Chelsea and Westminster Hospital - eHealth

The records relating to Mrs XY care in theHospital were incomplete & containedinconsistencies, inaccuracies, alterations &errors.”FAI report

Real WorldUncontrolled & MessyResearch/PolicyControlled or Remote

Are these frustrations unique tothe NHS?• PricewaterhouseCoopers surveyed 200 leading companies(Global)– They ran a total of 10,640 projects per year– Only 2.5% (254) delivered the desired business benefitsSource: Boosting Business Performance through programme and Project• There is considerable evidence of high failure rate in projectssustaining their efforts (as much as 70%)Daft & Noe 2000

Improving Care – making it happenSimple butHard .....cultureand behavioursInvest thetimeMeasurementComplicated butEasy

Medical Leadership and ITKey result areas• Education• Governance• High quality care– Patient centred• Research• Strategy• Service redesign• Workforce planning• CommunicationExamples• Electronic medical textbook• Information/guidelines• Outcomes by specialty– Appointment scheduling• HES/PAS data• Data for improvement• Data for• Capacity demand modelling• Bleep systems, mobiles,VoIP

Information technologyConnected healthcare – connects people• Patient centred wireless medical technology• Mobile healthcare (m-health)– Reducing ‘did not attend rates’– Results– Investigations - ECG• Telemedicine– End of Life care• Skype video and text– Communication notes– Long term conditions• Radiology reporting

mHealth Revolution• Patients are mobile (2008)– Worldwide 1.1 billion use the Internet• Worldwide 1.4 billion carry credit cards• Worldwide 1.5 billion have TVs• Worldwide 3.9 billion cell phonesubscribers– 70 Million in the UK• June 2006: 75 million text messages sent• June 2008 7.2 Billion text messages• RC Lefebvre, GWU

Improving Care – making it happenPatients willinfluence ehealthInvest timeSimple butHard .....cultureand behavioursMeasurementComplicated butEasy

Senior Clinicians duty of careDon’t need to be an IT expert!Recognise the value

Clinicians like dataUnderstandInterpretDeliver

Increase value by choosing the right option, namely the option that gives mostvalue; complements the workstreams primarily concerned with increasing valueby quality improvement.HighvalueHighvalueHighvalueLow valueLow valueIncreased valueresulting fromquality improvement –doing things rightIncreased valueresulting fromdoing the right things

What can clinical leaders do to help ?• Work closely– Locally• clinical e health leads• leads for e-health• Patients– Nationally• Meetings like this• Focus on an area of work – deliver outputs• Influence policy

‘Here is Edward Bear, comingdownstairs now, bump,bump, bump, on the backof his head, behindChristopher Robin. It is, asfar as he knows, the onlyway of coming downstairs,but sometimes he feelsthat there really is anotherway, if only he could stopbumping for a moment andthink of it.‘

We need to close the secondtranslational gapNot about new technologiesAbout using existingtechnologies better

Cost releasing• Simplifying the patient journey– Reducing duplication• Capacity demand planning ------poor !– Rotas– Waiting time / theatre utilisation– Reduce duplication• Optimising practice– Voice activated dictation– Automation of systems• Laboratory – clinician– Computerised CT coronary angiography– Centralised radiology reporting• Green - low carbon high value approach

Better health careIT is part of a system based solution

Summary• Clinicians• need to lead (with others)- ehealth leads/Boards/CHPs/Acute• need to listen to ...........• need to support– Can do culture» Enlightenment– Move from data rich information poor !......above average!• Action rather than talk.......delivery• Making a difference• Technology is cheap!!• Scotland internationally recognised for health

Value =(clinical outcome x patient experience) ‐ HarmResourcesCashReleasingNon‐CashReleasing

Implementationfor sustainable benefit

Example: CAP Care Bundle

Building capacity to deliver evidence basedsustainable implementationCo‐design ‐> Delivery• Multi-disciplinary and multi-stakeholder engagement• Integrated workingCo‐design ‐> MethodologyCo‐design ‐> Infrastructure• Delivering improvement driven research– Real time data and measurement– Tools and methods• pragmatic, systematic (scientific) approach– Training and education• Infrastructure for engagement– Frontline staff– Leadership and project management– Senior Clinicians– Patients

Creation of Co-DesignOpportunitiesco-design opportunity = activity + peopleOpportunities created through an activitywith a specific purpose that engagespeople who would not normally worktogether

Change... Is not that simpleWhat happens here?ImprovementSuccessTOPublic pressurePolitical pressurePoliciesGuidelinesFROMTime

Principles of the Real World• Change• Variation (predictable and unpredictable)• No ‘silver bullet’ will ever fix this– No ‘right’ answer• Compared to traditional medical research methods...– Controlled, minimal variation, artificial systems andprocesses• Research/evidenceX Leap of faithPractice

“All scientific work is incomplete – whether itbe observational or experimental. Allscientific work is liable to be upset ormodified by advancing knowledge. Thatdoes not confer upon us a freedom toignore the knowledge we already have, orto postpone action that it appears todemand at a given time.”Hill AB. The environment and disease: association orcausation?Proc Royal Soc Med. 1965; 58: 295-300.

Challenges for healthcare• Not about one-off solutions – No SilverBullet• How can you sustain improvements?• How can you ensure improvements areresistant to external changes?• How can you incorporate newevidence/ideas to continue improving?

Closing the 2 nd translationalgap • No ‘Silver Bullet’• Stakeholder engagement, ownership and sharedvision essential to implementation and managingchange– Starting point• Supporting Delivery (talk for another day…)– All opportunities use a scientific framework to supportdelivery based on principles from basic science,improvement methodology, change management andindustry.– Financial support of spontaneous and emergentopportunities– Expertise and infrastructure support

Making Strategy WorkPlanned/deliberateSpontaneousEmergent/craftedThinkingahead1Analysing situationand designingintervention2Engaging players indeveloping a spiritand purpose3Finding out whatreally happensaround hereReal time 4Project managing theimplementationprogramme5Living in themoment,responding toevents in the spiritof the plan6Noticing what ishappening, the dayto day decisionsbeing takenReflectingandlearning7Evaluating theimplementation8Reflecting on thedynamics9Putting togetherand telling the storyValerie Iles

High level process map; EntirePatient JourneyEmergencyDepartmentAcute MedicalUnitWardDischargeLoungeCommunityGPDistrict NurseHealth VisitorDischargeHomeKey Steps at C&W Hospital

Alignment of Health & Social Care• East Lothian Older People strategy• Governance of West Lothian CHCP• Governance of Alcohol and Drug Partnerships• Building capacity for Learning Disabilities• Integrated Resource Framework• Mental Health – Next Five Years

Quality Targets1. Reduce medication administration errors by 15%2. Achieve 95% compliance for risk assessments re:tissue viability, falls prevention and nutritionalassessment3. Maintain Hand Hygiene above 95%4. Eliminate Agency spend & reduce locum doctorcosts5. Increase direct patient care time to a 50%minimum through Releasing Time to Care6. All Senior Charge Nurses to complete Leading BetterCare7. All areas will capture feedback on dignity andcommunication and courtesy and demonstrateimprovements in patient experience8. Establish Clinical Academic Research Pathways forNMAHPS

“…I was admitted to hospital3 times in the 12 monthsprior to starting with hometele-monitoring. Since then Ihaven’t had a singleadmission. Not even throughthe winter months.”William Fry

“I used to see 8 or 9patients a day athome; with telehealthI can monitor and seeup to 35 patients on agood day”Clair Sparrius