Enabling Change in the NHS

Improving processes and adding value at Gloucestershire Hospitals NHS Foundation Trust


Ian Quinnell, Associate Director for Programme Management and Service Improvement, Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) gave a very interesting presentation at the Triaster Event 'Enabling Change in the Public Sector' held in February. What was covered is set out below.


Ian started by talking about the need for improvement in the NHS being widely recognised:

  • Increased demand for all services, limited resources
  • An increase in chronic diseases projected; with over the next 20 years those with diabetes and strokes projected to rise by over 30% and coronary heart disease by 50%
  • Expected to deliver savings of £20bn by 2015

The next 5 years are going to be extremely challenging for the NHS...
NHS England, 2014

And then focused in on some of the additional challenges being faced by Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT):

  • One of the largest hospital trusts in the UK, providing care for 612,000 people
  • A growing population: in 10 years the Trust will need to provide care for 850,000 people
  • Split over two sites, 9 miles apart: Cheltenham General and Gloucestershire Royal, often duplicating services and sometimes delivering them very differently
  • An aging population - Gloucestershire has had a greater than national average rise in those aged over 65 years, a trend that is projected to continue

As with every other trust, GHNHSFT has a Cost Improvement Plan (CIP) in place, setting out plans to reduce costs and deliver improvements. These cover a combination of initiatives and projects such as savings through procurement, improving Patient Pathways and working collaboratively with other trusts, such as Bristol, Hereford and Swindon.

However with all the quick and easy wins already achieved...it is now the time for transformation.

Harnessing the benefits of IT to improve the quality of care

Two years ago, GHNHSFT began looking at its healthcare technology. The NHS has a varied track record for successful delivery of new IT systems, so GHNHSFT approached this cautiously, with clinical leadership. However as their patient administration system (PAS) was at least 20 years old, nearing the end of its support life, and increasingly, struggling to serve current and future health information needs, it needed to be replaced to enable the implementation of a new vision for healthcare technology at GHNHSFT.

The change will be the biggest organisational change undertaken by the Trust.

Recognising that for the implementation of the new system to be a success, they would need to be absolutely clear about what they needed it to deliver, so started with the question, 'what do we actually do now?'

Going to 'hands on' operational staff - from Porters to Intensive Care - they captured the Trust's administrative processes in Rapid Improvement Events (RIEs). These events weren't new to the staff (they are an initiative of NHS Improving Quality); what was new was the information captured at the RIEs and what was done with it.

Engaging with operational staff in this way has several benefits:

  • Operational staff really understand the processes that they deliver on a daily basis
  • They often have ideas on how things could be done better and are really delighted to have a mechanism to share them
  • They are engaged in the process and therefore bought into the project

261 key processes were mapped in Microsoft Visio and signed off by the operational manager who owned the process.

The person/group responsible and the system currently used were captured - as this information was a primary requirement of the project - but couldn't be searched or easily retrieved in order to be used effectively. Also the process maps were large, difficult to follow and didn't show the end-to-end process. They couldn't easily be shared, lacked version control and supporting documentation. The information needed to be easy 'to get at' and all in one place.

So they looked at Triaster...

Useful, Usable, Used

The Triaster Solution delivers an intranet-based online gateway to GHNHSFT's Process Library. Currently the navigation is via the four clinical Divisions, the Estates and Facilities Division, or Corporate Division, and then by the sub-structure for each area.

It can be easily searched and the process maps can be understood and followed. Ownership, Responsibility and Systems are clearly shown, giving transparency in respect of the Trust's processes for the first time. Links to supporting information have been added and are easy to follow, enabling the Library to be an effective one-stop shop.

Ian explained that the contract for SmartCare had been signed the week of his presentation. Over the next two years this will deliver to the Trust:

  • A fully integrated clinical system
  • Patient centric electronic records
  • Provision of electronic order communications and prescribing
  • Real time data entry providing up to date information

The implementation will be driven by the Trust's processes, rather than the processes being driven by the new IT system, as so often happens. In addition all of the SmartCare training materials will be accessible from the Process Library, which will be used to support the implementation of SmartCare, (to the extent that the Trust is working with their supplier to try to hyperlink to the relevant Triaster process from within the clinical system).

The Process Library as a Trust-wide central source of information will be a massive cultural change for the NHS organisation; a slow and steady roll out is therefore planned as follows:

  • Highlighting the benefits delivered by the Process Library in the IT roll out
  • Introducing the Process Library as the source of accurate, up to date information
  • Introducing the Process Library as a key component of a model implementation and improvement

The next step will be to model improvement opportunities both within the Trust and the wider health community. The Trust interfaces with a lot of other organisations and there are significant opportunities to both do things better and save costs by looking at these interfaces.

Triaster look forward to supporting GHNHSFT as they move forward with these projects.


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