10 key learning points when introducing Digital Dictation
The financial rewards for hitting CQUIN targets for clinical correspondence can be considerable. Releasing this funding, however, calls for careful planning and clearing the hurdles that new systems and processes give rise to.
Here are ten top tips for a smooth and fruitful introduction of digital dictation at your Trust.
1. A blueprint for success
Ensure a strategy is in place for the generation, storage and delivery of clinical correspondence. It should be remembered that digital dictation is only a small part of the solution – and so consideration of the bigger picture is essential.
Trusts should assess how their clinical correspondence processes may have to change now and over the coming months to meet new CCG targets. The systems established should not only offer a reliable and robust solution but also provide a good platform for further process and operational developments.
Transcription for example, could be fulfilled by medical secretaries, internal or external transcription services, full or partial speech recognition or any combination of these options. Trusts should consider whether the preferred solution will accommodate these variations on one platform and, significantly, how it will appear to, and be received by, clinicians.
The delivery of correspondence electronically to GP systems offers another example of the importance of such a strategic approach. Acute trusts cannot be expected to adopt processes to meet individual GP practice requirements but need to consider the scope of their electronic delivery solution to meet the broader, and evolving, requirements of the CCG. It is essential market solutions are adopted, with ITK accreditation preferable.
This consideration was particularly important at Alder Hey, where the catchment area for their tertiary services is so wide they had to be in a position to meet the requirements of a number of CCGs. The resulting solutions will have far reaching consequences. Medisec Software is working with Healthcare Gateway and CCG’s in Cheshire and Merseyside to provide ‘hub to hub’ exchange clinical correspondence. This will enable Alder Hey to extend the reach of electronic delivery well beyond its local CCG and maximise the ROI in its paperless clinical correspondence process.
Other areas such as data and system integration are also key issues if the trust is to provide a robust strategic platform.
2. Generate light – not heat
Effective trust-wide communication is vital. Steps to implement a new clinical correspondence process will be taken to meet CCG targets, save money and improve patient care – all mandatory trust requirements.
An investment will be approved by a trust at the highest level and this sponsorship has to be visible to all the stakeholders throughout the process.
The best environment for change will be created if the need is recognised by all, and the agreed solutions are the most appropriate.
It is not for those charged with implementing change to do battle with reluctant users and the trust should decide how best to handle resistance to ensure it is appropriately addressed.
These lines of communication have been vital to address operational issues that arise and to reinforce the strategic direction in the face of any challenges to the changes.
At Southport & Ormskirk NHS Trust the engagement process started with a series of open days that were really well attended by clinicians and administration staff. The project is being managed by Informatics Merseyside who surveyed all attendees, using a questionnaire – the results of which were used to steer the implementation process.
3. Walk before you run
Pilot the solution to make sure you have got it right and that the trust is operationally ready for roll out.
Setting up a new clinical correspondence process requires that a number of things are working well – from the software, hardware devices, workstations and system set up processes to system support, training and associated materials, first line user support, reporting and monitoring systems.
At Medisec Software we have discovered the most reliable way to do this is to pilot the solution in a department or specialty and ensure all the services which the trust is going to rely upon are engaged. Experience has shown this to be the most effective way of ensuring any teething problems are revealed and addressed in advance of roll out.
A pilot also offers the opportunity for full knowledge transfer from system suppliers to ensure staff are capable of supporting the implementation and provides project managers with the information needed to devise plans for full trust-wide roll out.
At Doncaster & Bassetlaw NHS Foundation Trust the pilot was used to develop and test training scripts to support the roll-out process. The early engagement with the Training Department was crucial in the project and provided both IT support and operational support to users.
The pilot process has been essential at Southport & Ormskirk as the trust is implementing Medisec Software Digital Dictation to replace a system that failed to meet expectations. A fully operational pilot is being implemented within selected departments across both sites to provide confidence. The pilot will be evaluated against pre-agreed success factors before being released for wider roll-out.
