Blogs

    • Smarter use of IT in healthcare


      Mark Pilgrim is the Vice President of EMEA at NComputing and joined the company in February 2012 to develop its reach in virtual desktop solutions in markets across EMEA. Mark has worked in customer and partner facing roles within the global technology industry for over 25 years. Prior to starting at NComputing he held a number of senior roles, including Regional Director of Sales in the UK and Ireland at Quest Software and Managing Director at Teligent Ltd.

      The UK Government recently confirmed plans for smarter use of IT in healthcare. The goal of digitising patient records is to save £5billion a year while improving the quality of patient care by making it easier for medical staff to share and access records. Tight deadlines mean new infrastructure will need to be deployed rapidly and with minimum disruption or delay.
       
      But this kind of project comes with huge risks. The NHS deals with over one million patients every 36 hours and the experience of developing and deploying the IT infrastructure to support the service has been troubled. The most recent project to create a centralised database was scrapped in 2011 after costing taxpayers over £6 billion.
       
      So the decision of the current government to focus on supporting local schemes that roll-out healthcare IT improvements in accordance with national standards seems sensible. In seeking to bring the benefits of digital medicine within tight spending budgets, this should encourage the NHS to consider how desktop virtualisation can offer a more affordable, scalable and flexible platform for enabling NHS staff to access and share patient records.
       
      Next generation virtual desktop environments are ideally suited to address these requirements. The technology allows you to re-purpose old equipment, add mobility and widen access through new low cost and low power devices. In fact, these state of the art non-PC devices are ideally suited to the sensitive clinical environments into which computing could be extended under this plan. They have a smaller form factor, thus freeing up valuable space in a ward or treatment room, and are very easy to keep clean because they have no fans to retain or disperse bacteria or dust. Add to this lower sound and heat emissions and you can envisage how they can seamlessly be part of any clinical setting.   
       
      The Government’s announcement doesn’t go into the details of what platform will be used – this is a decision that will be made at a local level. But given the scale of this project and the determination for best value for the money, it would be natural for NHS organizations to take virtual desktops and apps more seriously because of the potential capital and operational savings, and significantly better end user experience for both patients and staff.  And what is being discussed in the UK has parallels in other parts of Europe and beyond.

    • Marketing skin cancer: What method is most successful in encouraging check-ups?


      Belinda Miller, Director of Insight and Context at marketing company, Corporate Culture, explains what the best way of getting men over 50 to get checked for skin cancer is.
       
      Persuading men of a certain age to get skin cancer signs checked out is no mean feat. For many people, it’s easier to ignore the warning signs than bother the GP with a seemingly minor ailment. But research shows that men aged 50+ are particularly reluctant to come forward early, which explains why skin cancer deaths are highest among men of this age, even though more women get the disease.
       
      This is a key problem for the health sector because later-stage diagnosis of skin cancer makes it more difficult to treat people and save lives. The rewards for successfully changing these behaviours and encouraging more men aged 50+ to present early are obvious but critical: the sooner they come the more likely they are to be referred and treated successfully; and the treatment itself will be more cost-effective because it’s cheaper to treat early-stage than late-stage skin cancer - the annual cost of skin cancer is estimated at more than £100m in England alone.
       
      We have been working with Cancer Research UK and the Department of Health on cancer campaigns for many years. In all initiatives aimed at changing a specific type of behaviour, it’s important to understand who you’re targeting, what factors are behind their current activity (or lack of action) and what the motivation would be for them to change. These theories are put into practice in our ongoing work for CRUK which has proven to effectively generate awareness of the early signs of skin cancer among older men across four different cancer networks.
       
      To build the knowledge base, CRUK was keen to understand which type of approach to engaging patients was the most cost effective at driving early presentations. This meant testing three different intervention approaches, using proven collateral in a campaign covering areas of Dorset Cancer Network. In Weymouth, residents were targeted with community outreach using a roadshow vehicle which offered skin checks at key periods. In Christchurch, ‘hit squad’ street teams were deployed to meet people in their own environment and talk one-to-one. Thirdly, direct mail packs featuring a personalised letter and fold-out advice leaflet was sent to men in North Dorset. In all cases, patients were given information on skin cancer signs and a prompt to visit their GP if concerned.
       
