By adding an MPage for prioritisation to its Oracle Cerner EPR, clinicians working at two hospitals run by our host trust, Calderdale and Huddersfield NHS Foundation Trust (CHFT), now see real-time patient lists.
This is helping to speed up the Trust’s waiting list validation process, reducing a post-COVID backlog by increasing efficiency, and preventing the creation of unnecessary appointments.
Previously, lists were compiled in spreadsheets and sent in bulk for validation and prioritisation every 3-4 weeks. This process created common issues for the hospitals’ validation team, including poor/slow response rates and replies sent on Microsoft Word which then had to be copied to the spreadsheet, thus creating a risk of mistakes and wasting valuable time.
Adding the Mpage for Prioritisation to the EPR saved 91 hours of clinicians’ time in one calendar month alone, whilst also preventing 5,000 unnecessary appointments, ultimately reducing waiting times to benefit patient care.
The rationale behind streamlined process
The rationale behind the project was an NHS mandate to provide each patient waiting for elective treatment with a P (priority) number between 2 and 4 – the higher the number the lower the priority. For example, the expected waiting time for someone with a P2 priority is a month, while P3 is three months and P4 applies to a patient wishing to postpone treatment.
This added impetus to an existing desire to create a streamlined prioritisation and validation process using a digital solution that had already been mooted by THIS and CHFT for the Trust’s two hospitals, Huddersfield Royal Infirmary, Huddersfield, and Calderdale Royal Hospital, Halifax, both West Yorkshire.
THIS is an innovative, collaborative NHS organisation providing digital and IT services to health and care providers across the UK in primary, secondary and third sectors, particularly NHS health trusts, GPs, laboratories, hospices and not-for-profit healthcare organisations.
We enable new, empowering, efficient, and secure communications and IT services for our host trust and other healthcare clients.
Digital health solutions delivered by THIS for CHFT have helped to make it one of the most digitally mature Trusts in England, and as such, digital solutions are the golden thread running through everything we aspire to achieve in conjunction with CHFT, to benefit clinicians and patients alike.
A systematic approach to project perfection
The ever-expanding range of digital health solutions is driven by the desire to develop new ideas to ensure staff have the tools they need to do their jobs efficiently, while systems can ‘talk’ to each to share vital information to support the delivery of patient care.
THIS’ project management service typically facilitates 40-50 projects for CHFT and other clients in the healthcare sector at any one time. All THIS project managers are PRINCE2 practitioners and base their work on the seven processes of that methodology:
- Starting up a project
- Directing a project
- Initiating a project
- Controlling a stage
- Managing product delivery
- Managing stage boundaries
- Closing the project
We used the systematic PRINCE2 methodology from inception to completion of the MPage for prioritisation project to monitor all risks, issues and actions.
The project’s aims were to:
- Provide real-time availability of information via a single source of truth.
- Reduce administrative time for clinicians and the validation team.
- Provide clearer visibility of patients’ changing circumstances to aid the prioritisation process.
- Increase efficiency to reduce waiting list backlogs.
Once the build was close to completion, weekly review sessions were created allowing all stakeholders to see the MPage in the test environment. This was a key factor in delivering the project successfully as it allowed all stakeholders to assess and review the functionality and layout of the solution.
Weekly checks were done in meetings between clinicians, the trust’s validation team and our project team. All change requests and test issues were managed using PRINCE2 methodology allowing for them to be assessed, prioritised and monitored once approved by the team.
Once the prioritisation MPage functionality had been added to the EPR, we ran both processes in tandem for four weeks to measure the statistics and analytic data from within MPage to ensure nothing was being missed that might have been included in the manual process.
The ultimate measure of success was tied to the fact that everyone on the waiting list had their case reviewed and had a P number assigned to them.
As a result of what we have achieved, the Trust’s validation team, which processes an average of 1,800 patients a week, now records straight into the EPR. Anyone in the process can add comments, and clinicians have the ability to open the page and view it. The responses are live and actioned.
Neil Staniforth, THIS’ Director of Digital Ops and Delivery, says:
“The fact that MPage writes directly into the patient's notes during validation makes the process a one-stop shop, easy and convenient. The result is increased staff satisfaction from a workload perspective among clinicians, and the validation team is pleased with the clarity it provides.
