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Nhs rotherham case_study_5

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  • 1. health 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.
  • 2. health 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 in. every shift. 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. Digging deeper 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
  • 3. health 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 hoped. 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 technology. change. 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 was happening. 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,
  • 4. health 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 process easier.
  • 5. health Getting district nurses up and records, and when paper is necessary. running 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.
  • 6. health 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
  • 7. health 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 systems, securely. 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.
  • 8. health 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 the future. 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 working. 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 955 5590.