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Lean methodologies that have revolutionised manufacturing are achieving impressive results in hospitals. Many healthcare managers are using the principles, systems and tools of Lean to stretch limited resources, improve the quality of patient care and safety, eliminate errors, reduce waste, cut delays and reduce the length of patient stays.
Lean provides, perhaps, the best opportunity to achieve gold standards of healthcare- offering a proven route to better care, better quality and lower costs- and succeeding where a raft of political initiatives have failed to make their mark.
Some people argue that healthcare is a totally different environment to industry and that Lean cannot be transported successfully to a patient focused environment. But a factory and a hospital actually have more in common than is first apparent. Both environments run complex processes where the scope for errors, quality problems, poor communication, waste and the failure to put the customer first is colossal.
Why Lean Healthcare?
There are huge advantages to using Lean in healthcare because it determines a new culture and system of checks and improvements- providing a sustainable methodology to continuously improve services. The NHS has a long history of trying to improve services against aggressive goals, but it lacks a sustainable methodology to achieve those goals and avoid the need to constantly set new ones. Everything that happens in healthcare – procedures, appointments, bills – is a process. The challenge is to improve and continuously do it better time and time again.
Lean healthcare involves a radical rethinking of working procedures in hospitals and elsewhere and a long-term commitment by management at the highest levels.
In hospital operational areas (wards, theatres, diagnostic departments, outpatients, etc) lean can achieve many tangible benefits, including reducing patient waiting times and faster preparation of operating rooms. It enables an organisation to discover the reasons for poor quality, for poor delivery, for poor management.
Whatever the challenge, the truly lean organisation can harness the ideas of its people to deliver even better care, and world class performance- freeing up clinician time to spend more time with patients, indeed to -End Waiting, Change Lives.
Lean implementation and principles
When our lean practitioners go into any organisation they identify all of the process inputs to work out where value is being added for the patient and where it’s not. This is similar to a medical diagnostic process where the symptoms are identified to understand the current condition and issues. Next step is to work with the relevant team to develop solutions for eliminating all the non-value added steps within the process. The aim is to cut out those factors that are a waste of time, money or resources. In a healthcare setting, it needs to be totally focused on putting patients first.
Good Lean practice is not based on finding quick, temporary solutions, but instead concentrates on how the work is done and how to eliminate the root causes of delays and other impediments to flow. It is easy to blame human error, but in the healthcare sector humans have to work within often highly complex systems, and it is usually the systems themselves that are the cause.
Five key steps to Lean can be applied to healthcare and these are:
1. Specify value in the eyes of the customer
Patients expect to receive the best care and service that can be provided, free of errors. This means identifying best practice in every step of the patient journey, both information and physical flow, and then rigorously applying gold standard work. This could mean always labelling samples at the bedside, applying care bundles rigorously, or eliminating opportunity for transcription errors by using IT effectively.
2. Identify the value stream
It is useful to start at the end of the process and follow the activity right back to the beginning. This is because the process of discharge often holds up the whole healthcare system, whether this is blocked beds, or follow up appointment processes.
3. Make value flow
No manufacturer would ever run every asset in the value chain at 100%. Customers would never contract to use all the capacity of every supplier, as they know this would guarantee failure the moment there is a small change in demand. But hospitals often run their wards at 100% occupancy. To enable patients to flow safely, there has to be unused capacity. This is actually more economic because the hidden waste in dealing with the errors, cancelled appointments, initiative lists, missed targets and lost activity is eliminated. This means turning the traditional accounting on its head, and focusing on giving value to the patients rather than on measuring activity and cost.
4. so the customer can pull.
When a service is capable, adequate and available, with good flow, it is possible to move to a system that is pulled by patient demand, rather than pushed onto the patient. The possibilities of this are very exciting: No need for outpatient appointments and waiting list procedures, just turn up at a convenient time.
5. Continuously improve in pursuit of perfection
Visual management is essential to show what has been achieved and how to improve. This ensures patients can easily see what has been done to make their service better. The Lean organisation will challenge every team to have a daily review, and write on the wall what the staff will do to make tomorrow even better than today.
The difficulties or challenges encountered in achieving each of these steps will vary from institution to institution depending on the inherent work culture and conditions but every step is essential and must be addressed if improvements are to be gained and sustained.
The Manufacturing Institute has partnered blue-chip enterprises, healthcare and public sector organisations in the UK and Europe over the last 15 years and has helped all these different sectors to understand their individual needs. Their more recent work with more than 15 NHS Trusts is helping to transform the care given by hospitals such as Stockport NHS Foundation Trust; Blackpool Fylde and Wyre NHS Foundation Trust ; Southport and Ormskirk Hospital NHS Trust; West Middlesex University Hospital NHS Trust and Royal Devon and Exeter NHS Foundation Trust. More information about these Lean initiatives and others can be found at www.manufacturinginstitute.co.uk/Healthcare
Groupcall is a leading provider of communication and data solutions to the education, public and private sectors. Stuart Abrahams, Groupcall business development director, discusses the positive impact regular communication between a school and a parent can have on a child’s education. He explores how a parental communication system, such as Groupcall Messenger, can assist Local Authorities (LAs) and its schools to achieve this.
The UK education system has undergone a major overhaul in a bid to streamline learning and help equip young people with the skills and knowledge required for a positive future. The Government has identified that parental engagement plays a significant role in achieving this and has consequently implemented recommendations for schools to adhere to in order to fully involve parents in their child’s education. An example of this is Manchester City Council, which has recently chosen to install Groupcall Messenger, a parental communication system which is proven to enhance parental engagement and improve attendance, in all of its 167 schools.
The deadline for parental reporting in UK schools is fast approaching. It is becoming increasingly accepted that parents who are actively engaged and involved with their child’s academic life, can have a positive influence on academic performance. The ultimate objective of parental reporting is to encourage parents and teachers to work in conjunction to support a child’s education and learning. If a child feels their parent is interested in their learning and general school life then they are more likely to strive to excel.
One aspect of what schools are required to offer to their parents is online reporting, which is being introduced to increase the level of information parents have access to, therefore boosting parental engagement. Those schools yet to provide online reporting will have an obligation to do so by 2010 and 2012 for secondary and primary schools respectively. A plethora of frequently updated information regarding a learner’s school information, such as attendance, behaviour, assessment, home work assignments and class work schedules is consequently made available. Improving the level of communication and the accessibility of educational information enables the school-parent relationship to become more meaningful.
With the parental engagement targets implemented, LAs should acknowledge these too to ensure that the relevant facilities and services are in place to help support its schools to achieve these.
Utilising parental communication systems
With an automated parental communications system, such as Groupcall Messenger, which is currently used in more than 2,000 schools across the UK and Europe, making contact with parents becomes simpler. Rather than being a time-consuming manual process which requires dedicated staff members and consumes staff resources and time, contact is quick, efficient and cost-effective. Via Messenger schools can inform parents of key information from the ‘Reporting to Parents’ guidelines including attendance, behaviour, progress, attainment and Special Needs. This improves parental engagement and means that schools need not rely on parents logging onto the school’s system to access student information.
For schools whose service procurement is influenced or managed by the LA, the council will want to support its schools in implementing the best solution; helping to ensure cost-effective and far-reaching efficiencies. LAs will be keen to support schools in successfully achieving parental engagement targets as this can positively affect the overall reputation of the council, for example, it is beneficial for councils to be recognised for having high attendance rates and first-rate exam results.
An effective parental communication system is able to directly inform parents quickly about incidents such as a child’s unauthorised absence via text or voice messages, this enables early intervention. Issues surrounding an absence can be identified and addressed in the early stages rather than being allowed to escalate and potentially become a more serious situation.
A solution with many benefits
Councils should bear in mind cost effective ways of sourcing and implementing an efficent parental communication solution in their authority. Manchester City Council has chosen to install its parental communication system due to its ability to enhance parental relationships and improve attendance. By centrally securing a parental communication system on behalf of all of its schools, the authority has benefited from bulk cost savings compared to schools procuring a system individually.
Manchester City Council’s MIS support manager, Vince Slatford, summarised: -As the support manager for school’s ICT, it is always a challenge to find new and intuitive ways of assisting schools in raising their performance levels. One of the many projects we are currently working on is to improve the attendance levels at each school and therefore that of Manchester as a whole. We were aware of a limited number of schools using various applications to text parents/carers in relation to first day calling. This seemed to be a cost effective and time saving method of engaging parents at an early stage to discover the whereabouts of each child.
