communicating analytical results 14 th January 2020 NHS England and - - PowerPoint PPT Presentation
Population Health Management PHM Analyst Academy: Problem structuring and communicating analytical results 14 th January 2020 NHS England and NHS Improvement Population Health Management Welcome Lucy Hawkins, Strategy Unit NHS England and
Population Health Management
NHS England and NHS ImprovementPHM Analyst Academy: Problem structuring and communicating analytical results
14th January 2020
Population Health Management
NHS England and NHS ImprovementWelcome
Lucy Hawkins, Strategy Unit
We’re (nearly) at the end of the Analysts Development Programme…
We started here…
We’ve covered a range of topics…
Needs eds as assess sessment ment and d opp pportunit unity y analysi sis Impa pact ct as assessme sessment t and d eval alua uatio tion Popula pulatio tion segmenta gmentation tion and d risk k predictio ediction Introd
uction to to actuarial uarial modell delling ing Pr Prob
lem struct cturing ring and d communic municating ting anal alytic tical al results sults
Wor
kshops hops
Quali alita tativ tive e Methods hods Logic gic Mode dels Syst Systems ms Lea eadership dership Evi viden dence ce
Web ebinars inars
All available at www.midlandsphmacademy.nhs.uk
What’s next?
Single sources of data used for performance management
PH PHM: : dir irect ctio ion n of
travel el
Systems of intelligence for population health improvement Individual organisation view of resource use; competitive culture Collective view of resource use; culture of stewardship ‘I don’t do numbers’; ‘politics’, pet schemes and hunches Analytically literate, intelligence-driven decision making Focus on individual services, pathways, interventions, etc Focus on needs of populations / population ‘segments’ Cost; reaction; bio-medical; doing to patients Value; prediction; wider determinants; serving and doing with populations
From To To
Analysts play a key role
Better er evid vidence ence = better ter decisions cisions = better ter outcom comes Major Major Next t Step tep: : Decision cision Suppor port t Units its
What’s next for the programme?
March ch Februar ary Januar ary End End of Life e Analy lysi sis Master astercl class sses Leaders rs sessions ions End End of PHM M programm ramme Celebra ration tions! s! Webinar ar – PHE PHM M Tool
Dates for your diary
Master ercla classes sses
These e are aimed at at Senior
ts within n the 11 Midlands nds STPs.
will be practic tical l sessions ions, spaces es are limit ited d to to 3 per STP .
Introduction to R – 4th Febr brua uary Automation using R – 18th Febr brua uary Population segmentation using Cluster analysis - 3rd March Risk prediction using logistic regression - 17th March Machine learning methods - 31st March h
Lea eaders ers sess essions ions
These e half day session ions s will introd
uce the skills ls and insights ts required to to make effect ctiv ive e use of analy lytics, tics, and to to work effect ctiv ivel ely y with analy lysts, ts, within sys ystems. ems.
Birmingham - 13th Februar bruary y Leicester - 25th Febr brua uary Stafford - 12th March Further her deta tail ils s on all ll sessions ssions is available ailable on our micros
e midl dlandsphmac ndsphmacade ademy.n .nhs. hs.uk
End End of
Progra
mme Ce Celebra ebrati tions
PHM Academy: End of Year Celebration 5th
th March
ch PHM: The Analysts Revolution 19 19th
th Ma
March ch
Agenda for the day
09:00 0 - 09:30 Registra strati tion n and coffee ffee 09:30 0 – 10:00 Welcome & introduction to the day Mentimeter questions L Hawkins, SU G Wrench, PHE 10:00 0 – 10:40 Problem Formulation Approaches S Wyatt, SU 10:40 0 – 11:00 The Cynefin Framework F Battye, SU 11:00 0 - 11:15 Break 11:15 5 - 12:00 From knowledge to decisions G Wrench, PHE 12:00 0 – 12:45 Group work: Problem Formulation L Hawkins, SU and A Dyke, SU 12:45 5 - 13:45 Lunch & networking 13:45 – 15:45 The time for a chief analytical officer is now (There will be a break in this session) M Farr, East Kent Hospitals NHSFT 15:45 5 - 16:00 Reflections & Discussion M Mohammed, SU, L Hawkins, SU and G Wrench, PHE 16:00 0 – 16:15 Close
Population Health Management
NHS England and NHS ImprovementMentimeter
Gareth Wrench, Public Health England
Population Health Management
NHS England and NHS ImprovementProblem Formulation Approaches
Steven Wyatt, Strategy Unit
Problem structuring a working definition for today
The process by which an analyst, working with her/his colleagues or customers, establishes and confirms the nature, context and complexities of a problem, such that s/he can specify with increased confidence a set of analyses that will appropriately address the problem.
