Building sustainable ICS staffing to weather the workforce crisis

By Dr Anas Nader

The advent of integrated care systems (ICSs) across the NHS marks an invaluable opportunity to facilitate greater collaboration, efficiency and more joined-up care for patients.

To be successful, this period of transformation needs to be underpinned by a strong, comprehensive workforce strategy that enables staff to be flexibly and safely deployed in line with fluctuating demand.

Amid present staff shortages and rising waiting lists, and with pressures set to grow over winter, this is, unsurprisingly, no easy task for organisations. As managers rightly address these immediate challenges, it’s understandable that little time or capacity is left to support broader workforce transformation. Yet the benefits of a transition to more collaborative ICS-wide staffing have the power to tackle these same challenges in the long-term.

While it may seem like another hurdle for teams who are already facing extreme pressure, there are a number of ways that ICSs can reap these benefits, without compounding workloads or piling additional pressure on staff. Throughout my time working closely with NHS organisations to tackle various workforce challenges, I have found the following steps essential to successfully enabling truly collaborative staffing. I believe they are also the key to unlocking a more sustainable, long-term workforce strategy.

Harnessing the power of collaborative temporary staffing

Temporary staff are crucial to the successful running of an ICS, helping to plug any gaps in rotas across the region. However, currently, when organisations are unable to source clinicians from their own internal staff bank, they must often turn to more costly external agencies to fill vacant shifts. Instead, by building a collaborative network of approved temporary clinicians, organisations can seamlessly tap into a much larger and more flexible contingent workforce from which to reliably fill shifts.

The key to effectively leveraging a collaborative staff bank is enabling compliant digital passporting for all participating clinicians. This means approved workers can passport their credentials across different participating organisations, without having to repeat compliance or background checks. As a result, they can more easily work across a number of different sites and locations and be deployed effectively in line with demand throughout the ICS.

Increasing data oversight

In order to reliably plan ahead, identify staffing gaps and deploy staff where most needed, access to comprehensive data insights is crucial. This means not only enabling managers to view data from within their own organisation, but granting access to pan-regional workforce data from across the entire ICS.

Dynamic data reporting, which provides timely, granular insights into organisational performance, can help measure the success of workforce planning, enable targets to be reliably met and pinpoint areas where improvements can be made. Individual organisations should be able to assess their own performance data and compare this with others in their region. With clear visibility over regional shift fill rates, workforce spend and staffing trends, it becomes easier to identify areas for improvement, while harmonising pay rates and maintaining safe staffing levels in a truly collaborative manner.

Introducing more flexible rostering

When it comes to rostering, the current systems at managers’ disposal are often slow, outdated and require large amounts of manual input. Introducing more streamlined, digital systems which can safely provide staff with greater flexibility and predictability, while reducing the admin burden on managers, can help open the door to more effective ICS-wide rostering in the future.

Rostering clinicians based on skillset rather than title or grade will allow managers to deploy staff more effectively, in line with patient need. This will also give staff the flexibility to safely work in a wider range of roles, in different locations across the ICS, and to access wider professional development opportunities. These are all essential to helping boost retention.

Meanwhile, multi-organisational rostering could begin to allow more efficient deployment of staff to areas of highest need across the ICS. This makes it easier for managers to reliably plan ahead and gives staff greater control over where they work, in line with their personal and other professional commitments.

Prioritising system integration

System integration is a fundamental prerequisite to the success of every single one of these steps. If the systems being used to organise staffing within different organisations are unable to communicate or share data with each other, genuine collaboration will remain out of reach.

When introducing new workforce management systems, organisations should prioritise those which are fully integrated or interoperable, enabling managers to directly share workforce data, rota planning and temporary staffing networks with other organisations throughout the ICS. This reduces the need for manual data input, minimising admin for managers and speeding up the transfer of vital data and information.

As a result, organisations will be able to collaborate in real-time and deploy staff to the most appropriate services in line with evolving ICS-wide demand.

To reap the full rewards of ICS working, facilitating a collaborative, flexible workforce is vital. This transition does not have to be costly, nor add additional burden to managers or organisations. By working together and implementing these four key areas of change, we can lay the foundations for strong, collaborative ICS-wide working, built to weather the challenges which lie ahead.

Ethicon showcases product portfolio in UK & Ireland hospital tour

By Ethicon

Ethicon, the Surgical Technologies Company of Johnson & Johnson MedTech, has launched its first-ever roadshow across the UK & Ireland, including a showcase that demonstrates the role of digital innovation in supporting the NHS to tackle the backlog of patients waiting for treatment.

Ethicon is committed in its mission to support healthcare systems to treat more patients and provide better experiences and outcomes, especially as recent announcements from the Department for Health and Social Care show how important digital transformation of the healthcare system is, with £2 billion earmarked from the spending review to help digitise the NHS and social care sector.

