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White Paper: Going mobile
How NHS Rotherham is challenging
traditional ways of working
This is the story of an NHS trust and a communications company. But it’s not
your traditional supplier/client relationship. By inviting ø into a genuine
partnership, NHS Rotherham has changed the way community health
workers do their jobs. And, by doing that, they’ve made patient records
easier to manage.
But it hasn’t been easy. Along the way both NHS Rotherham and ø have
learnt important lessons: that change takes time. That one size doesn’t fit all.
And that often, the most obvious answer isn’t the best one.
This is what happened In March 2007, they gave out 20 laptops
with 3G built in so that community health
In February 2006, NHS Rotherham adopted
workers would be able to access the
one of the new NPfIT Clinical IT systems. For
internet and SystmOne on the go.
the first time, clinical data for community
services was to be stored on one central In theory, the new laptops should have
system, replacing the traditional paper- improved the quality of patient records
based way of working. In line with the and made life easier. But many community
national NHS drive, it seemed that an health workers found the computers
entirely paperless system was in sight. difficult to use. The logon process was
complicated. Network coverage wasn’t
But travelling back to base to fill out digital
consistent. And the fact that some staff
patient records just wasn’t practical for
couldn’t access the digital record instantly
community health workers. They needed to
meant they were spending time trying to
be able to upload patient information on
find out details from patients that were
the spot, from their patients’ homes.
already on the system.
There was no national solution to this
The result was that lots of people were
problem. So NHS Rotherham had to think
still using paper records to save time. And
on their feet. Their answer? Give community
others, preferring the desktop computers in
health workers a laptop to take with them,
the clinics, were still travelling back to base
with SystmOne, the central IT system, built
to save patient information at the end of
Breaking new ground Although everyone could see the benefits
of the new system, the feedback from the
With no official guidance for how to
pilot scheme was mixed. So NHS Rotherham
introduce mobile working, NHS Rotherham
decided to look into what was going wrong.
decided to run a pilot scheme with 11
community services across the borough.
There was no national solution to this In November 2008, the NHS Rotherham
problem. So NHS Rotherham had to SystmOne team commissioned a report into
think on their feet. mobile working and how the project was
going so far. The results confirmed their make suggestions about how to get mobile
suspicions: lots of people weren’t confident working to stick.
using the equipment, and many said they
The team knew that ø had lots of
needed more focussed training.
experience helping other businesses switch
By that point, the SystmOne team had given to mobile working. So they asked them to
out over 100 laptops. And although some get involved.
people were really enthusiastic and making
good progress, other staff weren’t finding Getting started
the laptops as useful as the team had
Solving the technology issues was the easy
bit. As NHS Rotherham’s second network
provider, ø installed an APN link which
An outside opinion
quickly improved the 3G network across the
Introducing mobile working was clearly district.
going to be a much bigger challenge than
But to make the biggest difference, ø
the SystmOne team had thought. If they
needed to understand more about how
were to challenge traditional ways of
NHS Rotherham worked – the problems
working, they’d need to think carefully
people were facing, and what was stopping
about what people wanted and needed,
them from making the most of the new
and then take time to prepare them for the
To help them do this, ø introduced a
On a practical level, they needed to
business consultant from their professional
improve the coverage on the laptops. But
management service. His first task? To talk
on a more strategic level, they needed
to people: stakeholders, clinicians and the
independent, impartial advice. Someone to
people using the technology. Anyone who
look at the new system and at all the work
could help ø get to the bottom of what
the SystmOne team had put in, and then
But to make the biggest difference, ø A chance to speak up
needed to understand more about how The Rotherham SystmOne team gave ø
NHS Rotherham worked. three groups for a trial: district nursing,
school nursing and intermediate care. And at the end of the shift, the team
They invited people from each group to followed the nurses back to base. There,
a workshop where they could share their they noticed the nurses spent hours
experiences and thoughts. uploading patient records, picking up work
for the next day, and contacting other
The project team were pleased to see how
nurses. All things they could have been
many people volunteered to come along
doing on the spot – if they had the right
and get involved. Not only was it a good
technology and training.
chance to hear first-hand what had been
happening, but it was also a vital step in The team also saw that the nurses hadn’t
getting clinicians interested in the process got to grips with the IT systems they were
and interested in mobile working in already using. Because they’d only had
general. specific training on SystmOne, they weren’t
sure what else they could use the computers
A day in the life for. Yes, they could upload patient
information. But they could also schedule
The project team didn’t want to make
work. Email each other. And use other
any recommendations without seeing for
programmes like Microsoft Word that might
themselves what community health workers
have made life easier.
did on a day-to-day basis. And the best way
to do this was to shadow clinicians from the People weren’t making the most of the
three trial groups as they travelled to visit new technology, which meant time was
patients. being wasted. And from a security point
of view, the confusion had led to patient
The team started with district nurses. They
files being a mix of electronic forms and
watched how the nurses talked to their
paper – making them much more difficult
patients, all the time thinking about how
to manage and keep safe.
technology could make the process easier.
ø now understood how the nurses worked
and where they needed more help with the
They watched how the nurses talked
technology. So they used their findings to
to their patients, all the time thinking
make recommendations to NHS Rotherham.
about how technology could make the
Getting district nurses up and records, and when paper is necessary.