-Since then we have realised that Messenger can do so much more than just track and improve attendance and it has enabled us now to focus on the Parental Engagement strategy for the 2010/2012 agenda. Schools can send various forms of messages out to parents/carers relating to simple queries such as forgotten PE kits to school closures due to bad weather etc.
-Communication leads to community
Communication is such a simple basic human skill, yet can truly be such a large factor of academic success. As society become increasingly technologically advanced, it is vital that we exploit and embrace the ICT available to us in order to maximise the education provided to learners of tomorrow. Good communication is a two-way process and therefore should include both parents and the school. An effective parental communication system has the power to improve communication and provide huge scope for cost-savings. Manchester can demonstrate to other LAs the scope of what a parental communication system can achieve, and how via procuring a system to be applied on an LA-wide basis; LAs can gain best value, whilst also standardising quality for their schools.
VENDOR-NEUTRAL consultancies offering low-risk fee structures may be the compromise between long-term sustainability and the need for immediate savings in the NHS- de Poel.
The announcement from the number-one procurer of temporary agency labour, who manage the supply of temporary workers for more than 50 clients across the UK, comes in response to government plans to cut public spending by £12bn by being more efficient.
Unlike other management consultancies, de Poel says that vendor-neutral consultancies with low-risk fee structures can help manage NHS processes but with the added value of impartiality and without any initial outlay.
This is a compromise between arguments for long-term strategies to improve NHS services in the future, and the need for immediate cut-backs highlighted by the Chancellor Alistair Darling this week.
Chief Executive of de Poel, Matthew Sanders, said: -The argument against NHS outsourcing focuses primarily on how expensive management consultancies are, but this isn’t always the case.
-Our client-base for example, which includes charitable organisations with very limited spend, are only charged a percentage on the money they save. There is no initial outlay, and if they don’t make any savings, they don’t pay a penny.
He added: -Though there may be some things which the NHS can manage internally, there are others- such as the supply of temporary agency labour, likely to increase with a slashed workforce – which the NHS has neither the capacity nor the expertise to manage in-house.
-Unmanaged, the use of temporary agency labour poses huge legal, financial and qualitative risks to the NHS, as it remains one of the largest unregulated industries in Britain.
In his speech in central London which unveiled plans to reduce public spending, Prime Minister Gordon Brown also made reference to the value of technological advances in improving efficiency and bringing down cost.
Mr Sanders agreed, saying that the increase in organisational efficiency acknowledged by every single one of his clients in the most part came down to use of de Poel’s electronic timesheet and invoice-processing system.
COST-SAVINGS, increased human resources support and reduced bureaucracy, have been recognised by the NHS as positive results of outsourcing recruitment processes. A new scheme launched by NHS Employers is one of several offering organisations the chance to save millions of pounds by taking on some of their recruitment hassles and CRB checks, freeing up money, time and resources for other things.
A similar service, offered by the largest purchaser of temporary labour de Poel, is already proving effective for care and social housing organisations in the third and private sectors, saving as much as 12% a year on their temporary labour spend.
As well as reducing costs and administrative time through use of an innovative, online timesheet and invoice processing system, organisations such as Mears and Avante Partnership are enjoying better access to critical management information, improved quality suppliers and outsourced management of incoming legislation.
Chief Executive of de Poel, Matthew Sanders, said: -This is great news for all involved. The fact that the NHS are finally recognising the value of recruitment outsourcing means that organisations such as ourselves might finally get the chance to share procurement best practice with the public sector.
-Our relationship with some of the biggest care organisations, as well as the top procurement professionals within the retail sector, has equipped us with the capacity to help the NHS and the public sector generally, where they need it most.”
Director of NHS Employers, Sian Thomas, echoed some of these views. She was reported in the Health Service Journal as having said: -We [the NHS] need to learn lessons from other sectors, and embrace technology.
-People haven’t had the money to go out and make the massive investment in support functions. It’s difficult for small departments.”
In line with these observations, de Poel has developed a fee structure where there is no charge unless they find direct cost savings on organisations’ contingent workforce costs.
One of the UK’s most prominent stop smoking campaigners has joined Knowsley Health & Wellbeing to head up its work in helping locals to kick their smoking habit.
Christine Owens has been at the vanguard of smoking cessation for more than 16 years, having previously worked for the Roy Castle Lung Cancer Foundation. During her 10-years at the charity she was instrumental in setting up the North West Stop Smoking Services which has collectively helped more than 371,000 people quit smoking to date.
The well-known campaigner also played a critical role in lobbying for the introduction of the smokefree legislation in 2007 which banned smoking in all enclosed public spaces and workplaces.
She joins Knowsley Health & Wellbeing as programme manager for Tobacco Control, where she will lead work to reduce smoking prevalence. Knowsley Health and Wellbeing is already recognised as a national leader in stop smoking services across the UK, with more adult smokers quitting per head of population than anywhere else in the North West.
Christine, who is married with four children and lives in Runcorn, grew up in Halewood. She said: -I’m delighted to join Knowsley Health & Wellbeing. I grew up in the area and so I’m keen to use my knowledge and focus my efforts into supporting local people quit smoking. It’s still vitally important that we get the message out there that the single most important thing people can do to improve their health is to quit smoking.
Dr Diana Forrest, Director of Public Health for Knowsley said: -We are very privileged to have Christine on board. She brings such a wealth of knowledge and energy to the team, and is someone who has already made an incredible contribution to helping people live longer and healthier lives. We are looking forward to working with her to implement innovative initiatives which will further help Knowsley smokers to be free of the habit.
Food producers and suppliers are today offered the chance to capitalise on the growing local food goldmine following publication of a new feasibility study. The study, produced by Bidwells Agribusiness on behalf of the South East Food Group Partnership, establishes the growing demand for regional food at both a consumer and buyer level, and the difficulties that impact on suppliers and customers undertaking more business together.
According to Bidwells’ research, two in three London consumers currently buys or would like to buy more local food. The report also concludes that there is not currently enough supply of local beef, lamb, fish, fruit and vegetables to satisfy demand, implying there are significant opportunities available to the region’s suppliers and producers, with similar scenarios likely in other UK conurbations.
Valuing the London demand at £9.3 billion annually, the Bidwells study suggests a number of ways in which producers and suppliers could capitalise on the growing consumer appetite for local food and regional food. The report also demonstrates how this might then stimulate more long-term support for the British food sector.
The report makes two main recommendations.
1. The development of a food hub to support the food sector in the regions around London (South East and East of England)
The hub should incorporate a virtual business to business e-marketplace to enable producers, suppliers, buyers and retailers to engage more directly, and at the same time provide a platform for promoting food to consumers, helping stimulate the long-term demand for local and regional food where it counts
The study reveals how nearly all food buyers and retailers surveyed want greater links to producers, easier sourcing, less hassle, and a one stop shop. Having a strong and (interactive) relationship with the producer is essential, but being able to undertake administrative transactions across a range of purchases in one place is of equal importance. The study outlines how the development of a hub is critical to link up this disjointed market place.
2. The development of 10 – 20 street markets across the Greater London area
These markets would act as local food beacons at key locations across Greater London, enabling markets to play a greater role in providing fresh regional food at local levels
Both recommendations illustrate how it is possible for Britain’s food sector to put in place the necessary infrastructure to foster greater market access through the supply chain as well as outlining a viable and attractive proposition to consumers. In the current climate, this is not an opportunity to be missed.
Richard Walters, head of food marketing at Bidwells, said: -The shift away from organic has increased the focus on regional and local food, and people now want to know their food is the freshest it can be and know where it comes from. In addition, the challenge of the recession means that people want to support their local community as best they can, from buying local food, to sustaining local shops.
Henriette Reinders, managing director for South East Food Group Ltd commented: -The report gives us a detailed analysis of the demand for local regional food in the capital. This will assist us in focusing our efforts linking suppliers in our region with the buyers in the capital. It also strengthens our work with regards the wholesale market, New Covent Garden Market, where we try to improve the take-up of regional produce as well as the initiatives we undertake with the fishing industry to get more local species into the UK supply chain. It is a key priority for us now to realise the virtual hub idea and work with street markets to offer more regional food.
