The Model Hospital - Observatory of Public Sector Innovation

The Model Hospital allows trusts across the NHS in England to benchmark their productivity and identify areas to improve across the range of services they delive. For the first time, it provides data on productivity, performance and quality in the same place,
highlighting opportunities to improve productivity and reduce variation. The Model Hospital leverages the power of benchmarking to provide concise, insightful, actionable strategic information to support trusts to improve care for patients.

Innovation Summary

Innovation Overview

The Model Hospital has grown out of Lord Carter’s review of operational productivity and performance in NHS Acute hospitals, published in February 2016. The review found significant unwarranted variation across trusts, as well as a lack of awareness amongst trusts of how their performance compared to others. The NHS also lacked a ‘standard measure’ of productivity, making it difficult to compare and benchmark the performance of different trusts. Lord Carter’s review estimated that if all trusts could perform as well as the current average performers in all areas, the NHS in England could save at least £5bn per year.

Reputation and peer effects targeted at both individuals and institutions have been shown to be effective in driving improvement across the public sector, and the Model Hospital plays on these drivers by increasing the transparency of relative performance and productivity at a macro and micro level. Importantly, this model is not based on setting benchmarks or targets that are then
imposed on the service through regulation. The Model Hospital aims to make trusts themselves more aware of existing variation, pinpoint specific opportunities for improvement, and provide them with the contextual information and guidance to take action. To address these, the Model Hospital provides, metrics, benchmarks, case studies and best practice related to productivity, efficiency and quality across all areas of a trust’s work. Benchmarking and comparison is at the core of the Model Hospital, and trusts can compare their data with the ‘national median trust’ and with a selected 'peer group' - either one they've chosen themselves or picking from a number of pre-loaded peer lists, including their region, similarly sized hospitals or community trusts, or a list of ten calculated 'recommended' peers, chosen based on a range of factors including demographics, geography and case mix.

The latest edition of the Model Hospital, launched on 26 September 2018, includes a number of developments and features that take users more directly to the highest priority areas for improvement they might want to explore further. Using a benchmarking approach, we estimate the potential productivity gain possible in an area - for example, corporate services or geriatric medicine - both in terms of potential cash release, and potential additional activity that could be carried out at the same cost. Within each of those areas, we are then able to algorithmically identify potential drivers of those opportunities - for example, outpatients, or staffing costs, and directly provide users with relevant case studies or contact information for a subject matter expert.

At the centre of the Model Hospital's capabilities is the ‘Weighted Activity Unit’, created specifically for the Operational Productivity programme and Model Hospital. This is a single, standardised unit of clinical activity, roughly analogous to £3,500 'worth' of clinical output. The Weighted Activity Unit allows us to compare all of the clinical activity carried out between different trusts on a like-for-like basis, vital if benchmarking is to be credible.

The Model Hospital is structured around six ‘lenses’ (Board-Level oversight, Clinical Service Lines, Corporate Services, Care Settings, Clinical Support Services and People). Each lens contains a number of ‘compartments’ covering a specific area, for example, estates or nursing. Data and metrics in these compartments range from the high-level headlines, giving an at-a-glance view of overall performance, to more granular trust-level and ward-level data.

The immediate beneficiaries of the Model Hospital are trusts in England. The NHS collects more data than ever on its patients, procedures, procurement and workforce. The Model Hospital gives trusts access to easily comprehensible, standardised and comparable outputs from these data sources, all in one place. In an environment where many trusts have significant deficits, and staff time is focussed on servicing inexorably increasing demand from an aging and growing population, the Model Hospital provides comprehensive and easy to understand information to support trusts to take control of their finances and productivity. Crucially, the ultimate beneficiaries of the Model Hospital are the more than 1 million patients the English NHS sees every 36 hours. Greater productivity and better use of resources is not just a fiscal necessity, it saves lives by allowing available resources to be more effectively deployed, targeting areas of greatest opportunity and where patient need is greatest. As demand for services continues to increase, and patient expectations of health services rightly rise, the imperative to ensure that every penny is spent as effectively and productively as possible increases with it. The Model Hospital is at the forefront of that work within the English NHS and across the world.

Innovation Description

What Makes Your Project Innovative?

The scope and simplicity of the Model Hospital concept is unprecedented. As an in-house tool, the range of data
collections included is huge, and covers every service and area of expenditure of meaningful size across all trusts in England. The development of the Weighted Activity Unit (WAU), a standardised measure of output, and the related Cost-per-WAU, a standardised measure of productivity gives trusts in the NHS in England a way of visualising and comparing what they get for their money in a way that simply was not previously possible.

The Model Hospital is also taking a far more user-centred approach to development than the regulation-led approach that has often prevailed previously - by working directly with our users, who are managers and clinicians working at the front line of care, we can provide them with the tools they need to make better decisions to ensure their patients receive the best care and their organisations are sustainable for the long term.

What is the current status of your innovation?