19
Puzzles, problems and messes
20
messes problems puzzles
Formulation agreed? Single correct solution?
Ackoff, 1974, 1979
How many people received a home care package in Staffordshire last year? puzzle, problem or mess?
21
How can we sort out the urgent care system in Dudley? puzzle, problem or mess?
22
A hospital has 10 consultants and 50 nurses who are each available to work 220 days per year and who are capable to working on procedures of two types, A and B. A team of one consultant and two nurses can do 4 procedures As per day. A team of two consultants and 5 nurses can do 8 procedure Bs per day. For every 5 people that receives procedure A, 3 will need procedure B immediately afterwards. The hospital cannot transfer a patient who has received procedure A to another hospital to carry out procedure B. There is demand for 9,000 procedure As and 12,000 procedure Bs per annum. All consultants and nurses are capable of working on cases of types A and B, but can only work on procedures of one type on any given day. The net income to the hospital is £200 for procedure A and £250 for procedures B. What level of procedures A and B should the hospital do in
23
puzzle, problem or mess?
If we implement NICE guidance on falls prevention, how many falls might we expect to avoid? puzzle, problem or mess?
24
An exercise
a value between 1 and 6 for each of the questions
25
messes problems puzzles
1 2 3 4 5 6
26
messes problems puzzles
From a problem to a puzzle
27
messes problems puzzles
What’s in scope ?
28
Time Person Place
Time of day Day of week Months of Year Season Start and End Frequency / Periodicity Age Gender Ethnicity Social class Medical Condition Exposure to risk / intervention Achieving outcome Which service Living in… Born in… Registered with GP in… Events occurring in…
Sourcing and eliciting assumptions and parameters
29
Agreeing methods
Elements and Principles of Data Analysis Hicks S, Peng R 1. Data matching 2. Exhaustive 3. Sceptical 4. Second-order 5. Transparent 6. Reproducible
30
From a mess to a problem
32
messes problems puzzles
Characteristics of a Mess (Harn 2007)
33
A Warning
“One of the greatest mistakes that can be made when dealing with a mess is to carve off part of the mess, treat it as a problem and then solve it as a puzzle -- ignoring its links with other aspects of the mess. ”
Michael Pidd, Tools for Thinking
34
essentially a way of making sense of a complex problem through the eyes of a client group. As a problem structuring method, SODA aims to channel the cooperation of a variety of stakeholders into addressing a problem.
future by understanding the nature and impact of the most uncertain and important driving forces affecting
scenarios to find out more about near, medium and long term futures. It is a group process that uses techniques in workshops and the transfer of knowledge to understand the nature and impact of those driving forces that will affect the organisation
and have the most impact. With this method, it is important to gain a deeper understanding of the central issue important to the future.
most widely used Soft OA methods. It follows the logic that every problem is like a system that needs to be understood. Checkland felt that these systems (problems) could be better understood if compared to reality in a model which could structure a debate focused on the differences, and could later identify where changes need to be made.
developed Soft O.R. techniques. It aims to overcome the fact that any organisation has a constraint, or a number of constraints, that dominate the entire system and the secret to success lies with managing these constraints, and managing the system as it interacts with the constraints, to get the best out of the whole system. According to Goldratt, there are a number of key steps involved based on the fact that goal achievement is limited to at least one constraint. 35
Formal Problem Structuring Methods
Definitions from ‘Soft OR Techniques’ – Seagriff
R.