Walters concluded: -Our research demonstrates the sheer scale of the opportunity available to producers and suppliers in the South East and, by implication, across the whole of the UK. Having explored the challenges, Bidwells is now on hand to help regional food businesses – producers, suppliers, buyers and retailers – start capitalising on them.
-Bidwells has a unique understanding of the UK local and regional food market which can help organisations – such as the South East Food Group Partnership – and local businesses prosper in these challenging times.
For a copy of the full report and the next steps, visit
www.southeastenglandfoodanddrink.co.uk/londonfoodhub
How the UK manages its medical data has been the subject of heated debate recently, and the more solutions that are suggested, the more tangled the issue seems to become. In the last few months Christine Connelly’s NHS National Programme for IT has turned out to be an idealised and unrealistic project, and the Digital Britain Report has recommended a Government cloud computing approach to share information.
Google Health and Microsoft HealthVault have been suggested as custodians of public health data, and questions of individual privacy have been raised. Local solutions for Government IT have been argued for, and at the same time the NHS is about to face a freeze on spending and its -biggest financial crisis ever”.
In the midst of this chaos citizen’s attitudes to the role of the NHS and their medical records are changing. Historically, patients have been seen as the subjects of the data, rather than the owners. Now hundreds of start-ups are developing online tools to let citizens manage their own health information, and websites like HealthDataRights.org allow people to sign up to assert their rights to their own health data. Patients have become more discerning about the doctors they choose to see, and often search for information online to do for themselves what institutions cannot.
What is lacking here is a clear and definitive system to store and share information, not just between medical staff but also the citizen. None of the suggested options to date have presented a suitable solution. The age-old question is trust; who can we trust with our medical data? Who ultimately should be its custodian? There has been some opposition to a commercial body like Google or Microsoft that may have ulterior motives for the data, and if the citizen alone is the custodian, how can that data be properly monitored by the national health system? The NHS is the biggest employer in the UK, so why then should it not become the heart of data capture?
We need to find a system where data is effectively managed, safely stored, shared and immediately available to those who need it. If the Government could develop an information policy which demanded a -pool of data”, readily accessible to both the citizen and public bodies via secure intranets, the citizen could be assured the necessary restrictions were in place to protect and control access to their personal details. This vision is one of the federated identity model, where ultimately the citizen is made custodian of his/her information. The rules governing that information sit in a -brokering” architecture, allowing the citizen to establish the -rules” (policies) by which his/her data could be accessed.
A simple analogy is the way a Facebook account works, where the account owner is the decider of who can see which parts of their profile. The implicit theme here is that the network operates on a trust model (for example, you may share lots of information with someone you trust a lot like a family member, less with a work colleague and nothing with a stranger). With this approach the NHS would work like a knowledge bank with a safe deposit box, where you have a key, they have a key, but you need both to open it.
In years gone by trust in the NHS would not have been a question, as the Government dictated how information was to be managed and controlled. In a democracy, we tend to go through cycles of complete Government control which fail due to resistance to a heavy handed approach, versus a more relaxed and consultative approach which fails due to lack of control and direction.
The Government tends to swing between the two, when actually a combination of both is what is needed. What we need is a policy that is strong enough to take a firm line on what needs to be done, and realistic enough to take into consideration the needs and concerns of a variety of groups. Whatever we decide now will shape our public health system for the next few decades, so it is imperative that we take hold of that and get it right.
Paul Wooding, UK Head of Public Sector, NetApp
A substantial number of children in the UK still do not have a computer at home, and a third of families lack access to the internet. That is a real challenge for policy makers, local authorities, our education system and UK plc, as we look to prepare our next generation as they move into the workplace or continue their learning.
In January, Becta will launch the Home Access programme across England. This ground breaking government programme will change the lives of many families and increase the number of homes with access to a computer and the internet.
Home Access will initially target children in years 3 to 9 and provide funding to over 270,000 households by March 2011. Not only will it benefit children and potentially increase attainment levels in schools, but also support the regeneration of local areas and contribute to the re-skilling of parents. We know that digital connection means social inclusion and Home Access represents a huge step forward for many children and families.
Technology is undeniably a key part of everyday life, and local authorities can play a pivotal role in championing the Home Access programme.
Pilot
Earlier this year Becta, the Government agency leading the use of technology to advance education, concluded a pilot programme in Oldham and Suffolk Local Authorities. The pilot exceeded all expectations and awarded over 12,000 grants to families – over 90% of the eligible population within the two authorities.
This resounding success puts us in a great position as we launch nationally. There is a strong demand from parents for access to a computer at home, and findings from the pilot show that children are spending more time each week using ICT for learning.
Evidence tells us that access to technology can increase attainment and contribute towards improved GCSE results. This can have a major impact on future career prospects.
But it is not just in the classroom where there are benefits. The pilot also revealed increased engagement by parents and carers using ICT access at home to support their own learning and employability. An educated workforce is more loyal and productive, and is of benefit to a region. Now all eyes are on January when this programme rolls out nationally.
How it works
Once live, families who meet the eligibility criteria, such as receiving free school meals or certain other benefits, will be able to apply for a grant to purchase a Home Access package. Our appointed Grant Administration Service Provider (Capita) are taking care of assessing applications and issuing grants. Becta has also approved a range of suppliers where grants (in the form of a restricted use Barclaycard) can be redeemed at participating outlets.
The Home Access package itself is unique and available to any family, not just grant recipients, to buy from approved suppliers either online, over the phone or in local stores. With one year’s service and support, pre-set parental controls, anti-virus, and a suite of assistive technology software as standard; the Home Access package benefits the whole family.
The package has been developed to make it as easy as possible for families to get online and realise the benefits that technology can bring. Using technology is essential for many jobs and we have seen a number of instances where ICT has helped parents with their learning and secure employment.
We want local authorities to champion the programme. It can help up-skill parents and address unemployment in your area.
Looking forward to 2010
It is an incredibly exciting time as we count down the days until launch. Through this programme, we will support children and their families to ensure they receive the educational and social benefits that technology can bring.
Further information about the Home Access programme can be found at www.becta.org.uk/homeaccess
The recent announcement that CCTV images can now be used as evidence in the issuing of parking fines is of consequence to every local authority. Colin Forrest, Mail Creation Product Manager, Pitney Bowes discusses the extra burden that this ‘remote enforcement’ will place on councils.
From March 31st 2008 councils across England were empowered to use CCTV camera images to enforce parking fines. Prior to this ruling, parking tickets were only valid if placed on the vehicle or handed to the driver in person. The new regulations stipulate that CCTV cameras can be used only in areas where it is too -difficult or sensitive for an attendant to operate, such as a fast-flowing road or a busy junction. Now, fines can be issued through the post up to 14 days after the alleged offence occurred.
This new ruling continues to generate a great deal of comment across the media. Many pundits and consumer rights groups question the real motive behind the legislation, asking whether such it simply gives the green light to councils to up the hit-rate of tickets awarded and to spend the resulting profits to pay for wider services. In fact, under the new rules, Councils will no longer be able to set targets for revenues from parking or for the number of tickets awarded. Commentators also questioned the fairness of a system that enables tickets to be issued after the event, identifying blue-badge holding motorists as particularly vulnerable to this ‘fine now, deal with the circumstances later’ approach.
To date, any opinion on this new legislation has focused on the impact on the citizen. But what of the demands placed on Local Authorities? Are Councils equipped to efficiently cope?
A look at recent parking ticket figures serves to underline the extent of the extra logistical burden now placed on Council departments. According to the RAC, of Britain’s 25m cars, just 1m are on the move and 24m are parked at any time. Across England and Wales, the number of parking tickets handed out to motorists is approaching 8m annually – equivalent to one for every three cars. In the capital, the number of penalty notices has jumped by 45% in four years to 5.9m.
Of course, not every ticket issued will be via CCTV, and not every ticket will require posting. But if only a small percentage of this volume is made up of fines despatched through the post this still represents a significant volume of mail that local authorities were not previously having to process.
The new parking legislation comes at a time when local authorities are already under enormous pressure to become more transparent, to make services more accessible and to comply with e-government directives. The challenge is to reduce existing spend whilst simultaneously improving the level of service and accessibility to the citizen.
