Healthcare IM&T team of the year

NHS Waltham Forest

Awards 2009

If there is one lesson that the NHS should have learned by now, it is that clinical engagement is vital if the full benefits of a new clinical system are to be realised. The implementation of a RiO system in Waltham Forest sounds like it would make a great chapter in a text book on how to do it right.

The inclusive approach taken by the entire team at NHS Waltham Forest as they implemented the community and mental health electronic record over the past two years, won them healthcare IM&T team of the year in last year’s E-Health Insider Awards in association with BT, and the prestigious title of overall winner.

“We have moved from an old fashioned paper record to a good electronic clinical system and we have seen lots of benefits,” says Simon Midlane, associate director of ICT at NHS Waltham Forest. “But it has been a real cultural change too, and enabling that transformation to take place has been a major part of realising the benefits.”

A well run project

Programme manager Carla Morgan explains the approach. “We were very lucky having services who were keen and interested,” she says. “But we also used a tried and tested methodology for implementing the system and that gave us some structure.”

The project team used PRINCE2, which stands for Projects in Controlled Environments and is widely recognised and used in both government and private sector organisations.

From the outset, it also included very senior nurses. “They make our job easy,” says Morgan. “They know the clinical language and the staff know that they are experts in some challenging areas, such as safeguarding children and sexual health. They know the nuances of clinician’s jobs.”

This project team began by leading a series of workshops in which staff looked at RiO and discussed what they wanted from it. At these workshops, project team members looked out for people who would help take the project forward in their local work environment.

“Sometimes this was managers, sometimes it was clinical staff, and sometimes administrative staff,” says Morgan. “These are people who know their stuff and can spread the word within their services.”

The information and discussion generated at the workshops was fed back into meetings with these local champions. At these meetings, everyone agreed and signed up to how they wanted the system to work and support them in recording clinical data. That provided the project management team with their blueprint.

The third part of the project implementation was recruiting trainers from among existing staff. “Through the workshops we spotted people we thought might be good and encouraged them to apply for secondment as trainers for a year.

“They were mostly administrative staff, but all of them know their services really well. Their level of knowledge is different from that of our senior nurses and so they bring a completely different angle and completely different information which we have found to be invaluable.”

The final plank in managing the implementation making sure the team was open to ideas and feedback during reviews.

Morgan says: “When it comes to go live I think staff sometimes struggle with what their managers are asking them to do.

“You have to be quite supportive, but ensure they realise that it was all discussed and agreed within their service prior to go live. You also have to listen and have formal review processes in place so that the staff know their views have a forum.”

Plan, do, review

In NHS Waltham Forest, these reviews take place two to three months after go live in any given service. “By that time, people have given it a go and either found that it does work or it’s obvious it needs to be changed and we are supportive of that change,” says Morgan.

Jessica Michell, clinical transformation lead at NHS Waltham Forest, is one of the senior nurses on the project team. She lists a long string of benefits that moving to RiO has brought (see box). These include cutting and managing waiting times, answering patient queries more quickly, monitoring clinical improvements, improving record keeping, bed management and many more.

“Before RiO we could not record what we were doing and it was very frustrating,” she says. “I was always chasing round for paper reports to show we were making improvements in people’s lives. Now we can actually show how services are making an impact on people’s health. It really helps.”

Top of the list, though, is making improvements to patient care through sharing records. “Take an example we just had of a patient being cared for by the palliative care team,” she says. “The client was a single mother so the health visiting team were involved as well as dietetics and nutrition, district nursing, the respiratory team and our Intercare service who are based at our acute hospital.

“Because we were all able to share the clinical content we were able to ensure that whatever pathway she chose, all the teams were able to follow it; all her needs – and those of her child – were met.”

Next steps

Which is not to say that everything has been plain sailing. Some areas – notably sexual health and reproduction – were reluctant to share their confidential data within their own team and took some reassuring so they felt confident about how safe it would be and who would have access to it.

Michell says: “Governance is crucial. Sometimes it takes six months just to talk about governance before you can even start engaging with staff, but this time is never wasted it is an important step in the process.”

Of course a project like this never really comes to an end. Just recently, the team started to pilot RiO working with Choose and Book and next on the list is rolling it out to some of the services in the polyclinic pilot managed by NHS Waltham Forest. But so far, the well managed project has meant that everyone has been a winner.

Benefits of RiO at NHS Waltham Forest include:

  • Accurately recording staff clinical caseloads to ensure staff workloads are balanced
  • Support for meeting the18 weeks referral to treatment time
  • Active monitoring of waiting lists to reduce waiting times
  • Direct booking by inegrating Choose and Book into RiO
  • Staff being able to answer patient queries quickly and efficiently by referring to the electronic record
  • Clinical outcomes being monitored by using care plans
  • Support for clinical supervision, allowing team leaders to ensure quality care is provided, identify any training needs and ensure that best practice is maintained
  • Less duplication of tests and assessments for patients who attend different sites
  • Improved bed management, which in turn can reduce acute hospital admissions
  • Increased security with the use of smart cards
  • Better integration of teams that work across multiple sites
  • Supporting joined up care through sharing clinical content across teams
  • Support for providing care closer to patients’ homes
  • Improved record keeping and bench marking of effective and efficient care
  • Ensuring best practice is followed for clinical care
  • Improved coverage of NHS Numbers and ethnicity recording to provide services with better information about the people they are treating
  • Support in monitoring key primary care trust targets to ensure that priority groups are targeted
  • Improved IT skills amongst provider services staff.

The E-Health Insider Awards 2010 in association with BT seek out and reward outstanding work within the UK healthcare IT sector. Entries are open now on the dedicated awards website.

The deadline for entries is 4 June.

The awards will be presented on Wednesday, 6 October in the Grand Hall at the Grand Connaught Rooms, Covent Garden, London. For more information or to reserve a table, please visit the awards website.

To find out more about the previous winners of the awards, visit our case studies showcase. Last year’s Healthcare ICT Champion of the Year, Andy Inniss, is now an EHI video diarist.