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Case Studies
To give a more in-depth view of the impact of our software, we have curated a number of case studies giving the end user perspective, along with guides on how to get the best out of Ethitec systems.

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Tiara9 as a Tool for Quality Audit & Improvement
NHS Scotland Audiology
Tiara9 as a Tool for Quality Audit & Improvement

The Challenge
When NHS Audiology Services in Scotland embarked on a modernisation programme, there followed significant investment in hearing aid technology, infrastructure, information systems and training. What was then needed was a quality audit process to help evaluate progress made as a result. 

The modernisation programme therefore culminated in the creation of quality standards, which provided the basis for a nationwide improvement process. This involved adult and paediatric services around the country scoring themselves against the standards, followed by evaluation by colleagues, allowing self-assessment scores to be compared against peer review. 

This process quickly proved effective but compiling and reviewing the data from 14 health boards was a time consuming task so the next challenge was to find a way of automating it.

Angela Bonomy, National Audiology Manager for NHS Scotland, explains: “The idea was for the service audits to be conducted annually so we wanted to move to a web based solution, rather than the laborious process of sending emails backwards and forwards and manually inputting scores into spreadsheets. We realised that we needed a more efficient solution and went out to tender.”

The Solution
The answer proved to be Ethitec’s Tiara9 system, a clinical information management solution which provided the ideal platform for clinicians to record their performance against the standards.

Angela continues: “We liked the simplicity of the Tiara9 solution. It had all the functionality we needed, with a simple enough interface to make it clinician friendly. Equally importantly, Ethitec understood what we were trying to do, and were responsive and accommodating of any tweaks we needed to make to the system.”

Ethitec Managing Director, Simon Taylor, continues: “The application of Tiara9 as a quality improvement tool was quite an unusual one, but the fact that the software has been designed by clinicians and supports customised assessment screens meant it was a straightforward deployment to set it up for NHS Scotland’s Audiology services.”

Tiara9 was implemented as a secure web-based solution, with clinicians logging on to input scores from the various sites. The nine quality standards were created as template screens on the system, making it simple to record scores in the full range of criteria around ease of accessing services, assessment, developing and delivering the individual management plan, outcomes, professional competence, information provision and multi-agency working.

Once services have completed their self-assessment process, Angela receives an alert and can invite peers to conduct their review. With both these stages complete, the Tiara9 system generates a report showing both sets of scores and comments that provide the basis for an action plan for each service. It also aggregates the scores across Scotland to give an overall picture of performance.

The Benefits
The implementation of Tiara9 has delivered a much more efficient way of monitoring and managing performance. Management time that was previously taken up with the manual process of collating data and producing reports is now allocated to analysing the information and supporting the implementation of action plans.

The availability of nationwide information is also a huge advantage. It is now possible to produce performance reports and get a clear picture of what is going on across the country at the push of a button. 

As well as providing an effective management tool at national level, the system also helps individual services to identify areas of weakness and quickly put together action plans to improve performance.

Moreover, the reports show that performance is improving year on year in nearly every area and the Audiology service now has a quantitative tool to provide evidence of quality improvements.

Angela continues: “The reports quickly highlight where there are differences between regions; in some cases this can be down to demographics, which means we can identify trends, such as differences between rural areas and more densely populated cities. On the other hand, if a number of services are scoring badly in a particular area, we know that national intervention is needed.”

By benchmarking performance in this way, services can see when they are doing well, as well as when they are falling short of the mark. From a national perspective, this makes it easier to identify where expertise lies and use these sites as beacon sites to help others to learn from their experience. 

Angela concludes: “The process has given us powerful data to support the improvement process. If a service has the attitude: ‘But I can’t do it!’, we are now able to immediately signpost them to where others have achieved good results so they can go and find out how they did it. 

“For each of the criteria being measured, someone will be performing well so by pooling this knowledge, we can create a picture of what the perfect service looks like.”

One of the biggest achievements has been in obtaining this intelligence without increasing the administrative burden on local services. The fact that the Tiara9 solution is easy to use has helped win clinical engagement in the process.

Everyone can see the benefits of making information visible in this way and the benchmarking process helps keep services motivated to improve their own performance and learn from other experiences around Scotland.
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