Traditionally, local councils have been regarded as less than proficient at communicating with citizens. Whilst this may be changing, there is no doubt that, in many cases, existing practices are out-dated and still over-reliant on manual processes. If the additional influx of parking fine post is not factored in, Council departments could quickly find themselves unable to handle the volume surge.
Local authorities must be certain that any communications concerning parking fines are totally accurate and despatched on time and to the right person. Data security is one of the hot media topics of the moment and any business or public sector department failing in its data protection duty faces headlines that are big, bold and damning. Arguably, these headlines will echo longer for public sector bodies.
The answer is to evaluate current messaging practices and to gain a full understanding of how available technology can improve mail and messaging processes. Today’s hardware and software solutions can eliminate the risk of error from mail processing and can introduce unforeseen efficiencies to everyday functions.
The entire messaging cycle can be automated. Technology is available to fold and insert documents into envelopes – an otherwise laborious process. Envelopes can then be processed via digital meters which automatically weigh each mailpiece and add the correct postage amount to each item.
Local Government is under enormous pressure to cut unnecessary costs, to become more transparent in its operation, and to communicate more effectively with citizens. Introducing more efficient mail processes will go a long way to addressing each of these challenges.
There is no one-size fits all solution. Different authorities will have different needs – indeed, the earlier figure highlighting the number of fines issued in the capital compared to the rest of the country exemplifies this point. However, mail automation will result in communications that are accurate (controlled via barcodes to ensure 100% integrity), professionally presented and cost-efficient.
Cynical observers have suggested that the introduction of ‘remote’ fines is simply a way for local authorities to boost the war-chest. But the legislation makes clear that parking fine revenue targets are no longer acceptable. Indeed, for many authorities, the opposite is true – delivering fines through the post represents a burden. However, it may also be the necessary trigger to revamp existing communication techniques and to reap the long-term benefits of a more streamlined, automated approach.
Organisations of all sizes are being affected by rising costs and constrained budgets. While some commentators are seeing potential for recovery on the horizon, most businesses are still battening down the hatches and looking to make cost savings where they can.
With energy prices likely to rise and the government asserting greater pressure on the public and private sector to reduce carbon emissions with the CRC Energy Efficiency Scheme, one issue that is set to take centre stage on the business agenda is power management. But where in the business can financial executives look to make immediate savings and long-term improvements? One key area is IT.
IT is one of the biggest consumers of electricity within a business and unless policies are in place to reduce use, this is one area that could see a steady increase in consumption. The resource needed to power and deliver on demand services and rich web and multimedia applications is increasing, as are the capabilities required to store and manage the burgeoning amount of data that is being created. The use of personal computers within most organisations is widespread to provide access to services that employees, customers and partners have come to expect.
However, the always-on culture that is emerging has little regard for the consequences on cost and carbon emissions in accessing those services. Powering desktop computers that are on all the time when you have hundreds, if not thousands, of machines has serious cost and carbon implications. The average desktop uses 111 Watts of power when active according to the EnergyStar and US Environmental Protection Agency figures, with monitors responsible for 60% of the energy consumed. So what can be done to combat the energy efficiency challenge of IT deployment?
IT breaks down into two main areas: the servers, storage and networking equipment that makes up the back-end infrastructure, and the desktop estate that individuals use every day. The back-end data centre is already being targeted by IT for energy savings: technologies such as virtualisation and blade servers are being used to reduce the number of physical machines required to support the business, as well as cutting the amount of power consumed in the delivery of applications. Advances in server design and cooling systems are also helping organisations to reduce the amount of power that is used.
On the desktop side, technology exists that can control and automate the powering down of large numbers of machines when not in use or at specific times of the day. This is an area where simple steps can really make a big difference to energy bills and emission counts, however most companies do not have a desktop power management strategy in place. This could be down to some pre-conceptions around desktop power management that have to be overcome.
According to a world-wide survey carried out by Dimensional Research, the biggest inhibitors to deploying desktop power management are the IT department requiring late-night access to machines for security patching and updates to be applied (43 percent). The second largest reason was users not wanting their machines to be turned off without their knowledge (34 percent). Other reasons that were given included the potential impact on productivity from end-users, lack of awareness of solutions and the fact that savings were not represented in the IT budget so there was no impetus to do anything proactive.
One approach that can reduce power usage at the desktop level is to put a policy in place for users to turn off their machines in the evening when they leave the office. This can encourage power saving activities within the workplace, but unfortunately it means that there is no real way to measure what savings (if any) are being generated.
From a technology perspective, solutions are available that can reduce energy spending while also making sure that policies are followed. The use of Wake-on-LAN, as well as the ability to schedule patching and updates to be applied remotely, means that one of the largest objections to desktop power management from the IT department can be discounted. IT can also work with user groups to install new work practices and agree that all files should be saved and closed before staff depart for the evening. This change management strategy can also help to educate users on the reasons behind the new policy, getting their buy-in and making the change more likely to stick. It can also tie into other facilities management approaches aimed at saving power.
The amount of power that a desktop uses may seem small compared to the overall energy consumption of a data centre, but the sheer number of desktops that can be involved means that any investment in desktop power management can create significant savings for the company, on top of any carbon reduction results.
The NHS Borders cover a large rural area in Southern Scotland. The Trust is centred on Borders General Hospital, Roxburghshire, which employs over 1,000 people and serves as a community hospital for the central Borders, with a catchment of some 100,000 residents.
It acts as a secondary referral and teaching hospital within a network of rural Community Hospitals and General Practice (GP) surgeries completing a geographically dispersed, healthcare infrastructure. In the last year NHS Borders saw over 20,000 inpatient episodes and treated nearly 7,000 patients. Borders General Hospital and the Community Hospitals maintain as much as 94% bed occupancy.
In Partnership with Scottish Borders Council, Public Governance Committee and the Clinical Governance Committee, NHS Borders is committed to patient safety and patient experience, providing regular and timely reporting. Such reporting is now an expectation of the Scottish Government given the development of Local Delivery Plans, and so demands continuous monitoring of performance as a key element in identifying risks affecting Health Service delivery to the people of the Borders region.
Operational and patient data therefore forms a crucial element in the daily running of the trust and in the ongoing process of review.
The challenge
NHS Borders faced the dual issue of working with legacy systems on a scattered network with poor options for disaster recovery. Isla Forsyth, Systems Engineer, NHS Borders explained that, -There are over 20 General Practices scattered across the region, each with a small server on site which were using VERITAS Backup Exec but these backups where continually failing.
To further complicate matters, each GP server had its own tape drive, with the GPs sending in a tape once per month to bring data onto another server. However NHS Borders would experience constant tape and tape drive failure, therefore requiring Systems Team support almost daily. As most sites had three or four servers, there was always tape drives needing replaced.
Using infrastructure that operated with individual tape drives on each server was, -Quite horrible”, admits Forsyth. NHS Borders therefore sought to remove the tapes and create a central place for backup.
The Solution
Iain Allan, Systems Team Leader and his team began comparing the latest versions of VERITAS Net Backup, IBM Tivoli and, through reseller Capito, were introduced to CommVault’s Simpana Suite. Finding CommVault easier to use and implement, NHS Borders immediately adopted the Simpana product to manage critical backup and recovery. Despite the amount of legacy equipment, CommVault’s engineers rapidly addressed what few issues arose during deployment and established the current management protocols for centralised backup.
Today NHS Borders operates two NAS boxes, -Fondly known as Wee NAS, and Big NAS,” laughs Forsyth. The NAS boxes currently handle a terabyte and six terabytes of data respectively, backing up to tape. The usual demand from GPs is to backup to the NAS with one major file per week on this system, with data saved for three weeks before being overwritten. The Systems Team conduct incremental backups daily through the working week, with a full backup taking place each Friday.
Now, all data backup is held on a centralised tape drive, with a single daily report provided by CommVault to monitor the status of backups across the entire NHS Borders network. -We feel better knowing we now have a centralised copy,” continued Forsyth. -It has made management of what was a complex enterprise backup job much simpler.”
The Systems Team still checks the system every day, but with centralised management and reporting now available it has become a simple process of advising GP practices on the rare occasion of a backup not working. The GPs now know that the engineers are controlling the backup process, meaning their time is left to focus on patient care.
