Quince Jan 1997

The Quince?

This newsletter has been set up by the Directorates of Public Health and Patient Care at Bro Taf Health Authority to look at the work being done in the Authority itself and in the Trusts which serve the Authority in Quality Assurance and Clinical Effectiveness.

Aim of the Newsletter

• Inform – let our population, the general practitioners and the trusts know what is going on in the district to improve the quality and effectiveness of the health services.
• Improve – to set up a programme of promoting clinically effective changes in the district. For instance the Health Authority and the Trusts will agree 40% of their audit programme in the coming year.
• Enthuse – tell our population, general practitioners and trusts about ideas from elsewhere and how we can help you bring such changes here. The plethora of things happening here and elsewhere can paralyse us.

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D&Cs in Bro Taf

The Clinical Effectiveness experts have been saying, for many years, that D&Cs for women with heavy periods under the age of 40 are a waste of time. We looked at the figures for Bro Taf and, sure enough, very few operations are done indeed. The figure shows the way things are.

The small number that are done appear to be greatest in Porth Hospital, especially in terms of the total number of operations. The consultant assures us that these are coding errors. We will need to check the coding in future.

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What else is going on in Bro Taf?

There are a huge number of projects going on in Bro Taf. To date we have collected almost 200 separate projects.

Data that are collected include:

• Guideline developments
• Clinical effectiveness projects
• Pilot studies
• Audits
• Condition based agreements (contracts)

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Waiting times – check the internet!

By looking at the Internet on http://www.open.gov.uk/ you can call up the waiting times for operations in Wales. The figure below gives you an idea of how these vary from surgeon to surgeon in surgery for benign prostatic hyperplasia. It can be seen that there are considerable differences between individual surgeons for the total waiting time as given in the Internet.

There are data on all waiting lists in Wales, as well as Patient’s Charter information.

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Waiting times – check the internet!

By looking at the Internet on http://www.open.gov.uk/ you can call up the waiting times for operations in Wales. The figure below gives you an idea of how these vary from surgeon to surgeon in surgery for benign prostatic hyperplasia. It can be seen that there are considerable differences between individual surgeons for the total waiting time as given in the Internet.

There are data on all waiting lists in Wales, as well as Patient’s Charter information.

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What is clinical effectiveness?

The Clinical Effectiveness Support Unit (Wales) has suggested that the difference between Clinical Effectiveness, Clinical Audit and research can be summaries in terms of five questions

• What is the right thing to do? This is a research question and is strictly separate from clinical effectiveness issues. Ideally the Health Authority should support only services that are: government policy, of proven effectiveness, are so obviously useful that their effectiveness is self evident or are subject to research. This should certainly be the case for new developments.
• Are we doing the right thing? Requires a review of the evidence and local factors and requires knowledge of Evidence Based Medicine. This is the first stage for developing clinically effective services.
• Are we doing it right? This is the audit question and depends upon a clear answer to the previous one. This is the second stage for developing clinically effective services.
• Can we do better? This is the third question in the clinical effectiveness cycle. The art of bringing about change for the better is the most difficult part of the process. We often know what needs to be changed but the inertia of the professionals and the system as a whole seems to block change at every turn.
• A fourth question might be; how can we test if something is clinically effective? The methods used can be summarised under the heading of ‘Effectiveness Based Medicine’. This consists of using a standardised and validated approach to, a guideline or a business case.

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