The Ethicon roadshow began in September and runs until early December. It is a unique opportunity for clinical and non-clinical healthcare professionals to speak to representatives and industry experts about how driving digital transformation is pivotal in this mission, outlining the importance of Ethicon’s Surgical Simulation Strategy and Services & Solutions offering which gives surgeons additional information to support their clinical decision-making.

The products being showcased on the tour bus cover specialties including Colorectal, Gynaecology, Thoracic, and Bariatric. Ethicon’s digital offering has the potential to drive the next surgical revolution, bringing together the value of Next Generation Robotics and Instrumentation, Advanced Imaging, and AI-powered Digital Solutions.

Learn more about Ethicon and its product portfolio here.

“We’re focused on creating a differentiated digital ecosystem including working in partnership with our dedicated account management team to support a successful implementation, data insights, and best practice sharing,” said Jenny Nagy, Ethicon’s General Manager in Great Britain. She continued to highlight the value the company sees in this collaboration:

“Our Ethicon roadshow will give customers the opportunity to discuss innovation in healthcare and witness our innovations first-hand with our product demos hosted on the bus. Our mission may have been accelerated by the pandemic, but we’re keen to connect with our customers in-person to demonstrate the value we place on working together to advance the use of technology in tackling the biggest healthcare challenges.”

The Ethicon tour bus is also hosting:

Science of Energy Training
Surgical Simulation Suite
Product Training Innovation Workshops
New Product Innovations

Clinical and non-clinical healthcare professionals can register their interest in attending and booking a slot at their chosen hospital location here.

This is a sponsored article.

MIRACL announces new partnership with Birmingham Women’s and Children’s NHS Foundation Trust

By Integrated Care Journal

MIRACL – the world’s only single-step multi-factor authentication provider – announces their new partnership with Birmingham Women’s and Children’s NHS Foundation Trust.

With a new directive from NHS Digital to ensure multi-factor authentication (MFA) across IT services within the NHS, MIRACL was perfectly placed to deploy their single-step MFA system in these world- renowned hospitals.

Time is of the essence for all those working in the NHS, so finding a MFA solution that was efficient yet provided the additional layer of security that was now required and, at a cost that met the tight NHS budget, was a challenge. Medical records are highly sought by cyber criminals so any data held by the hospital is always incredibly vulnerable and must be well protected on every level.

MIRACL was able to integrate their single-step MFA codelessly, in just fifteen minutes – minimising disruption to services during the implementation phase, yet providing an added layer of IT security across the organisation. With thousands of users within the Trust accessing IT services on a daily basis, the transfer happened seamlessly and without any unwanted hiccups.

Furthermore, as a passwordless solution, staff weren’t tasked with having to remember yet another password or have to share biometric data. A simple four-digit PIN is all that is required – the patented tech does the rest.

David Marshall, Head of ICT at Birmingham Women’s and Children’s NHS Foundation Trust, added, “numerous staff throughout our sites are having to access NHS IT on a daily basis, but time is always of the essence and it is essential that not only is all data kept safe and private, but staff who need to access information can do so instantly and securely. It was no surprise when we were required to add multi-factor authentication to our systems but finding a solution that would fit our needs was a challenge. MIRACL has provided a single-step MFA that does not require a password and has integrated into our systems seamlessly.”

Rob Griffin, CEO at MIRACL commented, “when we were advised that NHS Digital were directing hospitals to install MFA, we knew our solution was perfect. MIRACL provides MFA, yet requiring just a single-step to use, means that staff can access the IT services as they were before and without the need to remember another password or have a second device at hand to authenticate by SMS. We all know that staff are often working at a high pace across the NHS, so sourcing a solution that did not waste precious time authenticating was really important.”

Since deployment of the service in mid-April, there have been a total of 150,000 authentications and only 283 failures or a failure rate of only 0.18%.

MIRACL is the world’s only single-step multi-factor authentication provider. It can easily be integrated into current company and NHS platforms and is a low cost verification option but with banking level security. It boasts clients such as Experian, Domino’s and Cashfac and has been licensed by big tech names such as Google and Microsoft.

For further press information, interviews or photography please contact the MIRACL press office: sarah.sawrey-cookson@miracl.com | 07765 110438

GHM Care messaging app integrates with digital care management platform Nourish Care

By Integrated Care Journal

Advancements in nurse call technology unearths a wealth of valuable data for care homes when surfaced alongside daily care records.

GHM Care has announced their flagship nurse call messaging and reporting tool Nexus will now integrate with Nourish Care’s digital care management platform. The ability to integrate personal care records with a nurse call system is a huge step towards a joined-up care environment.

Nexus is a messaging platform that delivers nurse call alerts directly to the smartphones of carers, improving staff efficiencies and response times.

