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«A rapid evaluation of SHREWD: the Single Health Resilience Early Warning Database Erica Wirrmann Gadsby Linda Jenkins Stephen Peckham Centre for ...»

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A rapid evaluation of SHREWD:

the Single Health Resilience Early

Warning Database

Erica Wirrmann Gadsby

Linda Jenkins

Stephen Peckham

Centre for Health Services Studies

University of Kent

Month Year


Further copies can be obtained from:

The Librarian

Centre for Health Services Studies

George Allen Wing

University of Kent


Kent CT2 7NF

Tel. 01227 823940

Fax. 01227 827868

chssenquiries@kent.ac.uk http://www.kent.ac.uk/chss

A rapid evaluation of SHREWD:

the Single Health Resilience Early Warning Database January 2013 Erica Wirrmann Gadsby, Research Fellow Linda Jenkins, Public Health Specialist Stephen Peckham, Director of CHSS and Professor of Health Policy Centre for Health Service Studies University of Kent

Commissioned by:

Matthew Drinkwater, Associate Director of Resilience NHS Kent and Medway Centre for Health Services Studies CHSS is one of three research units of the University of Kent's School of Social Policy, Sociology and Social Research, which is one of the UK’s leading academic schools, providing award-winning teaching and internationally-recognised research. CHSS is an applied research unit where research is informed by and ultimately influences practice.

The Centre draws together a wide range of research and disciplinary expertise, including health and social policy, medical sociology, public health and epidemiology, geriatric medicine, primary care, physiotherapy, statistical and information analysis. CHSS supports research in the NHS in Kent and Surrey and has a programme of national and international health services research. While CHSS undertakes research in a wide range of health and health care topics, its main research programmes comprise-.

o Risk and health care o Health and social care of vulnerable adults o Public health and public policy o Injury prevention and surveillance o Ethnicity and health care Researchers in the Centre attract funding of nearly £l million per year from a diverse range of funders including the ESRC, MRC, Department of Health, NHS Health Trusts and the European Commission.

For further details about the work of the Centre or for more copies of the report please


Diane Arthurs Administrator Centre for Health Services Studies George Allen Wing University of Kent Canterbury Kent CT2 7NF Tel: 01227 824057 E-mail: d.arthurs@kent.ac.uk Fax: 01227 827868 www.kent.ac.uk/chss Contents Centre for Health Services Studies

Executive summary


The need for an information sharing database like SHREWD

The function and objectives of SHREWD

Purpose and objectives of the evaluation



General experiences of using Shrewd


Key benefits of using the system

Problems with or disadvantages of using the system

The impact of SHREWD

Information sharing

Monitoring the situation

Making strategic decisions

Reflecting on the way system pressures are handled

SHREWD’s impact on efficiency and productivity

Costs of developing SHREWD

Staff time required

Efficiencies and savings in staff time

Lessons learned from implementation and use



Key findings

Further issues and questions

Executive summary This rapid evaluation took place in November and December 2012 and involved interviews and observations in Kent and Medway, across a range of organisations and categories of staff involved in developing and implementing SHREWD.

SHREWD was developed in Medway and then rolled out to Kent, so informants to the evaluation had differing experience with SHREWD ranging from almost no exposure, to being involved for three years since its inception.

We found that SHREWD had met many of its key objectives since it was easy to use, it required little training, and it presented key information in a simple and clear manner. Negative user experiences were more likely to be voiced in the roll-out areas, where SHREWD had not yet been fully integrated into existing ways of working, and was sometimes felt to be partially duplicating other information systems.

A number of aspects seem important to successful implementation and use of SHREWD. These include having central direction, assured funding and having responsive IT support. Spending time discussing what information is to be displayed and establishing the correct trigger values for red/amber/green/black rating is essential, and a substantial amount of time has to be allowed for this part of the process. Having accurate and timely data is also fundamental as SHREWD becomes less useful when data are out of date.

SHREWD is not yet being used to capacity and can deliver further benefits, for example when uploading of data has been fully automated, and as data builds up over time it can be used for more strategic purposes such as reflection and audit, and for prediction and planning.

This study has raised a number of questions relating both to operational and evaluative aspects of SHREWD. Operationally it is not yet clear how well SHREWD will fit into the new NHS architecture, who will be the lead organisation responsible for implementing and maintaining SHREWD, and how SHREWD’s licensing, development and associated costs will be met.

In summary this evaluation found that two years after its implementation, SHREWD had achieved many of its key objectives and there are indications of an improvement in the quality and efficiency of managing winter pressures in the site where it was developed. It was thought that there were further gains to be achieved over time. Further more detailed evaluative research is necessary to understand the impact of SHREWD on planning and managing winter pressures, and in particular, its impact on productivity and efficiency. Further research should also explore the processes of implementation to investigate why implementation in Kent was slower than anticipated, and how implementation in other areas might be improved.

Background In November 2012, the Centre for Health Services Studies at the University of Kent was commissioned by NHS Kent and Medway to conduct a rapid (23 day) appraisal of the SHREWD system and the way it was currently operating across Kent and Medway. SHREWD - Single Health Resilience Early Warning Database - is an “online, real-time early warning and decision support tool”, developed by Transforming Systems (a human systems focused software development company) in collaboration with NHS Kent and Medway, partners within the Medway health system, and the University of Greenwich, with financial support from the South East Coast Strategic Health Authority. It is a system designed to be accessed and updated by partners within a local health system in order to share ‘system critical’ information.

