Digital transformation/improvement/quality/performance: Continuing Healthcare service, patients with complex conditions

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Case Study Summary
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Overview summary:
Continuing Healthcare is a complex multi stakeholder assessment and funding decision making process. It has been the subject of NHS improvement programmes, National Audit office scrutiny and patient group pressure which led Simon Stevens to make a commitment to Improve the service whilst reducing the cost to the NHS. We focused on developing a solution to improve efficiency and chc2dst was identified as one of ten high impact innovations in 2018. The solution was co-designed with the NHS.
Challenge identified and actions taken :
In late 2016 IEG4 ran an open event for NHS staff to come and discuss where improvements in efficiency through digital could make most impact. Two nurses were very clear that if we tackled the very inefficient process, paper and complex assessments for continuing healthcare we would improve the service for families and patients and dramatically improve the efficiency of the NHS workforce.
Continuing Healthcare improvement is also the focus of the NHS through a strategic improvement programme and a Quality premium payment scheme for CCG’s.

We took on the challenge and with the support of the Cheshire and Wirral Continuing healthcare team developed an end to end digital referral, assessment, workflow and decisions software solution.

Over an 8-month period the software was developed as part of an “agile” project to the stage we had an operational solution which the NHS in Cheshire and Wirral implemented.

Dramatic improvements in quality and performance have shown through with the Cheshire and Wirral CCG’s achieving NHSE targets. The solution is now market ready for rapid adoption across the whole of England to deliver widespread benefits.
Impacts / outcomes:
Tracey Cole - the Head of CHC in Cheshire has presented at events with the NHS England SIP team with the following messages from utilising our solution. These will be presented again at the Kings Fund Digital Health and Care conference in July 2018.
  • Single point of entry of referrals into the process offers control and transparency over the work load
  • Improved quality of assessments received – particularly checklists being digital
  • Reduced volume of cases by better and quicker assessment and education of referrers at the checklist stage
  • Reduced paper and postage costs
  • Reduced admin time for the operations team
  • Reduced admin time spent by clinical team – quicker completion of DST’s
  • Better allocation of positive checklists to the clinical leads
  • Automation of communications across stakeholders reduces delay
  • Improved morale in the team – people doing a better job
  • Improved delivery of 28-day standard
  • Digital checklist supporting discharge to assess to achieve the 15% standard
  • Full transparency of patient progress through the CHC system
Cheshire and Wirral CCG’s performance against an 80% target has improved from 66% to 82% during the period of implementing chc2dst.
Supporting quote for the innovation from key stakeholders:
Reviewers for the NHSE software applications assessment:

“A much-needed system for improving efficiencies in the CHC process”

“A high-scoring, eminently usable system that greatly impressed all three of our assessors in terms especially of clinical efficacy, safety, security and privacy”
Which local or national clinical or policy priorities does this innovation address:
Strategic Improvement Programme for Continuing Healthcare, Paperless 2020 as part of the 5YFV, Quality Premium scheme for CCG’s
Plans for the future:
Collaboration with AHSN’s and STP organisations to deliver the innovation across the NHS and build the digital solution for CHC and Complex care.
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Tips for adoption:
The adoption process is very straightforward – One demonstration to frontline CHC staff and administrators, arrange a site visit to see the software in action, deploy an “instance” of the software into a test environment, configure the users and release the software to a live environment. Ongoing operational support from a Superuser/admin lead.
Contact for further information:
Charles MacKinnon
Charles.mackinnon@ieg4.com
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