The integration with Nourish will allow Nexus users to link nurse call activity against a resident’s personal care records, driving a greater resident experience through interoperability. Care teams will have complete transparency of the time of the day calls are being made, time of acceptance, reason for the call and the resolution times. This information surfaced alongside daily care records offers contextual oversight, further promoting better care decisions and outcomes. In addition, the integration will enable care teams to run detailed reports and populate care plans within Nourish.

Care homes will benefit from a more comprehensive picture of the personal care provided through more powerful data.

Neil McManus, Managing Director of GHM Care stated: “It’s been great working with Nourish on this project and now we can deliver exactly what our joint customers have asked for. The new functionality has been launched in response to the needs of care homes who previously would not have the time or capacity to record every nurse call alert in a resident’s personal care records. As a result, there is often a disconnect between care records and nurse call activity. The new integration overcomes this by automatically updating Nourish personal care records with any associated nurse call activity.”

Steve Lawrence, Head of Proposition and Partnerships from Nourish Care added: “We are thrilled to be partnering with GHM Care, their leading nurse call solution will open the door to new and exciting data insights when surfaced alongside daily care records housed in Nourish. I look forward to seeing the positive impact this delivers for care teams and those they support.”

Training & Development Lead, Luke Annetts, from Blackadder Corporation said: “I think the integration between Nexus and Nourish has worked well, the information transfers quickly from the Nexus cloud onto Nourish. I think that this information will be really helpful for reporting purposes, especially when we look at accidents/incidents and response times”.

Nourish Care is an app-based care management platform that allows care services to record at the point of care, streamline administrative processes and equip teams with the tools to provide more person-centred care and improve outcomes for the people they support. Nourish works with more than 2,500 care services in the UK and overseas within residential homes, nursing homes, learning disability services, mental health services, and other care settings. Nourish was one of the first recognised as a NHS Transformation Directorate Assured Supplier for the Digital Social Care Records (DSCR) DPS at launch and were also the first accredited by the PRSB as a Quality Partner, working to promote best practice standards for care.

To find out more about how Nourish can help your care service, visit their website www.nourishcare.co.uk to book your free demo today.

To find out more about Nexus by GHM Care, visit www.ghmcare.co.uk.

A person-centred, digital first approach to recovery

By Patricia Wynn

Ensuring that patient pathways are digitally enabled and person-centred is critical to tackling the elective backlog, writes Patricia Wynn, Director and Sales Leader, International Public Sector Health, Cerner Corporation

NHSE guidance states that “our ambition is to improve core digital and data services in hospitals to ensure we have the basics right.” A leading EPR provider in the UK and globally, Cerner supports systems to reach the minimum digital foundation and strive for HIMSS Stage 7 and beyond.

Cerner work across provider collaboratives to enable shared instances of the EPR. ICS-level collaboration reduces total cost of ownership and enables sharing of resources, such as PMO, training, back office and support. For example, a shared instance of Cerner accelerated provider collaboration across North West London ICS.

Imperial and ChelWest began sharing a domain in 2019 and now London North West and Hillingdon are set to join. According to Kevin Jarrold, ICS data and digital lead, “we have a growing agenda around collaboration across care pathways and the shared domain is absolutely fundamental.”

A shared domain has enabled NWL to gain efficiencies and generate much-needed capacity. Leaders can see across the system and transfer patients more effectively from one site to another. Virtual ward capacity is also managed centrally and embedded into the core EPR. Remote patient monitoring is leveraged from a variety of vendors, with all data feeding centrally into virtual wards created within the core EPR, enabling more efficient workflows and the sharing of virtual care staff.

Prioritising care

The national guidance outlines care must be prioritised based on clinical urgency, the impact of waiting on individuals and potential inequalities. To achieve this, North Central London (NCL) ICS uses Cerner HealtheIntent^®, a data and analytics platform that provides a single longitudinal record for every citizen, comprising data from all health and care organisations across the ICS.

According to Amy Bowen, director of system improvement, “[We built] an elective waiting list dashboard in HealtheIntent. Now we can show GPs for the first time ever what their waiting list looks like. We can cut that data by all the demographic factors, e.g. how many people have long-term conditions and how many? We can look and see by ethnicity, by deprivation – we can combine several factors. And we can actually understand that population at a practice level, at primary care network (PCN) level; by specialty, by borough.”

Transforming care

NHS guidance outlines transformation should focus on flexibility, ease of access and citizen control. Re-envisioning patient pathways – and ensuring they are digitally enabled and person-centred – will be critical. Royal Free London (RFL) has standardised and digitised 40 pathways.

Cerner experts are involved from the beginning of pathway design. Dr John Connolly, CEO of the Royal Free Hospital and group director of clinical pathways shares, “The goal of this ambitious programme is to ensure every patient can get the same high-quality treatment in any of the Trust’s three hospitals… and to create value for the entire healthcare system in the locality – not just our hospitals, but also primary care and public health services in an area that has high levels of deprivation.”

