Reproduced above is a recent exchange on Twitter. I’d better open by saying this blog post is not impugning the work of Samantha Riley or any other plot the dots people. On the contrary, the whole #plotthedots movement is an important part of a cultural change that is happening within the NHS at the moment. But I would like to take up the rhetorical device Samantha uses, to explore the issues that we have understanding data in the NHS.
Let’s take the tweet at face value. A world where every NHS board converted from RAG to SPC, along with CCGs and regulators. It’s worth noting that this would, in fact, be a substantial improvement on current practice. RAG rating presumably has its place as a management tool but as a data analytic instrument it is very lacking. RAG ratings treat 30 week waiting lists the same as 18 month ones- 16 hour waits in A and E the same as 6 hour waits. They give no help with interpretation in regard of trend or variance. In this new world boards will be able to distinguish chance variation from real changes. They will have due regard for both the trend and natural variation in a variable, and be able to adjust their certainty accordingly. This is all to the good.
But let’s think about all the things that we’ve left out here (I don’t doubt the #plotthedots people are quite aware of this, I’m just using the tweet as a jumping off point).
We’ve left out psychometrics. Are the measures reliable and valid? We don’t know.
We’ve left out regression. How much variance does one indicator predict in another? We don’t know.
We’ve left out multiple comparison. We reviewed 15 indicators. One shows a significant change. What is the probability that this is due to chance variation? We don’t know.
We’ve left out experimental design. We’ve reviewed changes in measures collected on four different wards- two of which have implemented a new policy, and two of which have not. Is the experiment well controlled? Are difference due to the intervention? We don’t know.
We’ve left out sampling theory. We have patient experience questionnaires in the main entrance of our hospital and they are distributed on wards on an ad hoc basis. Are the results subject to sampling bias? If yes, how much? We don’t know
We’re interested in producing graphics to help managers understand patient flow throughout our organisation. Excel can’t do it. What can we do? Nothing! In the bin!
I’m obviously exaggerating a little here, for effect, but the sad fact is that the NHS is in a very sorry state as far as its capacity for analytics goes. Many individuals who have the job title “analyst” in fact would more properly be called “data engineers”, in the sense that they can tell you very exactly what happened but don’t have a clue why. There’s nothing wrong with that, data engineering is a highly valuable and difficult skill, but it’s not analysis, and in fact career structure and professional recognition for true “analysts” (or, let’s dream really big here, “data scientists”) is sorely lacking everywhere.
I passionately want proper understanding of and engagement with data and statistical concepts right from board all the way across the organisation, and in fact I am busy at the moment in my own Trust offering in depth tutorials and one off lectures on concepts in data and statistics. I strongly support APHA’s aim to introduce rigorous professional accreditation of analysts.