Getting the Fundamentals Right – Ensuring the Success of Digital Projects through Solid Foundations

In March, NHS England launched a campaign to ensure all acute trusts give patients the ability to make appointments and receive messages online. This new national requirement must be met by the end of 2023/24 and NHSE wants each Patient Engagement Platform to integrate with the NHS App to enable patients to manage outpatient appointments and share information.

This pursuit is vital to ensure trusts across the UK are equipped to communicate with patients digitally, allowing them to engage on their channel of choice, encourage them to make better choices about their health and validate their position on the waiting list. The question that remains is, is it achievable?

During my time working in the NHS, I’ve worked with a number of trusts that aspire to achieve big digital transformation goals that will improve patient and clinical outcomes. Unfortunately, I’ve witnessed too many of these projects stall or fail due to a lack of core fundamental digital capacity to support transformation.

Poor processes lead to poor results

It’s no surprise that poor processes often lead to poor results. This stifles transformation and significantly delays project completion. Before implementing any digital transformation project, it’s essential that the right foundations are in place for the project to be successfully delivered.

Across the country, it’s not unusual to see administrators manually preparing letters or feeding envelope machines by hand. All processes that, if automated, would free up a significant amount of time which could be better spent supporting their clinical colleagues.

Additionally, problems stem from sensible processes that haven’t been properly implemented previously, such as mobile phone number recording. This is the process of recording patients’ mobile phone numbers for appointment reminders and safety precautions. If this recording is done consistently, this simple step can significantly help trusts reduce waiting lists.

When delivering our diagnostic programme, we analyse all trust departments to determine what patient communications could be digitised. In one Trust, we found an  administrator manually sending texts to patients every day to remind them of their appointments and in an attempt to reduce waiting lists. This incident would have been unknown to the trust without our diagnostics. Digitising such processes is possible and necessary, as opposed to forcing admin staff to take matters into their own hands.

In another trust, mobile capture was very low, with only 20-30% of patients’ mobile phone numbers. We worked with them over the course of a year to increase this, by ensuring patient mobile numbers were consistently being captured by administrators. Over this period, we found that internal processes had to be completely overhauled, receptionists retrained, and reporting into monthly board meetings to maintain visibility.

Once these steps were completed the results showed that mobile capture increased to over 65%. This led to more patient communications being sent by SMS, improved workflows, reduced DNAs, and less paper used at the trust. All of this was achievable due to the right processes being in place.

Templates matter

Many trusts don’t fully understand the process of moving from analogue to digital patient communications. It’s not something you can just switch on.

To get a Patient Engagement Platform up and running, the first priority is to ensure all outpatient letters are loaded onto the platform. However, a major factor that slows down this initial process is the number of letters across the trust that are not standardised. Often each department and speciality is slightly different. Meaning you could have the same letter from one department that uses different terminology or branding to another in the hospital.

Even if most of these letters give the same message, these slight differences amount to thousands of different variations. For a patient, it’s essential that they trust the information they receive from their hospital in whatever format, or on whichever channel they receive it. Inconsistencies in branding, fonts and terminology diminish this trust.

For example, we’ve previously worked with a trust to implement a Patient Engagement Platform and found that it had thousands of different templates for letters, similar in look to party invites. The design of these letters depended on the department’s definition of what was professional. To rectify this and standardise patient letters, we worked with every department to implement and enforce a standardised template using NHS standards.

Ensuring buy-in at all levels

Having decision makers involved in the project from the very beginning is another major factor in success. When implementing a new Patient Engagement Platform, we encourage trusts to ensure the right people are in project meetings and staff are educated on what is happening. That way, the important questions are asked early in the process. For example, what’s the current process? Is the proposed way easy to digitise? Can we even digitise it? How much work will this mean for the team? All important questions that everyone affected should be aware of.

It is especially important to involve information governance and business intelligence. Without these key decision-makers, projects are often delayed. For example, a project to rationalise letters quickly with processes signed off in good time could be put on the back burner if the trust does not have the required business intelligence resource. Without essential data from the business intelligence team at the trust, projects can be completely derailed, wasting precious time.

Ultimately, a project’s success relies on whether the right people are available and engaged throughout, and that understand the processes they currently have and what it will take to achieve goals.

Fast approaching deadlines and increasing waiting lists

As well as Patient Engagement Platform NHS App integration, all Acute Trusts now have fast-approaching deadlines to provide efficient communications for patients. In an environment with increasing waiting lists and ongoing industrial action, the targets set become harder to achieve.

In our experience, for a trust to implement a Patient Engagement Platform successfully and quickly, the fundamentals must be right before embarking on a digital transformation programme.
For a hospital to flow, every cog needs to be working together, efficiently. Every trust has a backlog of patients waiting for treatment, if you enable these trusts to reduce non-essential tasks and digitise them, this freed-up time can be used to support tackling these waiting lists. Digitising some of the many manual processes for administrators, like manually sending letters, can release capacity, enabling these staff to focus on more important tasks.

For example, our digital-first approach has already enabled 43 trusts and health boards to validate waiting lists at pace. As a result of Cardiff and Vale University Health Board focussing on the fundamentals, they digitised processes to reduce their waiting lists by 21.5% and continued to improve data quality throughout the project by requesting updates to contact details.

Enabling effective implementation through solid foundations

When working with a trust to implement a project effectively, we need to understand the processes already in place for that trust, making sure the right people are in the right place. If this means stripping back to the basics and working from the ground up, trusts will ultimately conclude digital projects in a better position while also creating better lasting foundations for future projects and process realignment.

By Concepta Wayment, former NHS Associate Director of Operations and VP of Transformation at Healthcare Communications

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