10 October – Blog getting technological in the acute therapy team
Hello, my name is Teri, a physiotherapist by background and I’m an integrated team leader in the therapy team at Airedale Hospital. I’d like to focus on our acute therapy team’s journey in making the transition from paper to electronic notes, with pointers on what to do and avoid in relation to technology developments, which will hopefully be useful to others.
We had exactly three months of preparation and IT support before our ‘go live’ date of 1st August 2016. We set up a SystmOne (the clinical system developed by TPP supporting one patient, one record) group consisting of key members from IT, admin, management and clinical staff nominated by and from each acute therapy team (orthopaedics, neurology, frail elderly, medical, respiratory). There was a mix of bands and clinical staff included occupational therapists (OT’s), physio’s (PT’s) and generic assistants. This mix was vitally important as we needed a group dynamic that wanted to be involved in change – to plan, do, study and act – and with enthusiasm, positivity and commitment to hard work within a short timescale. They took part in weekly meetings, for an hour or so, and kept to an action plan with responsibilities assigned to individual group members.
We set up a chart of crucial clinical documents that needed transferring from paper to the electronic system. This chart was probably one of the best things we created as it provided us with a logical way of thinking and allowed IT to keep up with all the amendments we were making on a daily basis by updating a single chart. It also dictated our layout on the system and ensured staff completed not only assessments but outcome measures, goals, referrals, screening tools and discharges.
The communication with IT and between members of the group was so vital. It became clear that jobs assigned to group members came at the top of their to-do list above any other work assigned to them. The department and individual teams had to put up with a heavier clinical workload to allow the group to make progress with this work. Communication from the group back to teams on a weekly basis also proved vital to ensure everyone was on the same page. Personally I found it difficult to justify all the time spent on the project and show the progress we were making because most of it was spent sat with IT and in front of a computer screen.
One advantage we did have was to see how our colleagues in the community had fared with the process. I know they won’t mind me saying that it hadn’t been ‘plain sailing’ so we could avoid their pitfalls. We decided early in the process to make our assessments as detailed as possible. I spent a lot of time looking at NICE guidance that we weren’t adhering too, particularly around falls and trying to incorporate the evidence based questions into our assessments. This meant lots of amending and triple checking. To my advantage, a few years before I lead the project on integrating OT & PT notes on paper which prepared me well for this project.
Training was vitally important. Each staff member had a session (or two) to look at the new system, and have a play around with the assessments. This is where I received a lot of feedback to help improve the wording of questions and add in anything important that was missing. Training was also where some staff members fell down as they didn’t give it their full attention or didn’t think they then had to practice after the training to help embed it. A user guide was set up and this is still available for staff to use.
So we went live on Monday 1st August 2016. There were feelings of apprehension at such a big change amongst staff but also excitement that this change would bring so many benefits and efficiencies once embedded.
Friday afternoon before ‘go live’, we set up a non-clinical afternoon for all teams, with a final run through of tasks. We had created posters around departments with instructions and a pocket guide for staff. We had many paper notes to discharge and it was the first time I’d had to lead an IT training session for a large group (20+). It was really hard work keeping everyone at the same point especially with differing computer abilities. It was also frustrating having staff dip in and out due to ward pressures and having to repeat, pass over and shout instructions over noise and chatter.
On the ‘go live’ date everyone congregated at 8.30am for a repeat of vital instructions. We had an S1 group of super-users for the team as the first port of call to try to resolve basic issues. A bleep was set up for a dedicated staff member who could deal with urgent queries immediately and talk through the issue or visit the person to go through it with them. Every day before leaving lunch that week there was a drop in session for enquiries/practice and flip chart was set up for written comments and issues that could be dealt with routinely.
It meant every person knew they had a way of communicating their issues and there were many! Here I have to give a big shout out to Helen Goulding (fellow team leader who held the fort those first three days as I had booked annual leave). As Helen and I had set up the assessments, we became the ‘go to’ people for SystmOne and had the responsibility of the hotline bleep, writing down issues that arose that we couldn’t resolve or that needed to change, as in practice they weren’t fit for purpose. The other important step behind the scenes was to find time to go back to IT support for amendments to assessments and protocols (repeatedly) until we found solutions. These changes then had to be communicated back to staff on a daily basis.
As I’m writing this, two month’s into the process, many changes have been made, the bleep has been devolved of its use, communication with IT is not daily but still often and staff are settling into using the system with great effect. Things we still have to do are to ensure MDT members we work alongside get the right training, are able to voice their issues and create new ways of working that suit everyone. We will have to adjust the format of our assessments, but we’re going to do it in a systematic way. Everyone’s individual issues will be collated, fed back through team reps and decisions made through the group.
Most surprising for me has been the range of emotions I’ve felt through the process – positivity, frustration, anger, helplessness, happiness and increased stress levels to name a few. Staff came to me with so many different issues (some very minor compared to the overall issue the SystmOne team were dealing with) that they felt was causing stress for both them and their team. I just had to take a big, deep breath and try to take away their stress with a smile and a positive response to their problems, but it wasn’t always easy.
My mantra has been throughout ….. This is the way forward, embrace the change now and it’ll become easier and in the end everyone will benefit. And I think we’re reaping the rewards already. We just need the rest of the acute services in the trust to join us.