The need for an information sharing database like SHREWD

Year-round capacity planning and accompanying escalation plans are recognised as essential for all health care organisations. Timely and fit for purpose information is crucial to the management of capacity and patient throughput at a time of excess demand on NHS emergency and acute care services (NHS South of England Escalation framework August 2012). If an organisation sees pressure building, all actions must be taken to reduce that pressure, and all system partners must be fully involved in supporting the organisation to prevent them escalating to Black status1. In addition to locally defined actions, there are a number of mandatory actions that must be implemented across the whole system prior to the declaration of Black status by an organisation. These actions require all partners within the health system to be fully informed and up-to-date with the situation in not just their own organisation, but within other organisations across the health system.

There is no single system for sharing information between agencies planning for and responding to season pressure events or major incidents. A review of the 2009 pandemic flu response and winter plans in Medway found that organisations were often planning and working in ‘silos’, using a range of different information and documentation which was not shared effectively or consistently at times of system pressures. Commissioners were often working without a clear picture of the operational status of providers across the health system as this could take 24 hours or more to collate. In addition, there were often several different plans related to different types of system pressures such as winter plans, flu plans, or major incidents, which meant reduced efficiencies and missed opportunities for common lessons to be learned.

According to the NHS escalation framework, an organisation’s ability to manage demand is rated according to an incremental 4-point scale, colour-coded from green (capacity is sufficient to meet demand; targets are being met), through amber and red, to black. A black status indicates a failure to manage current demand, and that help is being sought beyond the locality boundaries. For organisations at amber or red, there are a number of action points that must be taken to ensure the continuous operational delivery of healthcare services. SHREWD utilises this escalation scale (sometimes referred to as RAG rating), with each organisation identifying their own specific ‘trigger points’ between each of the points on the scale.

In response to this assessment, a paper-based system was developed in Medway to assist with information collation and sharing during the pandemic, and to focus discussions during multiagency teleconference calls. The potential for this system was quickly seen, and it was subsequently developed in 2010, with the assistance of Greenwich University, into the online database being used across Kent and Medway today. The initial focus of the work has been to support winter planning and response to winter pressures.

The function and objectives of SHREWD

SHREWD was initially designed and jointly developed to meet NHS Medway partners’ requirements. It was based upon the results of an in-depth requirements analysis (undertaken by the University of Greenwich School of Computing), and detailed work on indicators and trigger points undertaken by the Head of Urgent Care Commissioning. SHREWD was developed, tested and rolled out in Medway, and went live in the summer of 2011. It was then commissioned to be rolled out across NHS Kent & Medway in September 2011, and was recommissioned in March 2012, to take account of the learning and new requirements of the NHS as it adapts to meet the needs of Clinical Commissioning Groups.

The primary function of SHREWD is to support informed decision making through the identification of what, and where, stress is in the system, such as winter pressures or major incidents through the sharing of real-time information, such as bed capacity and staff availability.

The key objectives of SHREWD are to:

- facilitate a collaborative whole health economy approach to joint working and information sharing;

- provide real time information on a range of indicators agreed by partners;

- provide instant access to the information available at all levels from executive team/strategic to frontline operational in a series of dashboard formats;

- streamline a complex process of daily/regular multi-agency conference calls via the design and development of an E conference call, minutes and actions recording system;

- provide a proactive view of stress within a health economy, individual organisation or area of practice (e.g. out of hours activity, assessment units);

- identify single points of failure and create considerable system resilience for no additional cost;

- develop a system that can be used remotely (24/7) via the use of mobile technology e.g.


- allow whole system or focused training without the cost or impact on staff time.

At the time of this evaluation, SHREWD has been fully operational for a year and a half in Medway, and for several months across Kent (although Kent partners have been involved in developing and testing the system since September 2011).

Purpose and objectives of the evaluation The SHREWD system has not been formally evaluated to date. A value for money evaluation would be desirable, and is being considered for funding by the Partnership for Innovation in Health. Prior to that, however, CHSS were asked to conduct an initial rapid evaluation to assess, as far as possible within the timeframe of the study, the extent to which SHREWD is seen as meeting its aim and objectives, and to provide early indicators of the impact on resources within the local health economy.

Based on the perceptions of key system users, this evaluation addresses three main questions:

1. What issues have arisen from the implementation and operation of SHREWD?

2. To what extent and how has SHREWD contributed to improvements in the quality of coordination and planning processes?

3. What are the cost/resource implications of implementing/using SHREWD?

More specifically, it will:

- identify key stakeholder views about the system wide impact of SHREWD;

- provide information on the way SHREWD is utilised in NHS organisations;

- identify whether there are benefits in adopting and using SHREWD in data reporting, data management, organisation co-ordination and emergency planning;

- identify impact on resource use;

- assess the system against key objectives (set out in section 1);

- establish criteria for a fuller evaluation of SHREWD’s operation.

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