There is wide variation in performance of NHS trusts on key quality indicators across the Yorkshire and Humber region.
For example, the standardised hospital mortality index for patients with a fractured neck of femur ranges from 65 to 145 (65% of expected deaths in one hospital to 145% in others). However, trusts rarely share information about the structural and behavioural circumstances that might produce these differences. There is emerging evidence that using an approach called ‘positive deviance’ can guide the spread of excellent practice across the healthcare sector and produce large scale change.
To use this approach we must first identify ‘positive deviants’ - organisations, hospital teams or general practices that demonstrate consistently excellent performance in a particular area of care. Once identified, these organisations can then be studied in-depth, to reveal:
At the start of the programme we plan to bring together a group of stakeholders, including patients, staff, managers and academics, to identify three priority areas for this programme of work. These could include areas being addressed by other CLAHRC themes, for example, reducing emergency admissions for frail elderly patients (overlaps with the Avoiding Attendance and Admissions in Long-Term Conditions and Primary Care-Based Management of Frailty in Older People themes), therefore collaboration across themes will be important.
This approach, currently being pioneered within the Academic Health Science Network in Yorkshire and Humber, depends upon having good data on important patient outcomes from hospitals, general practices and other community services. For example, if one of our priorities is to reduce the length of patient stay without increasing readmissions for patients with respiratory problems, then we need information about length of stay and readmissions across all similar units within the region.
Working with the Yorkshire and Humber Public Health Observatory, we will have access to better information to help us to identify those units who are performing particularly well. A ‘positive practice network’ will be established as part of the academic health science network.
The role of CLAHRC will be to develop evidence-based methods for each step of the process and to evaluate the impact of the positive practice network on patient outcomes. We will also examine whether different approaches to implementing change in NHS organisations in the region offer good value for money.