Releasing Time to Care through Mobile Working

Julia ClarkeChief Executive

Bristol Community Health CIC

Who are we?What have we done?

• BCH is a small provider of NHS adult community services in Bristol. Turnover £45 million, 1100 staff, 100,000 patients, 300,000 patient contacts per year, 750 mobile workers, 35 services, urgent care and LTC management

• Completed a pilot of mobile working using TotalMobile with around 70 staff, now rolling out to 750 mobile clinical staff. 210 devices currently in use.

• Demonstrated significant productivity opportunity shared three ways with patients and staff

• Demonstrated significant data quality improvements• Achieved improved staff morale• Identified a lever for transformational change• Created a platform for further productivity and quality improvements

Why mobile working?

• Overworked frustrated staff: separate, duplicate data entry, excessive travel to and from base

• Poor data quality – incomplete, not timely• Paper records, manual paper based processes• No real time information available at patient

interaction• Poor clincial system design• Inconsistent and multiple versions of paper

forms

Critical success factors

• Initially: easy remote data entry at point of care– Improved quality of care– Productivity – time to care and do more for patients and GPs– Staff engagement and satisfaction and speak well of Bristol Community Health

• Quickly realised we could also have:– Better Management Information and Quality Metrics as a platform for

improvement– Offer innovation and value for money to Bristol CCG (NHS commissioners)– Gain G.P. satisfaction and support at practice level– Improve perceptions and reputation for quality, innovation and responsiveness

throughout Bristol– Cultural change– Improve our chances of re-winning our contract at tender

Technology & Mobile Working support our strategy

• Time to Care: Efficient & effective information management using TotalMobile on a mobile device has released time to care

• Managing our Money: Investment in front line teams and back office support personnel via TotalMobile has led to increased productivity and cost effective workforce redesign

• Making their Day: Knowing how we are doing at every level through data analytics, designed by both clinicians & performance team, empowers staff and sets a springboard for continuous improvement

• Being the Best: Mobile working provided an opportunity to transform services and organisational culture e.g. workflow processes, clinical & non clinical documentation review and ‘how we do things here’

What is Totalmobile?

• A simple intuitive application which– Works on any device– Works with and without live coverage– Is capable of linking with any clinical system– Is designed around the clinician – patient

interaction– First and foremost supports the mobile worker– Quick and easy to introduce and adopt

How we are doing it

• The hard way• Agile approach• Designed by healthcare staff for healthcare staff – pilot

version and new solution• Led by clinical champions • Bottom up change – transformation driven by clinical and

administrative staff at the frontline• Provides infrastructure, environment and tools to enable

improvement and change• Compact with staff to share benefits three ways

What we found

• Approach - initially an evolutionary approach was anticipated but an appetite for revolution was identified

• Scope and potential far greater than initially anticipated

• Became a key lever for transformational change and a core plank of our strategy & business plan

• Disruptive technology in practice• We needed more resources and it took longer

What are the benefits

• Patients: High quality healthcare, high quality information• Staff satisfaction: eager to embrace the change, time to

care, happy staff = happy patients• Productivity: reducing inefficient administrative

processes, decreasing data entry, repetition & duplication

• Innovation: huge potential• Security of information – greatly enhanced with new

processes & meets emerging HSCIC regulations• Analytics: platform for continuous improvement

Time Saved Per Day

• Initial immediate benefit of 30 mins/day in data entry

• Consolidated net benefit of more than 1 hour per day per

nurse (average visit time currently 40 minutes)

– Measured after taking account of quality improvements

– Measured after taking account of improved admin and

follow up activities being completed.

• Across BCH that equates to a potential for more than 140,000

visits per year, with 750 staff, or capacity of 50-100 additional

staff

Improved working lives for our clinicians its Gained

Staff Satisfaction Pre pilot Post pilot

% responding positively to "I am satisfied with the hours I have worked this week"

49% 83%

% responding positively to "I am confident about doing my job to a standard I am happy with"

52% 87%

% responding positively to "I am able to manage my time to meet the demands of the caseload"

49% 80%

82% of staff felt mobile working would have a positive impact on patient care in the future

Improved Clinical Quality Gained

Clinical Quality Pre pilot Post pilot

% of patients seen with evidence of a care plan completed and stored on electronic clinical records system

0% on RiO40% on paper

85% on RiO

% of patients with outcome, progress notes and activities completed and stored on electronic clinical records system

78% 98%

% of patients with consent form completed and stored on electronic clinical records system

15% 92%

Challenges

• Timescales - ambitious• Being first – leading the way• Cultural change – not ‘like for like’ from paper to

electronic record – transformation of process & care delivery

• Regulation & risk• Information governance• Realizing the benefits through changes to

workflow and working practices• The day job……..• Changing from RIO to EMIS during 2015• We needed more resources and more time

The new solution & future functionality

• Exploit capability of the device: photos, web based applications, apps, translation, dictation

• ‘Jigsaw view’• Trend data• Annotated photos• Satnav & lone working• Automated referrals, notifications and alerts• Scheduling• Analytics using the data• Integration with GP systems, ‘Connecting Care’, social care systems

Right InformationRight Time

Jigsaw View

Right Information, Right Time

Historical Trending Graphical View

North 1 Community Nursing Team, BCH Go Live: 27th May 2014

Releasing Time to Care through

Mobile Working