Getting people on board
Getting the right people on board at the right time is key. It is arguably one of the hardest but most vital aspect of any change initiative and is crucial to the successful adoption of new ways of working and system changes.
An empowered, collaborative, partnership of staff and patient representatives from each of the organisations involved is required.
Whilst the particulars will be unique to your local health and care system, this section has some tools and tips to help you identify your stakeholders, understand their perspectives and engage them positively in your project.
The case for change
A key priority for the UK’s health and social care system is to drive better, safer, more efficient care through widespread adoption of consistent standards and interoperable sharing of data that supports safe and effective transfers of care.
The accurate and timely sharing of information between secondary and primary care at the point of ‘transferring care’ is of crucial importance.
When a patient is transferred from hospital, the clinical accountability also transfers. In order to accept accountability, the right information must be available at the right time in order to make informed decisions with the patient.
The problem
Despite significant investment, the widespread adoption and achievement of standardised discharge summaries and the associated anticipated benefits across the system remain disappointingly low.
There is still much improvement required to the quality, consistency, accuracy and timeliness of data shared from secondary to primary care at the point of patient discharge.
Current problems include:
- 40-80 administrative and clinical hours spent per practice each week processing summaries.
- Clinical pharmacists have less time for patient-facing activities such as running long-term condition clinics.
- Risks to patient safety due to transcription errors and missing information.
- Delays in receiving summaries impact the timeliness of prescribing medications.
In the short film below, we hear from Tim Ballard, clinical advisor at the Care Quality Commission, and Claire Fuller, primary care director at NHS England, who explain the current challenges with discharge summaries.
The solution
Standardising the data that is auto populated by the discharge summary and improving the layout and presentation of the discharge summary itself is the first step in resolving some of these problems.
Acute hospital EPRs and GP patient record systems should ensure their systems are ready for sharing this information by making sure that the information captured can be structured and coded in conformance with the standard.
In the two short films below, we hear how the eDischarge Summary Standard will support the collation and sharing of key information at the point of discharge to support a safe and timely transfer of care.
Call to action
Implementation of the standard needs to be delivered as part of a wider change programme. Implementing standards is often viewed as a technical fix, but in reality, it is part of a wider service change programme to improve the experience of the individual receiving care and those professionals providing care.
If this change programme is going to be successful, everyone involved must understand the purpose of the change and what a successful conclusion might lead to. This works best when the change is framed in the form of a compelling narrative that connects with people emotionally as well as intellectually. Local health and care systems need to assess the best approach to delivering this change and identify what will motivate clinicians to deliver the change and the benefits to be realised.
The stakeholder engagement and analysis sections below outline in more detail who needs to be involved and how to get them on board with the change programme.
Resources to support the narrative
The approach PRSB has taken is in line with the national policies of the UK devolved nations, see below for the national strategies and a case for change template slide deck to use in your organisation.
Briefing your staff
It is critical that your stakeholders are actively involved from the start and have the chance to influence and contribute to the task of implementing the standard.
These slides provide an outline to help you brief staff on the project, the rationale for doing it and how they will be involved. You can adapt them to reflect the specifics of your local situation.
Stakeholder engagement
When starting your implementation, you should identify all the stakeholders that need to be involved in your project. The most useful thing we know from developing the standard is who your key stakeholders are most likely to be and what they are most likely to be concerned about.
A stakeholder is anyone who has an interest in or may be affected by the change to your discharge process in any way. Your stakeholders may have different perspectives and priorities.
- Do not forget to include organisations beyond the boundaries of your immediate health and care system
- Think about all the organisations that may need to receive discharge summaries from your hospitals e.g. out of area GPs, hospices, care homes etc.
A stakeholder analysis template is available here for download which includes a suggested list of stakeholders. This list should only act as a starting point and good quality process analysis should reveal more.
Other stakeholder tools
A power/interest chart offers a useful technique for analysing your stakeholders. Plot your stakeholders where they actually are rather than where they should be.