36
Soft Systems Methodology (Peter Checkland)
Checkland, P.B. & Poulter, J. (2006) Learning for Action: A short definitive account of Soft Systems Methodology and its use for Practitioners, teachers and Students
37
problem data method
Population Health Management
NHS England and NHS ImprovementThe Cynefin framework: (a speedy) introduction and exploration
Fraser Battye, Strategy Unit
We need to know what kind of situation we’re in before we decide what to do
"I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.” Maslow
The Cynefin Framework can helps us orientate
Weight loss for someone following a diet / plan Weight loss for someone trying to eat ‘more healthily’ Population level efforts to reduce obesity Population level nutrition with food system in crisis
Self-care for stable long- term condition (LTC) Diagnosis and guidance for single LTC Managing LTCs in context of crisis Diagnosis and guidance for multiple LTCs and lifestyle factors
Where analysts are called upon the most?
structuring?
to correct failures of process’ – it wants a ‘Clear’ world). The analyst as advisor?
to if ‘Complex’ Oth thers? ers? Over er to y
Uses of the Cynefin Framework for analysts?
framework-introduction/ (lots of resources on the Cognitive Edge website)
framework-for-decision-making
Just in case a 20min intro hasn’t been utterly comprehensive…
Population Health Management
NHS England and NHS Improvement Population Health Management
NHS England and NHS ImprovementNicola Dennis and Gareth Wrench, Public Health England
Knowledge to Action (K2A) Using K2A essentials
January 2020
Learning Objectives
Action” (K2A) is.
effective use of your analytical outputs by decision makers
51 K2A Training Resource – December 2019
The journey so far…
evidence on effective knowledge translation
Evidence What Works? (from Science of using Science programme)
innovation foundation), Director Alliance for Really Useful Evidence to test application of evidence to translation of health intelligence products
being presented here
52 K2A Training Resource – December 2019 52 K2A Training Resource – December 2019
“If you build it they will come”
53 K2A Training Resource – October 2019
…or will they?
The Breckon & Dodson Framework
A robust, evidence-based approach. Describes 6 mechanisms for enabling the use of evidence in decision-making:
use
evidence
making sense of evidence
54 K2A Training Resource – December 2019 54 K2A Training Resource – December 2019 Source: Using Evidence What Works? (from Science of using Science programme)
What is Knowledge to Action (K2A)?
55 K2A Training Resource – December 2019
An umbrella term encompassing knowledge translation, knowledge mobilisation, knowledge exchange, knowledge brokering… K2A aims to ensure that decisions about local or national population health and healthcare are based on the best data and evidence available … includes activities that help to ensure that evidence and data can be understood and actioned.
55 K2A Training Resource – December 2019
56 K2A Training Resource – December 2019
K2A aims to bridge the ‘know-do’ gap
What? How? Who? Why? Policy and practice Health intelligence/ evidence
‘Know–do’ gap between what is known and what is done
56 K2A Training Resource – December 2019
57 K2A Training Resource – December 2019 57 K2A Training Resource – December 2019
K2A aims to bridge the know-do gap
What is K2A’s purpose?
58 K2A Training Resource – December 2019
To support you to:
58 K2A Training Resource – December 2019
59
It helps support us to:
After going through the different areas of the grid you should have enough information to form a knowledge mobilisation plan.
K2A Training Resource – December 2019
The product – K2A Essentials
What? How? Who? Why?
59 K2A Training Resource – December 2019
60
K2A can be used across the Knowledge Cycle (4 stages) Helps bridge the gap between the knowing and the doing by assessing:
methods?
the release of other outputs? Repeat for different audiences
K2A Training Resource – December 2019
The product – K2A Essentials
When?
60 K2A Training Resource – December 2019
K2A approach - update 4 March 2019
When?
K2A approach - update 4 March 2019
Why will you undertake this work?
Why is it important? Why should your audience see or use this product?
influence the uptake of this knowledge?
Consider:
When?
K2A approach - update 4 March 2019
Who is the audience?
Consider the role they bring:
influence the uptake of this knowledge?
When?
How will you get your message(s) across to this audience? Consider:
groups
influence the uptake of this knowledge?
