Whilst the operational standards might be the indicators that generally receive most media, commissioner and political attention, there are many other important metrics that possibly have a greater connection to ‘quality’.

Indicators such as mortality rates, patient satisfaction and hospital acquired infection rates to name but a few all provide a useful lens to gain insight into the risk, outcomes and experience for patients.

Whilst many of the quality indicators show a similar pattern to the operational standards where ‘Outstanding’ > ‘Good’ > ‘Requires Improvement’ > ‘Inadequate’, some do not.

One such indicator is the ‘Hospital Acquired C. difficile Infection Rate’. For this indicator CQC ‘Good’ rated trusts regularly have the highest rates with the eight organisations with the highest infection rates all being rated ‘Good’.

Figure 1: Ranking chart for May 2017 C. difficile Infection Rate

Why might this be the case?

Is it related to ‘Teaching’ hospitals having a high proportion of the rated ‘Good’, whilst at the same time they possibly have a higher proportion of patients on treatment regimes where C. difficile is a recognised risk? I don’t know the answer to this, but I am sure a microbiologist or infection control nurse would be able to explain this phenomenon.

But comparing the ‘Teaching’ and ‘All Acutes’ pre-set peer groups on the Public View ‘Trend’ chart does lend some evidence for this theory (see figure 2), which shows ‘Teaching’ hospitals consistently reporting higher C. difficile infection rates per 100,000 bed days than the ‘All Acutes’ average.

Figure 2 Trend chart for Teaching v All Acutes peer groups for C. difficile Infection Rate

This indicator provides a valuable example for why we should not simply ‘manage the metric’ but seek to understand what the indicator represents and whether there are any contextual factors that should be taken into consideration when looking to make comparisons.

In part three we will be exploring some of the 'finance' indicators.  To get early sight of the CQC groups performance for these indicators click here to register for an account.