Recovery & restores are usually needed once a week. This is usually the result of an accidental file delete by users, but again is no longer a major issue, as files can be recovered in a matter of minutes. -This makes my job so much easier, because now everyone knows that they can get the support,” said Forsyth. Restores are also much quicker and, as a result, there is a new level confidence in the system.
NHS Borders’ primary focus has been on solving the long term issues of a scattered IT storage infrastructure and the backup and recovery issues that it created. With this now solved, the team is looking forward to identify the opportunities from using the unified data management tool for additional tasks. -Deduplication is definitely high on the agenda,” concluded Forsyth. -That will cut down on so much of our data storage and we know CommVault is ready and able to help with any of our system issues.”
www.nhsborders.org.uk/
www.commvault.com
Nottingham County Council (NCC) has made the decision to substantially increase its investment in online learning from SkillSoft, a leading provider of on demand e-learning and performance support solutions, in order to deliver more training to a wider range of employees, but at less cost than traditional classroom training.
In all, Nottinghamshire County Council has purchased up to 30 courses from SkillSoft with the potential for up to 1,000 users to access each one. Brian Fairchild, NCC service manager learning and development, says that old-style teaching on such an extensive scale would, -not be an option given the current economic climate. Yet he believes that providing SkillSoft e-learning courses will more than maintain the quality of training while extending its reach across the organisation.
Kevin Young, SkillSoft general manager EMEA, reports increased interest from public sector bodies as they investigate ways to maintain training momentum despite the threat of government budget cuts. -This situation is becoming a catalyst for change; giving councils the opportunity to re-assess the way they deliver training and discover that e-learning has matured and is now a viable alternative.
Fairchild explains that previously, only Nottinghamshire County Council’s IT department used SkillSoft e-learning to deliver training for ECDL (European Computer Driving Licence) accreditation. The council had also developed its own online course in-house and the new service from SkillSoft enables the council to build on this success.
-We wanted a programme that covered three different areas, he says. -First, we needed a wide range of general business and personal development courses that we didn’t have to design and build ourselves. Then, we wanted software with an authoring tool so that we could create our own tailored courses. And, finally, we needed to deliver higher level training combined with our own management resources such as HR guides, currently held on a dedicated intranet site.
-We put this all in one tender, but hadn’t imagined that one company would be able to do it all and had envisaged dividing it up among several suppliers. However, we were delighted when SkillSoft demonstrated that they could, in fact, cover our entire brief themselves.
SkillSoft is currently implementing the software with the aim of going live next month. Fairchild is looking forward to a streamlined system with all e-learning courses across the council delivered via a centralised SkillPort interface. -This alone will make delivery of courses far more efficient and manageable, he says.
He says that e-learning will also help the council’s risk plan. -For example, we are at the moment planning strategy in case of a flu pandemic. Recently we had to cancel training sessions because tutors were ill. What with having to re-schedule everyone’s diaries it turned out to be a time-consuming and, therefore costly exercise. Of course, with e-learning this isn’t a problem – and even if an employee is ill, they can easily go back and catch up without involving anyone else.
Background
Newham University Hospital NHS Trust is an Acute Hospital Trust based at Newham General Hospital (Plaistow), with some outpatient services located at the Shrewsbury Health (Forest Gate) and the Appleby (Canning Town) Centres.
The hospital primarily serves Newham’s 240,000+ population but also provides services to the residents of Redbridge, Waltham Forest, Barking & Havering, City & Hackney and Tower Hamlets. Its mission is to ensure a secure future for the local provision of high quality, value-for-money health services to the people of Newham and surrounding areas.
The challenge
In early 2008, the Trust found itself struggling to cope with the volume of patient records requiring processing. In some cases the total turnaround time for drafting approved patient notes was weeks – sometimes even months. The result was that medical secretaries were being distracted from important patient work by hours spent transcribing reports.
Newham’s goal was to become a leading Trust with improved services for patients, and it was therefore seen as essential to implement an electronic storage system for patient records. This was particularly relevant after substantial investment in the Trust led to more patients and a corresponding increase in volumes of paperwork.
Medical secretaries were using tape-based or direct dictation from consultants to record patient notes, and were accustomed to these methods. When the Trust deployed a digital dictation system, the adjustment to the new way of receiving electronic notes proved challenging, and the Trust therefore decided to outsource transcription to free up secretaries’ time for important patient work.
A UK-based supplier was selected initially, but the Trust was disappointed with the service and therefore sought a more efficient and cost effective solution.
The solution
The procurement department selected Dictate IT, the specialist provider of digital dictation, speech recognition and outsourced transcription services.
Mark Miller, Managing Director of Dictate IT said: -We analysed Newham’s specific requirements and tailored a solution to suit the Trust’s needs. Our system automatically assigns dictation to speech recognition, depending on the type of text and the turnaround time required, so high priority records are processed first. This was a key feature in this contract win.
Dictate IT outsourced transcription services were fully integrated into the Trust’s existing operating system, which allowed Newham to work with a single contractor rather than having to engage separate outsourcing companies.
Sheila Catt, Manager of Medical Secretaries at the Trust commented: -Dictate IT offers a very straightforward process whereby consultants’ recorded notes are electronically sent to Bangalore, India. We have seen a significant reduction in the turnaround time of dictation tasks – in some cases from weeks to hours.
With the help of Dictate’s unique Dictation system functionality, the Trust is now able to store and access electronic patient records in the form of transcribed documents. By outsourcing dictation, using the latest digital technology and devices, Newham has achieved top quality recordings. Dictate IT’s Outsource Solution (DIOS) has offered the Trust both direct and indirect advantages:
Improved working practices – DIOS has fuelled the drive towards better working practices and improved efficiency among administration teams – the Trust has seen significant savings on secretarial time.
Speed and accuracy – reports are now transcribed, proofed and error checked in 24 hours with 98. 5 percent accuracy guarantee.
Dictation is sent immediately with no threat of delays from staff availability or lost tapes and the documents are readily available for review.
Cost reductions – the procurement department has seen significant cost reductions as DIOS is less expensive to run compared to analogue tape dictation methods. The service has cut reliance on agency staff, paying for overtime, stationery costs and eradicates backlogs.
Integration capabilities have harmonised with hospital patient systems, databases and Cerner Millennium electronic patient record system.
Clinicians’ working practices have stayed the same with minimal training required. Also, Efficient the service has been utilised as a first step to reviewing benefits of other technologies including other digital dictation solutions, workflow management and voice recognition.
Pradip Karanjit, Head of Access and Capacity at Newham commented: -Although we still print and store hard copies of clinic letters in patient records, electronic access of clinic letters through Dictate IT’s has simplified the process of accessing information as and when needed.
The system enables consultants to dictate there and then allowing secretaries to action immediately, which has helped reduce our turn around time. The Trust aims to move away gradually from paper notes and eventually aim towards the electronic records that will help improve access to our services.
Results
Having used the services for over a year now, secretaries at Newham now report that they have more time to focus on other significant tasks. Improvements have led to the Trust receiving the award for Most Improved Hospital in the Caspe Healthcare Knowledge Systems (CHKS) Top Hospitals Awards in 2008. Newham gained the award based on achievements made by reducing waiting times and improving access, reducing mortality and infection rates and the quality of data produced. The Trust was able to reduce its expected deficit by almost half, down from £4.1million to £2.3 million in 2008 – a considerable achievement and one which has been made alongside a number of improvements to the patient experience.
Sheila Catt said: -The initial negative perception surrounding outsourcing was proved wrong as soon as the staff realised the benefits of being able to focus on other important jobs, leading to increased efficiency. We haven’t lost a single employee as a direct consequence of outsourcing and the error rates are minimal.
With pertinent, up-to-date, confidential patient information converted to a written text document, the Trust has been able to achieve high standards of patient satisfaction.
Diabesity – the increase in obesity-led type-2 diabetes- is demanding ever greater resources from health services globally. Whilst the NHS objective is to increase the management of such conditions in the community, the serious complications associated with diabetes result in numerous hospital admissions and out-patient appointments, whilst also reducing patients’ quality of life.
Many clinicians agree that greater patient empowerment is essential to improve weight and glucose management, yet individuals typically have little or no interaction with carers between appointments. While the NHS is reported to have pulled back from the use of patient portals, a forthcoming pilot of a diabetes-specific portal that provides patients with access to clinical records, trusted information and the ability to track weight and glucose measures against targets, looks set to prove the value of improving day to day patient/clinician interaction, argues Mike Paylor, Business Development Manager, Hicom.
