Learning about sustainability and the use of financial incentives from the NHS Safety Thermometer
Whytock C 1, Power M 1
1Haelo, The Victoria, MediaCityUK, Salford, M50 3SP
The NHS Safety Thermometer (ST) is a point-prevalence harm measurement tool developed in 2011 through the Department of Health’s Quality, Innovation, Productivity and Prevention (QIPP) Safe Care Coalition(1). On a pre-determined day each month staff are asked to use the ST to measure four common healthcare-related harms in all patients receiving NHS-funded care – falls, venous thromboembolism, catheter-associated UTI and pressure ulcers. From July 2012 organisations whose services were commissioned using the NHS Standard Contract were financially incentivised to collect data on NHS patients using the tool(1), and from April 2013 to demonstrate improvement in prevalence of one of the harms (locally agreed with commissioners(2).
The number of submitting organisations over time was examined. All measures of central tendency are means. Statistical Process Control (SPC) analysis was used, with the mean adjusted when meeting standard rules of special cause variation. Data are publically available; no ethical approval was required.
The number of total organisations submitting data increased over the incentivised period (613 to 849, 38.5% increase). From the end of the incentivised period the number of submitting organisations has steadily declined (849 to 673, 20.7% decrease) (Figure 1). The decline in this period appears predominantly driven by nursing and residential homes (389 to 272, 30.1% decrease) and to a lesser extent independent sector organisations (241 to 222, 7.9% decrease) (Figure 2). NHS trusts have shown a much smaller relative decline (223 to 219, 1.8% decrease) which appeared to begin before the end of the incentive (Figure 3).
We have found adoption of the ST to increase during the incentivised period followed by a decline, driven mainly by nursing/residential homes and independent sector organisations, approximately from the end of the incentivised period. Use has been better sustained in NHS Trusts. It is likely a higher proportion of care delivered by Trusts is NHS-funded and therefore subject to the financial incentive than the other types of organisation and this may have helped successfully embed use of the tool into practice. In addition, being generally larger NHS Trusts may also have more mature patient safety systems in place which encourage continuation of use. Smaller organisations may not have the same structures providing such a ‘central driving function’. Further work is required to more directly investigate the relationship between financial incentives and sustainability of harm measurement tools.
1. Department of Health. Delivering the NHS Safety Thermometer CQUIN 2012/13: A preliminary guide to measuring 'harm free' care. May 2012, London.
2. NHS Commissioning Board. Commissioning for quality and innovation (CQUIN): 2013/14 guidance. December 2012, London.
DECLARATIONS - This work was supported by The Department of Health QIPP programme 2010-14 and NHS England (patient safety division). Conflict of interest - none declared.