      The results were then evaluated. Traditionally, ‘big noise’ tactics and community  interventions have been deemed the best way of changing attitudes towards making a GP appointment by many in the NHS and cancer charities alike. This time, however, direct mail was the clear winner. Not only did the mail pack have a much lower cost per engagement, and ultimately cost per referral, than the other two methods, its prompted recall was the highest of all three channels. Tellingly, it provoked significantly more presentations. The marketing campaign was considered successful, and the direct mail tactic is already being rolled out to other areas of the country, including Avon, Wiltshire and Somerset, Peninsula and Greater Manchester, where we are now evaluating the impact of targeting female influencers as opposed to men directly.
       
      The Dorset campaign is an example of how setting the wheels of behaviour change in motion can lead to quick gains for health commissioners looking to make long-term savings from sustained alterations in attitudes and understanding. By persuading more men over 50 to check themselves for possible signs of skin cancer, what may appear to be simple marketing tactics has begun to change the way in which this vulnerable age group thinks about and acts on melanoma. To facilitate this, Cancer Research UK and the BAD (British Association of Dermatologists) have also developed a skin cancer recognition toolkit for GPs which is available at www.doctors.net.uk/skincancer.

    • Behaviour change and better care through Positive Deviance


      By Jane Lewis

      Trained by “the co-creator of positive deviance (PD)”, Jerry Sternin, Jane Lewis then created and led the UK’s first organisational PD project, which delivered significant social work time savings for Hertfordshire County Council.  She also has led successful community projects with Gosport Borough Council and is working with the Home Office to test the application of PD to difficult community safety problems.

      The NHS and its partners are facing a programme of colossal change to the structure and processes with which they work. Over the coming years, much hard work will be undertaken to initiate this transformation and the success of this agenda will very much depend on the changing behaviours of the community and changing the culture, leadership styles and relationships in organisations.  Sustainable change must be delivered and the way in which this is done is critical for success.

      The Traditional approach to transformation has limitations

      Traditionally change is imposed from outside consultants, or from top-down management. In these situations, staff can resist that change, viewing it as negative and feeling they are being criticised. The outcome is often that new policies, practices and structures are not adhered to for long and frontline staff become demotivated.  

      Sustainable transformation

      To overcome this negative trend it is important to realise that the skills, capabilities and wisdom needed to address the transformation agenda, and many of the seemingly intractable problems within the NHS successfully, can be found internally. Frontline staff know the culture inside-out and many already have easy-to-implement, cost efficient and extremely effective ideas of how to reach the desired change, such as placing the patient at the heart of the process. These people, who are already addressing the problems effectively – even when faced with the same challenges as their colleagues – are known as Positive Deviants.

      Positive Deviants have a big role to play in the NHS

      Positive Deviance is an innovative, inspiring, low cost and proven way of helping frontline staff help themselves. It is a group facilitation process that requires skills rather than money. It is not a top-down or a business consultant-led approach, which often comes with a hefty price tag and is met with resistance. The ‘community’ i.e. the staff, become the process owners and look to the practices and strategies of Positive Deviants, which are then disseminated throughout the organisation using practical activities.  The ‘community’ owns the measuring and recording of the process providing positive change, reducing resistance and often creating a needed boost to morale. 

       It creates behaviour change by ‘acting your way into a new way of thinking’ and works well in complex organisations, like the NHS.  Internal hidden wisdom is unlocked and used to address change. It has the power to change relationships between patients, service users and agencies, providing greater productivity.

      Positive Deviance in action

      The VA Pittsburgh Healthcare System in the USA used PD to advance their ‘Getting to Zero MRSA Initiative’. By engaging every person in the healthcare environment, including the frontline hospital staff, from janitors to consultants, it was possible to find positive deviance practices that reduced the spread of infection by up to 62%.

