Enabling Successful Change

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Enabling Successful Change Deployment

• Mental Health Change Network
• 19th January 2007

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Welcome!

• Eileen Fairclough
• Head of Service Implementation and Benefits, NHS
  Connecting for Health (NHS CFH)

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Your feedback from last time

• More time for discussion, group exercises, and
  longer time to network
• More information on the roadmap
• More information on the bigger picture
• More lessons learned

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Workshop agenda

• This afternoon will include
• A presentation from Wilf Bardsley on the NHS Care
  Records Service Mental Health  - Supporting Trust
  Strategic Objectives and Foundation Status
• An update on the strategic roadmap and CCN2
• Clinical engagement
• Discussion sessions on each of the above topics
• West London Mental Health Trust presentation

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How a good IT system can support Foundation Trust
status

• How good IT supports delivery of good healthcare

Wilf Bardsley Director of Nursing and Governance
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Breaking Inertia

• Trust-wide PiMS system for 7 years lead to
  reasonable IT culture
• Needed to do something by 2007
• Achieved senior support to improve IT in Summer
  05
• FT preparation focused organisation on improving
  Data Quality and Completeness around Governance
  and performance
• RiO provided opportunity to give staff something
  that would work from day one

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Progress at Oxleas

• Full Business Case agreed January 2006
• First Go-Live September 2006
• Trained over 1500 users
• Live in all services bar 1 borough
• Final phase on time for 5th February go-live
• RiO is now the primary clinical record

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Benefits

• Complete patient record available on any site to
  any professional at any time
• The electronic record is primary. Reduce
  duplication of records in different systems, and
  reducing reliance on paper notes
• Risk management informed by full patient history
  and current events. This will help to maintain
  patients safely in the community reduce
  admissions and reduce incidents between patients
  or from patient to staff member.

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Benefits

• Effective caseload management and care reviews.
  Informed supervision and management decisions
  about use of resources. Smoother patient journey
  and continuous flow through the system.
• Improved management information and activity
  reports. Local operational reports used to
  improve data quality. Evidence of follow-up of
  patients at risk of self-harm. Modernise audit.

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Benefits

• Improved assurance to support governance
• Improved patient involvement in care planning
• Improved reliability of information to support FT
  contracts
• Marriage between IT and clinicians
• Rigour of process developed better vision and
  clarity
• Value for Money

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Lessons Learned

• From previous system implementations
• Value of access to clinical information
• Ease of use
• Ensure source data quality
• Develop own staff to facilitate knowledge
  exchange
• Floorwalking and admin support direct to teams
• Structured involvement of clinicians as early as
  possible

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No miracles

• Quality of data in RiO dependant on source
  quality
• Integration with Social Care
• Access to RiO in prison based services
• Reliable access requiring additional out of hours
  support
• Developing reporting longer than expected
• BT Service Management issues

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What next

• Working with Phases 1, 2 3 to consolidate
  process changes and get the most from RiO
• Planning for strategic roadmap and future
  benefits
• Taking forward other IT initiatives to improve
  use and output of systems

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Update - Strategic Road Map and CCN2

• Eileen Fairclough
• Head of Service Implementation and Benefits, NHS
  CFH

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Where are we going

• A strategic vision that takes account of changes
  to NHS business drivers
• A clear strategic route map that describes the
  technology that will be implemented
• A better process of user engagement

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BT Proposals

• A change of supplier in acute replacing GE
  (previously IDX) with Cerner
• Mental Health and Community will be offered the
  Rio product from CSE Servelec
• The primary care solution will be Vision 4
  provided by InPractice Systems
• Development of an integration layer to facilitate
  data sharing across care settings

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The New Route Map

• Plans address two main concerns
• Speed up delivery of systems for acute
• Resolve uncertainty over the long term position
  of interim GP, mental health and community
  solutions.
• Vision of shared patient record across all care
  settings remains at the core of the NHS CFH
  programme for London

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RiO V6
RiO V7
RiO V5
Spine Compliance CB, PDS, SSO
Bed Planning Scheduling
SNOMED CT
Annotated Clinical Diagrams, eg Body Maps
CPA Review Scheduling
Validation of Clinical Notes within Assessments
Field Level Validation on RiO Forms
Prescribing (Release 1) Mental Health
Outpatients, Medicines, Administration and Drug
Service (Batch Prescribing)
Organisations and Professional Contacts Lists
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NHS engagement

• User Groups
• Governance - Care setting Programme Boards and
  sub groups
• NHS input into CCN2 at three levels
• Participation in detailed negotiation
• Big picture strategic issues
• Governance sign off by Programme Board and SHA
  Chief Executive

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CCN2

• CCN2 making progress with closure planned for
  end Jan 2007
• Deployment activity de-coupled and moving
  forwards
• Care Setting Programme Boards have reviewed BT
  proposals

• Main areas of concern are
• Achieving the Cerner configuration necessary for
  London needs
• Direction of travel with Primary Care
• Robustness of the integration solution
• Changing requirements eg Social Care

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Social Care

• Main concerns
• BT plans for integration are confined to three
  LSP products
• Social care scope is limited in CCN2
• NHS orgs in London are working closely with
  social care and need systems to support this
• Also need to future proof for new developments
  like Common Assessment Framework etc
• eSAP is a step forwards but it needs integration
  with RiO etc

• Proposed action
• BT are committed to deliver a social care
  additional bundle
• Keen for this to be developed jointly with input
  from BT, NHS and Social Care
• NHS/Social Care Work Programme should be
  established to address future needs
• Future of eSAP needs to be clarified
• Funding would need to be secured

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Business Transformation

• New agreement which updates and contractualises
  current approaches to change and training support
  
• Modelled demand
• BT change and training resource to support
  deployments and upgrades in MH
• BT change support for integration

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Over to you for your
?
Comments
Questions
Issues
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Networking Discussion Sessions

• Topic 1
• NHS CRS Supporting Strategic Objectives and
  Foundation Status
• Q How can you see NHS CRS / RiO helping your
  trust to meet its strategic objectives and
  Foundation status?