Supporting patients

Ultimately, a person-centred, digital first approach must include the person at the centre. Cerner Patient Portal UK, delivered in collaboration with Induction Healthcare, enables interaction and engagement between caregivers and their populations. A prostate cancer survivor in the Wirral explained, “I cannot emphasise how much the patient portal has improved the quality of my life. Those two weeks of waiting – the stress of revisiting the room where I was given my diagnosis – all that is gone now.”

NHSE’s operating priorities will not be achieved by overworking caregivers and staff, but by enabling them to work smarter and more collaboratively. Contact Cerner Corporation if you share a belief in the power of technology-enabled transformation and want to discuss how Cerner can support your system as in tackling the unprecedented backlog of demand.

Digital revolution – the benefits of paperless

By Marvin Douglas

The digital revolution is well underway, and the innovative new technologies utilised by start-ups have completely transformed business operations. However, there is still a significant number of SMEs and larger corporations that are completely reliant on paper. 41 per cent of businesses agree that moving to digital would cut operational costs significantly. However, the heavy initial investment and potential skills gap is presenting a tough hurdle for many organisations.

According to a study by Xerox, 55 per cent of businesses across western Europe and North America are still completely reliant on paper. A similar study found that 70 per cent of these businesses admit that they would fail within just three weeks should key documents go missing. With all this in mind, we look at the key benefits of going digital.

Why risk it?

Words like ‘audit’, ‘security breach’ and ‘compromised data’ are enough to raise the hairs on any businesses neck. Physical documents pose a multitude of problems when it comes to security, there is a huge reduction in the level of control the business has over them. Paper documents can be scanned, shared, and viewed indefinitely by anyone at all.

Research by AIIM reported that up to 50 per cent of businesses surveyed were unsure whether they had ever suffered a security breach due to a complete lack of visibility. Moreover, 31 per cent stated they had encountered poor record keeping to the extent that it would negatively impact regulation checks and audits.

Smarter, faster, stronger

Productivity is a key priority on any business’s agenda, to get the most from their employees a business should endeavour to establish streamlined processes, efficient operations and transparency. Utilising digital document management reduces the amount of time spent looking for required information dramatically.

Digitally stored data is easier to find, and the quality of data collected is improved; through digital templates and pre-agreed parameters companies can maintain consistent data standards universally. Lengthy approval processes and over complicated workflows are also a thing of the past, digital signatures make authorisation and communication much more efficient. The ability to access documents anywhere at any time through a centralised digital solution will reduce the risk of missed deadlines when employees need to work remotely.

Going digital provides a centralised view of all documents. Access can be controlled, allowing only the necessary and authorised employees to view confidential data. Clear trails can be established to monitor the progression and movement of key information and backups are easily created to avoid the heart-stopping loss of key business information.

Cutting the cost

The reason behind most business activity is to protect and improve profitability; going digital also has a compelling impact on a company’s operational costs. US research from The EPA found that companies choosing to go digital could save as much as $80 per employee in printing resources and the efficiencies that come with streamlining manual processes. For a business of 400 employees this is a sizeable saving of $32,000 per year.

Small businesses can benefit too. For smaller, less established businesses the transition to digital is likely to be much easier as there is less physical documentation to convert. This could mean the ROI is visible much sooner. Digitalisation will make the business considerably more agile and responsive, where competition is fierce the need to respond quickly and accurately to customer enquiries, competitor activity and market demand is essential – this is made much easier with visibility and strict organisation.

Going green – not to be barked at

Although this could quite easily be tied into an organisation’s profitability, reducing carbon footprint often comes with more benefits than just lower operational costs. Corporate social responsibility is a hot topic globally and is only set to get hotter. Recent data in the US showed that the average employee uses a staggering 10,000 sheets of paper a year, the equivalent of a 100ft fir tree.

In many cases, a company’s activity surrounding CSR has become an integral part of a prospects decision-making process. For those in B2B, many businesses with strong CSR values will actively seek out equally responsible organisations to purchase from.

Digital revolution requires effective physical device management solutions

As part of the digital revolution, businesses will be investing heavily in the devices that enable the process. The increasing number of physical devices in the workplace such as laptops, Chromebooks, tablets, smartphones, and other media devices means it has become necessary to implement effective physical device management solutions, protecting the longevity of the initial investment.

To find out why LapCabby provides the perfect storage, charging and syncing solutions for your new tech please visit our website: www.lapcabby.com.

North Lincs and Goole replace data warehouse in preparation for shared digital services across region

By Integrated Care Journal

NLaG chose Insource as strategic data management partner – initially as unified data foundation across three hospitals and community services.

Insource has been chosen by Northern Lincolnshire and Goole NHS Foundation Trust (NLaG) as its foundational data management platform and ultimately as a joint strategic solution in its move towards shared digital services with partner trust, Hull University Teaching Hospitals NHS Trust.

