What was the aim/problem?
Rising demand for increasingly complex care for increasingly frail patients who have multiple co-morbidities requires relentless efforts to eliminate wasted time that occurs as a consequence of traditional paper-based working patterns. All high efficiency production systems outside of healthcare use visual control panels to eliminate wasted time, to ensure quality, and to guarantee safety, such as ensuring that risk scores for patients are easily accessible to ensure that appropriate treatment is given in a timely manner. The overarching aim was to reduce avoidable deaths within the Trust.
What was the solution?
Electronic systems allow information to flow around an organisation thereby enabling effective coordination and planning. Complex modern healthcare cannot be made effective and safe without a high degree of coordination, and automated electronic systems are the only way to achieve this.
As part of the digital transformation journey at Gateshead Health NHS Foundation Trust, we performed a pilot project to demonstrate effectiveness of electronic whiteboard screens in one exemplar ward. The project included a package of digitally enabling measures for clinical staff, and has demonstrated both feasibility and benefits for patient care. Thus, it was decided to roll out digital whiteboards across another 20 wards.
What were the challenges?
As with many projects of this nature, there is a cultural change challenge. However, this was ameliorated by extensive engagement activities such as presentations, tours of the exemplar ward and meetings with all stakeholders. To ensure compliance from all staff, the manual whiteboard was removed at the same time as the digital whiteboard was installed thus, it was the default choice.
The second challenge to this project was ensuring that the transfer to digital was done quickly and in a timely way; as we needed to ensure that wards were never without patient data. Thus, close working with ward staff ensured that the transfer was done at the best time for that specific ward so it did not disrupt care.
What were the results?
Probably the most significant benefit was the reduction in time required to visualise risk scores for individual patients. The introduction of the digital whiteboards reduced this time by on average 43.5 minutes per ward per day. When this was extrapolated across all wards across the Trust this resulted in a saving of 5,292.5 qualified nursing hours per year. In financial terms this equates to a non-cash releasing equivalent of £89,760.8 per annum for the Trust.
“The “At a glance” screens on our ward make it quicker and easier to find our patients, to see who is ready for home, who needs a prescription and who needs extra help.” Dr Rob Allcock
Alongside the significant saving of qualified nursing hours there were other less tangible positives. For example as the data on the digital whiteboards linked to the Trust’s Patient Administration System (Medway), this encouraged staff to adopt a digital approach to noting; supporting the transition to becoming a digital trust.
What were the learning points?
It is vital to engage fully with stakeholders from the outset of a digital transformation project and to ensure they have input.
Digital transformation can be a catalyst to make us re-examine the processes we use on a daily basis. Just by adding a risk score column on to the board using real-time data has saved the Trust over 5000 qualified nursing hours per year.
Digital projects can add benefits but these benefits are amplified if they are part of a fully coordinated digital plan.
“Digital White Boards make it easier for me to see what needs to happen next for a patient to speed their discharge home”
The inclusion of digital whiteboards is part of a greater digital transformation programme, which will take the Trust through their GDE Fast Follower programme and beyond. To realise the full potential, it is important that the boards link up with other digital aspects and have the ability to display further data sets to support key clinical decision making. While the current metrics have been carefully chosen to support the needs of the clinicians, they are under regular review to ensure they serve the needs of the clinical staff and ultimately they are there to ensure patients receive the best possible care in a safe and efficient hospital.