      A very interesting example of PD practices comes from one particular hospital - the Albert Einstein Medical Center  - where a patient escort developed a unique method of disposing of his soiled gloves and gown. The escort worked out that by quickly sliding out of the gown, inverting it, folding it tightly and precisely stuffing it into a medical glove, he was able to compress the potential biohazard into a wad the size of a cricket ball prior to proper disposal. This eliminated the threat of the virus spreading and the technique has since been circulated throughout the hospital. 

      This change was easy, cost effective and because the change was determined by a staff member – not a top down instruction – it has resulted in lasting change. The solution to the problem was already within the hospital and using the staff’s internal wisdoms has had a huge impact.
      For more information, visit: www.woodward-lewis.co.uk

    • Redefining the island nation


      If health and social care in the UK is to make the giant leap towards a new model for integrated care, the ability to share information across the whole system will be essential. At present, the NHS comprises too many islands of information. Connecting them together is the island utopia. But getting there may first require the creation of islands of excellence as exemplars for success. Michael Thick, Vice President of healthcare technology solutions and services provider, McKesson, explores how delivering the information revolution may be less about making a giant leap, and more about taking small steps.

      The direction of travel for health and social care in the UK is misleadingly simple: we are moving towards a model of Integrated Care. But the complexities of the current model, from political, cultural and organisational perspectives, mean that the journey towards a patient-centric ‘whole system’ of care is likely to be a long and challenging one. In reality, that journey must start now. And while the end destination may seem very distant, there are progressive stops along the way that are both achievable and within reach – providing all stakeholders possess the collective will to travel together.

      The journey so far…

      The gauntlet for integrated care has already been thrown down. Just as 2011 closed with warnings of how the UK’s current model of healthcare delivery is no longer sustainable, 2012 opened in much the same way. Last December, NHS Confederation Chief Executive Mike Farrar said that the NHS needed to convince people to wave goodbye to the outdated “hospital or bust” model of care and urged health professionals to help improve the public’s understanding of the benefits of community-based health services and clinical homecare. As the new year dawned, Prime Minister David Cameron went further, issuing a directive to bring health and social care services together, and asking the NHS to make full service integration the same priority as had previously been given to waiting list targets. This same recommendation was subsequently, and indeed independently, reiterated by the King’s Fund and Nuffield Trust, whose January 2012 report Achieving integrated care for patients and populations argued that integrated care should be the decade’s “number one priority.” The publication, submitted as a joint contribution to the second phase of the NHS Future Forum’s consultation on the Health & Social Care Bill, argued that the government should create a framework designed to embed integrated care across the health and social care system – and develop a compelling narrative that places integrated care at the forefront of the hearts and minds of everyone working within the system.

      Recent announcements from the NHS Future Forum, whose latest recommendations for revisions to the Bill were published at the beginning of January, indicate that winning the hearts and minds of NHS professionals will be a critical factor in achieving meaningful change and, in turn, delivering the much-vaunted model of Integrated Care. The challenge, it would seem, is largely a cultural one.

      Information at the heart of strategy

      The ability to capture and, crucially, share information across all facets of the patient pathway is a fundamental requirement that underpins any aspiration to forge a sustainable model of integrated care. At present, the way in which information systems have become embedded into the NHS – with a wide variety of individual systems set up across primary and secondary care, as well as in palliative and social care – has led to a health service that generates islands of information. But does precious little with it.

      Historically, systems have often been built in a ‘tribal’ fashion by (and for) common NHS groups such as secondary care consultants, GPs, and PCTs. In the main, however, they have each proceeded to keep their information to themselves and have appeared unwilling to share it.

      But if, as government rhetoric suggests, we really do intend to put the patient at the centre of care, the whole model for healthcare delivery, and the informatics that support it, is going to have to change. And the cultural mindset of those who operate within the system will need to change with it.

      A new age

      The NHS Future Forum has, quite reasonably, said that the health service needs to drag itself out of the “information dark ages.” But, in an environment where good technologies that can help support information exchange are already well established, the Forum has been quick to place the onus for making that change upon the healthcare professionals that have previously resisted progress. The barriers to making the information revolution a reality, it says, are “much more cultural than they are technological.” The Forum’s recommendations call for a change in mindset within the NHS so that there is a tacit acceptance, and indeed expectation, that patients should be provided access to any information that is pertinent to their own therapeutic process.

