All sites engaged in this programme recognised the value of high-quality data in supporting integration. They agreed that data is a vital part of running effective health and care services. Used correctly, the latest digital tools can give frontline teams live information to support better decision-making and give leaders greater understanding of service challenges and opportunities, to support and effectively prioritise resources.
However, a lack of joined up data and insight that is trusted and meaningful to all partners had been a challenge faced by several sites.
When implementing new integrated ways of working, it was found that leaders in systems that understand performance and outcomes are consequently able to understand if the changes are achieving the high-level success measures and give operational teams and managers a more real-time view of performance to inform decision-making.
“The team has responded much better to a measure of ‘how many people did we support back to their own home this week’, rather than ‘how many assessments did we complete’–it’s clearly linked to outcomes and means more to the team.”
Operations director, Community Provider
What is the reality? The challenges being felt by local systems
Many ICBs or local systems have put significant effort into establishing data and digital strategies and responding to national assurance requirements. However, those engaged in this programme often reflected on how this is yet to translate into truly useful insights and information that is used every day, with some feeling a long way off a ‘single version of the truth’ that is trusted across the place. Challenges being felt by local systems included:
Systems and data
- Interoperability: partners have different data flows, and local reports may be built in different ways with contrasting interpretations, showing inconsistent impressions of performance. There are varying levels of digital maturity across systems and partner organisations.
- Place-based teams often do not have access to data at the right level to demonstrate outcomes tied to a specific initiative.
- Linked data sets are not always available and creating them requires aligning information governance.
Objective and useful information
- Systems often lack a single source of truth that can be accepted by all partners, to make decisions on priorities.
- Without the right level of visibility, debate can focus on anecdote and perception, especially across different partners, rather than based on objective evidence.
- Data gathering is often designed to generate high level oversight measures. These do not necessarily reach or drill down to measures that support day to day ways of working for teams.
- Data isn’t always “live” and is often reported with a lag, which reduces its value for operational decision-making.
Capacity, capability, and culture
- There can be a divide between digital, data and technology (DDaT) teams and operational or clinical teams, with tools and dashboards made without input from frontline teams.
- Digital tools may have been built or procured without strong engagement with operational teams, leading to gaps in understanding and missed opportunities to harness their capabilities. Focus is often on large scale data schemes, such as joint patient records or data lakes and infrastructure, without necessarily having clarity regarding how those capabilities will be used on the ground to support improved outcomes.
- Business Intelligence (BI) teams are often stretched given the increased appetite for data locally, as well as responding to the national data agenda and mandatory reporting.
Shared learnings on practical tools and approaches
The following learnings have been drawn together based on the engagement and input into this programme of work.
- Data barriers have existed for many years. While there are many lessons to be learnt from the past, it is nevertheless easy to be limited by previous solutions or old problems.
- Bringing together operational teams with BI or data teams has been a positive step for many. Where these teams are embedded within a partnership arrangement or working closely with each other, there can be gains in mutual understanding; operational staff can better understand the art of the possible and data teams can better understand what is useful day-to-day, and how data and insight will be used in practice.
- Senior leaders have a role to play in supporting and empowering their teams in this space and promoting the value of joining up operational and data insights to improve services.
- Systems should aim for consistent reports that are relevant to the integrated services; these are widely shared and acknowledged as a single source of truth by all partners. Operational staff can access support in harnessing data in their daily ways of working and use it to make decisions.
- Most progress has been seen where pace and action are prioritised above perfection. Digital strategies can paint a future with many features, capabilities, and an abundance of data. Prioritising the measures needed, ideally those linked to the target outcomes, and focusing on the ‘minimum viable product’ rather than generating a suite of dozens of KPIs, can bring earlier results. This process can also serve as a catalyst for delivery of further useful and trusted performance data, once the barriers have been broken down.
- Check that the measures chosen are the ‘top level’ measures for the system and speak to a range of needs and priorities among partners. They should be linked to overall outcomes and system benefits.
Staff in health and care services are generally motivated to achieve the best outcomes for individuals. If ‘performance’ is linked to this, it can support better results and team morale. For example, where a team leader can see the interventions given to patients by a community team as well as the outcomes for these patients, they can take regular action to improve decision-making and the quality of interventions.
If done effectively, it requires:
- Tangible KPIs, simple to understand, that are well-defined and clearly linked to achieving better outcomes for people.
- Regular access to up-to-date data on the performance against these outcome measures.
- Ensuring that service managers and directors understand the dashboards, including how to use them to identify priorities, take action, and celebrate success.
- Establishing clear links between levels of governance, where performance data is viewed, and where it is challenged at the higher level. Frontline teams are empowered to challenge and improve performance and escalate issues where necessary.
- Visibility of their outcomes-based measures of success.
- Analysis that informs action at appropriate pace (which in some cases may even be on a daily basis).
- Resources and autonomy to address issues and improve performance, informed by data.
- Clear responsibility to interrogate their performance data, along with accountability to continue seeking improvements in performance.
- Building this culture brings a stronger desire from all teams to be able to access clear, trusted data and insight, while aligning a wider group of staff to break through this barrier.
We hope that this publication will not be the end of the programme, but the beginning of a conversation. A series of events will be available to attend to explore the themes in greater detail and share experiences.
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