Day 39: The Dog That Doesn’t Bark

“The dog that doesn't bark” was jargon used today (new one to me) to describe a 'measure' that suggests there may be no problem, but behind the measure there are problems!

This was at an Area Team Mortality Workshop today to locally share best practise and learn from Sir Bruce Keogh’s Mortality Reviews of 14 hospitals. Very helpful presentation about the different measures that are used to monitor mortality in hospitals, including the benefits and pitfalls of each.  If you want to know the difference between your SHMI, HSMR or RAMI, Advancing Quality Alliance have written a good paper.

Data is important, but, as the jargon suggests, much more important to work together locally across organisations within a local community and to look at mortality from a patient perspective, not being constrained by corporate boundaries. This needs to include the components of quality (as defined by Lord Darzi & expanded by Don Berwick):

• Safety (avoiding harm from the care that is intended to help).
• Effectiveness (aligning care with science and ensuring efficiency).
• Patient-experience (including patient-centeredness, timeliness and equity)

 We need to locally develop an approach to reviewing mortality at a patient, organisation, pathway, community and population level that is based on best evidence from England and internationally.  Also, and probably most importantly, we must engage with and involve patients and carers in the design and use of this process.  This will also help in communicating what we’re doing to the public to provide clear transparent messages that include appropriate reassurance.

(sorry, wrote 200 words today; could have written much more, such an important and interesting subject)