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Paper-light approach will support better patient care

Published 07 October 2014

Julia Ball, assistant director of nursing at University Hospitals of Leicester NHS Trust, explains how less paper and closer working with clinicians to implement IT can improve patient outcomes


With one million patients every 36 hours and continual pressure from national targets, are NHS staff given enough support to deliver high quality patient care?

During 2013/14, University Hospitals of Leicester NHS Trust (UHL) treated 1,194,000 patients (or 3,271 patients per day). With the volume of patients set to rise year-on-year, we need to better equip our staff to cope with the additional pressures that will bring.

Like many other trusts, our staff are feeling the pressure of the NHS constantly being in the media spotlight. The media focus for many trusts is too often on poor outcomes. It is almost forgotten that the vast majority of hard working staff provide excellent world-class patient care.

15 months ago, our chief executive, John Adler, took on the challenge of boosting morale. He recognised that in order to achieve our strategy to become 'paper-light' and with government targets to consider, we needed to listen to our staff on the frontline. The overwhelming feedback has been frustration about the amount time spent on paperwork and the subsequent impact on patient care. Staff want less paper and more technology to support them in their roles.

So we have set out to use mobile technology to change the working lives of our frontline staff. This approach, along with our 'paper-light' vision has been accelerated by applying and winning investment from NHS England's Nursing Technology Fund for mobile devices, such as iPads and iPhones for staff use, as well as the Nervecentre mobile application software, designed to record patients' vital signs. One of the biggest challenges facing staff in the NHS is effective and efficient recording of observations as well as handover at the end of shifts. This is particularly prevalent during out of hours where ensuring consistency and continuity is often more challenging.

Our initial project, to deploy Nervecentre's electronic observations, handover and Hospital at Night solutions has already seen a number of key benefits but the mobile aspect of our new solution is absolutely crucial. Nurses can now carry out routine observations using a handheld device, with that data being instantly available to all staff responsible for that patient's care. The key benefit is targeted messaging to services and clinicians who can use that information to identify deteriorating patients.

Nurses no longer have to spend hours chasing updates by phone. As a result staff are more visible to their patients, spending more time at their bedside. Our staff feel content as they are able to better use their skills for caring and our patients are happier as they feel they are getting a better service.

What has made UHL's approach so successful is the involvement of our staff. Clinical engagement is imperative when implementing a major change to working practice. We achieved this by selecting five 'pioneering wards', to work closely with our project team to provide suggestions and feedback in how best to use the software for their needs. You can never underestimate how good it makes people feel to be involved in projects that are going to make a fundamental difference to providing care.

Our staff had tried to make the best of our existing workflow, working around any difficulties rather than instigating change. By acting upon their feedback and demonstrating our commitment to them, we have an incredibly powerful message - we have listened and have acted. That simple change in culture to focus on better support for our staff, has helped us boost morale and as a result has had a positive impact on patient outcomes.

By focusing on getting the implementation right within the pioneering wards, we anticipated the roll out across other areas of the hospital would be very rapid. Staff from these wards are 'champions' for the new system. Nursing and medical teams on some wards are 'buddying up' with our champions to draw on their knowledge and experience of deploying a new system whilst they themselves go through the implementation.

This is a very powerful way of working which has produced strong advocacy for the new system. We have also been proactive in our formal internal communications activities and together the results have been staggering - the number of system users is continually increasing in frequency and I have found consultants and nurses knocking on my door asking when they are going to get the software.

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