“We think the new process is the best we’ve ever had. The ultimate testimony to the success of this project, is that we know if we said we were going to take the new process away, clinicians would fight us, rather than help us pack it up!”
Listing the advantages of MPage for prioritisation
While the time reduction in spreadsheet creation and reconciliation allows more time for validation and review, the time saving for clinicians has halved from 10 minutes per patient to five. For example, in November 2022, 1,097 patients were prioritised, producing a time saving of approximately 91 hours for clinicians.
In the same month, 5,524 pathways were closed, freeing up approximately 5,000 appointments that could be offered to other patients.
Neil Staniforth, who was one of the six-strong project board and dynamic project team, adds:
“The benefits of this are twofold: it clears a backlog and if the appointments had not been cancelled, the patients concerned would have ultimately been booked for an appointment that was not necessary.”
As we did not want to disrupt clinicians’ work, we conducted the review through the lens of the Trust’s validation team and have identified the following further advantages:
- With MPage supporting real time data, as soon as a patient is validated, the information can be clinically reviewed and made immediately available for modification if necessary.
- Measurable end-to-end process - full audit trails are now available on MPage and the Trust’s Knowledge Portal Plus (known locally as KP+), identifying where each patient is in the process.
- Reduction in errors - all information is viewable in one centralised system, which means clinicians are no longer navigating between systems.
- Improved reporting – although limited reporting is currently available via KP+, MPage enables more varied opportunities.
- Improved clinical governance - all validation and clinical review information will be available within EPR instead of a spreadsheet.
- Reduction in general managers’ time to filter and distribute data. Previously, GMs were required to filter lists by consultant and distribute to the relevant ones. Data now lands directly into worklists, removing GM involvement.
- Reduced backlogs - improved ease of access improves productivity and supports the reduction of backlogs.
Kirstie Blackham, a member of CHFT’s validation team, says:
“We receive validations as soon as the consultant does them and any queries can be sent straight back. This is in comparison to the days and, at times, weeks it could take to send things back and forth via email. The whole process is a lot smoother; all the information is clear and easy to access. Even at this early stage, I feel like this will only speed up as people become more comfortable using it.”
The journey from collaboration to satisfaction
The MPage project was a collaboration between THIS, CHFT and St Vincent’s Health and Public Sector Consulting, which markets itself as a specialist in patient-centred healthcare solutions. It had two representatives on the dynamic project team to provide expertise that helped design, implement, and maintain the MPage solution.
The resulting staff satisfaction is borne out of the fact that clinicians can now see what the workload looks like in real time, creating better time management and increased availability among clinicians for patient treatment due to the eased administrative burden. Previously, if there was a big validation list, those involved would not know where they were up to at any given time, but that is now totally transparent.
Kirstie Blackham:
“As a relatively new member of the validation team, I was trained with and without the MPage in close succession. In my opinion the Mpage is a much cleaner and efficient way of working. I feel like it will be much simpler to train new starters and that it will massively minimise patients getting lost in the system.”
Once the new process was up and running, the ease of the system became clear and cemented engagement with clinicians, who could train to use it simply by watching the following two-minute video.
Interest in the new way of working has since been expressed by Bradford Teaching Hospital NHS Foundation Trust (BTHFT), with which CHFT shares its Oracle Millennium EPR. Representatives from BTHFT were already aware of the work being done within CHFT but due to circumstances did not have the capacity to replicate it at the time, a situation that now appears to be resolving.
This collaborative way of working has increased in-house skills levels among the EPR Service Delivery Team for CHFT and BTHFT, after the MPage went live the EPR Team took over some aspects of maintaining the solution. This was facilitated by a St Vincent’s technical handover document that outlines clear parameters the EPR Team could configure and change to be able to support the product into business as usual.
Get in touch with THIS
As well as working within its host trust, THIS provides digital and IT services to health and care providers across the UK in primary, secondary and third sectors, such as NHS health trusts, GPs, laboratories, hospices and not-for-profit healthcare organisations.
If you are interested in working with THIS, get in touch here.
