Using an indepth analysis of coding and case mix to investigate fitness to practice

Heather Walker - Consultancy Director, CHKS

Heather has been with CHKS since 1994 and has worked in the NHS as a records manager and at the Health Services Management Centre. She manages a team of 25 people, around half of them working in CHKS Assurance and Accreditation and the remaining working on benchmarking services. The Assurance and Accreditation team work more widely outside the UK providing accreditation of hospital and health care services and can award ISO certification. In the UK most of this work is focussed on radiotherapy services, hospices, care homes as well as assurance products for dementia and maternity care but they do also provide appraisal training for the health service.
The benchmarking team provides comparative information, analysis and interpretation to acute trusts on their performance in relation to quality, safety and efficiency with a large part of the work being on mortality statistics, market share and appraisal. The assurance and accreditation team work more widely outside the UK providing accreditation of hospital and health care services and can award ISO certification.

What was the focus of this particular piece of work?

I was asked to help a trust in the north west of England because staff had raised concerns about one of its consultants. When we first launched the Consultant Level Indicator Programme (CLIP), it was originally used for appraisal since it was the first time consultants could see data relating to their cases. Since then it has been used by responsible officers who are concerned they are signing off on consultants being fit to practice without much information.

How did you use your experience and expertise?

The data showed that this particular colorectal surgeon had a higher than expected mortality rate and more patients developed infections than would have been expected. However, my experience tells me that you need to examine the data carefully. When I worked in the health service I managed coding so I’m used to seeing what goes into each record. I know that by looking at the records you can start to build a better picture of the patient and the coding plays a large part in this. 

What did you find?

We took a closer look at his case mix and found that compared with his colleagues he was indeed an outlier. However, when we looked at a peer group with a similar complex case mix we found he wasn’t. The detailed analysis we carried out helped to show the trust its consultant was fit to practice.
One of the benefits of CLIP is that it allows you to compare with consultants from other trusts who are doing other similar work. This means we are able to establish quickly whether a consultant is an outlier and help to identify poor practice. This is particularly important with service reconfiguration where local colleagues may not do comparable work.

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