Project Aim
To improve safety, effectiveness and efficiency of community services by facilitating mobile working for
community based staff across Cardiff
Project Overview
As part of the UHB’s re-designed community services, an Electronic Patient Record (EPR) was introduced and made available to 3,886 Health Board staff working within 147 operational teams across Primary Care, Community and Mental Health services. To build upon this initiative and to remove the need for staff to return to their bases to collect and update records, a mobile-working solution was sought.
The project included the scoping of requirements from infrastructure to the end user, an option appraisal of different types of mobile devices, a pilot of a number of short-listed devices and a full rollout to district nursing and health visiting services.
District nurses and other health workers are now being equipped with new technology to help free up their time so that they can spend more time with patients. Wireless technology enables staff to have access to latest patient information, and provides a means by which they can update patient records
during visits. Overall, the approach is expected to realise a minimum of 15% increase in efficiency for community based staff.
Delivering Project Objectives
Benefits mapping and investigations were undertaken in 2008 and 2009 and a programme of infrastructural improvement to enable the solution commenced in the summer of 2010. This work included the commissioning of a dedicated 10Mb network link to the UHB, the procurement and deployment of mobile working citrix servers, and a pilot of end user devices.
The mobile working pilot started in September 2010 and over a six week period involved some 60 clinical staff from the district nursing and child health services, trialling five different netbooks. Feedback on the suitability of the devices was collected and hardware configuration changes were
made and operational process maps amended accordingly.
Following the pilot, a preferred device was identified. With the infrastructural improvement in place, the full roll-out commenced in April 2011 and although still in roll-out stage, there are already clear benefits being realised.
Key Achievements and Benefits to Date
- Pilot successfully undertaken in summer 2010 with over 90% of first 50 users of trial device confirming acceptance of the new way of working within Community Services.
- Preferred device identified through full consultation with users and ICT infrastructural improvements put in place.
- Comprehensive roll-out of devices started in April 2011 with 87% (370) having been successfully rolled-out to targeted community staff by early September.
- User acceptance of mobile working and positive feedback from patients for approach.
- New approach provides access to real-time patient information, which supports effective patient care and enables contemporaneous record-keeping.
- Gives access to Clinical Portal / Results Reporting, MS Office Suite, email, intra/internet and file servers.
- Enables essential patient equipment and medical supplies to be ordered swiftly by community staff via intranet, during patient home visits (via CEQUIP system).
- Early indications are that benefits will be delivered in patient care. Specifically, in terms of safety, responsiveness and improving efficiency (expected to be a minimum of 15% real terms increase in direct patient care).
- Efficiency savings through reductions in mileage, personnel bank and overtime costs are starting to be delivered and these are being analysed to ensure they are directly attributable to the project.
Learning
What worked well
- The inclusion of clinical staff in the design and development of the IT solution. The project has always been service led and therefore the integration into day-to-day working has the maximum benefit.
- Clinical staff led the user evaluation by assessing devices on weight, battery life, screen size, network availability and ease of use. This identified a light-weight netbook device being the prefered solution, which met all agreed criteria.
- The ‘clinical design input’ noted that staff wanted ‘safe not flashy’ technology, thus the devices chosen were relatively inexpensive and dour looking, reducing the risk of UHB staff being targeted for the technology they carry.
- Implementation support of 1-2 hours has been given to all new users to help understanding of devices, support arrangements and processes to keep users and data secure. Although resource intensive, it has been hugely appreciated and has greatly assisted user take-up.
What could have worked better
- Basic IT skills of community health staff are often low, resulting in a more elongated period than ideal for staff to gain the full value of ‘mobile working’. For example, pasting data between software programmes available to them through their netbooks.
- Network coverage ‘black-spots’.
Next Steps
Full rollout of mobile working with 435 staff equipped. Consideration will be given to extending the approach to all community services supporting the implementation of ‘Setting the Direction’.
Contact for Further Information
For any queries or further information about the project please contact Sue Morgan on 029 2055 6004 or e-mail sue.morgan22@wales.nhs.uk.
