Workflow processes and paperless operations

Contents

• Health and Care Systems Workflow
• Examples of inefficient processes
• Tasks and alerts
• Digitised processes
• Digitally Enabled Efficiencies
• Paperless Operations
• Internal processes
• Our Workflow, Processes, Alerting and Paperless Process Operations schemes will focus on
• Transformation Plan headlines
• Measures for success

MPFT has been in a significant transition phase for our systems and infrastructure technology since its formation in June 2018.

There is still much more to do over the course of this strategy in order to truly capitalise on the opportunities we have with our health and care systems.

Health and Care Systems Workflow

The Trust utilises over 30 key systems. Consolidating our electronic health record (EHR) would be a significant gain across community healthcare, mental health, learning disability and forensic services. However, this does not extend to the entire organisation and only begins to realise the art of the possible.

Our ambition is to shift the focus from our foundation phase of digital transformation in years 1-2 of the transformation plan, which has a primary focus on infrastructure and implementation of systems, to the process phase in years 2-3. This will focus on systems’ maturity, process improvement, broadening organisational adoption, leveraging feature updates, user training and awareness.

Through the digital engagement sessions, the theme of workflow processes were highlighted repeatedly:

• service users and staff are not always aware of systems’ capability that could be adopted now to introduce more efficient ways of working
• staff highlighted that systems did not help with decision making
• systems were difficult to use which increased administrative burden
• systems were not routinely helping with communication and collaboration
• systems were not set up to support staff in undertaking consistent and standardised processes to deliver care

We will undertake a multi-faceted approach to the workflow and process improvement opportunities. Key activities that transcend multiple themes on our digital strategy will ensure we can reduce waste and ineffective approaches, whilst leveraging the benefits of the systems capabilities at our disposal.

Examples of inefficient processes

We currently have teams established on our Electronic Health Records (EHR) that complete Microsoft Word referral forms via email outside of the system.

We have also identified the over reliance on paper. Some of our clinicians are driving urgent prescriptions to service users’ homes in person as a default approach and posting routine prescriptions.

In a lot of cases, we rely on phone calls to partner organisations to obtain vital information on results and medication. Due to inconsistent systems and digital forms there is a frequent need to make phone calls to partners for clarity on referrals with missing information.

We have staff that are hand writing assessment forms and care plans that are not digitised and scanning these into our systems before posting them to service users and back to GP practices.

There are occasions where multiple services need to collaborate on a service user’s notes. Without systems set up properly these are not validated as quickly as they could be if full features were adopted.

We have staff manually collating their own data sets to pull reports together which can take hours at a time for key processes in the Trust. These include audit, risk and compliance and our clinical placement services reporting. This is covered in more detail in our data and information theme.

“Regardless of whether infrastructure is reliable, care excellence on a regular basis is dependent on a clinical system that does what we need it to do. Workflow is a key issue with RiO.”
Andrew Saunders, Extended Scope Practitioner, IPOPS: Physiotherapy

Tasks and alerts

The systems we use are not always set up to our full advantage. Service user triage processes, clinic creation and waiting list processes are either too cumbersome or not set up at all in some cases. Some services resort to legacy spread sheet approaches to track this activity before updating the main EHR. This is inefficient and needs to change.

We need automated alerts in place to aid staff in their daily care activities. We need alerts for upcoming appointments or new additions to caseloads. We need alerts for care plans that are due to expire and referral to treatment times that are due to breach.

We need to make it easier for staff to request collaborative care by setting tasks for each other within our systems across our Integrated Care Systems (ICSs). This approach will streamline multi-disciplinary team input, order taking and the ability to manage the whole individual, not just the singular condition.

We will make it easier to see what needs to be prioritised by our teams at any given time.

Digitised processes

We know that natively designed digital processes are far more efficient than retrospectively digitally enabled processes. This has been evidenced locally on our newer designed care pathways and proven comprehensively outside of health and social care in the banking sector.

We are keen to learn and ensure our care pathways can start to be fully redesigned with digital in mind from the outset.

We will design with natively digital end-to-end care pathways in place wherever possible, making the most of the latest technologies and systems’ features.

We need our systems to work for our staff, and not the other way around.

For example, we will introduce workflow-based e-Care pathways that guide our staff through repetitive processes. With the correct forms, task management and alerting processes in place this will ensure clinical and care safety and will assist our staff in being more organised, efficient and feel more in control of their own caseload and daily priorities.

Further to the work on connecting our systems together, as detailed in the Integrated Care Systems and a Single Care Plan theme we will undertake significant work on reviewing the functionality and maturity of our existing internal systems. We will ensure we are adopting the latest features available to us within the systems we use, and we are supporting our staff in being more productive in their care.

“An aspiration for every system we use is for everything we need to be available within 3 clicks”
Steve Martin, Associate Chief Nurse, Chief Nursing Information Officer

We know our staff work tirelessly, but we need to support them with systems that help them work more effectively.

