Dr Foster Unit: Our background

The Dr Foster Unit was established in 2002 and sits within the Department of Primary Care and Public Health in the School of Public Health at Imperial College.

The main objective of the unit initially was to develop methods to explain variations in mortality rates in medium and large acute hospital trusts across England. The unit has expanded its remit and now delivers a large variety of analyses related to variations in quality of healthcare.

The unit has built on statistical methods developed during previous work from team members' involvement in two public inquiries: paediatric cardiac surgery death rates at the Bristol Royal Infirmary and into the crimes of Harold Shipman. From this work, we took away two key messages: routine data are useful for monitoring the performance of NHS hospitals and statistical process control methods deserve wider use in healthcare. We combined the two, and, in collaboration with the web development team at Dr Foster Intelligence, rolled out “Real Time Monitoring”: the first commercial analysis tool to be sold by DFI to the NHS and now in use at two-thirds of acute trusts in England. Similar versions have since come out in the Netherlands and the USA.

The unit has developed a system by which raw, uncleaned hospital episode data are cleaned and processed monthly. Further value is added to the data by the unit in the form of HRG codes, socio-economic deprivation measures, and derived measures (e.g. emergency readmission within 28 days, patient safety indicators) designed to add functionality to the data.

A number of useful applications have followed including a method to identify high impact users of healthcare, a practice based commissioning tool and an application to monitor and analyse hospital activity.