By Dr Charlotte Holroyd, Senior Consultant
We know that use of data to drive clinical service improvements in the NHS is increasingly important to ensure that proposed changes achieve the intended benefits for patients and staff. Our Analytics & Insight Team recently worked in partnership with Innovation Unit to co-design innovative patient pathways with frontline clinicians at a world-renowned specialist London-based foundation trust. Our approach combines rigorous analysis with engaged and innovative co-design, to deliver exciting positive outcomes.
To start with, we co-designed the pathways during workshops with a broad range of clinical and non-clinical staff, helping them to think about how technology and different ways of working could enhance the patient and staff experience, as well as efficiency and productivity.
Next, using the ‘Time and Motion’ approach, we shadowed staff to understand their key operational challenges and how could to the pathway could address these. In the surgical department, we logged the tasks completed by three nurses during a typical shift, at five-minute intervals, to provide a measure of the average proportion of time spent on specific activities (e.g. clinical, non-clinical, administration) at various points day. Moreover, by shadowing in the theatre suite, we were able to log any activities that were likely to negatively impact patient flow.
Two key findings emerged from the ‘Time and Motion’ study, which enabled us to refine the pathways accordingly:
- There were predictable peaks and troughs in clinical activity, leading to busy periods as well as quieter ones, particularly when nursing staff were waiting for patients to return from theatre. Our new pathway for ‘high flow’ surgery addresses this, it recommends that patients arrive at staggered times on the morning of surgery. This will aim to spread the clinical workload, reducing the incidence of peaks and troughs as well as reducing the waiting times for patients
- There were elements of practice within the theatre suite which negatively impacted patient flow, including difficulty contacting the ward staff to call for the next patient. This provided evidence that better use of technology could enable a more efficient flow of patients. As a result, the new pathway recommends the installation of screens to provide a live update of each theatre’s progress, so that ward staff know when the next patient is due.
In conclusion, our approach demonstrates that data (even relatively simple data) can be used to determine the benefits that are realisable through relatively small changes in service design. Secondly, it demonstrates the power of co-design, and of engaging clinical and non-clinical staff in service improvement to develop effective solutions.
Staff helped identify and address the practical issues they face on the frontline and were empowered to own the changes they proposed.
Staff provided positive feedback on the co-design experience, with one staff member saying, “It was great that we can all contribute towards this process”.