Back in 2015 we embarked on an ambitious and wide ranging programme of transforming our community nursing services (District Nursing, Intermediate Care and Specialist Nursing).The areas of change ranged from technology, clinical training, team structures, new ways of working and referral management. Our referral management project was to create a single point of access for the county (SPOA) to streamline and manage an ever increasing number of referrals with escalating complexity patients.
This is the story of our journey and what we learned in the process.
Benefits we achieved:
£59,000 Pay Cost Savings
Bank & Agency spend reducing
Business Intelligence
Enhanced care planning & co-ordination
ICT/DNBetter outcomes for patients
Caseload management and discharge planning
Gatekeeper role -visibility of non-commissioned activity
What worked well?
Staff engagement Multiple staff participation sessions Led and designed by clinicians Tested by clinicians
IT Provider Project Time Dedicated project time Multi-skilled Project team
Making tough decisions Support from Execs to curtail North roll out Support from the CCG
What didn’t…?
Resourcing the project Availability of staff to commit to participate in development role over a long period of time No ring fenced budget for transformation Control of IT Provider project hours Reliant on existing technology i.e. telephones from 2008
Technology
Current technology doesn’t allow for full functionality and the full scope of the transformation
Audit data Referrals Audit data from January 2016 gave a false picture Staff underestimated the amount of time they spend sorting out poor quality referrals Result was insufficient capacity in SPOA for Go Live North
Resourcing the SPOA Staff drawn from clinical service- some resentment from detractors The ‘on-the-ground’ need for clinical staff vs the need for experienced staff at the point of referral Started out as cost neutral- quickly became a CIP
Changes in referrer behaviour GPs started referring in ways not previously seen A lack of willingness to provide referral information in some areas Paths of least resistance
Staff Training & Capability
Complex, new record and clinical screens to master; new and inexperienced staff in a high pressure environment.
Clinical Governance A number of SIs related to SPOA process and performance Having to respond to changes in the H&SC environment when also trying to embed a new system and process
What would we change next time…?
Resourcing the project Secure a budget for staffing, plus the ‘unexpected’ items Obtain clear, written and agreed at Execs, confirmation of expectations regarding CIP
Technology
Give a wish list to IT Provider and ask them to find the options that fit the vision More engagement with GPs Even though we did, the message still didn’t get round or wasn’t grasped Result was insufficient capacity in SPOA for Go Live North