Innovative visual solution that makes a real difference in delivering high quality & safe care - Devon

What We Did

The Informatics team have developed an innovative electronic visual control board which was named ‘MyWard’. This was developed in collaboration with multi-disciplinary clinical and managerial staff, bed management, Chief Operating Officer and Quality Improvement Academy.

This is a national first for Mental Health, and Devon Partnership Trust are the very first Mental Health Trust to introduce such electronic visual control board, it is a remarkable innovation as although acute services are using electronic whiteboard for a while, they are not similar to the visual concept innovated by Devon Partnership Trust.

Innovation and implantation of such technology to improve patient care shows that the Trust are leading the way in bringing bed management technology into Mental Health services and advocating parity of esteem.

The concept of ‘MyWard’ is to provide simple visual clues and prompts for improving quality and safety of care.

Key objectives are:
• Enables control of ward resource to ensure key clinical interventions are completed in line with clinical measures and other time-sensitive protocols, which improves care delivery.
• Remove administrative burden and enable clinical staff to spend more time on direct patient care.
• At-a-glance visual storyboard for staff to get a clear picture of the ward, without having to look through multiple systems!

Previously, information on the progress of key clinical interventions about patients being cared for on a ward were hand written on a display whiteboard and had to be manually updated.

The new electronic Whiteboard is touch-screen system which provides near real-time information visually, using data from the clinical recording system where available, with an aim to highlight individuals who needs more intervention, enable targeting of resources, reduce administrative burden and improve ward efficiency and flow. The software is visible via web link and presented via 65inch touch enabled whiteboard in the nursing office.

In November 2014 The Chief Operating Officer wanted to support the wards to make better use of technology to facilitate timely intervention and ensure quality of care.

A series of meeting took place in January and February 2015 between the Performance Information team, clinical multi-disciplinary staff and other departments, to understand how staff resources could be targeted to achieve more timely and effective intervention. This identified the importance of a visual control aid for staff. A list of key clinical interventions were identified that were critical to good patient care and flow through the pathway. This list was then verified with other key operational and clinical staff. Following the scoping process in February 2015, a solution was designed and the development started in-house within the Informatics team. The initial design and development process was co-produced with the ward team. The development cycle was completed between March and June 2015.

The design was kept simple as the usability is one of the key factors considered as part of the scoping exercise.

Ward staff can now see key information relating to each individual patient via a touch- enabled electronic whiteboard. A series of icons are displayed alongside the patient name to show clinically relevant checks and completion status which alerts staff when things need to be actioned.

The Whiteboard product was tested on Beech Ward (Older People) in July 2015 and Coombehaven (Younger Adult) in November 2015. A series of small tests of change were implemented which resulted in a range of staff proposed changes to ensure that the Board was fit for use. This testing process ensured that the Visual control board were easy to access, easy to use and that the right intervention icons were visible to improve care. The Quality Academy lead, alongside Informatics staff jointly supported the test and implementation phase on both wards. Technical support was made available 24/7 for 2 weeks, as well as support to the ward managers/staff to support its use to improve care.

‘MyWard’ used data from the Clinical data recording system Rio, from the Trusts data warehouse. The data was about 8 hours old, some information was updated on the system as it was replacement for paper based processes, and particularly information that couldn’t be recorded on Rio. The Trust changed the clinical recording system in August 2015, and now working with the service provider to supply application programme interface (API), this is so that information can be pushed and pulled from the clinical recording system real- time, and staff will only need to use the whiteboard to record information, the API functionality is likely to be available around November 2016.

The usage of electronic whiteboard received positive feedback from staff at all levels, including consultants, ward nurses, managers and night nurse practitioners (Appendix D for quotes from staff).

Ongoing data collection shows that the whiteboard is used consistently by staff through weekdays and weekends. The detailed statistics is supplied as an additional document (Appendix B Whiteboard Usage Analysis).

In February 2016 a survey was carried out to seek feedback from staff, both at the Adult acute and the Older Peoples inpatient ward, 21 staff participated and the key findings are as follows:

– 85.7% staff agree that the electronic whiteboard helps them to plan their work.
– Over 90% agree that the electronic whiteboard contributes to patient safety/patient care. – 95% state ‘The electronic whiteboard makes it easier to see what tasks need to be done for patients.
– 90% felt ‘The electronic whiteboard has highlighted gaps in care that I have then filled.
– Over 80% staff feel that the electronic whiteboard supports them to run more efficiently. – 20 out of 21 staff would recommend the electronic whiteboard to another service.

