RECORDS, PRINT & DOCUMENT MANAGEMENT
Sharing
patients’ stories A shift to paperless working at the clinical haematology unit at Barts Health NHS Trust is helping to improve patient safety, consultant haematologist Dr Dan Hart tells NHE.
T
he implementation of Cerner Millennium at Barts Health NHS Trust’s clinical haematology unit has forced new ways of working as a necessary response to actual and potential patient safety incidents. Dr Dan Hart, who helped lead the implementation, said the way the unit is using the software, especially its clinical as opposed to patient administration functionality, has been very much “grassroots up rather than by managerial top-down diktat”. Patient safety The unit’s patients with severe blood disorders are particularly vulnerable to complications. But some of them were coming into A&E and not communicating the nature of their blood disorder well – this has especially been the case with some patients from the Bangladeshi community, Dr Hart said, who may experience language and cultural barriers about challenging doctors and advocating on behalf of their own healthcare. He explained: “We had a couple of near misses where they didn’t communicate they had a serious bleeding disorder and it wasn’t clear to the doctors looking after them: there were potential problems that could have ensued as a result. “We felt we could use electronic note-keeping to make it clear, as every doctor opens up the same interface for each patient wherever they are in the hospital. If it was flagged up on the front page with a diagnostic label that there was a significant bleeding disorder, that was a way of changing the pathway of care potentially in an attempt to try to avert problems, make communication clearer and obviously improve safety. “That went very well, so we then started adding in people’s diagnosis so that it’s clear to everybody who looks after them what’s wrong with them – not only what their bleeding disorder is, but if they’ve got other complications, such as heart disease, cancer or other issues.” Continuity of care The unit is now almost entirely paperless –
except for cases where the law, regulations, data protection and privacy require things to be written down on paper. Paper note-keeping in the unit meant far too many things were written down but never actually seen by other people who might benefit from that information, or married up properly with records kept in the hospital.
“ If there isn’t a good strategy from a hospital to support change, it can really slow it down.” Dr Hart said: “If we discharged someone at 2.30pm and there was a complication and they bounced back into A&E at 7 or 8pm, no-one would know or be able to see what happened at 2.30pm. Whereas now, you write down what’s happened and if someone else gets involved in their care later, it’s very clear what’s happened earlier in the day. There had to be buy-in from everyone, not just a few people having a go and others sticking to paper. We’re a very outpatientbased speciality, with a lot of ad hoc emergencies. Sickle cell anaemia, thallassemia, haemophilia – they’re chronic patients so we see them a lot and there are lots of people involved in their care. So in terms of continuity of care, particularly with junior doctors handing over rotas and people going off and on shifts, it’s been a good way of piecing together what’s going on with the patients.” Dr Hart said as well as the patient safety benefits, there were also benefits for the patient experience and communication: “We’re starting to capture some detail of activity that was never previously recorded. “It has changed my relationship with the patients in a way. I had a patient who had crashed his cab – relatively minor but he’d been through A&E. I hadn’t been involved in that clinical episode. He came back to the clinic three months later, and as he walked in and sat down, instead of me just sitting there smiling saying ‘how are you doing’, I could actually start by saying, ‘I’m really sorry to hear about the accident, is the cab back on the road?’” Cont. overleaf > © national health executive Sep/Oct 12 | 45
RECORDS, PRINT & DOCUMENT MANAGEMENT
His colleague Abbi Morris, a clinical nurse specialist, said: “The system’s made a world of difference.” She gave the example of having a little boy’s mother call her on a Monday morning. “He’d had to visit hospital over the weekend and I was able to reassure her immediately because I was reading the electronic notes made by the doctor who’d seen him. That really helps put people’s minds at rest. “It may sound simple but you can use those shared records to make patients feel much more like a person who’s known to all of us.” Evolution The implementation won a UK Public Sector Digital Award earlier this year, and has been highlighted as a successful case study by BT, which helped with the implementation. Jim Berrisford of BT Global Health told NHE: “Barts Health NHS Trust was one of our early deployments of Cerner Millennium in London in 2008 – only our third in the capital – and we’re now managing 19 systems across London and the South. Since it was installed, the system has been providing real benefits to the trust. This is underlined by its use in the haemophilia centre which is a clear demonstration of how
