Delivering better care for less

Financial cuts in health services have not been as drastic as elsewhere in the public sector, but healthcare providers are still feeling real pressure. They’re not taking it lying down though. Liz Holt, Director of Community Health Services for Blackpool Teaching Hospitals NHS Foundation Trust, talked to us about how the search for greater efficiency, where it counts in the community, is also helping the Trust to meet rising patient expectations of service.

“Over the past five years the biggest changes that I’ve experienced are around the funding of services,” says Liz Holt. “We’ve now got to try to provide the same with less money. We need to be more productive, and that’s a big challenge.”

“The other big challenge is public expectation of our services. This has changed quite considerably over the past five to ten years. Patients are expecting more responsive services, just as we all do with any service we access. I expect to be able to access my bank any time during the evening. Or if I want to buy anything, I expect to be able to speak to somebody. In the NHS it’s now similar. Patients do expect to be able to access services. So we are looking at evenings, weekends and just making services more accessible for people.”

“We also have to recognise that patients are also better informed than they were. Many patients have access to the internet. Most people now have a mobile phone or smartphone. We all expect to be able to get information we need at the touch of a button. This does put more pressure on our service. In short, we need to make sure that we’re able to respond quicker and with better information than we had previously.”

One of the ways Blackpool is responding is by using mobile technology to drastically reduce the paper-based administration that community-based nurses have to do. This reduces the time they have to spend travelling backwards and forwards to offices, giving them more time to care for patients in their homes. Significantly, Holt says that the technology they are using – deployed on tablet – is also improving the quality of service the nurses are able to provide when they are interacting with the patients at the point of care.

“Our district nurses have been equipped with tablet devices that are always connected to our back office records,” she says. “From the patient’s point of view the member of staff turns up to their house, they have all the clinical records they need there with them. It makes a big impression. And if the patient needs something ordering then they can do it there while they are with them. The patient knows that it’s been done, we don’t have to get back to them to just confirm, and we are usually able to say when the equipment or whatever it happens to be is going to be delivered.”

Whilst these benefits are being realised today, Holt says this is just the start of a brighter future for the overall patient experience. “We’re in the very early stages, but so far even though we can really see what benefits this kind of approach to improving front line service is going to bring,” she says.

“Planning ahead, we’re also gathering information whilst we’re seeing patients, using an app on the mobile devices to gather that information and measuring it against patient care indicators.”

Like Blackpool and a lot of other NHS organisations, Bromley Healthcare uses mobile technology to enable its staff to spend less time doing admin and much more time looking after patients. In particular Bromley is making great use of telecare – the remote monitoring of patients in their home. “We have patients who tell us that the telecare we provide has saved their lives on several occasions,” says Jonathan Lewis, the CEO for Bromley Healthcare.

Lewis also believes there are a range of other new ways that Bromley can improve service for patients that go beyond technology. This, he says, is being enabled and driven by Bromley’s status as a social enterprise.

“Becoming a social enterprise has put us into a competitive environment for the first time,” says Lewis. This, adds Lewis, has put an enormous focus on improving the quality of services that Bromley provides. “First and foremost we’re always trying to improve services to create better patient outcomes, but we also have this new reality that if we don’t offer the best services we will simply go out of business.”

“There are various structural processes we can put in place to deliver higher quality patient care, but the most fundamental driver of that is a new culture,” says Lewis. “So we work a lot on giving everyone sensible targets and then holding them to account for it,” he adds. “The NHS has been poor at holding people to account for poor performance. This is one of the main cultural journeys we’ve had to go through: to show our people that targets are targets and that we’re extremely serious about hitting them.”

Results suggest that the approach is paying real dividends, with measurable improvements results and service. “In the last 18 months, we have run a leg ulcer pilot that has reduced healing rates from 21 weeks to 5 and increased our productivity by 15%, to cite just one example,” says Lewis.

Significantly, Lewis says that the approach is also achieving very high levels of satisfaction from both patients and staff. “We’re a brand new organisation with new ideas, but it’s a measure of how our staff are engaged that less than 2% think we will fail,” he says “More importantly we’ve taken over services and taken their performance from bottom to top quartile in a matter of months. Our new approach, driven by a new service culture, is definitely working, In fact the scope to improve what we do is really only limited by what we can imagine and implement.”

Your next move

How is your service stacking up in the face of budget reforms?

Is there room for improvement in the experience you deliver to citizens from the contact centre to the front line?

Do you have a blueprint for customer satisfaction that will stand up in a brave new world of social media and multi-channel integration?

Could you partner with other organisations or find other innovative ways to share resources and deliver serves more flexibly?