developed in consultation with clinical specialty groups or expert clinical advisors for a particular disease or procedure and are typically categorised according to length of stay, mortality and readmissions.
The clinical profile makes use of existing national data sources in a format designed to make it easier for NHS Boards to use the information. The main data source is the Scottish Morbidity Records (SMR01) linked to National Records of Scotland (NRS) Death registrations.
Most of the clinical indicators in clinical profiles are presented in graphs called control charts. A control chart is a simple way of presenting data that can help guide quality improvement activities, by flagging up areas where there appears to be marked variation and where further local investigation might be beneficial.
There are two types of control chart in the profile:
- Funnel plots, which allow comparisons to be made between different NHS Boards or hospitals and the average for Scotland. Data are plotted in relation to the Scottish average and control limits set at three standard deviations from the average. Data points out with the control limits (sometimes called ‘outliers’) are said to exhibit ‘special cause variation’. This is where further investigation might be beneficial. However, it is important not just to focus on ‘outliers’, and with local knowledge subtler patterns in the data can also help gain an understanding of how clinical services are provided.
- Time series, which allows a service provider to monitor and review quarterly observations over a ten-year period in comparison to the equivalent Scotland trajectory.
The team has developed new presentation methods for the clinical profiles using the latest dashboard technology. This has enabled frontline staff to interrogate patterns in their own activity and outcomes, as recorded on the national datasets, with a reporting lag of as little as four months.
Clinical profiles have been designed as management information systems to be interpreted and used locally by NHS boards and clinicians. They present a range of data about medical and surgical activity and outcomes in Scotland. The data are most commonly presented by hospital of treatment; however, increasingly we will also be showing distributions of the same outcomes according to the resident populations of each NHS board. As before, the NHS boards will be responsible for reviewing, and where necessary acting upon, their own data. Local and expert knowledge needs to be drawn upon to meaningfully interpret the data and the clinical profile should complement other sources of local intelligence. It is important to note that the data in the clinical profile cannot be used alone as a basis for making reliable judgements about the quality of clinical care.
Healthcare Improvement Scotland is currently evolving aspects of what was previously the surgical and medical profiles methodology, to seek to enhance clinical engagement and maximise the influence that indicators derived from routine administrative datasets have in driving improvements in patient care. Information about the previous profiles projects (2006-2012) can be accessed below via links to the original surgical and medical profiles websites. Although the data/information included are now historical and there are currently no plans to refresh all the analyses, this information is still presented to allow access to the work/data at a point in time.