The partnership falls under the NHS Digital Aspirant programme, which is providing funds to nearly 60 NHS trusts to facilitate digitisation and help deliver a set of core digital capabilities. It is hoped that Insource’s platform, Health Data Enterprise, will see a significant upgrade to NLaG’s ageing data infrastructure system.

Christopher Evans, Associate Director of Information Systems, for NLaG commented, “whilst this is initially about replacing our ageing data warehouse, the core decision is primarily to ensure strategic alignment and collaboration between our two organisations. We already have a shared vision between NLaG and HUTH and we will be merging onto a single platform across both organisations within the next couple of years. What Insource gives us is data consistency and continuity of reporting across the wider regional footprint while we redesign clinical services and pathways to meet our integrated care goals.”

Northern Lincolnshire and Goole NHS Foundation Trust (NLaG) serves a population of more than 450,000 people covering North Lincolnshire, North East Lincolnshire and East Riding of Yorkshire. The Trust runs three hospitals: Diana, Princess of Wales in Grimsby, Scunthorpe General Hospital, Goole and District Hospital and also provides a range of community services across North and North East Lincolnshire.

Emil Peters discusses the next steps for the health and care technology sector

By David Duffy

Emil Peters speaks to Integrated Care Journal

Recently appointed CEO of Tunstall Healthcare, Emil Peters speaks to ICJ about the future of telecare and telehealth and the impact of a seismic era of system transformation for UK health and care.

“Great advances in medicine have been made during periods of immense stress and strain,” says Emil Peters, recently appointed Tunstall CEO. Peters finds himself at the helm of the largest social care technology provider in the country during a period of critical reform for the health sector. “A lot of our early medicinal advances originated from battlefields and war injuries,” explains Peters and the pandemic, he insists, has been the latest catalyst for change in the health sector – but the reform has not come from new antibiotics or medicines, but a newfound acceptance of the value of medical technologies, such as telehealth.

“Tunstall today has become an integral part of a constantly evolving definition of health and care“

Peters, who moved to Tunstall after 25 years at health technology giant Cerner (the last five of which were spent as President of the International markets), is no stranger to major upheaval in health reform – but even he would admit that the current period of turbulence is unlike any other the sector has faced. He enters his new role as the UK government releases a slew of policy reforms, with the intention of turbo charging a digital and data led transformation of the health and care sector. The latest paper Digital revolution to bust COVID backlogs and deliver more tailored care for patients, places telehealth as a central priority of the government’s digital transformation of the sector.

Peters likens Covid-19 to a dark cloud with a silver lining, “the pandemic has given us lived experience of technology, forcing our lives to be lived through screens whether they be your phone or whether they be your computer or your television.” Interestingly, Tunstall began as a Yorkshire based television repair company but has since grow to over five million users globally and almost two million in the UK alone, becoming one of the biggest players in telecare in the process. Now, Peters hopes to use this position of strengths to take on a newfound leadership position within the sector, helping to drive technology based transformational change, enhancing access to health care to disenfranchised communities and reducing rampant health inequality across the country.

At one point, the health tech industry was still arguing with hospitals as to the benefits of using digital over paper-based methods. Today it is widely accepted that telehealth is now central to the evolution of the concepts of health and care. “Through being able to connect patients and carers in the broadest possible terms, Tunstall today has become an integral part of a constantly evolving definition of health and care,” affirms Peters.

Evolving telehealth in an ICS context

If Covid was the “slap in the face” as to the value and potential of health and care technologies, then the prospect of integrated care in the UK could prove to be the mechanism which permanently embeds technology like telecare and telehealth into care pathways.

Each integrated care system (ICS) has placed preventative and personalised care, defined through population health management approaches, as central priorities to care delivery. In many ways, telecare and telehealth could be the glue that connects ICS wellness strategy, via enhanced access to care and reduced strain on healthcare services.

“The pandemic reminded all of us of the value of working together”

Previous barriers to technology adoption are being eroded in favour of holistically implemented transformational change and the rapid growth of the telehealth sector is helping to shift discourse away from simply reducing acute sector pressures. Priorities are now shifting towards maintaining good health for people as long as possible, keeping people healthy and supporting them in the best version of their life as they define it.

“Among many other things, the pandemic reminded all of us of the value of working together. Previous hesitations to collaboration have held the sector back – but these barriers are gradually being eroded and this collaborative momentum has manifested itself in the integrated care agenda.

“In the same vein that we used technology for our supply and demand calculations for the testing of PPE, we now need to think about that in terms of cancer, orthopaedics, neurology, all the other things that we need to be bringing to people because frankly, we kind of went away with that.”

A new era for health and care technology?

Peters considers the current moment a once in a generation opportunity to shift norms. “Historically the system has found ways of preserving itself. We were constantly training for trying to find ways to preserve what we have. Business as usual is no longer an option.”

