For a recent HTN Now panel discussion, we were joined by Andy Willis from Central London Community Healthcare NHS Trust (CLCH), and Gabi Cohen, director of delivery at Isla Health, to talk about how to deliver healthcare transformation projects successfully, covering topics including stakeholder engagement, interoperability, implementation, and more.
Andy shared with us a case study from Central London Community Healthcare, discussing the importance of approaching transformation in the right way.
“It’s about change,” Andy said, “and a lot of times when we’ve had new products or we’ve tried work on transformation it’s just been transactional; so we’ve looked to roll-out something with minimal training, and it falls flat”.
Looking at transformation as “a social movement” is important, Andy continued, “and getting people’s buy-in is very much a hearts and minds issue, so the product needs to be right, but when you’re getting staff buy-in, you need to be spending a lot of time making sure that you’re making this meaningful to staff, that it means something to them, and that you’re hitting what they want to hear and what is important to them”.
Andy also mentioned some of the challenges with transformation, noting particularly challenges with “restricted budgets” and “a growing population”, adding that, “sometimes we get hold of the money, but then we can’t get hold of staff to fill the posts”.
Transformation at Central London Community Healthcare
This initiative, Andy told us, started just before the pandemic, but “really took off” when COVID hit, “when we were looking at how we could digitise some of our offer, and how we could make efficiencies by engaging technology to do some of the work, and to improve our quality of service”.
The impetus for the transformation, he said, “helpfully came from the ground-up; so there were staff on the ground who had identified a need around collecting information on wound care in a much more systematic way; previously there were just some paper notes, and people occasionally taking photographs of wounds and keeping them on their mobile phone, which I’m sure will make our IG colleagues cry”.
When looking to work with a provider, Andy’s team were looking to put in place “a really slick interface” to improve wound care, and they met up with Isla early on, having discussions and spending “time developing the product with them”.
“I think that one of the keys to transformation is having a product that works, so when the staff themselves identified the need, we had a tailor-made product which worked really well and that the staff could use. You can tell by the take-up figures how well staff gravitated towards it. It enables improved communication, improved record keeping, but also some efficiencies; we’re a community trust with about 4,000 clinical staff who do a lot of travelling; anything that we can find that helps reduce travel time is a huge win for us.”
Objectives for Central London Community Healthcare
When rolling-out this initiative, the “problem” Andy and his team were trying to fix related to efficiency and enhanced patient safety in wound care: “What we were looking to do was to enable specialist input around tissue viability on the day-to-day work of the district nursing team, without having to get a specialist nurse to go and visit every single patient and assess their wound. The way that we’ve done this with Isla’s support, is to enable our district nurses to take pictures of a patient’s wound and track it in real-time, so they take a picture each time they see the wound, and our tissue viability nurses (TVNs) can see the change in the wound over time.”
After a picture is taken by one of the district nurses, Andy said, Isla’s solution enables them to provide a narrative within a structured text box, updating the clinical record “contemporaneously”, and granting TVNs a “full history of what’s happened”.
Starting in the South West during COVID with the initial roll-out of the solution, Andy told us that it is now “trust-wide”, and that expansion has been made “much easier; because we’ve identified that the product works, got it working well, demonstrated the benefits, and then made the case to roll it out to other teams”.
“It’s now more along the lines of deployment,” Andy went on, “because staff have already heard from their colleagues in the South West that it’s a good product, so they want to use it”.
On adoption, Andy shared with us some figures showing that 1,600 clinicians have been onboarded to the Isla platform to date; that they have submitted 200,118 photos and videos by using the solution; and that 17, 317 patients have been cared for through Isla.
Looking at data on submissions to the platform since October of 2020, Andy suggested that the roll-out has been “hugely successful”, saying that, “clinicians are using this product multiple times per day, because it’s a good product, and the figures show that they’re monitoring the same patients over a long period of time, which is as intended”.
Benefits realisation
The last slide of Andy’s presentation offered some insight into some of the benefits realised through the use of the Isla solution, including operational and efficiency benefits around reductions in clinical admin time of up to 26 minutes for image capture per patient, and TVNs being able to complete a review “3.8 times faster” using Isla.
Talking about the cost saving of £1.2 million, Andy said: “That’s a huge figure, and that number will continue to grow as we continue to roll-out the solution. As with a lot of NHS trusts, we’re trying to manage rising demand and a growing aging population; so a lot of times we’re developing products and we’re making efficiencies, but rather than being able to take money out, we’re absorbing the increase in growth.”
That is, Andy told us, up until now, when “we’re coming to a point where we’ll be fully rolled-out, and we feel that we’ll be in a position to genuinely take money out from those efficiencies”.
Insights
When it comes to the difference between a successful and an unsuccessful roll-out, Andy spoke about the importance of “finding a product that staff want”, adding that a lot of the time in the NHS, “we have to roll-out a product because we’re told to, or because it’s a national direction, but it might not fit our local situation or our staff”.
The Isla solution in particular, he shared, “is something that staff developed on the ground, so getting ideas about what they find useful and taking a bottom-up approach is important, and finding a company that will work with you to develop a product is helpful, because then you can streamline it and refine it to make sure that you’ve got a product that solves a real-world problem”.
What Andy considers a mark of success for the project is that, “we have people contacting us, asking us for their login and the training. We’ve got probably another thousand staff to add on before it’s complete, but we’re already at the point where we can actually start looking at taking the benefits out.”
When it comes to CLCH, Andy highlighted that successful adoption has largely been the result of staff being able to see the benefits and the impact of the solution in their everyday work with patients, and that this translated into having “a ready made group of champions to sell it with their colleagues”.
Gabi offered a supplier perspective on what makes the difference between a successful and unsuccessful roll-out, echoing Andy’s point about the need to leverage stakeholder insights when approaching implementation, saying: “We always start by engaging with clinical and administrative teams, and we process map every single step of the journey. That allows us to understand what parts of Isla’s functionality we should use in designing a really specific and targeted intervention. Once that’s done, it’s fundamental to ensure that there are no technical blockers or any barriers to being able to access the platform, so we spend a lot of time thinking about integration, interoperability, and data flows.”
In CLCH, Isla offers EMIS integration and SystmOne integration, which, Gabi says, “means data is always accessible, and we reduce administrative burdens”.
On interoperability, Gabi considered how when teams are visiting patients or trying to run a streamlined clinic, “it’s not feasible to have five or six screens open”, so “having that real interoperability and consistency around streamlined workflow is essential for clinical teams”.
Looking at how to ensure a solution is sufficiently embedded for the long-term, Gabi also talked about making sure that “the need is clear to the clinical team”, saying, “you’ll really get that adoption and embedded-ness when the intervention is focused on solving a problem that they experience every day, and you’re not going to have many challenges getting clinical teams to engage with that”.
“It gets a little bit trickier,” Gabi continued, “when you’re solving a less tangible problem, or its downstream, or you have an admin team solving for a clinical team; but once again, making sure it’s salient, making sure there are no technical barriers to accessing the tech, is what leads us to being able to maintain those numbers long-term”.
At Isla, Gabi said:
“The way we see it is that there are two key elements to this: the tech element and the behavioural element. It needs to be a really enjoyable experience for our users to use our platform; it needs to be easy, and if any challenges come up, we need to respond to them quickly and efficiently. We have development teams that are dedicated to just that, so as we get insights on the platform we’re able to quickly implement them. From the behavioural side, it’s absolutely key that our users feel like they can come to us for additional training and support, so we make sure we have that available.”
We’d like to thank our panellists for taking the time to share their insights with us.
To learn more about Isla’s implementation at Central London Community Healthcare NHS Trust, please click here.