Diabesity Epidemic
The rapid increase in the prevalence of obesity, type-2 diabetes and associated complications (diabesity) is a major global health problem. In Europe alone, approximately 33 million adults will be suffering from diabetes by 2010, and obesity, which is a major recognised risk factor for type-2 diabetes, is itself rapidly increasing in prevalence resulting in a diabesity epidemic.
According to the latest figures, about half the adults in England and Wales are overweight. About one quarter is obese. The number of obese people in England and Wales has nearly trebled since 1980.
The current cost of type-2 diabetes in the European Union is 15 billion Euros per year, and medical complications arising from diabetes account for up to 8% of total health costs in Europe.
This fast escalating cost is putting enormous pressure on the NHS at a time when budget cuts and Darzi-led efficiency drives are taking centre stage. Indeed, NHS organisations will be expected to make -very substantial efficiency savings- around £2.3 billion – in 2010-2011, when the health service’s three year settlement comes to an end.
And diabetes services are already struggling. According to an audit commissioned by the NHS Information Centre in 2007/8, 60% of patients with diabetes in England are not receiving the recommended level of care – just 40% of patients said they received all of the nine care processes as recommended by current NICE guidance.
Primary Focus
Yet it is the consistent delivery of these nine care processes that is essential to controlling the escalating costs associated with diabesity by minimising the incidents of complications such as heart disease, eye problems, gum disease, kidney disease, circulatory problems and neuropathy. It is also key to ensure that those obese individuals without diagnosed diabetes (potentially 500,000 according to Diabetes UK) are made aware of the potential signs since early diagnosis can reduce the risk of complications and improve long term quality of life.
Indeed, an estimated half of all diabetics suffer from neuropathy which manifests as numbness or pain in the hands, feet, arms or legs – although neuropathies can also affect the organs resulting in admissions to hospital or regular outpatient appointments.
And while the NHS strategy is to reduce hospital admissions and increase management of chronic conditions such as diabetes within the community, many Primary Care Trusts (PCTs) are still struggling to achieve this objective.
A growing number of clinicians now believe that patients need far more support and engagement in managing their own conditions. Diabetes is a constantly evolving condition that requires day-to-day management to assess the dangers of complications; patients need support in ensuring glucose levels are maintained and weight reduction goals reached and they need trusted information to support understanding of diabetes, its complications and associated treatments.
Patient Engagement
Yet programmes for greater patient interaction, including expansion of the NHS Healthspace Personal Health Record project, is now reported to have been shelved. And the current raft of alternative patient portal solutions are no more than online tools that enable patients to track their own weight and glucose measures; or GP based solutions to help patients manage appointments and view their own health records with no means of uploading clinical content. As such, none of these systems provide timely interaction with clinicians and, hence, leave patients to locate their own online information via search engines – much of which is of dubious clinical value.
Other patient-focused alternatives include private sector monitoring solutions, using contact centres staffed with nurses to triage diabetes patients based on readings delivered via the mobile phone. But these solutions are incredibly expensive – and increasingly unaffordable – and also fail to build upon any relationship with the key care providers within the NHS.
Improvements in proactive management of the growing diabetic population can only be achieved by delivering continuous patient interaction. A truly interactive patient portal would provide the ongoing carer/patient relationship that is essential in managing these chronic conditions.
Combining a sub-set of the information available to consultants and GPs, including history of admission, treatment records, side effects and blood test results, with excellent, trusted information about diabetes, a portal delivers true patient empowerment. At the same time, the patient can upload onto the portal information about weight and glucose levels, mapping results against pre-agreed targets thus enabling ongoing engagement with clinicians.
Add in diary management and appointment reminders, and the ability to provide feedback to clinicians on the quality of service received, the patient has a single source of information that should enable improved management and control of the condition and ability to highlight potential danger signs that could indicate complications.
Conclusion
The global providers of healthcare are still struggling to reverse the diabesity trend, with weight management and pharmaceutical regimes, to date, having minimal impact. And with the NHS taking a step back from patient portal developments, the focus is now on the commercial sector to prove the value of these systems to empower patients and improve both long and short term outcomes.
What is now required are joint pilots between the NHS and specialist software vendors that can demonstrate the clinical and financial value associated with improved patient empowerment. These pilots would go a long way to reinforcing the growing perception among clinicians that effective, proactive management of diabesity is key to enabling more patients to successfully control their diabetes within the primary care services, reducing the cost and pressure on the NHS Trusts.
ESRI (UK) has just launched the latest version of CrimeAnalyst, a complete Geographic Information System (GIS) analysis software package for policing and crime prevention. Developed with direct feedback from users, CrimeAnalyst 2.0 enables analysts to manage the increasing demands placed upon them by automating routine tasks and providing new powerful tools that allow them to conduct more in-depth analysis.
The latest release builds on the strong track record of CrimeAnalyst which is now used by police, public safety and national security organisations across the UK and in 16 other countries. Studies have shown that CrimeAnalyst saves users an average of up to five hours a week freeing time to conduct more in-depth analysis which informs decision making and resource planning.
Daran Scarlett, Industry marketing manager for ESRI (UK), comments:
-Analysts are being called upon to inform critical decision making in an expanding range of areas such as crime and disorder, contingency planning and counter terrorism. In a climate where additional resourcing is unlikely, meeting these demands on their time and resources is a major challenge. CrimeAnalyst 2.0 has been developed to provide users with more of the time and the tools they need to achieve their goals and targets.”
Saving time and increasing consistency
New for this release, CrimeAnalyst 2.0 now automates routine tasks by allowing analytical models to be easily created, saved and shared with colleagues to save time, reduce workloads and ensure consistency. These models can be scheduled to run at set times, ensuring assessments are delivered as and when required to those who need them, increasing their value operationally.
Understanding when as well as where
CrimeAnalyst already allows police forces to visualise crimes and incidents by time of day and day of week. CrimeAnalyst 2.0 takes this one step further with a new Seasonal Analysis capability, which enables users to visualise how patterns of crime change throughout the year or from one season to another. For example, this can be important for better understanding crime patterns within University towns that experience seasonal fluctuations in population, or to help inform road traffic policing strategies, drawing on seasonal weather data.
More insight into repeat patterns
Also new to CrimeAnalyst 2.0 is a feature which clearly communicates the extent of a particular crime occurring at the same location, for example a building continually being used for drug dealing. By clearly indicating and numbering the extent of repetition, this enables police resources to be concentrated where they will have most effect.
Exploit third party data and software
CrimeAnalyst 2.0 runs on ESRI’s ArcGIS platform which provides users with the ability to consume many commercial datasets which add value to their analysis, such as census information, 3D landscape and aerial imagery, including seamless free access to Microsoft Bing Maps base mapping. Users can also link to and exploit the functionality within other analytical packages, such as i2’s Analyst Notebook and SPSS data mining software.
For decades, the focus in healthcare business intelligence has been on acute hospitals, almost to the exclusion of all other sectors. Even when other areas began to acquire systems, the tendency was to start with primary care, and then commissioners, and leave mental healthcare as something of an afterthought.
What has caused that to change has been the move towards Foundation Trust status. Over half of all Mental Health Trusts have now achieved foundation status, putting them on a par with their counterparts in the acute sector. As Foundation Trusts enjoy increased autonomy they face a requirement for improved management and more robust financial control, which in turn poses a significant and unique challenge to Mental Health Trusts.
So what are the specific obstacles faced, and what role can business intelligence play in helping to not only meet mandatory mental health reporting requirements, but also to transform healthcare delivery?
Bridging the geographical divide
Mental Health Trusts can operate over hundreds of sites across large geographical areas, and across multiple local authorities and PCTs. A large proportion of the work carried out by Mental Health hospitals takes place on neither an inpatient nor an outpatient basis, but through community contacts.
All of which poses a challenge in ensuring unified and accessible clinical records – multiple case notes at different sites can make it difficult for health and social care teams, clinicians and managers to share patient data effectively to deliver the best possible care.
The deployment of electronic patient record systems will improve accessibility, but challenges remain, both in developing more flexible systems which can be adapted to the needs of the clinicians who use them, and also in educating clinicians on these new systems and the way in which data needs to be recorded.
