Title: Information Systems: Monitoring and Managing from Ward to Board
Funder: Department of Health (England)

Abstract: The Francis Inquiry has made a number of recommendations about openness transparency and candour. The recommendations are of two kinds. One concerns the need to develop cultures where “every health care organisation and everyone working for them must be honest open and truthful in all their dealings with patients and the public.” The other concerns formal governance arrangements. A range of stakeholders including Trust Boards HealthWatch commissioners and national regulators need better intelligence about services and particularly about patient safety and the quality of relationships with patients and carers.NHS hospitals - particularly Foundation Trusts - have implemented substantial changes in the collection integration and use of information in recent years. There is already widespread use of dashboards and other tools for routine and exception reporting. Equally there is good evidence of problems at each stage of the feedback cycle - data collection collation reporting and action. We aim to understand whether NHS acute Trusts have the information systems they need to manage services and to report to Trust boards and other stakeholders and to establish how far changes in the scope and content of formal reporting helps or hinders greater openness transparency and candour. There are four research objectives. The project will:1. Assess the extent to which Trusts are able to integrate activity quality outcome and cost information to enable ward teams to manage their services effectively and to improve services over time;2. Assess the extent to which such systems provide data that is valuable to other local stakeholders including Trust Boards HealthWatch and commissioners;3. Evaluate the impact of these systems on practices at ward level and on decision- making at Board level with particular reference to the promotion of openness transparency and candour; 4. Identify the barriers and facilitators to the effective re-design and use of these systemsWe will use a prospective case study design undertaken in two specialties at each of three NHS Trusts over a period of 18 months. Normalization Process Theory will be used to inform the design of the study. The study design has four discrete components one for each objective. Methods for the first objective: survey of 20 NHS acute Trusts to establish the current content and use of dashboards and other tools selection of 4 study sites interviews with clinical staff to establish current practices and changes over the course of the study period. Second objective: review of documentary evidence and interviews with stakeholders to establish the value of dashboards and other sources of intelligence. Third objective: studies to establish the impact of dashboards on practices including direct observation of ward teams Fourth objective: use of a range of data sources to identify common enablers and barriers across study sites. Data will be analysed using established case study methods including within-site and cross-site comparison and iterative interpretation of emerging findings.The benefits of the study will include a better understanding of the value of dashboards and other tools in practice their value in providing effective intelligence to a range of stakeholders guidance for NHS Trusts on the enablers and barriers to embedding them in routine practice and their impact on openness transparency and candour.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE