Busting BureaucracyWorking with the NHS to reduce burden and bureaucracy
Healthcare Efficiency Through Technology 2014
2
Setting the scene
• 1 Health and Social Care Act 2012• 2 Hard Truths published by the Department of Health published January 2014• 3 NHS Confederation report Challenging Bureaucracy• 4 A Strategy for the Health and Social Care Information Centre 2013 - 2015
A statutory duty of the Health and Social Care Act
2012
“.. seek to minimise the burdens it
imposes on others1”
The response to the Mid Staffordshire
inquiry Hard Truths
“…minimise bureaucracy,
enabling time to care and time to
lead2”
NHS Confederation’s
Challenging Bureaucracy report
“the effects and impact of
unnecessary bureaucracy from national bodies3”
“HSCIC has a statutory duty to ensure that the amount of time and effort involved in administration and bureaucracy is kept to a minimum to allow health and care professionals to devote as much time as possible to providing care to
people who need it 4”
3
How do we define burden and bureaucracy?
• Burden - “a duty or misfortune that causes worry, hardship, or distress”
• Bureaucracy - “excessively complicated administrative procedure”
4
Tackling bureaucracy in the NHS
• Audit of 16 acute trusts
• Busting Bureaucracy report
published
• Top 10 tips published
• Self assessment toolkit
• Working on a longer term
bureaucracy audit in collaboration
with two trusts: Royal Liverpool &
Broadgreen University Hospitals
NHS Trust Liverpool Women’s NHS
Foundation Trust
• Audits to be continued in Mental
health, Community and CCG’s
5
Auditing bureaucracy in the NHS
• 16 acute trusts• Week long
audit• Observation,
interviews and structured surveys
• Shadowing clinical and administrative staff
6
Testing the hypotheses
Hypothesis Findings
“Nurses and doctors spend a significant amount of time perweek on bureaucracy”
An average of 66 per cent of a junior clinician’s time is spent accessing or updating patient notes1
“The use of technology and smarter processes reduces burden and bureaucracy”
77 per cent of Trusts type up paper notes retrospectively into anelectronic system2
“The use of technology releases clinical staff time (which could positively contribute to the timeto care)”
The use of Computers on Wheels has reduced ward round times by 45 minutes3
1 Busting Bureaucracy Report, June 2014 - See Table 2, page 202 Busting Bureaucracy Report, June 2014 - See 2e, page 193 Busting Bureaucracy Report, June 2014 - See 3e, page 24
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Testing the hypotheses
Hypothesis Findings
“The better the local systems are, the better the acute provider is able to meet reporting needs”
It has taken some audited Trusts two years to fully implement a solution to delivering a new return;involving interim ad-hoc solutions, requirements definition, supplier quotation, delivery, testing and implementation. Until developed, manual bureaucratic processespervaded.
“A national concordat would have a positive impact on reducingburden”
In the preceding 12 months, an average of 10 external datasets were introduced or changed4
4 Busting Bureaucracy Report, June 2014 – See 1f, page 12
8
Report findings and recommendations
Controlling burden and bureaucracy
Implementing processes
Technology adoption to minimise bureaucracy
9
Top ten tips
10
Changes that make an impact
Review internal governance of data collections and ensure that there is a clear documented process for implementing new data collections and managing existing data collections.
Organisational ownership
11
Changes that make an impact
All data collections have a cost to an organisation. Ensure that all new and existing data collections are supported by a business case identifying the resource commitments.
Cost of data collections
12
Changes that make an impact
Ensure that investment decisions are assessed against criteria which drive clinical effectiveness, improve processes and reduce burden and bureaucracy.
Value of data collections
13
Changes that make an impact
Ensure that all data collections have: an identified owner; a review date and process; explanatory documentation and a support structure.
Management of data collections
14
Changes that make an impact
Consider the holistic implementation of data collections supported by efficient processes and appropriate, available and accessible technology.
Data collections, processes and technology
15
Changes that make an impact
Use the self-assessment toolkit at least annually to develop a baseline view of the level of burden and bureaucracy and to track improvements.
Understanding the impact
16
Changes that make an impact
Review the implementation of existing technology and its effectiveness in supporting efficient processes.
Driving efficiency
17
Changes that make an impact
Consider the implementation of new technology and in particular electronic patient records (EPRs) to directly support care pathways, care settings and data collection.
Data collection as part of
delivering care
18
Changes that make an impact
Explore innovative approaches to reducing burden and bureaucracy. Consider ergonomics, accessibility and availability of systems.
Embrace innovation
19
Changes that make an impact
Staff involved in data collections and the use of systems will have valuable insights and suggestions for improving efficiency and reducing burden and bureaucracy. Set up mechanisms to encourage their input.
User experience
21
What’s next?
Collaborative audit report
Self assessment toolkit
Top tips for trusts
Working with the Burden Advice and
Assessment Service
Two pathfinder trusts …
Further audits – Mental HealthCommunity
CCG’s
22
The journey so far…
“High quality data is crucial to transforming care, which is recognised by both health professionals and the public. However we want to work with providers to stamp out unnecessary bureaucratic burden on those who provide care.”
Kingsley Manning, HSCIC Chair
Source: BB press release issued on 6 June 2014