The approach we have taken at North East London is to deploy a single data warehouse from Ardentia, to ensure the information silos that can all too easily exist within the distributed geography of mental health are broken down. A web-based approach also means data can be shared more easily. Improving access to data in this way will not only improve care delivery, and meet management reporting requirements, but is also a fundamental building block to transforming healthcare delivery, giving clinicians the ability to lead, in line with the recommendations of the Darzi review.
Business intelligence for business processes
Foundation status requires Trusts to function on a robust and clear business footing. Greater autonomy brings with it the need for more far-reaching management decisions, based on reliable evidence and giving clear understanding of the issues that need to be addressed.
There is also a requirement for far more detailed financial reporting, a mandated requirement from Monitor, which oversees Foundation Trust applications, regulates performance and requires the development of service line reporting to meet these financial requirements.
The challenge for senior clinicians is to understand the financial and management issues related to the care being delivered, in order to ensure more robust management. They need accurate information on resources used, quality of care and financial performance, and to access this, they need powerful business intelligence solutions.
Dealing with complex patient pathways
Many patients with mental health have long-standing and complex needs. Unlike acute physical care – where clear-cut pathways determine the intervention needed – the challenge in mental health is to bring the relevant services together at the right time, according to patient need, ensuring the appropriate care bundles are delivered.
Within the treatment of a single patient for a single condition, there may be moments when the patient moves from one bundle of care to another. This would be the case, for example, when the patient is being treated for a sub-psychotic condition but goes through a psychotic episode in the course of treatment. This all impacts on resource usage and the costs involved.
Mental health trusts therefore require good quality data on multiple patient episodes and need to reason in terms of real pathways of care, in order to develop comprehensive reports and develop the right care package. Business intelligence systems must be able to bring together and link data from many different systems, to build pathways that identify community contacts, therapy sessions, outpatient attendances and so on into coherent pathways, to be analysed as a package.
Bringing it all together
That kind of complex care then needs to be married with financial data drawn from our accounting systems so that we can provide service line reporting and meet the management requirements set out by Monitor.
Looking at the financial implications and management issues associated with the care delivered in this way also does something else that is profoundly important: just as it brings together data about the healthcare activity we carry out, the inpatient stays, outpatient attendances and community contacts we deliver, with data from our accounts, so it brings together clinicians who provide the care with the finance managers who are answerable for the performance of the Trust.
Bringing together clinicians and managers to break down information barriers and meet the unique data challenges within mental health will not happen overnight, but in doing so, will generate unprecedented improvements in patient care.
Creating the clinical leaders of the future
The Department of Health, guided by the recommendations of the Darzi review, is committed to bringing senior clinicians and consultants to the very heart of decision-making. To do so requires clinicians to have an understanding of the wider financial and management issues, and the resulting challenge for Trusts is to provide the necessary data. This is where business intelligence is crucial, bringing together information on care delivered, outcomes and the financial costs attached.
North East London Foundation Trust is working closely with Ardentia to ensure we have good quality service line reporting which provides the data we need on cost, activity and outcome. As a result, for the first time, clinicians will get a more comprehensive understanding of the care delivered, empowering them to make more meaningful decisions, and to work more closely with commissioners to shape future healthcare delivery.
Give senior clinicians the data they need, and you give them the capacity to lead, to function in a business manner as proposed in the Darzi review, and as a result to transform care delivery and meet the needs of those who need it.
www.nelft.nhs.uk
www.ardentia.co.uk
A six-month project to barcode the mechanical and electrical components of every bridge, road underpass, pedestrian subway and tunnel in the City of Westminster has just been launched. Multi-disciplined service provider FM Conway, working on behalf of the council, is currently in the process of attaching the 20,000 barcodes, similar to those found on food packaging, to thousands of components.
When scanned by handheld computers, the barcodes allow the client, contractors, maintenance staff and independent inspectors to access a database of information about the maintenance record of that component, including pictures and repair logs.
The more well known structures that will have the barcodes include The Strand/Kingsway underpass and The Piccadilly Underpass, as well as Waterloo Bridge and the Golden Jubilee Footbridge.
David Yeoell, Assistant City Commissioner of Transportation at Westminster City Council, commented: -The benefits of this pioneering work will be significant. Maintenance will be focused to exact locations and problem sites analysed.
-The efficiency of the work and resources will be improved, particularly as the information is electronic and easily accessible. The information can also be used when looking at lifecycle costs and funding requirements.
The handheld scanners are an innovation that enhances the existing BridgeStation advanced asset management system, designed specifically by the London Bridges Engineering Group (LOBEG) to help with the management of bridges and other major highway structures.
Leading the work for Dartford-based FM Conway are Stuart Wilson, Service Delivery Manager, Bridges and Structures, and Bernard Hodgkinson, Director of Bridges and Structures.
Bernard commented: -This work builds on existing processes to regularly check and maintain important structures.
-The technology to house databases of information has been available for a while but this is the first time that barcodes will be applied to the components of structures so that information is fed back into the BridgeStation database.
The project to barcode components will take a team of five people until April 2010 to complete.
Melanie Teal, Chief Executive of The Consortium, the UK’s largest independent provider of school supplies, with over 30,000 products from school stationery to school furniture, looks at how resource budgets can be consolidated and money can be saved how this can benefit the whole school or college.
Schools and colleges are hard pushed and budgets are already squeezed. Whether it’s rising fuel and lighting costs bringing in unexpected costs or declining parental contributions and donations driven by the recession, many external factors are affecting how schools can stretch their often limited resources budget.
Melanie Teal explains: -Making sure you get value for money is one way of stretching any budget and has increasingly become an important priority for all those involved in ensuring schools and colleges have the right essential supplies to help deliver a high quality education. But when you are in a sector where purchasing expertise isn’t a natural requirement of the job it can quickly turn into a headache as you weigh up the pitfalls and benefits of different suppliers.” From Melanie’s experience she can recommend two approaches to any education leader looking to get the best value from its resource budget.
1. Consolidate. In recent years there has been a major focus on how schools and colleges buy. In many cases, this has resulted in an increase in the number of suppliers being used as schools have sought the lowest price for specific types of goods. The downside of this is a corresponding increase in the administrative impact of managing supplies and the disruption attached to the increased number of deliveries. So, finding suppliers who are competitively priced across a comprehensive range of products can help schools consolidate orders (and deliveries) as well as contributing positively to the environment.
2. Let schools get on and teach. The reality is that providing education has to come first and it isn’t always easy to find the time to searching out the best deal. Many teachers and school leaders end up doing this in their own time. The good news is that suppliers are out there who can help with all aspects of a school’s day to day curriculum and maintenance needs. Many of these suppliers are happy to look at a school’s overall spending requirements and tailor an offer for them. This one-off negotiation can then free up valuable and busy staff to get on with their vital role of teaching the children or managing the school. A number of local authorities have done this negotiation on behalf of their schools, e.g. Bristol, Dorset and the Welsh Assembly.
Teal expands:
-Freeing up time for either administrative or leadership staff is just one way a good resource supplier can help a school. For example easy returns, guaranteed next day delivery and even a friendly voice at the end of the phone can allow schools to reap benefits in terms of ordering their resources and quickly moving on to get their job done. This allows leadership teams and support staff to focus on the bigger things in life – namely, delivering first class education.
Case study: Manor Lodge School, a co-educational private school in Shenley, Hertfordshire with pupils ranging from 4 to 18 gradually switched its main stationery orders, its arts and crafts orders and its exercise book orders to The Consortium. The school’s purchasing manager Melanie Jawett said:
-Two years ago we started switching our orders to one supplier, The Consortium. The quality of goods, service and delivery was so high and we were particularly pleased to get all the packages individually marked as requested so we could distribute straight to classes and match the different invoices against our own systems. I estimate this has saved us at least two days work!”
Advice and guidance: The Consortium has produced some new advice and guidance to help schools and colleges countering the squeeze.
1. Whether its classroom resources, exercise books or outdoor play equipment it shouldn’t be about buying the cheapest. With high use items they need to stand the test of time so it’s important to weigh up value and hardwearing factors as well as looking at the whole-life cost of bigger spend items.
2. Look at ways technology can you save you money and help the environment. For example, many schools are seeing the benefit of online resources and whiteboard technology in bringing down the cost, both in time and paper, of endless printing and photocopying.
