The Hospital Mortality scorecard: Its impact on learning from deaths

Introduction and Literature

The importance of balanced scorecard (BSC) has been studied in various management perspectives and likewise its role in the emergency hospitals in the Western World. However, the use of this Balanced scorecard among clinicians  especially in the hospital setting with regards to performance monitoring and strategy implementation is still needed. As Mortality rates become an important national metric among hospitals in the UK, we examined the impact Balanced scorecard on learning from deaths.

Methodology

The Learning from Deaths (LfD) framework in the NHS requires that  providers must review patient deaths and identified areas for learning and improvement. We conducted an Initial Task and Finished group evaluation of the Learning from deaths process as an organizational improvement project in October 2023.  Within the areas of  improvement works, we implemented changes within 10 out of  the 11 major identified tasks. We also designed a Mortality and Morbidity meeting attendance Matrix. This is then followed by an A3 Improvement methodology on the scope of our Learning from deaths.

Results

The improvement work has led to our Bi Team creating an Early Warning Mortality Dashboard with its implication for monitoring and Learning. The Mortality dash board consists of over all deaths including inpatient, elective admission and child deaths. These include an achievement of 100% capture of Clinical Frailty scale, Recording Comorbidities at time of first FCE with average dept of coding more than national average and the development of mortality Early Warning Scorecard. There is now a monthly  visibility of the crude mortality. This allows us to capture deaths related to No Criteria to Reside contributed by frail elderly patients. We are now having visibility of the SHMI value and the HSMR, which are a smoke signal for quality of care.  It is possible to see the monthly recording of where deaths occur in each wards.

Overall the summary KPI Dashboard includes a quarterly SJR  of 14.6 % and Diagnostic groups accounting for Mortality metrics.