Part of this is going to be introducing
NHS Rotherham and ø quickly set about digital pens. These will let nurses make
addressing each of the problems they’d digital and paper records at the same time,
seen. The project team ran training sessions so the information will be on the central
to make sure the district nurses were up system, as well as in patients’ homes.
to speed with all the different systems. Having experienced how digital pens have
And, importantly, they reassured people improved efficiency in other trusts, the
that it was okay to use the computers with team are confident that people will be able
programmes other than SystmOne if they to start using them without changing their
needed to. day-to-day routines.
The team are now encouraging nurses to
Helping school nurses use the system
schedule more of their work electronically,
rather than going back to base to send Next, the team shadowed school nurses.
faxes. And they’re making sure no one is The problems here were similar to those
given a laptop unless they’re comfortable in district nursing. As school nurses have
using it. to work quickly, they don’t have time to
upload information electronically after
What the team haven’t recommended
seeing each patient. And when they’re
is going entirely paper-free. They saw
travelling from school to school, it’s
how important it was that nurses left
unrealistic to expect nurses to lug around
paper records behind in patients’ homes.
equipment they might not even use.
So instead of getting rid of paper
altogether, they want to give people The project team spent time with the school
guidance on how to create patient records, nurses, finding out what wasn’t working
so they know when to use electronic and how they could help.
Then, as with the district nurses, they made
The team are now encouraging sure people were given proper training
nurses to schedule more of their work on how the IT systems worked. Not just
electronically, rather than going back to SystmOne – but other programmes that
base to send faxes. might make their jobs easier.
A head start for intermediate care After the training sessions, the team
made sure they stayed in touch with the
Finally, the project team looked at how
community health workers. They asked for
they could help the intermediate care
feedback once people had started using the
professionals. No one in this team had tried
technology. And they helped out with any
mobile working before, so it was a good
questions or problems that came up.
chance to see whether thorough training
would help them get used to the new The result of this thorough roll-out?
system. Clinicians in intermediate care are now
spending 33% more time with patients than
After shadowing the clinicians, the team
they were before.
took the laptop training programmes they’d
run in the past, and adapted the sessions Instead of travelling back to base to upload
to make them as relevant and useful as information, they understand the systems
possible. Before, they’d used one-on-one well enough to create patient records on
training, but they now realised it would be the spot. They can also contact each other
more cost-effective – and helpful for the remotely. And divide work up without
clinicians – if everyone learnt about the having to be in the same room.
system in groups.
It’s a huge achievement, and one that
The newly designed sessions included proves the real value of mobile working.
lots of practical information about the IT
systems, but they also gave people the Making changes across the trust
background to the scheme. That way, The partnership with ø has given NHS
people understood why they were being Rotherham the confidence and time to
given laptops, and how mobile working explore other opportunities. ø were
could make things easier in the future. trusted to lead on the roll-out to District
Nursing, School Nursing and Intermediate
Care. This freed up time for the NHS
The result of this thorough roll-out? Rotherham team to explore other ways
Clinicians in intermediate care are now technology could help community teams
spending 33% more time with patients work more effectively and efficiently. And
than they were before. identify working processes which could be
automated to free up more time for carers • and, of course, carrying on talking to
to care. people to make sure they’re happy with
the new technology.
Physiotherapists and Speech and Language
Therapists are now using digital pens to
Making changes further afield
support the way they work by allowing
them to capture profession specific In the longer term, ø are looking into ways
information where ever they treat patients . to make it easier for NHS trusts across the
Patient information is captured at the point country to realise the benefits of mobile
of care and records are transferred quickly working. NHS Rotherham and ø have
and seamlessly to SystmOne. Work is already invaluable knowledge as a result of this
underway looking at how the children’s journey together, which other trusts can
red book can be digitised to ensure the benefit from.
Children’s Services team only have to
One of the main challenges will be creating
record information once - drawing on ø’s
common elements to the patient file for
expertise to link up these records with other
key clinical groups. At the moment, the
same clinical teams region to region collect
Other plans for NHS Rotherham and ø different pieces of information in different
include: formats during patient visits.
• changing the IT system to make it more Common elements of the patient file could
intuitive be made widely available in a digital format
with the opportunity for a trust to add
• setting up an extended email network so
fields unique to them. Such an approach
people don’t need to send faxes
will reduce duplication of effort across the
• making it easier for clinicians to get hold NHS and remove another barrier to more
of each other and share information flexible working.
It’s a big project, but one that ø now have
Common elements of the patient file the knowledge and experience to tackle.
could be made widely available in a
digital format with the opportunity for a
trust to add fields unique to them.
A long-term partnership Having a fresh pair of eyes helped the
SystmOne team see where they needed
Although NHS Rotherham and ø
to change things. And NHS Rotherham’s
have made some big changes, this is a
willingness to invite ø into the team – and
partnership that is going to last long into
into the heart of the community health
department – has been crucial in making
But both sides know nothing can happen sure the new systems are right for the
overnight. The successes with intermediate people using them. NHS Rotherham and
care have shown that change has to happen ø have become a proper team, making
gradually, and that it has to be managed decisions together, and working towards
very carefully. The team have seen that it’s one common goal.
not enough just to get new technology
Where systems were already in place, ø
and expect everyone to use it. To introduce
have helped make those systems work
something successfully, whether it’s digital
more efficiently, paving the way for future
pens, a laptop or a new piece of equipment
changes. Most importantly, though, they’ve
in the future, it has to support the clinical
managed to get the community health
need and everyone has to be behind it first.
professionals in Rotherham behind mobile
Want to know more?
To find out more about how NHS Rotherham and ø are working together, get in touch
with the Rotherham SystmOne team on 01709 302714. Or with ø’s NHS team on 0800