the functionality can be adapted to suit a trust’s own particular needs, increasing efficiency and improving patient care.” Dr Hart added: “It just felt a natural evolution for us to develop and try to push towards a more patient-centric, safety-conscious system. It was a very natural change that most people in the department bought into. “I’m not quite sure why it hasn’t been as easy to implement elsewhere. In talking to colleagues it can be basic. For my cancer colleagues who have equivalent important safety issues and communication issues, if they have an existing bespoke computer system already then it’s very difficult to have two computer systems working in parallel because everything duplicates. We were lucky that we weren’t duplicative; we didn’t have a pre-existing way of doing this.” Support for change Dr Hart told us: “I feel strongly that trusts need to recognise that change requires support and micro-management. “We came to an understanding with some of the members of our IT management team, on the potential of what we were doing and
got a lot of good help from the team. Some of our guys identified that we needed more mobile terminals around our day unit and the hospital then provided those to make it work. It wouldn’t have worked without that support. “My anxiety is that hospitals need to recognise that to get staff – particularly junior medical staff who rotate very swiftly – to buy into IT implementations can be really challenging. If there isn’t a good strategy from a hospital to support change, it can really slow it down. “We’ve been a bit up and down with that; we create favourite diagnostic lists so that we all code in the same way but they have to be built up as an individual so for a new registrar just starting, I can’t give him or her my lists and say ‘these are the things we need you to code’. We have to build them in a laborious manner. “Hopefully that will change with the new iteration, but if it doesn’t, people should know they’re the kind of things that make or break change.” Dr Dan Hart
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what you mean
Matthew Parker, a member of the Independent Print Industries Association (IPIA), has published a book for people looking to get better results in print negotiations – The Print Industry Negotiation Handbook. The book is aimed at people within the print industry, but NHE spoke to Parker to get some insight on what NHS customers can do to get better results.
N
egotiations are often seen as zero-sum games, with a winner and a loser. But with the NHS needing to cut costs and make efficiencies wherever it can, and print suppliers keen to offer new services, it doesn’t have to be.
be as open as possible with what they are trying to achieve. But there has got to be something in it for the supplier as well. If it is going to be a long-term relationship, it does have to be a win-win situation.
Matthew Parker, author of ‘The Print Industry Negotiation Handbook’, published in May, told NHE: “Negotiation should be a win-win situation. The role of a good negotiator is to win a little bit more than the other party but it shouldn’t get to win-lose.
“Flexibility and openness are the name of the game. And before getting to that point, do lots of research first to make sure you know you’re heading down the right track. It’s horrible for anyone to be in negotiations where they have to do an about-turn and completely change what they’re doing, because that can throw the negotiations out of kilter and it can stop people from trusting the negotiator.”
“Both parties need to understand what they need to get out of the negotiation. They need to understand when they should walk away; that’s a common issue in print negotiation – sometimes people are so desperate to do the deal. It’s like eBay, isn’t it? You are so desperate to get something that you keep bidding and bidding, and then discover you could have bought it cheaper brand new.” In this way, negotiating over potential print services is similar to negotiations for any other business service. Parker said: “Buyers should 46 | © national health executive Sep/Oct 12
Parker went on: “When I run face-to-face negotiation training, I go through one of the exercises at the beginning of the day, and people just go for it – and they are not always as open as they might be. Quite often the exercise gets bogged down; it’s designed to show this. “People wonder where they went wrong. Often the negotiation wasn’t what people who are taking part in it were expecting to happen, and
we talk about that and they say ‘Well, if only I’d known that beforehand’. Things could have gone so much further if they had tried to be a bit more open with each other.” Another important message is familiar to health managers dealing with shrinking budgets: quality vs cost. Parker said: “If all you are going to negotiate on is price, it either works or it doesn’t and you are left in a difficult situation. If you have a good set of conceptual goals you know if you are going to be pushed on price, is there something you want in return? “I’ve got a goal setting system called NICE that encourages people to set goals in certain ways, which means they can then negotiate much more flexibly afterwards.”
Matthew Parker
FOR MORE INFORMATION For details and to get the handbook, visit: http://profitableprintrelationships.com/ negotiation-handbook-information/