When?
K2A approach - update 4 March 2019
It’s important to have a clear vision of the main message you want to communicate and the lessons you want to share. What do they need to know about – what level of detail/type of knowledge? General content, functionality, methods/caveats, interpretation
What health issue(s) does this product address? What makes the message meaningful to this audience? What do you want to achieve with these messages for this audience (inform decision making, change attitudes, change behaviour/practice, raise awareness, share knowledge of tools)?
When?
influence the uptake of this knowledge?
66 66 K2A Training Resource – December 2019
67 K2A Training Resource – December 2019
1) Think about your PHM core team product (or another recent piece of analysis) 2) Consider the main audiences for whom this is intended (the Who?) Then consider the following for each audience using the K2A essentials grid: 1) The Why? 2) The How? 3) The What? Report back
Group work
67 K2A Training Resource – December 2019
K2A Training Resource – December 2019
When?
Population Health Management
NHS England and NHS ImprovementLucy Hawkins and Alysia Dyke, Strategy Unit
We are going to use the 1-2-4 4 all ll method! We will let you know when to move on to the next stage.
1.
minu nute 2.
airs rs - Share for 2 mi minut nutes es 3.
Small all grou
ps - Share for 4 mi minu nutes es
What are some of the common analytical questions that you get asked?
We are going to use the Wis ise Crowds ds method! We will let you know when to move on to the next stage.
1.
Split lit into
main n grou
ps 2.
ach h grou
p needs eeds:
based on what you have heard this morning (and other experience!)
Using what you’ve heard this morning how might you approach these questions?
The steps are as follows. We will let you know when to move to the next stage:
minute nutes
nutes es
recommendations on the challenge – 5 mi minu nutes es
and what they will take away from this – 2 mi minu nutes es
Using what you’ve heard this morning how might you approach these questions?
Write your thoughts on a post it note and stick onto the flip chart over lunch!
And finally…what would be your top tip for problem structuring?
Population Health Management
NHS England and NHS Improvement Population Health Management
NHS England and NHS ImprovementMark Farr, East Kent Hospitals NHS Foundation Trust
1. Reflections
2. Models, Frameworks
examples.
3. Disruption
4. Next steps
steps.
→Data is the new oil
→Big data is like teenage sex
Board assessment Analytics team assessment
A. Information function as a new independent think-tank. B. Remember why we are here. C. The emerging interest in advanced analytics. D. Exponential change in technology and media. E. Development of STP wide thinking. F. Data is the new oil – who manages the pipes? G. Workforce is key. H.
“I don’t want the CEO to know something before me” COO
“I don’t want the DD to know something before me” Specialty Lead “I see.” Director of Information “I don’t want the COO to know something before me” Divisional Director “I see.” Director of Information … Director of Information
“I don’t want the CEO to know something before me” COO
“I don’t want the DD to know something before me” Specialty Lead “I see.” Director of Information “I don’t want the COO to know something before me” Divisional Director “I see.” Director of Information “Do you know what? – you lot are such a rabble and you change so often that, in our patients interests I’m just going to make this the most transparent trust in the country. I’ll telI everyone everything all at the same time. See you in hell.” Director of Information
“I heard a CEO speak at a conference saying that baggage handlers are as important as pilots – as an analogy for clinical staff and analysts.” Senior Analyst
“What do you think?” Senior Analyst “I see.” Director of Information “It made me feel really valued.” Senior Analyst “I see.” Director of Information … Director of Information
“I heard a CEO speak at a conference saying that baggage handlers are as important as pilots – as an analogy for clinical staff and analysts.” Senior Analyst
“What do you think?” Senior Analyst “I see.” Director of Information “It made me feel really valued.” Senior Analyst “I see.” Director of Information “I think you’re an idiot. There is a saying in India that you are either the doctor or you are there to serve the doctor. Clinically led, professionally and managerially supported.” Director of Information
“Have you heard? – lots of senior people are saying that more people than normal are dying in our Emergency Department .” Deputy COO
“OK. Weirdo.” Deputy COO “I see.” Director of Information “It’s really bad isn’t it, I think we should do a case note review and raise it with the CCGs and NHSI.” Deputy COO “I see. May I do some analysis first.” Director of Information … Director of Information
“Have you heard? – lots of senior people are saying that more people than normal are dying in our Emergency Department .” Deputy COO
“OK. Weirdo.” Deputy COO “I see.” Director of Information “It’s really bad isn’t it, I think we should do a case note review and raise it with the CCGs and NHSI.” Deputy COO “I see. May I do some analysis first.” Director of Information “Simple SPC charts show that it’s about the same as last year. We’ve also build a model that can forecast flu spikes accurately two weeks ahead. You could use it to plan staffing rotas this winter. ” Director of Information