“I’ve seen a lot of ‘tech for tech’s sake’, and those endeavours tend to be like shooting stars. They burn bright and they fade away“

“Telehealth can enable clinicians to see the people they need to see. It allows people within the clinical space to operate to the top of their licence. And it allows me as a son and as a neighbour to operate to the top of my licence when caring for loved ones. Technology like telecare can help me check in on my elderly neighbour, to check in on my mother, who lives in San Antonio, Texas, thousands of miles away.”

Peters’ bread and butter is facilitating health and care innovation but his focus with Tunstall will be less on the outright ‘technical innovation’. Rather, Peters is interested in innovating the constructs of how they apply technology. “Our focus is much more centred on value. What is the value of what we’re about to go do? Is it just tech for tech’s sake? Or is there a clearly defined purpose in mind?”

Peters wants to move the sector from a ‘thousand flowers blooming at once’ mentality to innovation, and towards a focused approach built upon consistent standards. “I’ve seen a lot of ‘tech for tech’s sake’, and those endeavours tend to be like shooting stars. They burn bright and they fade away. But the innovations that really produce value for the provider, for the person, for the family, those are the things that that will truly be lasting.”

“It’s up to us, how much we harness this moment,” insists Peters, who warns that a complacent approach to innovation risks returning to a ‘business as normal scenario’. “Are we going to try to fight to go back to the way that we did and run our outpatient clinics the way that we had? Or has this given us a new view on how things can happen? Clinicians want and need to spend time with the people that truly need attention from someone of their levels of qualifications and who can truly have an impact.”

In Peters’ mind, the impact that is needed with technology cannot be understated insisting that, “it must become this century’s version of a clean water supply for the health and care sector.”

In September 2022, Tunstall will be joining ICJ and PPP for the ICS Roadhshow, a series of regional conferences to discuss the progress of integrated care at a localised level. To find out how to get involved, please visit our ICS Roadshow homepage.

Digital communications tool provides solution for healthcare data protection

By Joost Bruggeman

Joost Bruggeman, former surgery resident at Amsterdam University Medical Centre, and CEO and co-founder of Siilo, discusses how secure digital communications tools can ensure patient confidentiality and solve healthcare data protection issues.

Instant messaging apps have become essential tools in our daily lives – their convenience, reliability and sheer ubiquity have transformed how most people communicate, both socially and professionally. At the height of the pandemic, their value within the healthcare sector became even more pronounced, as they enabled rapid information-sharing to help medical professionals learn how to deal with a hitherto unknown virus.

In these circumstances, medical staff came to appreciate the benefits of being able to share details about individual patient cases, including photographs and other sensitive medical data. It facilitated timely and seamless collaboration, without which many more lives would have been lost.

The benefits of ‘off-the-shelf’ messaging apps, however, don’t come without risks. Within the medical sphere in particular, a mistaken message could put patient confidentiality and data protection in jeopardy, while threatening one of the most fundamental aspects of healthcare ethics.

Overcoming data protection issues

Since instant messaging apps are clearly of value within the health and social care sectors, a solution is needed to overcome data protection issues. In fact, this challenge was understood some time ago, and was a key influence behind the development of specialist healthcare apps such as Siilo, which places data security and medical compliance at the heart of its development.

Designed specifically for healthcare professionals, Siilo undertook the task of preserving the usability that people expect from the technology, while simultaneously ensuring that patient data could be exchanged safely and compliantly.

Paul Cowley, Chief Information Officer at St. John & St. Elizabeth Hospital (HJE) in St. John’s Wood, London, recognised the importance of adopting a messenger service which has been tailored to the healthcare sector’s unique challenges. “Timely, effective and safe patient care often requires rapid communication with multiple clinicians and sometimes offsite. A secure, easy-to-use app is needed to facilitate this level of care.

“While temporary guidance was issued during the pandemic that allowed the use of well-known commercial messenger services to help reduce the risk of patient care being compromised, as a hospital we recognised that such services increase risk both in terms of patient data security and patient care, particularly because of the need to anonymise communications wherever practical.”

Security and compliance

Unfortunately, many health and social care professionals and organisations are unacquainted with these issues. Indeed, a survey by the European Heart Rhythm Association (EHRA) revealed that 88.3 per cent of its members regularly use commercial instant messaging apps, like WhatsApp, for sharing clinical information with medical colleagues, yet 29.3 per cent admitted they were unaware of EU data protection regulations. A further 46.7 per cent indicated there are no regulations in place at their institution regarding the sharing of clinical data via instant messaging.

Given that specialist tools have been developed, why are they not mandated among healthcare professionals? The problem is that many health and social care providers still don’t understand the risks involved with off-the-shelf messaging apps because of a simple failure to differentiate between security and compliance.

