Quality Account 2010/11 - James Paget University Hospitals

Priority 1b: Patient safety – Reduction in mortality rates
AIM: To integrate HSMR measures into clinical and managerial
processes
The Hospital Standardised Mortality Ratio (HSMR) is an indicator of healthcare quality that
measures whether the death rate at a hospital is higher or lower than you would expect. Like
all statistics, HSMRs are not perfect. If a hospital has a high HSMR, it cannot be said for
certain that this reflects failings in the care provided by the hospital. However, it can be a
warning sign that things are going wrong.
The HSMR compares the expected rate of death in a hospital with the actual rate of death for
a number of diagnoses, for example, heart attacks, strokes or broken hips. For each group
of patients it is possible to work out how often, on average, across the whole country, they
survive their stay in hospital. This is achieved by taking into account their age, the severity of
their illness and other factors, such as whether they live in a more or less deprived area. This
provides a figure for how many patients we would expect to die at each hospital. This is then
compared with the number of patients that actually die. If the two numbers are the same, the
hospital gets a score of 100. If the number of deaths is ten per cent less than expected they
get a score of 90. If it is ten per cent higher than expected, they score 110.
Care is needed in interpreting these results. Just through chance, some hospitals will have a
higher mortality rate and some a lower rate. It is inevitable that half the hospitals will have a
worse than average result and that some will be quite a lot worse than the average. It is
important to focus on "outliers". These are hospitals where the results lie outside the normal
range, or particular groups of conditions where results lie outside the normal range, for a
particular hospital.
An HSMR 14 point action plan has been approved by the Trust’s Board of Directors and
Management Team, to integrate the use of HSMR data with other tools. Specialties with a
higher than average mortality rate can understand why this has occurred and take any
necessary steps to improve. The action plan will be owned by the Trust’s Management Team
and progress against the actions will be monitored through the existing performance
management processes. A regular update on progress will be provided to both the Board of
Directors and Management Team throughout the year.
Executive Sponsor: Medical Director
Responsible officer: Deputy Director of Performance
Objectives: The Trust aims to reduce its overall and specialty specific HSMR to less than
100 throughout 2011/12.
James Paget University Hospitals NHS Foundation Trust
Quality Account 2010/11 Page 10 of 62