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Partner Content (Aviva UK Health): Quality’s a team game

Using data science to help drive value-based commissioning in the private healthcare industry

Whether purchasing a product or service, the assurance of quality is paramount. None more so than with medical treatment.

But what does quality really mean? And, how do you measure it?

For some it’s brand. In the medical sense this could be the perception that the best specialists and facilities are London-based. Harley Street is a prime example, but it’s just a postcode.

Another measure could be the volume of procedures the specialist has undertaken. While there’s a lot to be said for experience, does quantity really represent quality?

Medicine is moving at such a pace that a specialist using the latest technology may have carried out fewer procedures but delivered far better outcomes for their patients. For example, interventional cardiology has now superseded previous techniques such as open-heart surgery. Yet, cardiologists who have practised for many years and not updated their practice may not be able to provide this new service. And, some conditions can now see better outcomes from non-invasive interventions, such as the use of physiotherapy to treat back pain. Measuring on volume alone could prove unreliable in this situation. Moreover, assessing quality on the amount of procedures an individual has undertaken could drive unethical behaviours by enticing them to perform unnecessary treatments.

Clinical outcomes and experience are arguably more robust measures of quality. But, does the success of a procedure really depend on one person? The simple answer is no. The health ecosystem is intrinsically linked. Patient outcomes can be influenced by factors outside a specialist’s control. Drugs need to be administered, dressings changed, and the right rehabilitation programme followed.

That’s why, when we talk about quality health provision, we take a broader view of the complete customer journey, from the point of claim all the way through to the completion of our customers’ clinical treatment. This approach gives us a better understanding of the value our propositions bring to our customers’ lives.

Providers registered with the Care Quality Commission (CQC) have a duty to ‘assess the risks to people’s health and safety during any care or treatment and make sure that staff have the qualifications, competence, skills and experience to keep people safe.’

In simplistic terms, this means that a hospital isn’t just ‘bricks and mortar’. Its staff all have a role to play in improving the quality of patient care – be it protecting against infection or working together to deliver the best outcomes in and out of theatre.

This ethos underpins the new draft Medical Practitioners Assurance Framework developed by the Independent Healthcare Providers’ Network (IHPN). The Framework will enable hospital providers to strengthen their assurance processes to support patient care through the clinical governance of medical practice.

The ‘diva’ ‘I don’t need to justify my clinical decisions’ attitude still exists amongst some. However, this collaborative approach sees a positive step-change in working practices which can only lead to better outcomes for all parties.

Quality measures

We believe that CQC and HIS ratings are currently the most robust, independent measure of quality in its holistic sense. That’s why they underpin our customer guiding approach. While the hospital is awarded the rating, it’s a reflection of everything that’s in it; staff, facilities, patient experience – not just the bricks and mortar.

Think of them as the Ofsted of health provision. You don’t solely choose a child’s education based on the facility alone. Yes, reputation, effective management and good facilities are prime considerations. However, the quality of the teaching staff, safety record and culture may be more important.

And, while we’re on the topic, sometimes we need to go out of catchment to get what’s right for our children. We accept this – often going to the extremes of moving area. It’s no different when talking about healthcare – although without the need to sell your house.

That’s not to say we don’t take steps to ensure the quality of specialists. Our introduction of condition-based networks enables us to assess like-for-like treatments against independently stated measures such as the Royal College of Surgeons Commissioning Guidelines. And it’s a prerequisite for clinicians to share quality data with us to be considered for our condition-based networks.

We have strict governance and monitoring in place to ensure that the specialists we work with are continually delivering the most clinically appropriate treatment to our customers and acting with integrity.

Moreover, we capture and analyse data to help evolve and build quality models to support our Specialist Finder Tool and improve our customers’ overall experience. And, through our holistic approach to quality measurement using CQC and HIS ratings, together with our consultant quality modelling work with our inhouse global data science practice, we believe we’re leading the way in the use of data science to help deliver value-based commissioning in the private healthcare industry.

Find out more about Aviva UK Health here.