Productivity gains can and will be made by adopting enhanced systems features, and we will help our service users and staff do more. This will include better training, simpler access to information for decision support, and the ability for staff to achieve what they need to do more easily with less chance for error or repetitive administration tasks.

“RiO is extremely inefficient to use, we could be seeing 20/30% more patients should the workflow in RiO be improved with basic features”
Aqeeb Karatela, CPFA Senior Physiotherapist, Staffordshire

Our Business Architects will work in collaboration with our service users, service leads, managers and our Quality Improvement (QI) colleagues to map out care pathways and opportunities for innovation and workflow improvement through adoption of new ways of working and new system processes.

These processes will be consistently mapped with design software and through utilisation of Business Process Management (BPM) software systems, we will ensure that workflow design can become usable systems functionality more efficiently.

We will ensure that new care pathway designs are undertaken with the most recent digital capabilities in mind, ensuring we transform against the art of the possible and not old ways of working.

“Many tools are replicating physical approaches and processes rather than taking advantage of what makes digital different”
Kings fund, Digital Revolution

We will learn from other organisations that use similar solutions as the Trust to understand the good ideas that may already be in practice in other health and care settings.

Through pro-active sharing sessions we can learn and adopt to increase the speed by which we deploy new system features and configuration approaches.

Through this learning, we will rapidly implement processes for referring between teams within MPFT and across our partners, with the ability to accept and reject where appropriate.

We will introduce individualised information portals to inform our staff of their daily care activities and “to do list” priorities.

We will have system alerting on exceptions that need urgent attention, for example, a notification of a pending service user review point.

We will establish single points of access phone systems and corresponding clinical and care systems triage lists. This will support onward referrals solutions, faster appointment allocations and will enable bookings into multiple teams. This will improve the way we discharge and auto-populate key dates from our systems to prevent manual entry.

These are just some of the approaches that we aim to review and introduce by making the most of features already available within our systems. The aim is to release time to care to ensure that systems work for staff and not the other way around. We will prevent the need for staff to feel the need to adopt other manual processes. 

"With effective systems we are able to complete allocation of work and share information quickly, benefiting patient care. We do however have to duplicate lots of our work as our systems are not interlinked which can be frustrating and time consuming for the staff.”
Hannah Copeland, District Nursing North

Our strategic supplier partnerships managed through our Head of Health and Social Care Systems, procurement and MPFT Digital Service Development also play a significant role in ensuring all of our Trust suppliers are progressing system features requests that are fundamental to our new digitally enabled processes.

In addition to our primary EHR our other health and social care systems all require ongoing supplier management for further updates and developments to continually streamline our processes across all service areas including:

• home first services
• dental services
• substance misuse and drug & alcohol services
• sexual health services
• Improving Access to Psychological Therapies (IAPT) services
• musculoskeletal (MSK) services
• social care services
• diabetic retinopathy
• community hospital services

Our engagement sessions have highlighted that regardless of the service area, similar process improvement opportunities exist in the coming years.

For faster improvements, we need to leverage the capabilities of our existing product features wherever possible

Digitally Enabled Efficiencies

There are many additional digital technologies which the Trust aims to review and introduce to further support our staff in their daily activities.

We share the NHSx ambition to improve log in speeds to multiple systems. Through the introduction of a Single Sign-On (SSO) solution, we can address the fact that we have to access a significant number of different systems with different usernames and password complexities. By introducing a seamless way of accessing multiple systems with the same set of secure credentials we can improve efficiency.

The detrimental impact on staff morale and efficiency is well known and is a key priority to be addressed. If we can improve our log in times, reduce the frequency that our staff forget their passwords or get locked out of systems, we can release time to care.

“There’s too many systems and too many passwords, and we keep getting locked out of too many systems and losing too much critical time.” 
Dr. Ian Turner, Deputy Chief Nurse / Director of Infection Prevention & Control

Another key technology that can release significant amounts of time for our clinicians and practitioners is a voice to text transcription system.

There are members of our workforce that may not have a fast typing speed, or may not have English as their first language. These staff are still bound by the same demands to update their service user records as quickly and accurately as possible.

Many staff have reported the need to work into the evenings to ensure that their notes are up to date and validated in the interests of maintaining an up to date service user care record. This is often compounded if operating within a community team where the systems are currently not as reliably accessible.

Through the introduction of voice to text transcription systems, we can rapidly reduce the burden on our staff that currently struggle with their typing; improving their wellbeing and work-life balance, whilst also improving the speed by which our records, letters and responses to service users and health and social care colleagues are achieved.

“We need to move away from 5mins of rushed care and 10mins of typing”
Suresh Packiam, General Manager Community Health Services

Many business processes have been improved through our COVID-19 response through the use of BPM workflow-based software solutions. These are co-designed and implemented through Staffordshire and Shropshire Health Informatics Service (SSHIS).

