Patient First, the UK's largest patient safety event, will return to London's ExCeL on 21-22 November 2017
During 2013/14, University Hospitals of Leicester NHS Trust (UHL) treated 1,194,000 patients (or 3,271 patients per day). With the volume of patients set to rise year-on-year, we need to better equip our staff to cope with the additional pressures that will bring.
As in many other trusts, our staff are feeling the pressure of the NHS constantly being in the media spotlight. The media focus for many trusts is too often on poor outcomes. It is almost forgotten that the vast majority of hard working staff provide excellent world-class patient care. The media have been blinded by the string of high profile cases which have brought our great service into disrepute. What they fail to pick up on, is the really positive work that many trusts such as UHL are doing, not only to improve patient care but to better support their staff without which there would be no NHS.
15 months ago our chief executive, John Adler, took on the challenge of boosting morale.
He recognised that in order to achieve our strategy to become ‘paper light’ and with government targets to consider, we needed to listen to our staff on the frontline. In 2013 he introduced ‘Listening in to Action’ forums. These forums, which he personally chairs, invite staff to give direct feedback on what they find good and bad about their jobs, so that the trust can make things better for staff and their patients. The overwhelming feedback has been frustration about the amount of time spent on paperwork and the subsequent impact on patient care. Staff want less paper and more technology to support them in their roles.
We had already started to look at improving workflow processes by implementing new technology but funding was limited, so when the Nursing Technology Fund was announced, we immediately applied. We received over £600,000 from the first tranche, which was set up to allow trusts to buy technology for nurses, midwives and care staff. This boost of funds has allowed us to accelerate our ability to deliver on our ‘paper light’ promise.
Our application focused on using mobile technology to change working lives. The funds are being invested in the provision of mobile devices, such as iPads and iPhones for staff use, as well as Nervecentre mobile application software, designed to record vital signs. One of the biggest challenges facing staff in the NHS is effective and efficient recording of observations as well as handover at the end of shifts. This is particularly prevalent during out of hours where ensuring consistency and continuity is often more challenging.
Our initial project, to deploy Nervecentre’s electronic observations, handover and Hospital at Night solutions has already seen a number of key benefits but the mobile aspect of our new solution is absolutely crucial. Nurses can now carry out routine observations using a handheld device, with that data being instantly available to all staff responsible for that patient’s care.
The key benefit is targeted messaging to services and clinicians who can use that information to identify deteriorating patients.
Nurses no longer have to spend hours chasing updates by phone. As a result staff are more visible to their patients, spending more time at their bedside. Our staff feel content as they are able to better use their skills for caring, and our patients are happier as they feel they are getting a better service.
What has made UHL’s approach so successful is the involvement of our staff. Clinical engagement is imperative when implementing a major change to working practice. We achieved this by selecting five ‘pioneering wards’, to work closely with our project team to provide suggestions and feedback in how best to use the software for their needs. You can never underestimate how good it makes people feel to be involved in projects that are going to make a fundamental difference to providing care.
Our staff had tried to make the best of our existing workflow, working around any difficulties rather than instigating change. By acting upon their feedback and demonstrating our commitment to them, we have an incredibly powerful message – we have listened and have acted. That simple change in culture to focus on better support for our staff has helped us boost morale and as a result has had a positive impact on patient outcomes.
By focusing on getting the implementation right within the pioneering wards, we anticipated that the roll out across other areas of the hospital would be very rapid. Staff from these wards are ‘champions’ for the new system. Nursing and medical teams on some wards are ‘buddying up’ with our champions to draw on their knowledge and experience of deploying a new system whilst they themselves go through the implementation.
This is a very powerful way of working which has produced strong advocacy for the new system. We have also been proactive in our formal internal communications activities and together the results have been staggering – the number of system users is continually increasing in frequency and I have found consultants and nurses knocking on my door asking when they are going to get the software.