Somewhere in the historic lowlands of Scotland, where William Wallace once led the Scots in a fight for independence, is the area once known as Lanarkshire. According to legend, the famed Scottish patriot was married in this land and many say it’s where his story began.
Today, the one-time county of Lanarkshire is broken up into four councils, including North and South Lanarkshire. It is there, in those two councils, that the National Health Service (NHS), the U.K.-based government health system, is making inroads of their own—using actionable data and capacity management dashboards to improve care.
Indeed, the success of NHS Lanarkshire, which operates three medium-sized acute-care facilities, could be a lasting lesson for both U.K.-and-U.S.-based healthcare provider organizations alike looking to streamline and improve care in the era of value-based reimbursement.
Leading the effort for NHS Lanarkshire is Alan Lawrie, acute services director. He says the area in which the health system serves is a mix of both urban-industrial and rural populations. Aging and rampant chronic disease have upped the number of emergency department attendees requiring admission into acute-care.
“Just like with all health systems in the U.K. and an emerging amount in America, the balance between planned care and emergency care is one we’re challenged with on a day-in, day-out basis,” says Lawrie. “It is one of the reasons we were keen on exploring the use of dashboard technologies to manage healthcare transitions at the acute-care spectrum.”
Alan Lawrie
Eyes in the Sky
NHS Lanarkshire, with assistance from business intelligence and mobile software company, MicroStrategy (Tysons Corner, Va.), has developed multiple dashboards used to manage care. Those dashboards inform leaders of current capacity, bed availability, information on who is being discharged, triage times, and the extent of patient’s injuries or illness across the three hospitals in near real-time. This is especially vital for care in the emergency department, allowing NHS Lanarkshire to comply with government regulations that ask that each patient in the ED to be seen, assessed, treated, and either admitted or discharged in a four-hour window.
“In each of the three hospitals you’ve got a large screen. It’s got the department, it’s got the numbers and the doctor (and practitioners) in charge can see what’s happening with flow, what’s happening with the numbers, and see what’s happening with the acuity of the patient. Most importantly, they can see how close they are to reaching that four-hour target,” Lawrie says.
From a tactical perspective, Lawrie and other leaders at NHS Lanarkshire are the proverbial eyes in the sky. They can see make strategic decisions to move that flow around ensuring each emergency department is evenly capacitated. Beyond the ED, NHS Lanarkshire’s use of dashboards allows it to look at the entire hospital. If a patient needs admission into a cardiology ward, the dashboard lets them know if a bed is available.
While the dashboards don’t integrate into the electronic medical record (EMR), they do include the patient’s unique medical number—called the community health index (CHI)—in Scotland. This allows clinicians to get background information on the patient before they even step foot in whatever department they’re being treated in.
Another dashboard helps NHS Lanarkshire to develop planned care strategies for individual patients. They can see which patient has been referred into the hospital, which specialty that patient has been assigned, how long they’ve been waiting, and if they are converting to either an inpatient or outpatient procedure. Again, this helps the health system comply with government regulations.
“In Scotland, we have a legal requirement to treat patients within 12 weeks from the day they’ve agreed to and been referred, until the first outpatient appointment. This dashboard allows monitoring—by consultants, specialty, and hospital—where we have capacity and how things are moving on those individual patient journeys,” Lawrie says. “If a patient moves into that 12-week danger zone, they get flagged.”
As of June 30, 2014, NHS Lanarkshire had treated 98.3 percent of patients within that 12-week span, called the HEAT standard by the Scottish government. Only one other NHS-based health system ranked higher than Lanarkshire.
The ED dashboard used by NHS Scotland
Credit: MicroStrategy
Easy to Use
Over the course of his career, Lawrie has gotten accustomed to that “sinking feeling” of when he has to introduce a new technology and the inevitable backlash it will face. That simply wasn’t the case for these dashboards.
“Every single clinician that has seen this, especially in the emergency department, has said, ‘It’s fantastic, there is no training required, it’s point and click, and it intuitive to use,’” Lawrie says. “It’s become addictive for senior executives and senior clinicians.”
The most challenging aspect of the developing and rolling out the dashboards has been figuring out what data to incorporate. Eventually they agreed to start with a more vanilla data set. Lawrie says if they had gone too fancy it would have turned people off.
Lawrie did say there are plans in development to make the dashboards more intricate. NHS Lanarkshire is working on a way to include patient safety metrics, such as hand hygiene compliance, in the dashboards. The health system would also like to create algorithms that allow them to predict capacity requirements in the future, he adds.
