Bringing in mobile working with secure access to clinical records on tablet devices is one of the key ways we transform community health and care services to make them more efficient, and to improve the experience and outcomes for service users.
Across the healthcare industry, successfully introducing new technology can be seen as a big ask, as it changes so much of the way people work and the culture.
But effective use of technology eliminates paperwork, supports clinicians to do their jobs and provides real time information at the point of patient care, even where mobile network signal is weak. And, introduced as part of a review of the service rather than being bolted on ensures that the benefits can be captured, and colleagues can co-design their own ways of working to solve small inefficiencies which soon add up.
And our rollouts have created huge benefits for both our colleagues, our patients and service users as the efficiencies it brings in allows our clinical staff to spend more time in face to face meetings with them doing what is important – providing quality care and advice.
For example, in Adult Nursing we have rolled out mobile working across many of our settings and we’ve recorded benefits including:
• A 30 per cent increase in face-to-face time with clients, as a result of not having to complete paper and electronic records on multiple systems;
• Capacity for up to two additional visits per nurse per day, by reducing travelling time to and from base for access to computer systems and clinical records
• A 61 per cent reduction on time spent on inputting clinical records
• Improved experience for service users, since the scheduling system allows us to provide them with accurate appointment times
• Client records are now secure and shareable with GPs and others more easily, and instantaneously, allowing better clinical decision making
• Improved access to clinical data at the point of care.
Community services are vital, lifeline services for those who depend on them to stay living independently for as long as possible, and services such as Rapid Response nursing help to avoid the need for hundreds of unplanned visits to A&E every year.
We strongly believe in investing in and modernising community services as a crucial part of the health service, finding modern and efficient ways of delivering services to ensure good value for the tax payer, improving experience for service users and focusing on improving outcomes.
And, of course, mobile working in community services is now a key part of the Paperless NHS by 2020 plan set out in the NHS Long Term Plan.
We were among the first NHS providers to implement secure, truly mobile working when we first implemented it in our Surrey Community Services in 2012. We aimed to create new ways of working for our teams that would reduce the time they spent travelling back and forth from their base, improving efficiency and increasing the amount of time nurses had available to spend with our service users.
Following the success of this project, we implemented mobile working in Health Visiting and School Nursing services in Devon in 2016 and, since then, it’s been a key part of our operating model for all of our community-based services.
In all services where we have brought in mobile working, the system has replaced a combination of outdated paper-based systems combined with non-mobile computer record keeping.
We’ve found that before the introduction of mobile working, clinicians in services were frequently spending only one third of their day with clients, with the other two thirds being filled with admin tasks and travel to and from people’s homes or surgery locations.
Needless to say, the reliance on paper records alongside IT systems across these community services has often led to duplication, meaning a great deal of time spent on record keeping. In addition, there were several cases of data being input multiple times into different systems.
This duplication introduces several risks because more than one copy of notes can exist, or paper copies can be lost in the home while paper copies also introduce an information governance risk, especially if lost.
While the above shows that the need was definitely there to transform, we had to ensure we took our workforces with us as is always the case when you bring in wide, sweeping cultural change.
But the benefits are enormous and we wanted to find a solution to stop client frustration surrounding the following:
• Lack of continuity of care due to different nurses visiting each time
• Lost records
• No appointment times, unsure of expected time of arrival
• Missed or delayed visits
• Poor communication.
After mobile working was tried and tested in Surrey back in 2012, it delivered the benefits expected which paved the way for further implementation across the organisation.
Since 2012, Virgin Care has continued to invest heavily in mobile working and has implemented solutions from a wide range of software and hardware providers, depending on commissioner and ‘local health system’ requirements.
Transforming services is more about changing ways of working, with the new system as a key part of this, than “bolting on” technology to existing ways of working but in our experience it is the technology which causes the most anxiety with colleagues who are used to other ways of working.
Prior to roll out, we offer our teams training on tablet devices to help them accommodate the change and to better understand the new systems and technology, this included helping colleagues set up their devices as part of a group, and a full day of tablet training – practicing with colleagues – allowing them to get familiar with the device and software in a safe environment.
Briefings on the new ways of working, standard operating procedures and ways of working were also included, and the training is followed with a two-week test period to allow colleagues to gain confidence ‘in the field’ while having access to additional support.
Colleagues reported benefits to their practice, including the easier access to patient records and notes from previous appointments as wel as access to apps such as the British National Formulary (BNF) and NICE Guidelines in their pockets 24/7.
More recently, colleagues have been able to make use of translator apps and navigation assistance to support those they work with.
Consistently, we have seen an increase in our colleagues’ overall satisfaction of working with a mobile working platform compared to their previous ways of working.
Virgin Care’s implementation of mobile working as part of a new way of delivering community nursing services has meant teams have easier, secure access to medical data and tools to help improve the way they work.
And our methodology is proven to work across multiple systems, service types and geographies – with benefits delivered in each rollout over the course of eight years.
In Adult Nursing, there has been a 30 per cent increase in face-to-face time with clients as a result of not having to complete paper and electronic records. In turn, this has added two additional visits per nurse per day. On top of this, there has been a 61 per cent reduction on time spent on clinical records input. This new system has allowed colleagues to enhance client care by providing them with accurate appointment times and an end to duplication of records.
There have also been benefits achieved in children’s services. Families using these services now receive a 13 per cent increase in face-to-face contact time because mobile working has reduced travel times by a third (30%).
Mobile working also means that our colleagues enjoy a 100 per cent increase for handover and lunch, improved lone working security and a 42% improvement in referral handling and scheduling time – meaning faster access to support.
And, not only does this system increase the confidence of our service users in the belief that they are receiving high quality and efficient care, our clinicians are engaged and excited by our new systems, allowing us to better meet demands across our services.
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