“The board report is a bit boring isn’t it? I find it difficult to get into.” Chair
… Chair and CEO “I see.” Director of Information “I agree. I also really struggle to find the time to read it as I’m constantly travelling.” CEO ... Director of Information … Director of Information
“The board report is a bit boring isn’t it? I find it difficult to get into.” Chair
“Blimey. That would be cool, just like the BBC, sort of.” Chair and CEO “I see.” Director of Information “I agree. I also really struggle to find the time to read it as I’m constantly travelling.” CEO “Would you like me to summarise it into a podcast and a vlog that you can access while travelling.” Director of Information “Yes, sort of.” Director of Information
“I think STPs are just the latest talking shop, nothing will get delivered.” Finance Director
“So how much money have you saved?” Finance Director “I see.” Director of Information “But you have to be at the table. We need a presence.” Finance Director “I see.” Director of Information … Director of Information
“I think STPs are just the latest talking shop, nothing will get delivered.” Finance Director
“So how much money have you saved?” Finance Director “I see.” Director of Information “But you have to be at the table. We need a presence.” Finance Director “I see.” Director of Information “Actually, a lot is possible. We can reduce the cost of external management consultancy by linking our best analysts together. We can develop economies of scale in warehousing, analytics and begin to solve region-wide issues.” Director of Information
“We’re going to run an exciting programme to transform flow in our emergency department, it’s going to save money and improve outcomes.” Transformation Director
“We don’t seem to be making any progress.” Transformation Director “I see.” Director of Information “My team need some data so that we can build a case to recruit more staff and buy some new sytems, the rotas themselves are probably fine. Number of attendances and number of ambulances by month please.” Transformation Director “I see.” Director of Information … Director of Information
“We’re going to run an exciting programme to transform flow in our emergency department, it’s going to save money and improve outcomes.” Transformation Director
“We don’t seem to be making any progress.” Transformation Director “I see.” Director of Information “My team need some data so that we can build a case to recruit more staff and buy some new sytems, the rotas themselves are probably fine. Number of attendances and number of ambulances by month please.” Transformation Director “I see.” Director of Information “We’ve found that when Dr Jones and Nurse Smith are on we achieve the national standard but when Dr Gardener and Nurse Evans are on we don’t – it’s now statistically significant. The number of attendances and ambulances are irrelevant. Get out of the way, we’ll do it. ” Director of Information
“I find it difficult to find time in my busy life to keep fit. I’d also like to study for a PhD at some point and maybe only work term time when I come back from Maternity leave” Analyst
“So?” Analyst “I see.” Director of Information “I heard that at BMW they force their senior staff to move down to four days a week and take up tennis or the piano so that they don’t all die of a heart-attack at age 60.” Analyst “I see.” Director of Information … Director of Information
“I find it difficult to find time in my busy life to keep fit. I’d also like to study for a PhD at some point and maybe only work term time when I come back from Maternity leave” Analyst
“So?” Analyst “I see.” Director of Information “I heard that at BMW they force their senior staff to move down to four days a week and take up tennis or the piano so that they don’t all die of a heart-attack at age 60.” Analyst “I see.” Director of Information “Sounds great. I’ll organise Pilates for us all every Tuesday. I’ll get you funding for your PhD and develop a flexible hours system so that you move work around your life. I hope that this means that you might work here for another ten years.” Director of Information
“I’ve built all these great reports in Excel/Tableau/Qlikview/PowerBI [delete as appropriate] but nobody ever looks at them.” Analyst
… Analyst “I see.” Director of Information “Those doctors and Ops people are idiots.” Analyst … Director of Information … Director of Information
“I’ve built all these great reports in Excel/Tableau/Qlikview/PowerBI [delete as appropriate] but nobody ever looks at them.” Analyst
“But I fulfill my job description. I build password-protected pivot tables that I hide on the intranet and I bombard people with spreadsheets that crash their email. ” Analyst “I see.” Director of Information “Those doctors and Ops people are idiots.” Analyst “No, you are.” Director of Information “Provide them the data on their phone in an application that only needs a password the first time. Link them through to rigorous simple to view analysis and offer them detailed narrative and a presentation whenever they need it. I’m going to link your pay to how often your work is viewed. ” Director of Information
Triple A (in honour of the Health Foundation)
www.nesta.org.uk/blog/public-sector-data-analytics-four-steps
Can we see details of admissions to hospital from care homes in our area, and reason for ambulance call outs? Which care homes should I target first with work to reduce hospital attendances and admissions?
