Title: QualDash: Designing and evaluating an interactive dashboard to improve quality of care
Funder: Department of Health and Social Care

Abstract: There are over 100 National Clinical Audits (NCAs) in the UK. There is variation between healthcare providers in the extent to which they engage with the data and some providers experience challenges in using the data to inform quality improvement (QI). Quality dashboards use graphical displays to improve feedback of audit data. AIM To develop and evaluate QualDash, an interactive web-based quality dashboard that supports clinical teams, quality sub-committees, NHS Trust boards, and commissioners to better understand and make use of NCA data, thereby leading to improved quality of care and clinical outcomes. RESEARCH QUESTIONS • In what contexts and by what mechanisms are NCA data currently used (or not) to improve quality of care? • What are the most effective means for clinical teams, quality sub-committees, boards, and commissioners to view and interact with NCA data? • What other data need to be presented alongside NCA data to build a more complete picture of care quality? • In what contexts and by what mechanisms do quality dashboards lead to increased engagement with NCA data and subsequent improvements in care quality? METHODS PHASE 1 Interviews with members of clinical teams, quality sub-committees, and boards across 5 NHS acute Trusts and relevant commissioners, focusing on 2 NCAs, will be used to articulate the implementation chain regarding use of NCA data and identify blockages to effective use and how these might be overcome, providing requirements for QualDash. A workshop with suppliers of other NCAs will determine which requirements are generalisable to all NCAs. PHASE 2 QualDash will be developed through an iterative design process, involving focus groups with clinical teams, quality sub-committees, and boards from 1 Trust, relevant commissioners, and patients and carers. We will explore the impact of presenting other data alongside NCA data. Controlled user experiments will assess comprehension, usability, and acceptability of QualDash, in comparison with existing formats for feedback of NCA data. PHASE 3 An implementation strategy for QualDash, tailored to the 5 Trusts and relevant Clinical Commissioning Groups (CCGs), will be developed through focus groups with clinical teams, quality sub-committees, and boards from the 5 Trusts and relevant commissioners. PHASE 4 QualDash will be made available in the 5 Trusts and relevant CCGs. A controlled interrupted time series (CITS) analysis will investigate impacts of QualDash, using process measures from the 2 NCAs. Ethnographic observations and interviews over 12 months will provide insight into contexts and mechanisms that lead to those impacts. PHASE 5 If progression criteria are met, a cluster randomised controlled trial will be designed, using the CITS results to decide the effect size the trial should be powered to detect. KEY OUTPUTS • Requirements specification and program theory to support design of QualDash • Technical specification for QualDash • Interactive web-based quality dashboard, using novel visualisation techniques, tailored to meet needs of different users • Actionable guidance for clinical teams, quality sub-committees, boards, and commissioners on how to integrate use of QualDash into practice to improve care quality BENEFITS AND POTENTIAL IMPACT QualDash use is anticipated to lead to increased access, comprehension, and engagement with NCA data, motivating QI initiatives that will lead to improved care quality. QualDash will be adaptable to all NCAs so if benefits are demonstrated they can be provided across the NHS.

Lay abstract: Over 100 national audits are undertaken in the NHS, each focusing on a different area of care. They provide healthcare professionals, managers, and those responsible for planning NHS services (commissioners) with important information about whether a hospital is meeting expected quality standards and how the care provided compares to other hospitals. This can encourage hospitals to make improvements. For example, when an audit of hip fracture care was introduced, there was an increase in the speed with which patients received surgery after a hip fracture. However, some healthcare professionals and managers have found it difficult to make use of audit information. Dashboards present information as graphs and are thought to make it easier for people to understand the information that is presented. Dashboards are already being used in the NHS but existing dashboards are static images, presenting information in a standard format. In this project, we will use computer technology to develop a dashboard that is interactive, allowing healthcare professionals, managers, and commissioners to easily and quickly explore national audit information to understand where improvements in care delivery should be made. We will work with staff from 5 NHS hospitals and commissioners, first interviewing staff to gather their ideas about how audit information is used, challenges in using audit information, and how these challenges might be overcome. These ideas will be used to design a dashboard and to develop a plan for introducing the dashboard so healthcare professionals, managers, and commissioners understand why the dashboard is being introduced and know how to use it. The design of the dashboard will depend on what healthcare professionals, managers, and commissioners tell us is useful and will be tailored to meet the needs of different users. It is likely to include the ability for staff to: 1) compare a hospital’s performance with that of hospitals located nearby and hospitals that are further away but of similar size; 2) explore how much the performance of a hospital varies, identifying areas where there is room for improvement but also identifying areas where there is good practice that can be disseminated more widely; 3) see a visual image of how a hospital’s performance has changed over time, to help them decide if changes in the way care is delivered are having the anticipated effect; and 4) explore the relationship between different types of information recorded in the audit and how this compares with other hospitals, for example seeing if differences in outcomes for patients are due to differences in how care is delivered or how the hospital is resourced. We will get feedback from patients and relatives on the design of the dashboard, to ensure the dashboard presents information that patients and relatives consider is important. We will make the dashboard available to the 5 NHS hospitals and commissioners via the internet and we will observe over a year how they use it. We will interview staff to get feedback and use this to make improvements to the dashboard during this time. We will keep track of how much the dashboard is used and, at the end of the year, we will see how the quality of care delivered in those hospitals compares to hospitals that did not use the dashboard. The findings will provide knowledge about the impacts of the dashboard, which features of the dashboard provide most benefit, and what is needed to support the use of the dashboard.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE