Carl Davies, Solutions Director, TeleTracking
The NHS sits at one of the most pivotal moments in its history. Whilst internationally recognised as a healthcare model that leads the way in terms of equity of access and ensuring people continue to receive services that are free at the point of care, operational outcomes remain its Achilles heel and have worsened in recent times.
Facing unprecedented challenges on demand and workforce, plus a lack of integration between care settings, the NHS is pressured on both elective and non-elective care fronts. Yet, positively, there is a recognition that change is required and a galvanised movement to achieve this. New, more radical, approaches are needed; approaches that embrace digital solutions at the most strategic, system-wide level as well as at its operational core. It is critical that this thinking is put into action now, as Integrated Care Systems (ICSs) began operation as statutory organisations from July 2022.
Carl Davies, Solutions Director (Europe), TeleTracking, explains the role that operational platforms must play in the new NHS: enabling more capacity and more effective management of that capacity by providing the foundation for better visibility, coordination, and control across care settings.
NHS Pressures & Safety Risks
There are two types of risk associated with healthcare, clinical risks (associated with direct patient care) and operational risks (risks to the organisation), which both increase the likelihood of adverse events[i]. Interestingly, decreasing operational performance, particularly in the Emergency Departments increases the likelihood of both the operational and clinical risks and has been shown to result in significant increases in excess, and therefore preventable, deaths[ii]. When systems begin to produce unnecessary administrative steps in order to try and maintain control, it creates additional unnecessary work, which itself comes with an opportunity cost of that resource failing to be allocated to value-adding, productive work. It also applies significant pressure to those individuals, working in already strained and under-resourced environments.
There is currently an unprecedented level of pressure within NHS organisations and systems. Problems that existed prior to the COVID-19 pandemic have worsened (the elective care backlog is now estimated to sit at 12 million by 2025) and problems that did not exist have added to the challenge (i.e. staff resilience/PTSD; ongoing COVID-19 demand; long-Covid caseloads;). This ‘wicked problem’ situation requires radical thinking and sophisticated solutions. Part of that will require integrated technology that can free staff from an unnecessary administrative burden and give them the time and space to manage, not only their own workloads and the patients they care for, but also their own wellbeing and mental health.
In the NHS Winter Plan, Amanda Pritchard asked all systems to operationalise 24/7 command centres, to ensure the safety and resilience of the operational function across their local health and social care geographies. Operational systems can be the supportive technologies that provide the missing piece of the puzzle alongside the clinically focused Electronic Patient Records.
The changes being asked for in the Winter Plan require both new structures and processes and, most importantly, ‘people’ to work in different ways. That is, people to engage in order that we understand our problems and what is needed; people to help shape the future that we wish to build; and people to action any plans that are required. However, these people need to be supported and given the time to engage. During the pandemic, our NHS workforce stepped up to meet the demands placed upon them, not blinking or faltering during what were unforetold demands on both their physical and emotional resilience. Now, more than ever, we need technologies that not only improve the healthcare system, but that help create the type of change that makes the lives of our workforce easier and simultaneously more effective at delivering the outcomes expected from them by NHSEI and the DoH. In a nutshell, we need systems that transform the operational core and will help give time back to staff within the organisation; give leaders visibility of the whole system; and executives control over the risks associated with the competing pressures it faces. It is likely the only way we can truly decrease the risk of adverse events that ultimately lead to harm.
ICSs, EPRs and Operational Platforms
With Integrated Care Systems (ICSs) taking centre stage as the core delivery mechanism for the radical changes to health and care services that are needed, the spotlight is on the processes and systems that will help them achieve this joined-up, patient-centric care. Indeed, the former health and social care secretary Sajid Javid latterly set new targets for the adoption of Electronic Patient Records (EPRs) or Electronic Medical Records (EMRs), asking for “90 per cent of trusts to be at Level 5 on the HIMSS maturity model by December 2023, with the other 10 per cent well on the way to deploying an EPR.”
As predominantly a technology for – mostly clinical – data capture, which can support decision-making across the system in relation to an individual patient, EPRs are undoubtedly an essential component of the digital transformation journey that the NHS is on. However, there is a vital function that runs alongside them, that has an arguably greater impact on performance and outcomes: the ability to capture and view in real-time the range of operational processes and where pressures are building or being exerted on the system; to recognise how they can be improved or changed, and support decision-making with regards to relieving those pressures.
Consider the information that is required to ensure effective management of beds across both the Acute Trusts and the wider system, and the coordination of the many workflows that must seamlessly work in unison, but are often linear due to outdated mechanisms for capturing and communicating data. This is where operational platforms can help increase the visibility of that information (providing one single truth), the speed of its transmission and enable flows to run concurrently rather than step-wise – and further support by building in controls, automation and tools for coordination of workflows.
These systems ideally run alongside an EPR as a specialist, operationally-focused suite of technologies that can provide all the necessary tools for releasing time back into the organisation. That is, additional time for people: time for healthcare professionals to spend with patients; time for staff to support the management of their own wellbeing; time for management to create changes in structure to support new ways of working; time to support the delivery of the performance improvement targets as described in the planning guidance; and time for patients to be moved through the hospital as needed, in accordance with their personal needs, providing assurances to the Executive that the system remains safe.
Reform
Effective outcomes are the emergent product of excellent technology combining with excellent people. Maidstone and Tunbridge Wells NHS Foundation Trust (MTW) is one example of an Acute Trust that has deployed an operational platform alongside its EPR to support and enable excellence in its internal management practices.
Great leadership combined with this operational system focuses on how all of the operational components of the Trust work together, supporting the coordination of complex information flows to drive more effective organisational decision-making. It links A&E admissions with site coordination teams and wards, and goes further into connecting services such as portering and bed cleaning functions to remove delays, reduce unnecessary administration and improve efficiency.
It gives full visibility of Trust-level bed capacity and imminent discharges, a system-level control centre dashboard and most recently, with an extension into Kent Community Health NHS Foundation Trust’s community hospitals and virtual wards for management at home, provides everything that is needed for visualising, managing and improving bed capacity and resilience across the integrated care setting.
The technology has helped take out the time spent on non-value adding activities to enable improved thinking and planning, such that the workforce can be supported effectively, in ways that work for them. MTW has used the time and space created by the platform to put both the patient and its workforce at the heart of its improvement work. The result? Organisational change, improved patient flow management and more effective matrix working. They have ZERO 52-week waits and the best urgent care performance in the region, all achieved alongside clearly identifiable financial savings.
Moreover, they’ve given staff back more time, have reduced the use of escalation spaces and have been able to redirect resources as required, enabling increased agility. Finally, despite increasing pressure at the front door, with extremely high attendances and admissions, it has one of its lowest occupancy rates in years leading to them being the 2nd highest performing Accident & Emergency Departments in the country, and overall 6th best Trust in the country.
Conclusion
As Graham Kendall, former Director of the Digital Healthcare Council commented recently: “If we are to reverse the seemingly ever-upward waiting list trajectory, we need to make the most of our existing resources and that can only be achieved by embracing strategic digital solutions.
“This means we need to develop a holistic approach that embraces system-wide thinking; challenges known blocks to progress; and encourages and supports NHS staff through significant change. Digital solutions will play a critical role in acting as both the glue and enabler to achieve measurable and sustainable improvements.”
Operational platforms are key to identifying known bottlenecks in the system, mainly due to linear, archaic practices and unnecessary administrative activity, providing visibility and improvement of them in real-time. They are instrumental in improving coordination and control across the system and seek to support clinicians and managers by relieving them of unnecessary and duplicative administrative work. They are therefore fundamental to giving clinical staff time back to care; to unlock and allow more effective management of the capacity that is going to be key to, ultimately, improving outcomes and saving lives.
[1] Cornalba, C (2009) Clinical and Operational Risk: A Bayesian Approach. Methodology and Computing in Applied Probability volume 11, pg 47-63
[1] Jones et al (2022) Association between delays to patient admission from the emergency department and all-cause 30- day mortality. Emerg Med J 2022;0:1–6
