How going with the flow led to a better patient journey

When ABMU (Abertawe Bro Morgannwg University) Health Board decided to build a £60m state-of-the-art hospital building, they knew it was important to invest in ensuring patients continued to receive the best possible experience.

With over 1,000 outpatient appointments every day, there was a need to evolve a system that worked well for the current building so that it worked even better and was future-proofed for the new building.

A joined-up approach was required that reduced the administrative burden while increasing patient satisfaction and when the new facility opened in July 2015, this is what was delivered.

The solution was a fully integrated patient flow solution helping doctors, nurses and other staff effectively manage the entire patient journey, improving efficiencies and, most importantly, making the patient’s experience as positive as possible.

Five-year plan

As one of the largest hospitals in Wales, Morriston Hospital in Swansea is home to an extensive range of outpatient services including renal medicine, neurology, oral and maxillofacial surgery, and a regional tertiary cleft service for children and adults.

A five-year project was announced in 2012 to build a new home for these services in a state-of-the-art, purpose-built, two-floor outpatient building.

An important part of the project was to also develop better, more efficient ways of capturing patient data and making visits to the hospital as seamless as possible for patients.

Behind the scenes investment

Programme manager Suzanne Rodgers says it was vital this investment behind the scenes went alongside the very visible building work taking place: “From the word go, we needed to ensure we took a whole system approach to dealing with the entire patient journey to be certain that we were able to capture everything – from patient arrivals to test information to outcome records – accurately and in real time.

“In the past, all these processes had largely been paper based, a system that had worked well for us but was in need of updating to ensure improved patient flow administration, made up of the fewest steps possible and reducing paper and time wastage.”

We gained a detailed understanding of the whole patient journey from a multidisciplinary perspective.

She continues: “To make sure we started on the right track towards achieving our aim of creating a modern and paper-light outpatients’ environment, we partnered with patient flow management specialists Intouch with Health, based in Cirencester.”

There were several challenges that Suzanne and the team at ABMU needed to address alongside Intouch to ensure the solution worked functionally in the hospital.

Says Suzanne: “We had a brand new building being developed so any solution had to consider the new operational environment as well as the varying requirements of multiple departments that were ‘moving in’ to the building.

“Two large patient waiting areas, that were to be included as part of the ground floor of the new building, also needed to be managed effectively, and above all, a huge variation in existing working practices meant that we had to work with Intouch to work with all those who would be moving into the new facility to ensure the new system met their needs.”

Establishing a team of key stakeholders

To move the project forward, Suzanne and her team worked alongside Intouch to establish a multidisciplinary team built up of key stakeholders from across clinical and operational roles, as well as the health board’s own IT and software development team and the National Programme for Informatics.

She continues: “We conducted detailed process mapping with clinical colleagues to encourage them to challenge ways of working and to help them realise, and then maximise, the benefits of technology-enabled working.

“As a result, we were able to gain a detailed understanding of the whole patient journey from a multidisciplinary perspective, and identify waste and key areas where we needed to make improvements to patient flow and data capture.

”This allowed us to put together a detailed specification for what we needed and led us to the decision to procure a solution from Intouch.”

A key foundation in supporting ABMU’s aim of achieving a “paper-light” environment for the new building would be for its clinicians to have electronic access to patient records. To support this, ABMU designed a bespoke Documents Management System (DMS) in conjunction with Intouch.

Suzanne explains: “We worked with a large group of secretaries to build our DMS to allow us to create and store clinical correspondence electronically.

The solution was a fully integrated patient flow solution helping doctors, nurses and other staff effectively manage the entire patient journey, improving efficiencies and, most importantly, making the patient’s experience as positive as possible.

“Using the NHS number as the patient identifiers in the DMS, our clinicians can access all patient letters, regardless of the hospital site the patient has visited. Other key documents including discharge summaries and operation notes have also been made accessible in a web based documents portal that has been designed with the input of our clinicians.”

So what does the patient journey look like now at ABMU?

“It’s a much more integrated affair”, says Suzanne. “When a patient arrives they check themselves in and are then directed by the kiosk to the appropriate waiting area to their appointment.

“When the clinician is ready, that patient is then called to the consultation room via an electronic screen, which in itself has helped to make the patient’s wait time a much more pleasant experience.”

The management of patient tests has also been addressed as part of the flow management solution, with the process becoming a lot more efficient.

Suzanne adds: “If any patients have a test as part of their appointment, we can now manage this electronically and provide departments such as radiology and ECG with a live work list of expected patients, meaning they can manage and control the traffic within the department much more effectively.

“We have also been able to completely cut out unnecessary waits for busy departments such as radiology by using electronic outcome forms to record what tests are required on the patient’s next visit, and then updating our patient administration system (PAS) which will then bypass reception and direct them straight to radiology on their next visit.”

Improved experience

The implementation of electronic outcome forms has also enabled ABMU clinicians to take direct control over the next step of a patient’s journey, including when and where they should be seen.

Suzanne adds: “Switching to electronic outcome recording has meant our clinicians can enter information in real time, ensuring that procedure outcomes are recorded and data captured accurately, which in turn helps to improve our patient pathway and reduces the amount of time that admin staff spend on completing the input of paper forms.”

Turning Morriston Hospital into a paper light, ultra-efficient building presented a number of challenges.  But, says Suzanne, the Health Board is already realising the many benefits of an efficient flow of patients.

One person likened the new hospital to moving from the fourth division to the premiership.

“To date, over 160,000 patients have been moved through the department using some or all of our patient flow solution, providing a much-improved hospital experience. In addition, over 87 per cent of patients are choosing to check themselves in on our kiosk, which has meant our reception team are able to deal with those who do need to speak to them more efficiently.

“Being able to fully integrate the whole patient flow solution has also allowed us to standardise over a million clinic letters and documents which are now stored centrally, and our DMS enables ABMU Health Board letters to be available at a national level.

“Since going live, we have received positive feedback from our clinical, administrative and senior management teams. Our patient surveys have also collated fantastic feedback across the board.

“One person even likened the new hospital to moving from the fourth division to the premiership. Now there’s a compliment!”

Abertawe Bro Morgannwg University, supported by Intouch with Health, were 2016 HSJ Award finalists.
Call 01285 657516 or visit www.intouchwithhealth.co.uk