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Using Technology to Coordinate Healthcare Teams Effectively


Introduction

 

The need to do more with less is prevalent in all organisations, both in the public and private sectors, but is especially important for NHS Trusts. Whilst we are all aware of this, it can at times feel like an enormous quest – so how can this really be achieved with tangible results?


Currently there are two key initiatives driving the requirement for change within the NHS, one is the NHS QUIPP Challenge, the objective of which is to reduce costs by £15bn - £20bn per annum. The other is the Health and Social Care Act of 2012, which seeks to drive greater integrated care - putting the patient at the centre of the NHS. These are not the first initiatives put in place to drive change within the NHS. In 1992 the Tomlinson report attempted to create an internal market, however this failed to fully recognise the requirements for integrated care, putting the ‘market’ rather than the ‘patient’ at the centre of NHS objectives.


Currently Monitor, the independent regulator for NHS Trusts, chaired by Dr David Bennet, is tasked with ensuring that such integrated patient care takes place and efficiencies are achieved throughout all the Trusts. By focusing on patient wants and needs, understanding what clinicians require to fulfil their duties and work more effectively; will ultimately deliver both the enhanced care and cost efficiencies. Effectively this creates knowledge share - smoothing the flow of communication and making access to important information available with ease, simplicity and obviously security.


Background


For such knowledge share to be effective, a cohesive infrastructure is required. This requires the ability to integrate disparate information systems, with different communication platforms, for a range of communications options with differing end points. Combining different technologies with different devices, such as WiFi, Desk Phones, Cordless Phones, PCs, Computers-on-Wheels and Bleeps, is essential to this challenge. In addition, any data must be easy to assess and readily available at the point-of-use. But can technology on its own provide the way forward, or is something else required?


It must be remembered is not just clinical staff that need to deliver services in our hospitals. By providing more efficient methods of communicating and delivering the right information to those who need it, will allow all staff from all levels and services, (from the Porter to the Senior Clinician) to deliver higher performance standards. All of which ultimately benefits the patient and delivers efficiency benefits right across the organisation.


Careful planning is the key


When thinking about how to build the right infrastructure and ensuring that the right device is available, it’s important to look at the forces driving and influencing the use of technology and the type of technology used. Key factors include:


Performance and legislation

The financial or economic environment

Technology and social change

Reliability and deliverability of service

Security and information management


These factors combine to influence the change of technology usage not only in healthcare but in many other areas of business, industry and social environments. The impact these considerations may have on the organisation will differ. How you can best maximise and utilise these changes are factors that will help to shape how the organisation will function.


Being SMART


One of the growing methods of delivering information to the point-of-use or point-of-care is the adoption of SMART devices and applications. This has less to do with the actual hardware, and more to do with the use of the software, giving the user what they really need, fully utilizing the opportunities created by the IP and Wireless revolution. However, these technologies are, in terms of the healthcare market, still in their infancy. Whilst wireless technology adoption is progressing, it has not been accepted as quickly as in other industries. However, this is a real revolution, so understanding wireless and its impact can provide and deliver new and innovative services and solutions. There is a real opportunity to develop new solutions, which integrate often disparate and stand-alone information resources, to a unified point-of-need.


Bring Your Own Device?


As an example of a response to the need to maximise cost benefit, some organisations are actively considering BYOD (Bring Your own Device). Initially the financial case for this strategy seems to be very strong. There would be no need to have a department administrating Mobile devices, Users, SIMS etc., so costs could be reduced.

However, there will be a requirement to monitor which devices are available, ensuring that they operate correctly across the internal networks. There will be a constant requirement to check and administer phone numbers, to provide local PBX management, to administer multiple and personal email addresses - so any cost saving can easily be negated if left unchecked. You would also have to measure the physical cost savings against the more important risk of accountability - should a privately owned device fail, what is the solution? There are other potential issues as well:


Who is responsible for the functioning of the device?


Who is responsible for paying for the devices and ensuring that no bars are in place?


Who is responsible for ensuring that vital messages get through in an emergency?


Who is responsible for ensuring that the consumer devices are compatible with your own in-house systems? (i.e. any Java systems, and could they be guaranteed to run on an Apple device?) The potential drawbacks could be considerable.


So a well-considered and strategic approach to the adoption of new and innovative technologies can provide real benefits, but they must be thought through with the total impact understood. Innovation is adopted best when it is proven to work and corporations understand how to best utilise the technology offering.

Security considerations


One of the most important considerations for any healthcare organisation is security - it is vital to protect all data from unauthorised individuals. Whilst storing patient records on devices saves time and improves the process flow, this information must be secure and only accessible to those people who actually need it. If this is the case, should private devices be brought into the work environment at all? If we do not understand what is operating on these platforms, then the integrity of the whole information infrastructure is at risk.


Technology for Technology’s sake?


To get a truly objective view of the debate it’s important to consider why consumers want to use very sophisticated communication devices within the workplace. Would it be fair to suggest that consumers could be guilty of just using technology for technology sake, just because it is available and new? Has technology become more of a fashion or a status item rather than an aid to communications and if so does this really have a place to play in the

workplace? Do consumers really understand and maximise the technology that they have bought?


Consumer technology is sometimes more advanced in terms of its use, adoption and possibly innovation than that which is applied to the organisational environment. The IP and Wireless revolution is providing a creative force for change, with the development of new and innovative solutions structured for the work environment. There is not only an expectation, but a demand even, that these solutions will be available to new and young professionals entering the healthcare sector. In fact any sector of the UK economy. The question for healthcare organisations is: can we or should they meet this challenge?


In a healthcare or business environment, it should be questioned if IT managers always need to demonstrate that they are ahead of the technology curve by always looking for the next new advancement or could they prove their functional worth by utilising the technology they currently have, but in a more efficient way? Perhaps they should not be nervous of promoting older technologies, as long as it is the most relevant technology for the department or people concerned and matches the staff requirements. For example; a robust on-site, walkie-talkie radio for a Porter or Security Officer instead of a SMART device may be viewed as more sensible.


In the end the question is one of balance, using the right application to meet the actual, rather than perceived need. By doing this, we are not only providing the right tools, we are also doing this in the most expedient way, maximising both efficiency and efficacy in terms or the desired improvement.


Maintaining the failsafe


Well implemented and planned technology can make life easier and having communications on tap can be an important part of this. However what happens when something goes wrong?


Communications technology needs to work well - the message must get to the right person at the right time on the right device. The most important function of communications is its ability to continue to work, even when other technologies fail - critical messages must get through every time at any time. By being able to reach the right people when you need to, saves considerable time and cost, in terms of time, resource and task management.

In a Hospital it’s imperative that all technology delivers. In an emergency there is no margin for error. Those responsible for the delivery of internal communication systems should create a system whereby the device, with the right levels of reliability is available for the task in hand. SMART devices, for example, should predominantly be used for one-to-one applications, such as checking records, results etc., when time is not critical but access to information is useful at the point-of-care. If it takes a couple of minutes for information to be downloaded this is seen as an improvement on the time it takes to find and read the necessary information, or to refer to another source of information source, i.e. a colleague.


When communicating to groups (or one person to many), mobile devices send the message sequentially and therefore it will take a bit of time to reach all of the required recipients. If the message is not vital and seconds do not count then this is an acceptable method to use. However, if the message needs to reach a team of people urgently then the bleep system is often more appropriate, as the message is broadcast to the required personnel at the same time.


Normally, no discussion is required, emergency teams are trained to react on the information supplied and do not waste time responding or asking questions - this is a call to action, they just move. In an emergency your communication systems must withstand the most stressful of situations, whatever the environment.

Likewise communication networks must be reliable, risk strategies must be employed when things can and do go wrong, back-up services, perhaps less fashionable analogue services are retained and maintained, to help ensure information and communications integrity.


Measuring the benefits


From a management perspective, technology must be measurable, so change and implementation can be measured and where required re-deployed. Most communication and information systems log all activity on the system; this not only does this provide a measure, but provides an audit trail, should you ever need to review the communication trail, for litigation purposes, you can demonstrate exactly what processes were followed and by whom.


By using technology, you get a bird’s eye view of all activity within the organisation, giving you management information in which to base more informed, strategic decisions. It can be used to gauge resource use and allocation. If, for example a senior clinician is receiving too many interrupts from a bleeper and internal text messages, this can impact patient through-put, for example 10 calls can equal 2 minutes of follow-up time, so 20 minutes is wasted, which is an appointment delayed or even lost!


Real examples in the healthcare sector


It’s useful to consider real-world examples of how technology can be used to co-ordinate teams and provide better healthcare and make the most of resources. Here are three examples of this in practice:


Alarms on machines such as blood bank fridges or medicine storage fridges. When these are not working within optimum parameters, the machine will send an alert to maintenance, thereby ensuring that the blood and medical supplies is protected; saving costs, saving time in terms of rescheduling resources.


Patients who need extra care, such as dementia patients can be monitored from a distance, so that the care is always there and less intrusive for the patient. For example, if they are getting close to an area deemed hazardous, a discreet alarm can be sent to dedicated staff who can guide the patient back to where an area in which they are safe. You can even use technology to remind low level dementia patients to take medication at appropriate times.


Using bleepers in the healthcare environment is an alternative approach to call and remind patients of appointments hours before attendance and used in the waiting room environment, allowing them to use hospital retail and restaurant facilities, making their attendance a more pleasant experience.


Summary


Whatever technologies you choose to work with within your organisation, it must be the best fit for you and it must be flexible to allow you to develop and enhance solutions and develop applications over time.

In essence the best approach is one of choice and control. A mixture of older and newer technology that can interact and be applied to provide the right tools for the right situation, will offer numerous benefits including saving time, improving workflow and reducing costs.