Tuesday, 14 July 2020 17:58

Revolutionising nursing and patient care with Qlik

By Emma Williams

GUEST OPINION by Emma Williams, Care Capacity Demand Management Program Manager, Capital & Coast District Health Board, New Zealand

Capital & Coast District Health Board (CCDHB) hospital services are based in Wellington, New Zealand’s capital city. We have around 2,800 nurses and midwives who serve a population of approximately 300,000 people from inside and outside the greater Wellington region.

As services experience an increase in the acuity of patients, we need to increase their care capacity. To better match capacity to care with patient need, we are implementing a national program called Care Capacity Demand Management (CCDM). This program ensures we have the right nurses in the right place, at the right time.

The program has three core aims: (1) to deliver quality patient care, (2) to ensure a quality work environment, and (3) to ensure we are making the best use of our resources.

My clinical experience has helped me to understand that information is critical to getting the understanding and insights needed. Qlik Sense and Qlik mashups have made it so much easier to meet the core aims by making essential information available. The transparency that information offers has helped us gain an organisational commitment.

Data at the centre of it all

The program is underpinned by a nationally-defined set of metrics called the Core Data Set, and by validated patient acuity information which is held in the TrendCare workforce planning and workload management system. TrendCare is the Ministry of Health’s approved acuity tool that every DHB is required to use to assist in the implementation of the program. TrendCare metrics are included in the Core Data Set.

The use of TrendCare means that we focus on acuity-based, not ratio-based staffing (ratio-based staffing allocates the number of nurses to beds and does not take into account changes in patient acuity). It is vital that we match our nursing and midwifery resources and workloads to the acuity of our patients to ensure both patient and staff safety.

All areas that use TrendCare for monitoring patient acuity have also set up Local Data Councils (LDCs). The program has established almost 30 LDCs, each comprising of a group of frontline clinical staff who use the Core Data Set to identify improvement opportunities and monitor success.

Making data invaluable – the CCDM Dashboard

To make the LDCs work effectively and use the time of busy clinical leaders effectively, we needed to make their Core Data Set results instantly available. We did this through a combination of Qlik Sense apps and a Qlik-based mashup. Without this, clinical leaders would find it difficult to access the data, and time-consuming to present results from a number of different reporting systems. The use of data may have been devalued but this approach has made data invaluable.

Our CCDM Dashboard and apps – which went live in April 2019 - pull results from multiple data sources including TrendCare, payroll, rostering, incident management and patient administration and make them available in one place. It allows full transparency about what is happening in our wards over time for both our patients and staff (e.g. it enables us to produce monthly results as required by the national reporting program).

Making data useful – in-built data literacy

The dashboard helps us to “tell the story” with the data. The design is clean and simple, making it easy for users to triangulate results and test assumptions. Users can also easily monitor the success of changes and improvement initiatives. If they want to explore the results further, they use a link from the dashboard that takes them to the relevant sheet of the appropriate app.

Change is happening

The combination of strong clinical and operational governance, supporting software and great Qlik developers is creating real and positive change. A big part of my job, and the job of my team, is talking to clinical leaders and taking them through the benefits of CCDM, TrendCare and Qlik. As they start to tell their own stories with data, the message of how good this program is for patients and staff alike spreads through the DHB. I’m pleased to say that we have the right relationships across the organisation to make this work.

With this change comes a hunger to know more. We run data literacy training for nursing and midwifery leaders and are getting requests to expand this to general managers, accountants and other staff. Through Qlik and our data literacy work, we really are enabling a DHB data-driven decision-making culture. People are becoming increasingly comfortable asking about what the data is saying and working out how to use it to deliver the best patient care within a safe and effective workplace.

As staff learn more about what we are doing, the more they want access to the data. At CCDHB we have been conservative in our purchase of Qlik licenses, starting with 200 and growing to our current 600. Most of that demand is driven by the CCDM program and it is not stopping.

The learning never stops

CCDM is continuous improvement in action. In addition to our data literacy program, we have a Core Data Set group that focuses on enhancing our ability to work with the data and improve its quality. It also informs future development, including guiding new metrics to add to the dashboard, suggesting priorities for new Qlik applications, encouraging benchmarking with other DHBs and hospitals. All of this feeds back into data literacy work creating a virtuous cycle of improvement. In every meeting we all learn something new. Insights come from everywhere.

Our chief nurse says that with analytics and the CCDM program, we are developing the world of nursing and midwifery and I honestly believe the use of Qlik within the CCDM program is practice changing.

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