3. Try to encourage a staff policy of planning in advance so you aren’t racing to buy against a deadline and ensure you get what you need at key times of the year.
4. Look to build relationships with a small number of good suppliers and give staff clear guidance on who to use for what. This will speed up the buying process and reduce administrative complexity. There should be a spin off environmental benefit in reducing the number of discrete deliveries. If you choose suppliers who are also environmentally focused, you should do even better.
5. Research what all the different companies offer. Check for hidden charges on small orders, next day deliver or when returning goods. Can you place orders at times and in ways to suit you? Can you speak to a real person if you have a problem?
6. Take advantage of, and seek out, discounts. Particularly if you can take deliveries in larger quantities.
7. Check that what you are buying is fit for purpose. This works both ways, buying a premium product when a budget will do is just as wasteful as buying a poor quality product when a better one is needed.
In our experience only 1 in 50 RFPs (Requests for Pricing) in the network and applications technology space calls specifically for performance testing to be part of the package. The rest focuses attention in detailing the product requirements, which will only answers the questions -What does your device do? and -What is its functionality?, not -Will it work with my network requirements?
Some RFP’s call for a Performance matrix and on occasions this extends to asking -how much traffic can the device or application handle? However, without independent real world verification (performance testing) in the context of a network’s/application particular traffic types and mix, how can a direct comparison be made? How are your technical people expected to differentiate between new technologies’s of which they have little or no practical experience? What is the difference between the latest technology switch priced at £12k and a switch available at £2k, with similar functionality? More importantly how will you understand the comparative performance in the live network/application environment?
Often purchasing professionals shy away from what they consider the additional expense of performance testing, perhaps they rely on traditional negotiation skills and trust engineers to make the appropriate selection of technology and location. Contrast this with decisions based around real test results where the risk of failure is reduced. Your ability to negotiate is increased through a thorough understanding of the requirements, and it’s not uncommon for post test prices to fall 20%! Add your ability to select the right technology for the right place in your network and the direct savings could outstrip the investment 50 fold.
Why don’t more buyers include test as part of the selection programs? Is it because they don’t realise the huge potential for savings? Or perhaps they don’t know where to start?
We know from our work with West Country Universities, a very large Services Information provider, and many others who do independently test what they want to put into practice, that the outcome of adding -Independent Testing to an RFP is worth a reduction in overall bid prices of up to 20%, that equates to £1m on a £5m project! By testing and selecting the right switch for the right application the Service Information provider for example, stands to save £8m a year! Year on Year! As well as avoiding embarrassing in-service failures.
As buyers becomes better educated and informed through understanding the impact of the test results, essential RFP inclusions like ‘ensure solutions are tested pre deployment’, can be included and contractual negotiations can then be based on facts and evidence of performance .
Where to start, is simple to us, but not perhaps to the commercial buyers. Spirent provide testing methodologies appropriate to switches, routers, server load balancers, firewalls, web applications, database services, application servers, WAN acceleration and applications so that at the very least their suppliers will have to carry out contextual testing as part of their submission rather than guessing best performance. If the contract is of a significant value they might want to complete this testing independently. The cost of testing is around 1 to 2% of the value of most midsize projects, the cost of not testing is a great deal bigger than that.
For More Information Contact:
Kate Innes ZonicGroup
kinnes@zonicgroup.com
A storm is brewing.
As we head into 2010 the healthcare sector is facing many challenges. Not only are budgets being cut but many institutions are faced with growing customer numbers. This means more customer data to manage. Sophisticated technology is also adding to the problem.
Doctors are seeing an increase in super-high resolution imaging technology for diagnosing and treating patients, which in turn is leading to ever more data to manage, secure and store. Every one of these issues is causing huge headaches for the IT managers. While UK hospitals need to grow their storage capacity, many lack the budget, physical space or even sufficient energy supplies to do this. It’s the perfect storage storm.
For the budget-challenged IT manager in the healthcare sector the need to do more with less has become a sudden and harsh reality.
In the past, radiology and cardiology departments were the primary users of medical imaging systems, picture archiving and communication systems (PACs), including CT scans, MRI, cardiac catheterizations and echocardiograms. But recently medical digital imaging has exploded into many more specialties in the medical sphere. Pathologists and dermatologists are among the new users. Images of tissue samples and skin lesions improve diagnosis and track the progress of patients’ treatments.
Also, new cancer diagnostic exams involving the latest medical imaging equipment, such as digital mammography, produce thousands of high-resolution images per study. But the practical ability for most hospitals to host more equipment to store and manage more data is being severely impacted by the expectation that many UK hospital datacenters are rapidly running out of space and power.
About five years ago, the average 500-bed hospital needed less than two terabytes of storage for its medical imaging. Today, it needs 50TB to 100TB for the average 150,000 to 200,000 imaging-related procedures done annually in these facilities.
Storage efficiency is, therefore, being cited as one of the biggest drivers for hospitals determining their storage spend this year and beyond. This was confirmed in a study by analyst research firm Enterprise Strategy Group. Its survey of 504 global storage professionals found that budget-conscious storage decisions in 2009 will be driven by efficiency. The survey also identified that specific efficiency-friendly technologies enabling data reduction, intelligent tiered storage and storage reservation were among the top priorities for the next 24 months.
Intelligent tiered storage is particularly important to the healthcare industry, as it can provide hospitals with a cost-effective way of centralising their image database and other storage resources. On top of the images, hospitals also store thousands of other files that must keep on file regardless of how big they get.
However, only a fraction of this data needs to be accessed frequently; the majority of files, once they pass their useful life, are never opened again. Tiered storage automatically moves the least accessed files to the lowest-cost tier of storage. Similarly, if an infrequently accessed file later becomes more popular, this will be moved back up to the faster, more expensive storage so that it could be accessed and downloaded more quickly.
Interest in fluid storage technologies like these clearly indicates a growing trend, indeed a flight, towards greater storage efficiency. By boosting the efficiency of their storage infrastructure hospitals can accommodate data growth within strictly limited budgets. And they can do all this using a smaller hardware footprint that in turn consumes less physical space and draws down less energy. When these technologies are combined, the compounded efficiencies can be dramatic and immediate.
It’s not uncommon to see 90 percent utilisation improvements over legacy storage capacities resulting in further significant reductions in energy needs.
It sounds simple enough but a major hurdle remains. Hospitals often find it very hard to break free from the traditional and large storage brands, now pilloried for their excessive inefficiencies, to which they’ve grown accustomed to using.
They are also reluctant to move when they look back at the high investment in training and other costs they’ve incurred. However, with the economy at the fore-front of all major spending decision there is now much greater pressure on IT managers to explore new options that deliver greater efficiency. The historical reluctance to transition from the big brands is starting to erode as value and efficiency move to the top of the priority list.
Annual storage requirements for many providers are increasing at a rate of 20% to 100%. Ballooning storage requirements have resulted in a number of challenges, from cost to disaster recovery to security and access issues. IT managers need to ramp up their knowledge of intelligent tiered storage as quickly as possible and ensure that it’s a central platform for their future storage strategy. Not only will this help solve their immediate problems of data growth, budget limits, space and energy, but it can just as directly benefit their hospital’s bottom line. In this period of economic uncertainty, a healthy obsession with efficiency will be the key to weathering the storm.
Additional Case Study – Compellent drives 90% energy saving at University College Hospital Galway
One of Ireland’s major academic teaching hospitals, Galway’s HSE University College Hospital, was experiencing vast IT requirements spread across the various departments and hospital sections.
By June of 2008 storage levels were at a critical level for UCHG and they were on the verge of running out of storage, and were close to capacity on the model of SAN they currently had. These problems were compounded further by the fact that their existing SAN was also past the end of its product life and could not be upgraded. The only option was to buy a new one. Their existing SAN vendor was happy to sell them a new SAN but there was no way of avoiding the same problems again over the next 3 years.
Through working with Origina’s Innovation & Development team UCHG devised a pioneering new storage framework for the entire organisation. Origina storage architects designed a solution built on Compellent Storage technologies that delivered a vast variety of benefits that solved the organisation’s storage problems and, moreover, facilitated their requirements into the future. Based on Compellent’s energy-efficient storage area network (SAN) the solution is saving the hospital 90% on power and cooling costs, and with no model range, the same SAN can be used until a 900TB capacity is reached.
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