A comparison of timely completion of intervention against target with 3 months post testing shows and increase in Beech from 38% to 91.6% checks completed within target and Coombehaven from 35.8% to 90.7% (Appendix E for improvement analysis).

Beech ward have a weekly multi-disciplinary clinical team review meeting every Tuesday, and Thursday. This meeting used to take almost 1.5 hours as information needed to be sourced from paper records and different IT system. Having the whiteboard showing the real-time information, (and detailed patient information is also visible from the whiteboard, just by pressing the patient name) makes a significant difference and the meeting now takes 45 minutes. (Appendix D for staff feedback).

Devon Partnership Trust are now looking into spreading the application to other areas of work, e.g. – delivering 24/7 Liaison Psychiatry service.

Manual display whiteboards were time consuming to use and maintain. The electronic visual control board (MyWard) enables more efficient control of resources resulting in improved care for patients.

This innovation was required to support the following outcomes:
• Ensure key aspects of clinical care are delivered in a timely manner to enable effective bed management
• Facilitate effective review of current ward processes between handover and ward round • Reducing the administrative burden for staff so more time can be spent focusing on patient care
• View key information related to the individuals in one place

The Whiteboard was tested on both an Older Peoples and Adult Acute ward. Small tests of change were carried out using Plan, Do, Study, Act methodology and appropriate processes implemented to ensure that the Board was fit for use.

Key actions:

• Patient focused – The core purpose of the electronic visual control board is to improve the quality and safety of patient care, by enabling ward staff to provide timely intervention where it’s needed most. Throughout the design and development process, patient safety, delivery of high quality care and experience was kept at the heart of the entire process.

• User engaged development process – The ward clinical staff were fully involved in the scoping and system design, the software solution was reviewed throughout the development process by ward users so they felt it was simple, intuitive and ‘personalised’ for the ward use.

• Collaborative innovation – The visual control board (MyWard) innovation is an excellent example of collaborative working between multi-disciplinary clinical and non-clinical teams. From scoping, design, development to release, every single step of the project was done through engagement from clinical (ward staff, nurses and consultants), and managerial staff, safer staffing and bed management team, Medical Director, Chief Operating Officer and the Quality Improvement Academy.

• Quality driven outcome – Well thought through small tests of change were carried out using Plan, Do, Study, Act methodology and appropriate processes to ensure that the Board was fit for use, and that it provided the right checks to maintain a high quality of care.

• Considered implementation – Fully supported training and practice guidance were provided by the Quality Improvement Academy and Informatics team. From day 1, ward staff were trained on how to use the electronic whiteboard software, and help guides were made available in different format, including easy read version. One staff member from the informatics team was present all day everyday for the first week of implementation to provide 1-1 assistance. The ward staff were encouraged by the level of operational and technical support, which in turn resulted into successful implementation of MyWard, and became an integral part of the clinical ward environment and fully embedded in their operational practice.

Measurable results:
• Ease of use – 21 staff participated in a recent survey to both wards, 95% said ‘The electronic whiteboard makes it easier to see what tasks need to be done for patients’. The whiteboard is easy to log onto, it only requires a 4 digit pin number which is unique to the ward.

• Sustainable innovation – The information is not easily corrupted/changed e.g. in early tests we noticed that a fly landing on the board changed the status of one of the clinical icons. Both wards now have high definition touch screen monitors which needs a human touch to operate the functionalities.

• Responsive Design – The electronic whiteboard information is translatable to a mobile IT platforms i.e. laptop and tablet etc. as long as the device was connected to the Trust secured network (N3).

• Improving patient safety – The legacy manual whiteboard took approx. 2 minutes per task, as staff needed to look into information from different systems, in ‘MyWard’ it takes approx. 30 seconds per action, therefore creating 63% time improvement for each action which is used for direct patient care.

• Improved compliance – In delivering key clinical care delivery against local and national standards, over 90% delivered within time.