4. The proven path to project delivery
Stick to NHS project management methodologies, such as PRINCE, which have structures and procedures to ensure the right representation is present, the communication strategy is formalised and issues such as quality assurance are fully covered. This would include a provision for managing clinicians’ objections.
5. Assume strategic control
Steps should be taken to control the way dictations are carried out. The most efficient transcription process is where voice-files are tagged with all the data required to identify the patient, the author, the letter type and the clinic attendance details. This enables letters to be ‘topped and tailed’ automatically by the clinical correspondence software system, leaving the transcribers to type the body copy only.
At both Alder Hey Children’s and Doncaster and Bassetlaw Hospitals Trusts, the majority of dictations take place in clinic rooms where authors can dictate directly into the system.
It made sense to consider this process the norm and to support it accordingly, providing tethered devices in the first phase of implementation. Furthermore, both trusts only provided pocket dictation devices to those users with an agreed need.
As all dictations appear in an integrated transcription workflow, the ratio of tethered dictations can be viewed a key measure of process efficiency.
Control has been extended at Alder Hey to force uniformity in the way clinic letters are dictated. Alder Hey has been mandated by its local CCG to provide clinic letters in a set format. To achieve this efficiently, the trust has added a dictation script to the front end of the process, meaning transcription is much quicker and compliant with CCG requirements. This was not met with total acceptance, emphasising the need for an effective communication process.
6. Supporting and empowering clinicians
Ensure ongoing training and support is provided for the use of digital dictation systems and equipment.
Trusts are notoriously neglectful at providing adequate support to ensure systems are used properly and deliver the anticipated results. It is essential clinicians have confidence the equipment will be in place and serviceable and that any problems are addressed quickly. As they are using these facilities all day every day, the support services have to be up to the challenge.
Medisec worked very closely with Olympus at Alder Hey to provide clinicians with the equipment they preferred and were closely involved in the pilot phase to ensure the site was operationally ready.
Feedback from the open days conducted at Southport & Ormskirk highlighted the importance of this to project success. It is often the simple things that are key – ensuring there are sufficient workstations available, for example, and that clinic rooms are properly set up and maintained at all times for dictation.
7. Meeting the paperless challenge
Trusts should be focussed on an end-to-end paperless process, with Jeremy Hunt having thrown his weight behind proposals to make the NHS fully paperless by 2018.
In the clinical correspondence process it will not be the digital dictation solution that proves an obstacle but operational issues such as residual printing, letter attachments and managing the sign off process.
The print problem poses an interesting challenge and requires a strategic approach to provide a reliable operational solution.
Medisec has been at the centre of the solution at Alder Hey, separating electronic mail from the residual physical post and providing all the print instructions to the outsourced solution providers. Operationally, this provides a big fillip for the trust as, in addition to the printer hardware support, it can make significant time cost savings.
Doncaster & Bassetlaw uses Medisec Software to do all the print sorting, separating electronic mail and centralising the printing process internally. This solution has enabled them to adopt a phased approach to becoming paperless.
8. A springboard for far-reaching efficiencies
When a fully integrated clinical correspondence process has been successfully implemented, its potential should be maximised by using it to review administrative operations in a more strategic light.
Systems will, after all, be in place to support moves such as establishing transcription pools, deploying speech recognition solutions or outsourcing.
9. It’s good to talk
Ensure effective communications are maintained after implementation and on an on-going basis. This is particularly important where the implementation of integrated digital dictation has led to internal reorganisation, such as the introduction outsourced solutions or development of onsite centralised transcription services. Buy-in and acceptance of new systems and processes can be short lived and so communications strategies should be formulated in a sustainable fashion.
10. Trust in the experts
Engage your preferred digital dictation supplier in an on-going consultancy role and, where appropriate, draw upon their experience and expertise to advise on relevant operational matters.
Medisec Software advises and supports its trust partners in considering operational changes and, with clinical correspondence processes a key area for improvement and cost saving, in planning for the future.
For a more detailed discussion of the any of the points and observations summarised below, please email:
ceri.rothwell@medisecsoftware.co.uk
