Releasing Time to Care through Mobile Working Julia Clarke Chief Executive Bristol Community Health CIC

Who are we? What have we done? BCH is a small provider of NHS adult community services in Bristol. Turnover £45 million, 1100 staff, 100,000 patients, 300,000 patient contacts per year, 750 mobile workers, 35 services, urgent care and LTC management Completed a pilot of mobile working using TotalMobile with around 70 staff, now rolling out to 750 mobile clinical staff. 210 devices currently in use. Demonstrated significant productivity opportunity shared three ways with patients and staff Demonstrated significant data quality improvements Achieved improved staff morale Identified a lever for transformational change Created a platform for further productivity and quality improvements

Why mobile working? Overworked frustrated staff: separate, duplicate data entry, excessive travel to and from base Poor data quality – incomplete, not timely Paper records, manual paper based processes No real time information available at patient interaction Poor clincial system design Inconsistent and multiple versions of paper forms

Critical success factors Initially: easy remote data entry at point of care –Improved quality of care –Productivity – time to care and do more for patients and GPs –Staff engagement and satisfaction and speak well of Bristol Community Health Quickly realised we could also have: –Better Management Information and Quality Metrics as a platform for improvement –Offer innovation and value for money to Bristol CCG (NHS commissioners) –Gain G.P. satisfaction and support at practice level –Improve perceptions and reputation for quality, innovation and responsiveness throughout Bristol –Cultural change –Improve our chances of re-winning our contract at tender

Technology & Mobile Working support our strategy Time to Care: Efficient & effective information management using TotalMobile on a mobile device has released time to care Managing our Money: Investment in front line teams and back office support personnel via TotalMobile has led to increased productivity and cost effective workforce redesign Making their Day: Knowing how we are doing at every level through data analytics, designed by both clinicians & performance team, empowers staff and sets a springboard for continuous improvement Being the Best: Mobile working provided an opportunity to transform services and organisational culture e.g. workflow processes, clinical & non clinical documentation review and ‘how we do things here’

What is Totalmobile? A simple intuitive application which –Works on any device –Works with and without live coverage –Is capable of linking with any clinical system –Is designed around the clinician – patient interaction –First and foremost supports the mobile worker –Quick and easy to introduce and adopt

How we are doing it The hard way Agile approach Designed by healthcare staff for healthcare staff – pilot version and new solution Led by clinical champions Bottom up change – transformation driven by clinical and administrative staff at the frontline Provides infrastructure, environment and tools to enable improvement and change Compact with staff to share benefits three ways

What we found Approach - initially an evolutionary approach was anticipated but an appetite for revolution was identified Scope and potential far greater than initially anticipated Became a key lever for transformational change and a core plank of our strategy & business plan Disruptive technology in practice We needed more resources and it took longer

What are the benefits Patients: High quality healthcare, high quality information Staff satisfaction: eager to embrace the change, time to care, happy staff = happy patients Productivity: reducing inefficient administrative processes, decreasing data entry, repetition & duplication Innovation: huge potential Security of information – greatly enhanced with new processes & meets emerging HSCIC regulations Analytics: platform for continuous improvement

Time Saved Per Day Initial immediate benefit of 30 mins/day in data entry Consolidated net benefit of more than 1 hour per day per nurse (average visit time currently 40 minutes) –Measured after taking account of quality improvements –Measured after taking account of improved admin and follow up activities being completed. Across BCH that equates to a potential for more than 140,000 visits per year, with 750 staff, or capacity of additional staff

Improved working lives for our clinicians its Gained Staff SatisfactionPre pilotPost pilot % responding positively to "I am satisfied with the hours I have worked this week" 49%83% % responding positively to "I am confident about doing my job to a standard I am happy with" 52%87% % responding positively to "I am able to manage my time to meet the demands of the caseload" 49%80% 82% of staff felt mobile working would have a positive impact on patient care in the future

Improved Clinical Quality Gained Clinical QualityPre pilotPost pilot % of patients seen with evidence of a care plan completed and stored on electronic clinical records system 0% on RiO 40% on paper 85% on RiO % of patients with outcome, progress notes and activities completed and stored on electronic clinical records system 78%98% % of patients with consent form completed and stored on electronic clinical records system 15%92%

Challenges Timescales - ambitious Being first – leading the way Cultural change – not ‘like for like’ from paper to electronic record – transformation of process & care delivery Regulation & risk Information governance Realizing the benefits through changes to workflow and working practices The day job…….. Changing from RIO to EMIS during 2015 We needed more resources and more time

The new solution & future functionality Exploit capability of the device: photos, web based applications, apps, translation, dictation ‘Jigsaw view’ Trend data Annotated photos Satnav & lone working Automated referrals, notifications and alerts Scheduling Analytics using the data Integration with GP systems, ‘Connecting Care’, social care systems

Right Information Right Time Jigsaw View

Right Information, Right Time Historical Trending Graphical View

North 1 Community Nursing Team, BCH Go Live: 27 th May 2014 Releasing Time to Care through Mobile Working