NIHR RMF: Quality and Safety in Hospital Performance

Early detection of problematic hospital trusts is paramount to the safeguard of lives, and a of great importance to organisations responsible for monitoring hospital care, as is the case of the NHS and the Care Quality Commission in England.


While some of the differences in performance between hospitals are a result of intrinsic patient related factors (e.g. differing levels of deprivation, comorbidity, and age), others are likely connected to the care offered within each hospital. In this context, it is important to distinguish between safety and effectiveness of care, particularly in performance evaluations and in processes aimed at detecting serious performance issues.

Why this research is needed now

There is considerable public interest in the early identification of hospitals providing low safety care to the patient populations they serve. Existing hospital performance indicators make overall assessments of excess mortality within hospitals, accounting for patient and diagnostic characteristics. These overall indicators are not designed to assess whether this excess mortality originates from safety or effectiveness issues, as they provide a broad initial assessment of hospital performance.

Aims & objectives

This study aims to develop measures of hospital performance that allow routine detection of potential issues of safety of care, while differentiating them from other quality performance issues. The study aims to analyse large sets of routine, observational data to assess and compare the safety and quality of care provided by different hospital trusts.


This research has been funded by a grant from the National Institute for Health Research (NIHR) through their Research Methods Fellowship programme.

Protecting Patients

This study involves data collected by NHS Digital on all hospital admissions in England between April 1st 2010 and March 31dst 2015. This data allow us to identify hospital admissions that resulted in a death and model the overall mortality risk associated with an admission during these years, accounting for the patient’s diagnosis, demographic variables, and comorbidities (other co-occurring health conditions).

No patient identifying information (such as name, date of birth or address) will be made available to the researchers. All identifiable data will be removed by the NHS data managers before any data is made available to the research team; all data received by the research team will be ‘pseudonymised’ (i.e. NHS Digital will assign a non-identifying ID number to each record, in place of the deleted identifiable information such as names, dates of birth etc.). No record-level data used in this study will be transferred to any third country or international organisation at any point.

Personal health data was acquired from NHS Digital, and processed under the umbrella of exemptions (9,10, and 11) to article 9 (1) to special categories of personal data (medicine, public health, and for research).

The overall Data Retention Period for the project ends on 31/05/2021, and all original personal data will be securely deleted by this date. The legal basis for processing this data relies on the General Data Protection Regulation articles 6 (1) (e) and 9 (2) (j). The basis for dissemination relies on the Health and Social Care Act 2012 – s261 (1) and s261 (2)(b) (ii).

Despite these safeguards, should any individual wish to have data related to them excluded from the study i.e. wish to exercise their Patient’s Right of Objection to their data being used for research, or their Right to Erasure (‘right to be forgotten’) under article 17 of GDPR, they should contact the study team (contact details listed below) requesting that their data be excluded from the study. Please provide your full name, sex, date of birth, address details so that NHS Digital can identify their data, and exclude it from any data extraction performed in connection with this study. This study involves no decision making or profiling that would produce a legal or other significant effect on any participant.

Data Controller

The University of Sheffield is the Data Controller for this study. Please see the University of Sheffield General Privacy Notice for information on the handling of personal data by the university for research (e.g. this study), including details of the data protection officer, supervisory authority, right of complaint, and lawful basis for data processing under GDPR.

Contact Information

Professor Jon Nicholl, Professor Stephen Walters, Dr Richard Jacques, and Dr Ines Henriques-Cadby
Sheffield Centre for Health and Related Research
Regent Court
30 Regent Street
S1 4DA Sheffield, UK

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