The basic promise of ‘end-to-end’ encryption, which is offered by the best-known messaging apps, certainly provides a strong element of security. It means the servers of the vendor cannot decrypt the message data even if they wanted to because they don’t have access to the encryption keys that belong to this encrypted data. However, this only applies to data while it is ‘in transit’ from one phone to another. What happens when the data is ‘at rest’, i.e. delivered to a phone or other device?

After a phone receives a message, several synchronisations take place with common messaging apps;photos and videos are synced automatically to the photo library of the phone, where the media is not encrypted; all conversations are backed-up by default and automatically go onto the cloud services of the phone provider – where message data is also stored unencrypted. As such, all these unencrypted conversations are exposed to unauthorized third parties.

Importantly, the professional who makes the decision to share information about their patient is always held responsible for protecting the patient’s confidential data. On a messenger app, this remains the same – the sender is always responsible and therefore needs to have control of what happens with the information on the receiving end of that communication. This control is often not possible and means many conversations taking place over common messenger apps are not compliant with medical confidentiality laws.

This is a huge problem because it becomes impossible for any healthcare professional sending an instant message on most services to be able to guarantee patient confidentiality. A way which is often used to get around this is to anonymise patient information within communications, but this also brings problems.

As recognised early on by Paul and his team at HJE, if healthcare teams cannot clearly identify which patient they are communicating about, it will almost certainly lead to confusion and mistakes. Since all healthcare professionals have sworn an oath to “do no harm”, this risk is often one not worth taking.

Communication and collaboration

For staff at HJE, Siilo has become a key tool in improving communication and collaboration between staff, and therefore improving patient care. A good example of this can be highlighted via its use in supporting the hospital’s Urgent Care Clinic (UCC), which is also helping to drive adoption in other departments.

“If a UCC doctor feels the need for input from a specialist consultant or the patient needs onward referral to a consultant, the UCC doctor can now use Siilo to contact a relevant specialist consultant rapidly and securely wherever they are.”

It is also proving to be an invaluable component in the day-to-day running of its medical team. “Siilo is now the ‘go to’ for some of our multi-disciplinary team meetings (MDTs). It solved a problem with a desire to increase the frequency of our MDT meetings without placing undue burden on the clinicians that contribute.

“It also allows ad-hoc MDT meetings where clinical circumstances dictate a patient’s case needs a review ahead of the next scheduled meeting. The messenger app allows clinicians to collaborate securely and contribute from whatever location they are working, regardless of their diary commitments.

We know the opportunities for the app are vast and since adoption, we are already seeing options becoming wider and wider, with more exciting use-cases being frequently put forward by staff.”

A growing number of healthcare organisations in the UK are recognising the tremendous benefits offered by digitalisation to the healthcare sector. While this is encouraging, it is essential that tools and technologies are truly fit to meet the standards expected. For communications technologies, this means applying absolute rigour to ensure patient confidentiality.

Joost Bruggeman is a former surgery resident at Amsterdam University Medical Centre and now CEO and co-founder of Siilo. For more information, please visit www.siilo.com.

For more information about St. John and St. Elizabeth Hospital, please visit: www.hje.org.uk

Built Environment, Digital Implementation June 16, 2022

Driving innovation: a case study using a simple evaluation tool

By Simon Dodds; Alan Macdonald; Fay Wilson; Terry Young

Professor Terry Young, Dr Fay Wilson, Alan MacDonald and Mr Simon Dodds describe for ICJ an evaluation tool that was used to support the development of a rapid access clinic in an existing health centre in Erdington.

Project management is simple: look after people, plan well, monitor effectively and intervene as needed. However, people, planning, monitoring and intervening are complicated, so good project managers mix in experience and tools they pick up over a lifetime.

Figure 1: Map of the project design to extend the capacity of an existing health centre (in blue) with rapid access care (click to enlarge).

Case study

The team from Badger (Birmingham and District GP Emergency Room) Group used a 6M Design® approach with three pre-implementation stages (map, measure, model – a prototype based on a simulation), and three phases of implementation (modify, monitor, maintain).

Once a working upgrade of the facility was in place, two reviews were conducted in January 2022, using a simulated set of patients (based on a typical case-mix) and putting this stream of virtual patients through the service to see how it was responding.

Across the two days, the workforce involved in the review included: heath care support workers; receptionists; and clinicians – around 8 people in all. A 4N framework was used for collecting and analysing the feedback.

To understand 4N, figure 2 (used with permission from SaaSoft) shows a creative journey into new territory – leaving behind what is already there and implementing what is desired. Specifically, 4N feedback uses the dimensions of time (present/future) and emotions (positive/negative) to create a chart which is split into quadrants, defined as:

Nuggets (relates to the present and the things about which the stakeholders have positive feelings)
Niggles (relating to the present but capturing features where the feelings are negative)
Nice Ifs (similarly, relating to the future and positive feelings)
No Nos (finally, relating to the future and negative feelings)

Niggles identify what hasn’t gone to plan to date. To grasp this feedback, an improvement tool called a Niggle-o-gram® was used, based on the familiar failure modes and effects analysis (FMEA). The list of niggles was graded based on three scores:

Incidence: how often does this niggle occur (never, 0 to 9, always)?
Impact: what is its effect (no impact, 0 to major impact, 9)
Influence: how much can we do (nothing, 0 to 9, change it completely)

Using this scheme, niggles that nobody could do anything about were assigned low priority. In this case, the top 5 niggles came out as shown in table 1.

