There are significant opportunities to improve productivity by bringing to bear the tools widely used in other sectors for improved resource management to plan staff rosters, patient flow, and match capacity to demand.
Tracking and management of staff time through e-rostering solutions can be used to ensure that the workforce is employed where it is needed most, enabling quality and efficiency improvements. Well implemented systems can avoid under or over-staffing, reduce the reliance on locum or agency staff, and provide less stressful working patterns. E-rostering solutions should be used to match skills in the workforce with patient need, and deploy resources flexibly. This means that they should not simply constitute electronic versions of paper rosters, but should be used as a tool to redesign workforce deployment. When linked to clinical record systems, e-rostering can incorporate task management and allocate clinical tasks to staff in real time. Active support for mobile working can also reap significant productivity gains. Remote access to records, via tablets and other mobile devices, can transform the way that staff in the community can deliver care. Instead of having to travel to a base twice a day to pick up and return heavy notes, a case list can be downloaded at home. Apps can include CDSS and in-built protocols, facilitating efficient care which is compliant with best practice; as well as working in both online and offline mode to facilitate mobile working.
We should be tracking all materials… tracking the time of our procedures and automating our scheduling… The more analysis we have on that… the more clinicians can make efficient decisions which will then improve their productivity.
— Joel Haspel, GE Healthcare Finnamore
MIA Maternity (Isosec and Imperial College Healthcare NHS Trust, UK)
MIA Maternity is an app designed for community midwifes, introduced by Imperial College Healthcare NHS Trust (ICHT) in 2015. It enables midwifes to enter all data directly into an iPad, which automatically syncs with the hospital database. Instead of having to travel to the hospital at the start of each day, the midwife can download a case-list from home and the app will suggest an order of cases based on geographical location. The app works in offline and online mode; when online it will push and pull data from the central hospital server, ensuring all patient information is up-to-date and available to other members of the maternity team. MIA Maternity has improved patient care, with quicker data entry leading to more time spent on patient contact, improved continuity and handover as all team members have up-to-date notes readily available and compliance with best-practice guidelines aided by prompts and in-built protocols. In addition to improved staff satisfaction the app also has direct cost-savings: saving 5 hours per midwife per week, equivalent to £500,000 across a department of 50 midwives — an ROI of around 6 months.
United Hospital, US
Centralized patient-flow systems have saved United Hospital US$5 million annually through reduced expenditure and fewer income penalties arising from the A&E department being on divert. The initiative centralized the management of patient flow within the hospital with the support of an electronic flow system and integrated with the main hospital electronic record system. The combined system enables staff throughout the hospital to see and update real-time patient status information and location. By having a comprehensive, real-time view of the location, need and treatment of every patient in the hospital, not one from hours earlier, staff can more rapidly and effectively resolve blockages or care needs. At the back end of the system data-mining capabilities enable workflow and capacity usage to be improved over time, driving further savings.
In the US, patient tracking systems are being used to track not just the status of rooms, equipment, patients and waiting times but the location of all the people managing care via a “command center”. This approach was advocated by a number of those we interviewed. Ultimately, they argued, this line of sight should go across the system and include GPs, ambulance and community services. Involving end-users in developing patient flow software is essential to ensure it meets clinical and administrative needs and is easy to use.1 Some providers have encountered significant resistance to what can be perceived as ‘big brother healthcare’, but by being flexible to staff input about how systems work, concerns have been overcome in some providers.
“Bring your own device”: A number of organizations have found that giving ward nurses a mobile device such as a tablet or mobile phone and allowing them to take it home, customize it and use it for personal tasks has ensured higher uptake of the technology. Not only this, but they found that nurses were checking their rounds on the way to work and familiarizing themselves with the handover notes.
Capacity to work offline: In moving to mobile working, benefits can be gained from applications that can work offline, enabling mobile workers to carry out tasks where Wi-Fi is not available — and to upload their notes to the clinical system once a signal is restored.
We’ve found [wearable person to-person communicators] to be particularly beneficial. In ward situations the average time for a nurse to find another nurse has gone from 3 minutes to 20 seconds, and that’s saved huge amounts of time multiplied out across the wards where it’s been implemented.
— Richard Ashby,Metro South, Australia
1Poulos CJ, Gazibarich BM, Eagar K. (2007) Supporting work practices, improving patient flow and monitoring performance using a clinical information management system.Aust Health Rev. Apr;31 Suppl 1: S79–85