      The responsibility for delivering a workable infrastructure for information exchange across health and social care should not, of course, be placed solely at the door of those that work within the system. Progress will require a collaborative effort – and both politicians and informatics experts will need to play a major role in driving the new environment. The government’s Information Strategy, which will finally be published this May having previously suffered delays, should help provide a framework, as well as a timetable, for change. Ahead of that, the NHS Future Forum’s recommendations reinforce the call for the universal adoption of the NHS patient number across health and social care by the end of 2013 – a challenge that should, at the very least, sharpen the pencil for mindset change and enable interoperability between systems.

      But, despite such potentially pressing obligations, the cultural battle will not be won overnight. It will be a long and arduous slog that must begin with a sustained demonstration of the benefits of developing more informed patients – and by sharing best practice examples of where success has been proven. Such examples already exist – the challenge is to generate more.

      Talking to each other: system interoperability

      Much of the technology to facilitate an information revolution within an integrated care system already exists – it simply needs joining together. The issue of interoperability of systems, identified by the Future Forum as a key requirement for progress, will be pivotal to success. The NHS must challenge the model that has allowed it to develop fragmented islands of information without ever connecting them up.

      At present, it is practically impossible to track patients as they move from one part of the NHS organisation to another and, as a consequence, the islands of information merely perpetuate. But with greater connectivity – interoperability – this dated model could quite quickly, and simply, become transformed.

      There is a growing will among more forward-thinking NHS professionals to work in partnership with technology suppliers to address the issue of interoperability. Proactive clinical providers are increasingly attempting to improve communications with their peers in primary, community and social care, and are helping to pioneer efforts to link systems in ways that can transform service delivery right across the patient pathway. In the process, they are helping to convert islands of information into islands of excellence that can act as exemplars for others to follow and, indeed, improve upon.

      Disruptive innovation

      There has been much talk in recent months of the concept of so-called ‘disruptive technologies’ – the notion that something very simple can transform the way we do things and, at the same time, make that process much more efficient. The consumer world is full of examples of disruptive technologies that were dismissed when they were first introduced but have gone on to become an essential way of life. ATMs are a perfect example.

      Healthcare, now more than ever, needs to embrace the concept of disruptive technology and explore ways in which it can move steadily towards meeting some of the ambitious objectives being thrown at it by the reform agenda. Facilitating interoperability may yet prove to be that simple solution that acts as a game-changer – but this will not happen by accident: healthcare professionals have got to want to make it happen. Other industries, notably airlines and banking, faced – and overcame – the challenge of interoperability years ago. They did so because they wanted it to work. Healthcare must develop the same appetite.

      Taking small steps

      The journey towards integrated care, supported by an ‘information revolution’ that hopes to arm patients and clinicians alike with the right information at the right time – with the patient at the centre – does not need to be viewed as a giant and hurried leap into the unknown. It is simply not possible to turn around a whole national healthcare delivery service in anything less than ten years – but it is possible to take incremental steps towards the stated destination, and along the way generate ideas and examples that may help others reduce the journey time.

      There is, of course, a danger that the government’s ambitions to impose an integrated care model and revolutionise patient access to information can, at times, be dismissed as political rhetoric. This can lead to a temptation at ground level to sit tight and wait for nothing to happen. But there seems little doubt that the UK’s current health model is no longer sustainable and that a significant overhaul of the system, and the culture, of healthcare is required to meet the demands of the modern day. Doing nothing, therefore, is not an option.

      But for healthcare professionals, the move from rhetoric to reality can be achieved by adopting some simple solutions. Changing the old world tribal systems into systems that satisfy the most appropriate ways of working doesn’t happen by brute force – that’s been attempted in the past and has failed. Instead, there are examples of disruptive technologies – small, simple applications – that allow people to review the way they work and do things differently yet more effectively. We are not going to go from the old world systems to a new way of working in one jump – but small, incremental steps, starting perhaps with a willingness to link systems together, can help the NHS make a steady journey towards integrated care. And from fragmented islands of information, build bigger and more effective islands of excellence.


    • 111: Evolution or Revolution?


