Abstract
The English National Health Service (NHS) announced a new programme to incentivize use of the NHS Safety Thermometer (NHS ST) in the NHS Operating Framework for 2012/13. For the first time, the NHS is using the Commissioning for Quality and Innovation (CQUIN) scheme, a contract lever, to incentivize ALL providers of NHS care to measure four common complications (harms) using the NHS ST in a proactive way on one day per month. This national CQUIN scheme provides financial reward for the collection of baseline data with a view to incentivizing the achievement of improvement goals in later years. In this paper, we describe the rationale for this large-scale data collection, the purpose of the instrument and its potential contribution to our current understanding of patient safety. It is not a comprehensive description of the method or preliminary data. This will be published separately. The focus of the NHS ST on pressure ulcers, falls, catheters and urine infection and venous thromboembolism is broadly applicable to patients across all healthcare settings, but is specifically pertinent to older people who, experiencing more healthcare intervention, are at risk of not one but multiple harms. In this paper, we also describe an innovative patient-level composite measure of the absence of harm from the four identified, termed as “harmfreecare” which is unique to the NHS ST and is under development to raise standards for patient safety.
Highlights
In 2012, the English National Health Service (NHS) embarked on a national incentive scheme under the Commissioning for Quality and Innovation scheme (CQUIN)[1] to incentivize providers of NHS care to take a snapshot measure of four common harms on all patients being treated in NHS care on a predetermined date each month using the NHS Safety Thermometer (NHS ST).[2]
The national NHS ST CQUIN in 2012/13 incentivizes organizations to establish measurement systems and submit data collected using those systems according to the definitions and criteria set out in the NHS ST
We describe the rationale for this large-scale data collection, the purpose of the NHS ST instrument and its contribution to our current understanding of patient safety
Summary
In 2012, the English National Health Service (NHS) embarked on a national incentive scheme under the Commissioning for Quality and Innovation scheme (CQUIN)[1] to incentivize providers of NHS care (excluding patients under 65s in mental health units and paediatric patients) to take a snapshot measure of four common harms (pressure ulcers, falls, urinary infection [in patients with catheters] and venous thromboembolism [VTE]) on all patients being treated in NHS care on a predetermined date each month using the NHS Safety Thermometer (NHS ST).[2]. In the NHS, services are currently contracted from a wide range of providers including hospitals (providing acute NHS care to inpatients) and community providers (providing NHS care in patients’ homes, nursing homes and community hospitals) by primary care trusts (commissioners). This commissioning responsibility will soon be transferred to newly established clinical commissioning groups. In addition to normal “baseline” payments to providers for care, the CQUIN framework uses financial levers to incentivize providers to achieve certain quality goals.[3] The national NHS ST CQUIN in 2012/13 incentivizes organizations to establish measurement systems and submit data collected using those systems according to the definitions and criteria set out in the NHS ST. Where providers achieve a CQUIN “goal”, in this case monthly surveying of all eligible patients in NHS-funded care using the NHS ST, they can earn an additional payment set as a proportion of the actual outturn value of the provider contract
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