The dials on the dashboard screen flicker between red and green, to indicate targets missed or met, outside the orthopaedic ward of the Golden Jubilee national hospital in Clydebank.
The information displayed here is free of medical jargon and simple to understand, led by what relatives themselves said they wanted to know about the place where their loved ones were being cared for. And it is also brutally transparent – a single patient fall or pressure sore is a missed target, making angry red blots appear at the bottom of the screen. There has been one of each in this particular ward over the past month.
It takes Hugh and Wilma Blair, who have been visiting Wilma’s sister as she recovers from a hip replacement, a few moments to process the level of access they are being given to Golden Jubilee’s core data.
Wilma points out the 100% score for hand hygiene over the past month (“they’re very particular about that”), while Hugh attempts to convert the number of days since a patient last contracted the C difficile virus on the ward (3,572) into a more manageable unit of time.
Updated regularly as more data is added, several such screens around the hospital cheerfully highlight the sort of statistics most hospitals would, at best, feel sensitive about displaying quite so overtly.
But the screens are the public presence of a unique digital framework – which collates more than 300 measures of quality of care, from complaints to compassion – that has gained Golden Jubilee a world-leading reputation for technological innovation in healthcare. It is interactive, predictive, accessible by every member of staff, from ward to board level and from anywhere around the world, on desktops and as an app.
Adapted from an off-the-shelf dashboard product bought by the hospital four years ago, it has attracted global interest from countries such as the US and Australia and is about to be rolled out to four other boards in Scotland.
It also represents a mammoth feat of data gathering, explains staff nurse Elaine MacKenzie at the start of her shift in the surgical day unit earlier in the day. “Every day, someone is given a badge as hand hygiene monitor and the data is put into the system, even in the middle of the night.”
In this age of smartphones and tablets, most staff are already technically competent, she says, although there is training available to learn how to adapt the app for individual clinical needs.
Every ward has its own local indicators, says MacKenzie – high dependency will be different from critical care – as well as those national targets that need to be measured across the hospital. Nursing staff have weekly audits to analyse the results. And the framework cuts back on bureaucracy and paperwork because staff designed it and trust it.
The technology has been utterly transformative, explains the hospital’s chief executive, Jill Young. “Staff wanted something to correlate information: for example, in an orthopaedic ward, if A and B are breached can you alert C? The product we have now is interactive but also predictive and analytical. Staff can see trends coming through, and it gives you that healthy competition because it’s in public for all to see. Ward managers will ask each other: how do you manage to get 98% in that competency?”
Young consults her tablet, focusing on an individual ward. “See, there’s one pressure sore there?” she says. “I can see above-average staffing levels … actually, they’ve got a good skills mix.” Swiping through various on-screen charts, she muses: “What’s their occupancy like? Ah, it’s touching the upper threshold … so their ward is absolutely jam-packed. And what’s their absence rate? Oh, they’ve got a number of staff off sick.”
She concludes: “Their ward is full and the complexity of the patients is up to the highest level. So rather than that ward being penalised for poor quality because a patient had a pressure ulcer, we actually put more support in there. It gives you a completely different perspective.”
The framework the app is based on is NHS Scotland’s 2010 quality strategy, which was built around three goals: being safe, effective and person-centred. In consultation with staff, Golden Jubilee has since developed its own set of values to work by, and approached Strathclyde University to get a validated measure of those values, including “a can-do attitude”.
“With patient experience, we have all the measures you’d expect in a hospital – death rates, complaints – but we also measure compassion of our staff towards patients,” Young says. The new values dashboards use the caring behaviours assurance system, an international research project that Golden Jubilee was the first hospital to use. Patients are asked to pick key words on a tablet screen to describe how they were greeted when they first arrived, or how scared they felt on the way to their operation.
With an internationally recognised research centre attached to the main hospital, it is no surprise that Golden Jubilee has embraced this degree of embedded technological innovation. But the hospital is also a national centre of excellence in heart and lung services, orthopaedics and opthalmology.
Soon staff will be able to put clinical data into the app, and the medical director, Mike Higgins, is excited. “It seems simple, but it is difficult to get these sorts of things right,” he says. “Inputting clinical data will be very useful but also very complex. Even a simple indicator like mortality isn’t as straightforward as you imagine.”
For example, if a particular cancer is nearly always fatal, is a risky intervention with a lower likelihood of success to be encouraged? These are the sort of triangulations the framework can assist with.
For now, says Higgins, the app is interesting to dip into and sparks conversations. “If there are a few clinical incidents in one ward, I’ll have a chat to my assistant directors about the reasons why.”
For Higgins, the quality framework app is an outward manifestation of what makes Golden Jubilee special. “This really is a unique institution, with its focus on measurable quality and patient experience. It’s very different from anywhere else I’ve ever worked.”