The Model Hospital has recently been released in a v2, and continues to go from strength to strength. We now have 13,000 registered users, a 4-fold increase from July 2017, and remarkable for a potential market of 167 acute trusts. We continue to improve and iterate on our initial concepts, continuing to seek out fresh insights that we can provide to our user base.

Now that we have an established core of users visiting the product at least monthly, and a mature product available for over a year, we are beginning to see more direct evidence of projects and improvement programmes built on the data and insight that we provide. We are beginning to evaluate these, but the early signs are very encouraging - in its first year, the Top 10 Medicines programme, of which the Model Hospital was a critical part, saved £324 million pounds across the NHS in England, simply by encouraging pharmacists to use less expensive biosimilar or generic replacements for expensive drugs.

Innovation Development

Collaborations & Partnerships

We have developed collaborations and partnerships with a variety of key organisations – from central government agencies or programmes such as NHS England, the Care Quality Commission, NHS Digital and the Getting it Right First Time (GIRFT) programme with whom we coordinate strategic priorities and aim to develop one shared ‘version of the truth’ for the NHS in England, to independent sector organisations who provide bespoke data collections for the product.

Users, Stakeholders & Beneficiaries

NHS Patients - access to more productive services, able to deliver more, better quality care to more patients, more efficiently.

Managers in NHS trusts - greater understanding of their services, better decision making, sharing of innovation and good practice.

Government officials and NHS managers - deeper understanding of the challenges faced by NHS Trusts, and better understanding of NHS performance on a range of measures.

Innovation Reflections

Results, Outcomes & Impacts

We are currently in the early stages of a project to more fully evaluate and explore the impact of the Model Hospital. However, we already have evidence of its value in use. One trust, who identified that their water costs were significantly higher than that of their peers, found that fixing the leak responsible saved them in excess of £100,000 per year. Other trusts have reported savings of a similar magnitude from similarly simple fixes. The ‘Top 10 Medicines’ feature introduced last year provides trusts with 10 medicines currently in use that could be replaced with much cheaper biosimilar medicines, with no impact on patients – in its first year this saved over £300 million.

In future, we expect to see further improvements on this scale, as well as the range of NHS organisations using and seeing the benefits of the Model Hospital expanding significantly into ambulance, mental health and community trusts.

Challenges and Failures

First amongst these is the timeliness of data. In many areas, where other datasets are available, we are already updating data every month, at a less than one-month lag, a significant achievement. In other areas, particularly relating to financial data, the delay in gathering and reporting data remains a barrier. This is currently unavoidable in some cases, but work is currently under way to find proxy measures and datasets that will enable us to provide a more real-time indication of performance. The next key challenge for the Model Hospital is in making the data and information within the tool more actionable for trusts. Whilst in some areas this has been straightforward – the top 10 medicines feature is one example – in others understanding the actions a trust might want to take to address a high cost area, or to further investigate an under-performing area is less clear. We are exploring ways in which we can work with trusts to unlock the value provided by their data.

Conditions for Success

High level backing, giving the time and space to research and develop a high-quality product, and the relatively
large resource required to get a large-scale digital product up and running. Buy-in from users and ‘the system’ more
widely is also essential, in this case both to ensure high-quality data are provided to integrate into the tool, and to
ensure that they are willing to engage with and use a self-serve tool once it has been provided. These conditions
can be pro-actively created or promoted through active stakeholder and user research and engagement. Finally,
the availability of timely, high-quality data either direct from a central system or collection, or the ability to collect
pro-actively from users to populate the tool is critical to success.

Replication

A similar tool could be created and replicated across any public service comprised of multiple delivery organisations where there is unwarranted variation to be addressed, for example education or police services. We have had discussions with the departments in UK Government responsible for these services to explore where they may be able to replicate or re-use our work, although this has not as yet progressed. Critical to any expansion to other areas, however, will be availability of high-quality data and willingness to share this data widely – where private sector systems are used, for example for staff records or procurement, this may be a barrier to successful adoption of the methods used by the Model Hospital.

Lessons Learned

It is vital to clearly define a scope and core strategic objectives for a digital tool like this. Once success had been demonstrated, we received requests and comments for a wide range of additional functionality or content for different target audiences or purposes. Whilst there may be a case for some additions or widening of scope, or indeed for new products to target these new audiences, a clear sense of core strategic goals and direction is very helpful in these discussions.

Our user-centred approach to development has also been essential to the success of the Model Hospital. being responsive to the needs of the sector allows us to provide real value to our users, rather than providing tools we think should be useful. In some areas, particularly data development, we still have some way to go on this as we continue to build analyses that cut to the heart of the challenges our users face, but we continue to improve every day.

Finally, although there has at times been resistance to our focus on productivity, often perceived as overly focussed on financial gains, we have persevered with a consistent message that productivity and our work is about both inputs and outputs i.e. cost and clinical performance and quality. Both elements are essential. By acknowledging the importance of the service itself, we have engaged more effectively with the people delivering services on the front line, and built a productive relationship with them that we hope will continue into the future.