QualDash: Designing and evaluating an interactive dashboard to improve quality of care

Start date: 1 October 2017
End date: 31 December 2020
Funding: National Institute for Health and Social Care Research
Value: £850,923.12
Primary investigator: Professor Rebecca Randell
Co-investigators: Professor Joanne Greenhalgh
External co-investigators: Dr Roger Parslow (retired), Professor Amanda Farrin, Professor Chris Gale, Professor Justin Keen, Professor Robert West, Professor Roy Ruddle (all University of Leeds), Ms Julia Lake (Leeds Teaching Hospitals NHS Trust), Professor Dawn Dowding (University of Manchester)
Postgraduate research fellows: Dr Natasha Alvarado, Dr Lynne McVey

There are over 100 National Clinical Audits (NCAs) in the UK. There is variation between healthcare providers in the extent to which they engage with the data and some providers experience challenges in using the data to inform quality improvement (QI). Quality dashboards use graphical displays to improve feedback of audit data. AIM To develop and evaluate QualDash, an interactive web-based quality dashboard that supports clinical teams, quality sub-committees, NHS Trust boards, and commissioners to better understand and make use of NCA data, thereby leading to improved quality of care and clinical outcomes.

RESEARCH QUESTIONS

In what contexts and by what mechanisms are NCA data currently used (or not) to improve quality of care? What are the most effective means for clinical teams, quality sub-committees, boards, and commissioners to view and interact with NCA data? What other data need to be presented alongside NCA data to build a more complete picture of care quality? In what contexts and by what mechanisms do quality dashboards lead to increased engagement with NCA data and subsequent improvements in care quality?

METHODS

PHASE 1 Interviews with members of clinical teams, quality sub-committees, and boards across 5 NHS acute Trusts and relevant commissioners, focusing on 2 NCAs, will be used to articulate the implementation chain regarding use of NCA data and identify blockages to effective use and how these might be overcome, providing requirements for QualDash. A workshop with suppliers of other NCAs will determine which requirements are generalisable to all NCAs.

PHASE 2 QualDash will be developed through an iterative design process, involving focus groups with clinical teams, quality sub-committees, and boards from 1 Trust, relevant commissioners, and patients and carers. We will explore the impact of presenting other data alongside NCA data. Controlled user experiments will assess comprehension, usability, and acceptability of QualDash, in comparison with existing formats for feedback of NCA data.

PHASE 3 An implementation strategy for QualDash, tailored to the 5 Trusts and relevant Clinical Commissioning Groups (CCGs), will be developed through focus groups with clinical teams, quality sub-committees, and boards from the 5 Trusts and relevant commissioners.

PHASE 4 QualDash will be made available in the 5 Trusts and relevant CCGs. A controlled interrupted time series (CITS) analysis will investigate impacts of QualDash, using process measures from the 2 NCAs. Ethnographic observations and interviews over 12 months will provide insight into contexts and mechanisms that lead to those impacts.

PHASE 5 If progression criteria are met, a cluster randomised controlled trial will be designed, using the CITS results to decide the effect size the trial should be powered to detect.

KEY OUTPUTS

Requirements specification and program theory to support design of QualDash Technical specification for QualDash Interactive web-based quality dashboard, using novel visualisation techniques, tailored to meet needs of different users Actionable guidance for clinical teams, quality sub-committees, boards, and commissioners on how to integrate use of QualDash into practice to improve care quality

BENEFITS AND POTENTIAL IMPACT

QualDash use is anticipated to lead to increased access, comprehension, and engagement with NCA data, motivating QI initiatives that will lead to improved care quality. QualDash will be adaptable to all NCAs so if benefits are demonstrated they can be provided across the NHS.

Publications and outputs

[Randell R, Alvarado N, McVey L, Greenhalgh J, West RM, Farrin A, Gale C, Parslow R, Keen J, Elshehaly M, Ruddle R, Lake J, Mamas M, Feltblower R, Dowding D (2020) How, in what contexts, and why do quality dashboards lead to improvements in care quality in acute hospitals? Protocol for a realist feasibility evaluation, BMJ Open 2020; https://doi.org/10.1136/bmjopen-2019-033208

McVey L, Alvarado N, Keen J, Greenhalgh J, Mamas M, Gale C, Doherty P, Feltbower R, Elshehaly M, Dowding D, Randell R. (2020) Institutional use of National Clinical Audits by healthcare providers, Journal of Evaluation in Clinical Practice, 27: 143– 150. https://doi.org/10.1111/jep.13403

Alvarado N, McVey L, Greenhalgh J, Mamas M, Gale C, Doherty P and Randell R (2020) Exploring variation in the use of feedback from national clinical audits: a realist investigation, BMC Health Services Research 20, 859. https://doi.org/10.1186/s12913-020-05661-0

Alvarado N, McVey L, Elshehaly M, Greenhalgh J, Dowding D, Ruddle R, Gale CP, Mamas M, Doherty P, West R, Feltbower R, Randell R (2021 Analysis of a web-based dashboard to support the use of national audit data in quality improvement: Realist Evaluation. J Med Internet Res 2021;23(11):e28854 doi: 10.2196/28854

McVey, L., Alvarado, N., Greenhalgh, J. et al. Hidden labour: the skilful work of clinical audit data collection and its implications for secondary use of data via integrated health IT. BMC Health Serv Res 21, 702 (2021). https://doi.org/10.1186/s12913-021-06657-0