Data solutions and digital transformation at North Bristol NHS Trust

The Challenge

North Bristol NHS Trust (NBT) is one of the largest hospital trusts in the UK with an annual turnover of £532 million.

NBT was struggling with NHS statutory changes, reporting pressures, disparate systems and data quality overheads. In order to solve these challenges NBT looked to implement a trust-wide data warehouse and business intelligence solution.

The core requirement for this solution was to ensure it would be the primary reporting function for the whole trust. NBT wanted to provide all data needs to any department across the Trust through a centralised BI function that would have this solution at its heart.

In addition to the data warehousing solution, NBT had many disparate reporting tool options and it was important to implement one solution where any member of staff could go to source any report or dashboard output.

Following implementation, NBT needed the solution to be maintained under a managed service offering but built in a way to ensure self-sufficiency in the Trust’s team, so that the solution could be extended in line with new and changed requirements

The solution

NBT chose CACI to provide and implement a new data architecture including a Trust-wide data warehouse solution, Managed Service Support, and deployment of leading BI software.

The solution integrates a vast quantity of data from many disparate sources including administrative, clinical and finance systems. Additionally, the solution incorporates business logic in order to calculate and model the trust’s income. The solution is fully maintained by CACI through the provision of a managed service and a structured product release schedule.

The solution incorporates a layered database architecture incorporating integration, Operational Data Store, translation, star schema and semantic data mart layers.

This design reduces ongoing maintenance costs and increases flexibility to new requirements or interface changes. Historical data integrity is preserved through the implementation of an efficient slowly changing dimensions design and a full data quality process is built into the data flow enabling reporting and resolution of data quality issues. Both row and column level security governance is built into the design along with NHS privacy measures.

The logical design of the solution along with its interfaces is documented along with physical database design features to achieve optimal performance on the operating platform.

Data was migrated and re-factored from legacy solutions to maintain data history, and particular attention was made to how the cut-over point was implemented.

NBT benefited from CACI’s experience in promoting outcome-based dashboards for the healthcare sector. This enabled NBT to set up the best possible framework and method for rollout of BI analytics across the organisation, ensuring high stakeholder engagement for outcome alignment and adoption of change. Experience in the use of data science has allowed the Trust to further exploit its data to help improve patient outcomes through accurate predictions.

The results

Since implementation, NBT has been able to centralise its BI function and source all data through the single-governed version of the truth. It has ensured data readiness, completeness and accuracy is in place and always available for reporting.

NBT’s income is comprehensively calculated on a daily basis, with data quality issues managed and corrected in a timely fashion. The accuracy and completeness of this process has delivered a significant financial benefit to the Trust and an early return on investment.

Data is readily available and accessible to stakeholders across the Trust via a centralised portal, with most data updated on a daily basis and some updated every two minutes, allowing near real-time decision making. This has been especially valuable for the ED department and the ED clinicians as David Hale, Assistant Director of Informatics: Business Intelligence, IM&T at NBT, explains:

“They were able to see on arrival and refreshed every two minutes, the wait time in ED, attendances, discharges and performance… and they could see that information benchmarked against how other EDs were performing as well. We’d never been able to do that before. For the consultants, it has completely changed their approach to work. It’s become a platform on which we intend to build further real time reporting.”

Following a jointly executed project, training and knowledge transfer, the NBT team are fully empowered and self-sufficient in using and future expansion of the solution. This covers construction of analytics and addition of new data sources.

Through the innovative design of the CACI solution, NBT benefits from a fully-maintained core product, yet retain the flexibility to expand the solution to meet local and future needs (e.g. adding new data attributes, entities and rules).

NBT are part of the CACI NHS user community and benefit from the sharing of content and ideas with other trusts, as well as benefitting from CACI’s commitment to and investment in the NHS.

After working with CACI for 2 years, NBT was faced with the challenge of responding to Covid-19, when it was asked by NHS England to host the new NHS Nightingale hospital being built at the University of the West of England’s (UWE Bristol) Frenchay campus. The relationship built with CACI over time meant that they knew they could pick up the phone and reach out for support on this time-sensitive project. You can read more about the Nightingale project here.