The cost of the project is broken down into three categories:

• Initial development
• Additional rollout
• Recurring maintenance

Initial development

Senior Application Developer (Band-7) worked within the Performance Information team alongside Head of Performance Information on the scoping, design, technical development and deployment of the product.

Scoping and implementation* x 20 days £ 5,435.58 Band-7 x 3.5 months development time £13,202.00 Whiteboard and PC (IT assets) £12,000.00
Estates cost £ 1,000.00

TOTAL: £31,637.00

* This includes time from Head of Performance Information and the Quality Improvement Academy for scoping, oversight and implementation support.

Additional rollout – per deployment

Band-7 developer 15 days £ 2,829.13 Whiteboard and PC (IT assets) £ 6,000.00 Estates cost £ 500.00
Contingency £ 670.87

TOTAL: £10,000.00 Recurring maintenance

Application Development function within the Performance Information Team x 12 days per annum at Band-7 – £2,263.00

** Please note, all banding above is calculated at mid-range (NHS ‘Agenda for Change’) including on-cost.

An estimated circa £10k savings in staff cost per ward per year has been identified as an offset to the implementation costs, this is based on time savings achieved from meetings, handover sessions and data input via the use of the electronic whiteboard.

Wider Active Support

This product has been innovated through multi-disciplinary (clinical and non-clinical) staff engagement, at this stage we have not partnered with external organisation as both technical and operational expertise are ‘in-house’ within the Devon Partnership Trust.

Co-Production

In February 2016 a survey was carried out to seek feedback from staff, both at the Adult acute and the Older Peoples inpatient ward, 21 staff participated and the key findings are as follows:

Looking Back/Challenges Faced

The project involved multi-disciplinary engagement, user ownership, good process of small tests of change, practical training and support programme for successful implementation. This is one of the pioneer projects of the organisation where these useful, pragmatic and supportive techniques was applied and has been incredibly successful. Looking back – we would not do it in a different way.

This innovation was required to support the following outcomes:
• Ensure key aspects of clinical care are delivered in a timely manner to enable effective bed management

Facilitate effective review of current ward processes between handover and ward round
Reducing the administrative burden for staff so more time can be spent focusing on patient care

• View key information related to the individuals in one place
We undertook the following actions to achieve the outcome:
• Patient focused – The core purpose of the electronic visual control board is to improve the quality and safety of patient care, by enabling ward staff to provide timely intervention where it’s needed most. Throughout the design and development process, patient safety, delivery of high quality care and experience was kept at the heart of the entire process.

• User engaged development process – The ward clinical staff were fully involved in the scoping and system design, the software solution was reviewed throughout the development process by ward users so they felt it was simple, intuitive and ‘personalised’ for the ward use.

• Collaborative innovation – The visual control board (MyWard) innovation is an excellent example of collaborative working between multi-disciplinary clinical and non- clinical teams. From scoping, design, development to release, every single step of the project was done through engagement from clinical (ward staff, nurses and consultants), and managerial staff, safer staffing and bed management team, Medical Director, Chief Operating Officer and the Quality Improvement Academy.

• Quality driven outcome – Well thought through small tests of change were carried out using Plan, Do, Study, Act methodology and appropriate processes to ensure that the

Board was fit for use, and that it provided the right checks to maintain a high quality of care.

• Considered implementation – Fully supported training and practice guidance were provided by the Quality Improvement Academy and Informatics team. From day 1, ward staff were trained on how to use the electronic whiteboard software, and help guides were made available in different format, including easy read version. One staff member from the informatics team was present all day everyday for the first week of implementation to provide 1-1 assistance. The ward staff were encouraged by the level of operational and technical support, which in turn resulted into successful implementation of MyWard, and became an integral part of the clinical ward environment and fully embedded in their operational practice.

Sustainability

Clinical information and live bed status from the whiteboard is readily available for Trust staff, and managers, to access key pieces of information real-time. The whiteboard is designed and implemented in such a way so that it’s driven by the whole team, not just key individual(s) to mitigate staff related risk i.e. absence, role changes etc. With regards to the technical maintenance of the system a robust technical infrastructure has been developed and 24/7 help function is provided by the in-house informatics Team.