      Jean Challiner, Chief Medical Officer at trusted provider of clinical decision support and content products for healthcare professionals,  Clinical Solutions, discusses the challenges of the NHS 111 service and highlights why deployment of a proven technology infrastructure is essential.

      The accelerated introduction of the NHS 111 programme, which is due for national roll out by April 2013, is provoking questions and opinions.

      So far, the main discussion points have been around the potential increase of workload for GPs, the need for more active clinical engagement with the 111 service roll out amongst clinical commissioners, and the financial implications when managing patient demands for treatment. 

      Coping with call volumes

      Success will bring its own challenges; effective marketing of the memorable ‘111’ number could lead to a rapid up-surge in call volumes that the new service will not have the capacity to handle.

      These worries seem set to be realised as the new service beds in, given the planned forecast of 16 million calls in the first year of the service. Peak periods of demand as a result of health scares or just regular winter pressures will add further strain.

      The anticipated immediate surge in calls can be managed effectively, but only if the supporting technology is designed and deployed appropriately.

      It is imperative that providers ensure they have a fully resilient 111 infrastructure from the outset. This will provide the required security they need and ensure there will be almost no circumstances that result in reduced performance. This is critical given that the success of the initial service will see it extend to its full scope, which includes all non-urgent and social care calls generating between three and 10 times anticipated call volumes.

      Business continuity and disaster recovery are also essential. Whilst the volume and the ubiquity of the service will grow and the dependency of the health services on 111 will increase, there will be no tolerance for downtime. Dedicated 24/7 managed services must be available to offer the responsiveness that is essential to support business delivery on a daily basis and during the most active periods, for example at night or during festive seasons.

      In many regions, the predecessor services are currently based on small, shared infrastructure hubs, which allow them access to the National NHS Network (N3).

      These hubs will not have the necessary resilience for NHS 111. Upgrading them will prove too expensive. If the new service is to succeed, it will have to be based on an infrastructure that has the track record of handling tens of millions of calls.

      Clinical Solutions has set up this type of infrastructure for existing 111 pilots. Although each of the pilots is quite small in its own respect, they are all running on national scale IT infrastructure that has proven its scalability over the past 10 years for the national triage service. During the 2011 festive period the technology was used by over 1,250 simultaneous users in the UK and could therefore give plenty of headroom to any of the local services.

      Tackling the cost of ownership

      One of the key challenges for NHS 111 is the cost of call handling. However, whilst call handling time is the key priority for the service providers, when it comes to the economics of 111, for commissioners (and patients) the focus is on call sorting outcomes.

      In addition to this, care providers are concerned about the associated costs of non-clinical call takers trying to deliver high quality health advice, as specified by the NHS 111 service. GPs are concerned that they will be left with an unnecessary increase in workload (and therefore costs) if inappropriate referrals are made to them or care advice given is inadequate.

      The key to removing all these challenges is to have the right delivery model with optimised clinical content, such as TeleGuide 111 from Clinical Solutions. Technology can efficiently and cost-effectively support call handlers step by step through their part of the triage process. Clinicians can then validate the outcomes or complement the encounters when needed.

      When it comes to delivery pricing, the largest risk for providers is to ensure that surge requirements are covered. Swings in call volumes can be multiplied by ten during a given year and herald large associated capital expenditures to sustain estimated peak demand. A non-onerous contract, such as one that can accommodate a price per call with no upfront investment, will enable the provider to concentrate on service introduction. For providers needing to move away from the local hubs to ensure resilience, this type of contract will also remove a serious cash hurdle if they want to deliver a successful 111 service.

      NHS 111 is an ambitious endeavour. It is creating challenges for providers around unit pricing, interoperability and patient demand management. All these technical and process hurdles can, and will, continue to be addressed one by one as the service evolves. The real revolution of NHS 111 may well be its ability to cope with the scalability requirements of the service. These scalability demands can only be managed through the deployment of a proven and adapted infrastructure, which allows providers to easily introduce and deliver a successful local NHS 111 service from the outset.
        

  • Virgin Wines
  • Virgin Wines
  • most read
  • most commented
Quick Search247 Staff Discounts
NHS Purchasing
back to top