Strategy Survival Guide

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Collecting data - Surveys In Practice 1: SU Alcohol Misuse Project Studies of a small number of hospital Accident and Emergency Departments have suggested that alcohol is associated with a large number of visits, particularly at weekends, but there has been no well-validated nationally representative study of the burden imposed by alcohol on A&E services. To address this gap, the alcohol project commissioned two surveys. Study 1: The first was a questionnaire-based survey contracted through the Health Development Agency to MORI. This cross-sectional survey covered all 224 A&E departments in England. This was designed broadly to replicate the first such survey in 1997. As coverage was intended to be 100%, sampling issues were not raised. The aim was to quantify use of different procedures for recording and handling alcohol-related cases (coding schemes, diagnostic categories, types of intervention), the perceived prevalence of such cases, the major difficulties posed by such cases, and to identify possible future improvements to provision. The questionnaire was sent to one clinical director and one nursing director in each department. Initial response rates both in 1997 and 2002 were around 20%, as expected. Non-respondents were subsequently contacted directly by telephone, raising the response rate to 61%. Study 2: The second survey was a single 24-hour "census" of a nationally representative sample of A&E departments on a fixed date. This was designed to test three hypotheses: • Alcohol related A&E attendances will be associated with violence and assault incidents • Regional variations in alcohol-related A&E attendances will be related to regional general population prevalence of excessive drinking and alcohol misuse • Higher levels of alcohol-related A&E attendances will be associated with higher levels of violent incidents towards A&E staff This survey was commissioned from a leading authority in a major medical school. Sampling was based on the need to test for a statistically significant difference in the prevalence of alcohol-related A&E attendances by men between the regions of England. The desired sample size of cases in each region was estimated on the assumption that in each region the proportion of A&E cases which were alcohol-related would be similar to the prevalence of excessive drinking by men reported in the year 2000 General Household Survey. The maximum regional prevalence was 25%, the minimum 17%. To detect a significant difference between two independent proportions, the required number of cases in each population was estimated using a sampling formula. This was done by the survey specialist advising the team. A&E departments were selected by random sampling from the national list stratified by the 9 Government Office Regions and by urban/rural catchment area. The survey was planned to be undertaken through direct interview by research nursing staff trained specifically for this purpose. The questions were designed to establish: • whether alcohol has been consumed in the past 24 hours • where and when the last drink was consumed • whether the attendance was related to a violent incident • whether the patient had been a victim of violence or not • where and when the violent incident had occurred • any category of criminal offence related to the attendance • whether an injury has been sustained and if so the nature of the injury • reported hazardous drinking in the past year using an established questionnaire anonymised to protect confidentiality A breath sample indicating alcohol level was included to provide an objective assessment of alcohol intoxication. Each A&E department was asked to report any verbally or physically violent incidents in A&E during the 24hr census period. Studies 1 and 2 were linked in that the second survey’s breath test measurements were intended to validate staff perceptions of the prevalence of alcohol-related cases as determined by the first survey. However, study 2 was not solely a validation exercise. Hospitals are in many respects autonomous. Research surveys of patients generally required the permission of hospital ethics committees. Ethics committees often raised issues about the proposed studies including concerns about whether individual respondents can be identified from data records, and the preservation of respondents’ confidentiality. This process took considerable time and needed to be factored into the research commissioning process. Where several hospitals were involved, as in the case of the second survey, multiple centre research ethics committee (MREC) permission was sought to avoid the need to approach each hospital separately, which could have taken considerable time. Strategy Survival Guide – Strategy Skills Page 124
Collecting data - Surveys In Practice 2: Gap Analysis - Communidad de Madrid The "Comunidad de Madrid" is one of the 17 regional governments in Spain. In 1995 it decided to implement a quality plan based upon the disconfirmation model of satisfaction. The Comunidad de Madrid measured both the satisfaction of its citizens as well as the satisfaction of the clients of its public services. The Comunidad de Madrid has developed and registered its own satisfaction measurement model called CAL-MA (Calidad-Madrid: Quality-Madrid). CAL-MA is based upon the concept of a service quality "gap": between expectations and perceptions of service. The gap (usually negative) is taken to be the scope for improvement. Surveys are carried out every year on different representative samples of clients. Measurement of expectations takes place separately from that of perceptions of the service. For further details see: La Calidad del Servicio Publico' 1999 Comunidad de Madrid. Strategy Survival Guide – Strategy Skills Page 125
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Strategy Strategy Survival Survival
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Building an Evidence Base 113 Data
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A Framework for Strategic Direction
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Cost-benefit & cost-effectiveness a
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For further material, see the Ratio
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Compelling vision for action - the
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Designing an implementation plan In
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Creating Public Value http://www.nu
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