Figure 2: Bridging the creative gap, while taking what works well with you. — Figure 2: Bridging the creative gap, while taking what works well with you (click to enlarge).

A more intuitive way of grasping the feedback is to produce a word cloud, weighting the size of words in each quadrant by their priority in the rankings.

Figure 3: Word cloud of key issues raised in all four quadrants of the 4N feedback process. — Figure 3: Word cloud of key issues raised in all four quadrants of the 4N feedback process (click to enlarge).

Using the findings to address key issues

One tension to emerge was around staffing, since booking patients in at reception takes less time than appointments with the healthcare worker or clinical staff. With everything running absolutely smoothly, a single receptionist might have coped, but interruptions and sporadic other tasks meant that having two receptionists was important for safety.

In turn, this created a tension between having a workload that would utilise two receptionists, and the capacity for healthcare and clinical appointments. In the end, a system designed for 10-minute appointments was fine tuned to 12-minute appointments to get the best combination of reception and other staff usage.

A second issue was Covid safety in a waiting room that could only accommodate 4 patients. Again, from modelling and other analysis, this was too few to manage the overall capacity planned for the centre, so a new process was developed whereby patients arriving in their cars would use their cars as their waiting room (and the receptionist would contact them to walk straight to their appointment), freeing up the waiting room for the exclusive use of those who arrived in other ways.

In the end…

Using a 4N framework as part of the management of an expansion of a health centre, an existing service was quickly upgraded for rapid access Covid patients, and tested robustly for capacity, throughput and safety.

Tools such as this are critical to the success of any agile or pop-up service. The good news is that the 4N approach is easy to understand, straightforward to implement and bridges the worlds of experience and clinical quality.

About the authors

Mr Simon Dodds, MA, MS, FRCS

Mr Simon Dodds is a general surgeon at University Hospitals Birmingham NHS Foundation Trust. He studied medicine and digital systems engineering before following a career in general and then vascular surgery. In 1999, he was appointed as a consultant surgeon at Good Hope Hospital in North Birmingham and applied his skills as an engineer and a clinician in the redesign of the vascular surgery clinic and the leg ulcer service.

In 2004, the project was awarded a national innovation award for service improvement. This experience led to the design, development, and delivery of the Health Care Systems Engineering (HCSE) programme.

Alan MacDonald, BSc

Alan studied at Nottingham Trent University and has a BSc (Hons) in Biomedical Science.

He worked for the Badger Group as an Out-Of-Hours primary care team leader and later became a data analyst. Since the start of the COVID-19 pandemic in March 2020, he became directly involved with the development of a multi-lane drive through Covid Referral Centre at the NEC.

He has been instrumental in the deployment of other temporary drive through clinics across Birmingham. He has also been actively part of the original team who were successful in applying this concept to the first purpose-built drive through clinic in the UK

He is frequently involved in new & novel projects within the out of hours primary care sector and is currently studying Health Care Systems Engineering.

Dr Fay Wilson, MBChB, FRCGP

Fay trained in Birmingham and has practiced there as a GP there since 1985. Her extensive national and local portfolio includes: NHS HA Non Exec, GMC fitness to practise chair, and associate postgraduate dean at Health Education West Midlands. She has served on the council of the BMA and other bodies. Fay brings people together to develop new models of care, a notable success being the Birmingham Multifund co-operative, a pioneering nurse-led walk-in centre and a prototype GP provider-at-scale ahead of its time in the mid-1990s.

Dr Wilson is medical director and co-founder of Badger, a GP social enterprise since 1996 providing out of hours and urgent primary care. COVID-19 introduced her to systems engineering, new people and new ways of thinking. Her ambition for the last decade has been to slow down.

Prof Terry Young, BSc, PhD, FBCS

After 16½ years as a research Engineer, Divisional Manager and Business Development Director, Terry became a professor at Brunel University London for 17 years.

He has a BSc in Electronic Engineering and Physics, a PhD in laser spectroscopy both from the University of Birmingham, UK.

His research has been in health technology, health services, and information systems. He has taught information system management, project management and e-Business.

His awards include the Operational Research Society’s Griffiths Medal, 2021, for analysing the return simulation methods offer when used to improve healthcare services.

Prof Young set up Datchet Consulting in 2018 to support innovation on the borders of academia, health and industry, of which the project reported here is an excellent example.

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