Which care homes should I target first with work to reduce hospital attendances and admissions? Which care homes have the highest number of avoidable conveyances to hospital or emergency admissions?
Which conveyances/admissions are avoidable?
Which care homes have the highest proportion of conveyances to A&E which do not result in admission?
What is the work needed to reduce avoidable conveyances?
What are the reasons for the conveyances which do not result in admission?
information?
want answered?
What problem are you trying to address? 1/3 of permanent admissions to care homes are previously unknown to social care but presumably known to health. ACTIONABLE: What would you do differently if you had the right information? Develop processes to ensure that patients are risk of a permanent admission to a care home are referred for a social care assessment at an early stage. APT: What AAA question do you want answered? How do patients/residents permanently admitted to a care home without prior contact with social care differ from those who have been in contact and what contacts have they had with the NHS? ANSWERABLE: What data do you need to answer the question? Person level linked health and social care data or bespoke collected audit data
DISRUPTION
VBVIPs Public Health Patients and Public Management Consultancy Pharma DH and NHSDEIX Academia
No, you’re not having
do want to dance. You need to respond quicker and cheaper. You need to help. We’re going to publish your data more transparently. You need to publish your methodologies and train. You need to lose weight/turn up for appointments/share your data. You need to engage more downstream. Bring your expertise. You need to make infrastructure and IG easier or get out of the way.
Analytical Leaders
VBVIPs Clinicians Analysts Operational Teams Create demand for analytical competency for aspiring Execs Designing a course to introduce analytical techniques
Population Health Management
NHS England and NHS ImprovementMohammed Mohammed and Lucy Hawkins, Strategy Unit
We are going to use the 1-2-4 4 all ll method! We will let you know when to move on to the next stage.
1.
minu nute 2.
airs rs - Share for 2 mi minut nutes es 3.
Small all grou
ps - Share for 4 mi minu nutes es 4.
Entire e grou
p - Feedback for 5 mi minu nutes es
What have been your “stand out” moments today?
We are going to use the co convers ersation tion café fé method! We will let you know when to move on to the next stage.
1.
cide on a talking ing obje ject ct to to use se for your ur discussion scussion 2.
und 1 1 - As As tables, bles, pass ss the talking ing obje ject ct around und the e table le, , allowi wing ng indi divid vidua uals s to to respond spond to to the e quest estion ion (4 4 minut nutes) es) 3.
und 2 2 - As As tables, bles, pass ss the talking ing obje ject ct around und the e table le, , allowi wing ng indi divid vidua uals s to to respond spond to to what t was s sa said d in the first rst round und (4 4 minut nutes) es) 4.
und 3 3 – Open en discuss scussion ion (2 2 minut nutes) es) 5.
ire group
5 minut nutes) es)
What have been your “stand out” moments today?
Population Health Management
NHS England and NHS ImprovementGareth Wrench, Public Health England
Email: england.stgphm@nhs.net www.midlandsphmacademy.nhs.uk
Useful resources
Population Health Management
NHS England and NHS Improvement