These rapid development approaches have ensured our staff have been able to book vaccine appointments, receive appointment reminders, re-schedule appointments, book lateral flow tests and populate lateral flow test results.

The pandemic has taught us how quickly we can create robust and efficient digital processes from a standing start. In the coming years we will continue to review and digitally enable our business processes, repetitive tasks and transactional tasks.

“Digital should support our staff to make their work more efficient (leaner, faster, cost effective) and provide a good quality, informative and timely service to our patients” 
Victoria L Titley, Operational Lead for Speech and Language Therapy

We will also improve our staff efficiency by empowering them with greater access to organisational knowledge through a new and improved knowledge base supplemented with chat bot functionality and enhanced use of our communications platforms such as email, SharePoint and Microsoft Teams.

We need to capitalise on the ever-expanding capability of workflow features in our existing products such as Microsoft Planner for action tracking that offers dynamic reminders and updates as opposed to static spreadsheets that require staff to be proactive.

Microsoft Teams approvals for document control and Microsoft Teams shifts will support capacity and demand of our workforce.

We need to make it easier for staff to be aware of the best approach for tackling common problems through training and communications and simple guides on which tool is best placed for which job. This will be achieved through ongoing training, digital champions engagement and the creation and upkeep of our Digital Toolkit.

“People are feeling overwhelmed with all the different communication methods. We could be much more efficient with communication and workflow.”
Jennie Collier, Managing Director of Staffordshire & Stoke-on-Trent Care Group

Paperless operations

There are many paper-based processes still in place across the Trust which often result in delays, extra manual tasks for scanning, legibility issues, printing costs and delay.

We will review all priority clinical and care assessment forms and paper-based prescription processes to ensure as many of these are available within our systems as possible to reduce the reliance on paper.

We have already deployed solutions such as eObservations on tablet devices but will expand its use across all appropriate wards.

We will also deliver Electronic Prescriptions Medicines Administration (EPMA) and Electronic Prescription Services (EPS) to improve the speed that observations, medicines administration and prescriptions can be undertaken, recorded and captured against our service user records without reliance on paper.

Our service user paper records and storage costs are also a consideration when it comes to continued use of paper. Subject access requests that are digitised can be completed reliably and much faster than a manual paper records retrieval process. This costs the Trust money each time we need to refer to paper documents in secure storage.

Our ongoing digitisation will reduce the reliance on paper records, while also ensuring that legacy issues such as legibility, speed of location and retrieval and manual handling tasks are a thing of the past.

Much of the organisation’s correspondence with our service users is also undertaken through traditional paper and postage approaches. Even when service users are electing to be contacted through digital means, we are often still reliant upon printing and posting letters, forms, questionnaires, leaflets and colour printed wellbeing guides.

We understand there are times paper letters are required and through our inclusive approaches to capturing communication preferences, we will always provide a paper service where it is appropriate to do so. This is described in more detail in our Digital Inclusion and Equalities theme.

For service users that opt-in to digitised communications approaches, we need to improve the availability of digitised service user facing forms and guidance. Through digital platforms such as our website, this will improve the speed by which our service users can respond to the request for information, reduce the burden on populating the request and ease of responding.

We will look to make digital correspondence, for those that choose it, available via secure email or portal access. Digitised approaches also deliver on our sustainability and efficiency objectives of less paper and postage costs.

We will be mindful of the need to ensure that when we do digitise internal and service user facing forms, we do this with full compliance of any copyright of licenced forms, making use of the NHS Digital National Clinical Content Repository Copyright Licencing Service to ensure that we gain the benefit of nationally funded copyrighted forms without funding the copyright fees locally.

Internal processes

Our internal staff business processes are not yet fully digitised and still rely on too much paper or inefficient non-digital based submission approaches.

“We are a service that perhaps needs to be more digital and less paper based. We send out lots of forms, care plans to parents so need to streamline this to make service more efficient and effective”
Pamela Simkin, Team Leader Special School Nursing

Personal staff files are still commonly held as paper copies and a digital approach will be introduced for these records in the coming years.

In recent years, work has been completed on some electronic forms for workforce change and termination processes, yet there is still significant digitisation to be undertaken to reduce the burden on our staff. At present there is too much reliance on the completion of Microsoft Word document based templates for staff appraisals, return to work forms, new starter local induction forms, and many more.

Our Application Development team will continue working through the most commonly utilised forms across the Trust and make these available via e-forms, improving ease and speed of completion and achieving process outcomes quicker.

With the rapid expansion of home workers, the inbound mail for staff to work based addresses is also increasingly becoming an issue. We will explore the options available to ensure that staff receiving correspondence to their work address at times of home working have the means to be aware when post has been received and how to access it without the need to travel to offices to collect the correspondence.

Measures for success