Topic 2 The Strategic Roadmap / CCN2 Q What
opportunities and challenges can you see for your
Trust in relation to the roadmap? Q How can we
work together to maximise the benefits?
Or
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Refreshment Break
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West London Mental Health Trust Communications
Stakeholder Engagement

• Hannah Flaherty
• Communications Manager

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West London Mental Health Trust

• 18,000 clients received an intervention in 2005
  2006
• 3,800 staff across 32 sites
• 2,000 PCs and associated printers
• Go live October 2006 phased rollout
• 90,000 records migrated
• 500 people trained and using RiO

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Deployment of NHS CRS

• Role-based implementation across all services
  (except high secure)
• Administration
• Home Treatment
• AE Liaison

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Case study Hammersmith Fulham Mental Health
Unit CRHTT

• Before

After
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• I love RiO - says Tessa Campbell, the team
  administrator
• Ive only worked here for four months, and when
  I started PsyMon was already about to be phased
  out. Although PsyMon was fairly straightforward
  to use it wasnt as user friendly as RiO. Anyone
  in our team can access RiO and enter notes and
  look up clients, and that gives me the chance to
  spend time focussing on other aspects of my job
  and not just entering information onto the
  system. It also means no need to try and check
  handwriting with clinicians to work out what it
  is meant to say, so that saves a lot of time!

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• For me the best thing is that as a doctor I feel
  my notes are more secure than they were before
  says Dr Mayank Gupta
• Its more convenient and you can see all the
  past notes. Its a very good system. We dont
  have to chase notes and it is more time
  efficient. I can also see the potential for
  developing RiO further.

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Communications and Stakeholder Engagement Planning

• Communications planning January 06
• Communications formally started March 06
• Communicated with
• Staff
• Service users and carers
• The public
• Local patient and public involvement forums
• Social services
• Primary Care Trusts
• Strategic Health Authority/ies
• Other external organisations, voluntary groups
  etc

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West London Mental Health NHS Trust
Leaflet for staff
Monthly newsletter
Intranet page

• Regular updates in Team Brief, weekly email
  bulletin Monday Matters
• Posters counting down to go-live
• Newsletter for external stakeholders
• Leaflet for service users and carers

mousemat
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What went well and what I would do differently

• What went well
• Overall good level of awareness
• Intranet effective
• Good response rate to competitions
• Communications a central point for queries prior
  to go live

• What would I do differently
• Should have used NHS CRS branding
• Involve communications in project meetings

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Over to you for your
?
Comments
Questions
Issues
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Clinical Engagement

• Dr Martin Baggaley
• Clinical Lead, NHS CFH London
• Consultant Psychiatrist, South London Maudsley
  NHS Foundation Trust

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Benefits

• Most clinicians understand the potential benefits
  of CRS
• Majority cynical of anything useful ever being
  delivered
• Majority cynical of language and philosophy, e.g.
  see benefits as cost saving

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How to Engage Clinicians

• Need engagement and support from the executive
  Chief Executive, Medical Director, Director of
  Nursing, Heads of Department
• Identify Clinical Champion(s)
• Identify and Support Super Users

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How to Engage Clinicians

• Identify key opponents/objectors
• Offer luddites extra training/support
• Concentrate on enthusiasts and hope they will
  carry the ambivalent majority
• Leave the hard core non users until they are the
  distinct minority

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Often fail to discuss the Potential Costs of IT

• May often taken longer resource implication
• Involves change
• Alter traditional roles
• Interfere with service user clinician
  interaction
• Important to be honest and may need to adjust
  clinic lists etc

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Achieving Benefits

• Recognise short term v long term
• Short term doing what has always been done more
  efficiently
• Focus first on easy benefits that are readily
  achievable
• Long term doing things differently

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Witholding

• If a phased deployment is possible, may generate
  a competitive desire to have the system
• Use those involved in earlier phases to help roll
  out elsewhere

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Feedback

• Appropriate forums to feedback progress, identify
  problems, spread good practice
• Inform wider community of benefits being accrued
• Need good base line data to be able to
  demonstrate real benefits

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Clinical Engagement From Now

• More sophisticated benefits will accrue from
  Care Pathways across settings (i.e.
  Community/Primary Care/Acute)
• NHS Structures are not set up to facilitate this
• Therefore must think about how to set up
  appropriate structures/ways of working to achieve
  cross setting benefits

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Questions
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Clinical Engagement Discussion

• Question 1 What clinical resources do we need
  to engage in NHS CRS?
• Question 2 How can we make sure we get clinical
  sponsorship for NHS CRS?

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Workshop Wrap-up

• Eileen Fairclough
• Head of Service Implementation and Benefits, NHS
  Connecting for Health (NHS CFH)

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Workshop Wrap-up

• Further questions?
• Next workshop May 2007
• Feedback forms

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Thank you!