Strategies can then be explored to manage them in their current positions or to even move them into other positions that might be more advantageous to the project.
Consider the activities and deliverables and the extent to which your stakeholders are involved with them. A RACI chart offers an effective method for this, with tasks down one side and stakeholders across the top.
Categorise your stakeholders as:
- Responsible: people or roles that are responsible for the delivery or task.
- Accountable: people or roles that are answerable for the quality of the deliverable or task.
- Consulted: people or roles who provide information relevant to the deliverable or task e.g. domain experts and end users.
- Informed: may not contribute directly but should be kept informed about a deliverable or task.
Write your business case
To assist with your implementation, you can download and personalise this example proforma business case which includes hints and tips on the benefits and gains you can expect.
You will need to tailor to the business case to your own unique circumstances within your organisation.
Leadership
High quality leadership is another key ingredient for success, here are some key points to consider.
Clear and consistent purpose
Why are you doing this? What problem do you need to solve? What will finished look like and what needs to continue happening after you’ve completed the project?
The right people at the right time
This takes preparation. Those involved need to understand ahead of time the expectations on them. What are their competing priorities? Do they have the skills needed?
Relationships are everything!
Shared vision, shared storytelling, connecting with people emotionally, shared ownership, mutual trust, value and respect for each other. Remember that feedback is key – make sure you actively seek and hear it.
Buy-in
Work hard to secure buy-in from staff at all levels in each partner organisation as early as possible. Keep people up to date, your stakeholder map and comms plan are key here.
Communication
Keep people up to date with what’s happening, build that story. What is going well, what progress has there been and what changes to the plan have occurred since the last update?
Be realistic
Things always take longer than you think, overestimate the time required for the project. Engaging suppliers, understanding the current state, agreeing your plan all takes time and must be well underway before you begin any of the technical work.
Collaborative working
For individual organisations within a health and care system it is often easy to lose sight of the big picture of care beyond the boundaries of your own organisation. There can easily be a perception that you are only responsible for the elements provided by your particular team or organisation. Success requires collaborative working and mutual accountability around a jointly agreed vision.
The process of discharge summaries has historically been seen as a one-way communication system structure. This has resulted in a lack of team mentality and a ‘divide’ between hospital and general practice. The rarity of feedback and sharing of insights between stakeholders hinders the appreciation of each other’s perspectives and needs, exacerbates the problems and increases the risk of patient harm.
“Collaboration is essential within each system as well as between systems and national bodies. Rather than thinking about national organisations, regions, systems, places and neighbourhoods, organisations and teams as a hierarchy, we should view each other as real partners with complementary and interdependent roles and work accordingly.”
Shared ownership of the ongoing monitoring of discharge performance by a multi-organisational quality and improvement team will help to support a culture of continuous evidenced improvement. Take a look at the discharge metrics dashboard in the ‘Putting the standard into practice’ section for more information.
Each health and care system would benefit from a designated pan-organisation quality lead to ensure the changes delivered are sustained and kept in line with other changes happening in your system.
COLLABORATION CHECKLIST
Establish clear objectives and goals
Clearly define roles and responsibilities
Assign accountability
Communicate effectively with regular and transparent messaging and listening
Facilitate regular interaction among team members from different organisations
Foster a culture of trust, respect and mutual understanding
Recognise and appreciate expertise and contribution where feedback is welcomed
Encourage a culture of learning and continuous improvement
Flex and adapt to respond to the inevitable challenges along the way
PRSB Standards Explained
Why we need standards to record our health and care information in a consistent way so that it can be made available whenever it is needed.
Making change happen
Transformation programmes need clear goals, the right leadership and engaged staff and stakeholders. Get started by reading our information on transformational change.
PRSB Support Available
If you have a question for PRSB, please contact our support team. We have an expert team who can help you find the answer, or direct you to the right place.