Dave Mills, a Patient Services & IT manager from Oxford describes how they have saved both time and money by modernising their practice’s back office processes.
In the modern NHS it seems that all the major primary care headlines are very much focussed on the end result of all of our endeavours…. the patient experience. How to improve clinical care, how to make sure there are enough appointments for the patients, how to bring the private sector theories on ‘customer’ service and apply them to the modern day GP surgery.
All of these goals are all very right and proper. But every house has to be built on strong supporting foundations, and in our surgery we had started to find that the workload involved in many of our supporting back office processes was quickly spiralling in the wrong direction and taking time away from patient care.
In the beginning
Our crunch point came when the pigeon holes in our admin room were full to bursting with paperwork and we simply couldn’t fit everything in to the doctors trays each day. We knew we had to make some fundamental changes to the way the whole surgery dealt with paperwork and the traditional comfort of actually seeing a piece of information written down on paper in front of you.
Thus began our ongoing journey to tackle all areas of the practice to make the back office processes more efficient and paper light with the use of strategically placed IT systems. Looking at the piles of paperwork arriving by post each day there was an obvious place to start!
As easy as 1 2 3
At the same time as we had began to notice a problem our PCT was offering practices in the county the option to have PCTI’s Docman software installed. The theory being that it would replace the rather basic scanning solution in our clinical system, and allow us to send the 600 or so patient documents per week around the business electronically at the touch of a button and with a complete audit trail. Needless to say we did not take a lot of convincing to sign up!
After an initial bedding in period to get used to the system it provided an instant magic bullet solution to our overflowing pigeon holes. The doctors got their patients documents the moment they were scanned, and they could forward them to the admin team to book appointments, read code diagnoses, whatever their heart so desired.
Docman did initially have one drawback which PCTI soon rectified. Whilst the system was easy to use when you knew how, the interface did look a little overly complex for those who are not naturally drawn to the world of Windows, Google, and Wikipedia. Shortly after we had installed Docman an update was released called iWorkflow.
The iWorkflow interface is far more streamlined & easier for most users to get to grips with. In fact when we switched it on pretty much everybody was able to use it without any training, it was that intuitive. There were also a number of new features which we have used to add substance to the style.
- Scanning templates: When a document is scanned the member of staff can click on a template name and the document will automatically be sent to the correct person. For example ‘Registered GP’ will send the item to the patients doctor without the need for staff to look up who that is. We also set a template up for all reports and forms to be sent to the practice administrator. Many of these were chargeable, but if sent straight to a GP often ended up being completed and sent off with no invoice. The administrator was able to do this before sending them on to the GP, generating the practice a sizeable increase in income.
- Quicksteps: These are very much like the Macros in EMIS LV, you can program them to complete several steps in one mouse click. The upshot being that 95% of the documents a GP receives are processed with a single click, and they can be sent to the correct person with a uniform explanation of what is needed to be done with the document. We have set up unique sets of quicksteps for each department, and documents are now passed around in the blink of an eye.
Following on from the initial success of Docman, we added Docman Hub after. This automatically downloads all of our patients out of hours GP reports, and hospital discharge summaries straight into our Docman system ready to be sent to the GP and attached to the patient record. Gone are the days when the receptionists had to sit and print out reports only to re-scan them into a different program. We are now downloading up to 100 documents a day in this manner
The most recent initiative we have embarked on involves yet another of the Docman family of programs. The dedicated ‘Library’ module for all of the practices non patient related documents, and a dedicated suite of ‘BackOffice’ mini applications.
Our staff continually have problems finding the correct documents on our network drive. The list of them is truly staggering and keeping on top of what is old and what is new is a herculean task with line upon line of folders and file names. The library module allows us to give documents tags which are searchable with a single click. We have started implementing this in reception initially with tags such as ‘Minor ops forms’ ‘Registration forms’ ‘Patient forms’ etc. The results so far have been encouraging, with less time spent searching the proverbial haystack for that pesky referral form that you just know is “in there somewhere”.
Next to the library, are several mini back office apps. These mostly take the shape of replacing a number of the old paper records that we have to keep. As we all start the relentless march towards CQC registration in 2013, these will be an invaluable tool to keep all our records in one easy to access and easy to update location. There are currently apps for Accident Logs, Asset Registers, Death Register, Fridge Temperature Logs, Significant Events, Practice Feedback, and a register of births.
Results
Over the past 4 years the practice has seen an increase in incoming paperwork of 75%. Thanks to the changes we made we have been able to process this without any extra investment in staff admin time.
Our GP’s have found that they have made similar efficiency savings when dealing with their patients paperwork. When you consider that a full time GP can receive up to 200 pages of patient documentation each week, they are each saving between 1-2 hours every week just from this single improvement. That’s the equivalent of up to a dozen patient appointments for each doctor.
We have also seen numerous other time savings ranging from a receptionist saving half an hour a week searching for documents, far fewer mistakes as the systems reduce the possibility for human error significantly, and information is more readily available at people’s fingertips when they need it. Investigating and fixing human errors is always something that can drain valuable management time, especially in a large practice such as ours. We have noticed a reduction in time spent on this particular task of up to an hour a week.
On top of the efficiency savings we have also generated extra revenue due to cutting out numerous charging errors from incorrect routing of reports that are not covered under the NHS.
With the continual pressure on primary care budgets as well as other big projects such as CQC registration on the horizon, we couldn’t have coped without paying as much attention to the back of the business as well as the front.