I’ve been fortunate to spend time with a variety of healthcare professionals. During this time, I feel I’ve gained a valuable insight into the inner workings of a number of NHS providers. One of the first things I realised is that despite offering the same or similar services, providers often differ in their organisational setup and delivery. As such, insights gained from one trust may not be applicable for another. And so we must be careful when making sweeping statements about the challenges and requirements of all NHS providers. Notwithstanding, I feel that my recent meetings with two mental health trusts revealed several challenges other providers can relate to.
Mental health trusts
Mental health trusts in England are under huge constraints to ensure that people get access to the care or services they need, when they need it. Patient demand and expectations continue to grow, while resources and budgets have failed to keep pace. For mental health trusts to deliver appropriate patient care, when it is needed, the onus is on ensuring time is spent making clinical decisions. This means minimising costly and time-consuming administrative work within assessment teams. Mental health trusts are on the receiving end of large referral volumes 7 days a week, with virtually no respite. The challenge for assessment teams is to quickly identify patient need, record information and ensure the patient receives an appropriate outcome. Although clinical decision making takes place throughout this process, it is the final step that should demand the most attention. Assessment teams have a finite amount of time in which to make clinical decisions, and all too often this is constrained by referral volume, referral quality and also referral clarity. Assessment teams will receive referrals from a range of sources including GPs, partner agencies and police. This wide range of referral sources makes it incredibly difficult to implement referral templates, or establish a standard referral procedure. For example, it is not uncommon for mental health assessment teams to receive referrals via email, e-fax, or through several different file types. In addition referrals will frequently contain several attachments, requiring staff to sift through and extract vital information. My experience from spending time with two assessment teams is that they have become experts in dealing with this range of referrals and requests. That is to say, they’ve found a way to make it work, while ensuring patient safety is upheld. In these two examples spreadsheets formed a central role, as I’m sure they do elsewhere. Multiple spreadsheets, designed to log and track patient information throughout the referral journey. There are clear risks with this approach. With no formal workflow embedded in a system it is the responsibility of users to remember to follow correct procedure. While I was with the assessment team it was clear they understood exactly how their processes worked. They remained vigilant at all times, performing extra checks to ensure no referrals have slipped through, and no appointment missed. While the existing team were adept at following these procedures, it represents a significant challenge when key staff are off work. Recruitment represents a significant challenge in most sectors, and healthcare providers are no exception. The challenge is twofold; getting the right people in and, getting them up to speed quickly. The second challenge is magnified when there is no standard internal procedures, or when multiple systems are required to perform the role. A higher level of training, or hand-holding is required, to talk new staff through various quirks of the system. And while in the long run this investment of time is important, in the short term it detracts from that all-important function; making clinical decisions.
What’s the process for improvement?
I look at this kind of process, and think why can’t it be simpler? Well the short answer is it can – but it requires a bit of work. When investing precious time and resources into a new system you want to ensure that they are being used to develop something that solves some of your organisation’s biggest challenges. Not simply adding another system or process to understand – furthering the complexity. So, how do you achieve this? It starts with an open discussion that enables us as a software company to fully understand your current ways of working and why you work in a certain way. We can’t solve your challenges unless we understand them completely. This is one of the areas we pride ourselves on at psHEALTH. We know our customers, and we commit into an ongoing partnership. We also know healthcare, and through discussions like I’ve described here, we’ve developed our credibility as trusted advisors and partners of a number of healthcare providers.