The following is an excerpt by Head of Communications at Brighton & Hove City Council, John Shewell.
The public sector is facing unprecedented challenges – not least huge financial pressures, with Chancellor George Osborne’s 2010 Comprehensive Spending Review unveiling the UK’s biggest spending cuts for decades.
The Government laid out plans to slash more than £80 billion from the public purse, with schools, councils, hospitals, the fire brigade and police all affected.
In short, the public sector cannot continue working in the same way it has done since the 19th century, when county and district councils began.
At the heart of these challenges lies communication. Research carried out by Ipsos-Mori shows that the more the public feel informed about their services, the more satisfied they are with an organisation. Communication becomes more complicated with the changing media landscape. Newspaper circulation is in decline both nationally and regionally while online audience share continues to grow apace.
In the face of real change in the public sector, communication has undergone its own quiet revolution. Where local public services need to find more efficient and effective ways to engage with people, social media is proving to be an invaluable new tool.
The case for social media
Various public sector organisations have been experimenting with social media over the last few years. Age-old industries are turning to modern technology to reach their audience through a medium that is mutually used by people of all backgrounds and ages.
Social media is fast becoming an essential component in an organisation’s business strategy. However, social media in itself is not a strategy.
The challenge is to avoid focusing on creating a “social media strategy”. This narrow field of vision ignores the fact that a good reputation is built on an integrated, multi-disciplinary approach to reputation management. Today’s tech-savvy citizen commands a different relationship. No longer are they willing to be passive recipients; they expect to be active participants in sharing information and creating content.
Citizens are now prosumers rather than consumers. These are people curating content on issues that they care about which often means they can either support or destroy a brand (also referred to as “folk ads”, “open source branding” and “vigilante marketing”).
At the heart of this lies a desire for citizens to feel valued. This means they are being listened to and are involved in the shaping of an organisation’s brand; making them feel empowered and making brands more “social”, and the Twitter hashtag is bringing people together to talk about issues they care about.
The riots in the summer of 2011 across parts of the UK demonstrated the power of social media, playing a key role in organising people to wreak havoc across the country, costing UK companies millions of pounds. But it was also a force for good in bringing citizens together to clean up and reclaim their streets.
Throughout the August riots, Sussex Police used Twitter to publish a steady stream of updates from the “top cop” all the way down to the frontline – answering questions from citizens and setting the record straight when rumours started to spread.
The vast majority of the public sector still relies heavily on traditional communications based on media relations, marketing and paid-for advertising. All three are problematic and resource intensive.
Media relations means relying on TV, radio, newspapers and magazines, often with declining audiences, to disseminate messages that may not necessarily convey the full story, which may limit the audiences’ understanding of the organisation’s actions, thus impacting on the organisation’s reputation. Advertising, on the other hand, is expensive and often ineffective when applied to people who are increasingly impervious to obvious marketing.
Social media, therefore, which includes blogs, podcasts and social networks, presents a better opportunity for the public sector to communicate in both directions in a cost-effective, authentic and direct way. It presents engagement opportunities with traditionally hard-to-reach groups, for example young people, and can reach a new audience as a consultation tool.
By using social media, public sector organisations are able to talk to citizens in the way they want and on their terms - addressing the issues that are important to them. Not only can these organisations share information about new services and listen to discussions taking place in the blogosphere – that may or may not include the public sector organisation – but the opportunity also exists to contribute to these discussions.
Together with the rise of the internet and social media, local public services are provided with an opportunity to forge new relationships with citizens. Even schools are recognising that social media can be used for educational purposes, as instead of seeing it as a distraction to pupils, they are adding it to the curriculum.
Social media use in the public sector has not yet reached its height. As we carry on learning more about its possibilities and form stronger relationships with audiences along the way, our organisations’ reputations will continue to grow.
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Managing Director of healthcare performance management solutions MedeAnalytics UK, Paul Fitzsimmons, explains, there is no time for long drawn out debates and discussions about the right way forward; changes to clinical pathways, the removal of unwarranted variations in practice and rapid propagation of best practice will be key to realising the vision of the NHS over the next five years.
The leadership role of clinicians within the new NHS cannot be underestimated. But how can the NHS overcome the inherent disconnect between clinicians and managers to drive forward change and realise the vision of improved patient care? Simply cutting management heads and expecting clinicians to fill the gap cannot work without putting in place new processes and information resources to support these individuals.
So what is the route forward? The NHS has little time to introduce such change given the financial constraints. Promoting clinicians to full time, as opposed to rotation based–management roles is one option. And, as the E-Health insider campaign over recent months has demonstrated, there is a strong commitment across the NHS for dedicated Chief Clinical Information Officers (CCIO) to lead on IT projects and drive the increased use of information to support patient care.
But while CCIOs will have the respect of their clinical peers, these individuals cannot operate in an information vacuum. Despite the huge investment in information resources over the past decade across the NHS, too much of this information remains within the confines of finance departments. Outside finance there is limited understanding of the depth and quality of the current information available; leaving many clinicians lacking even basic insight into performance, and providing poor performing clinicians with the chance to argue information cannot be trusted.
Without adequate, trusted information, resources managers – even CCIOs – have simply no room for manoeuvre. How can any manager – clinical or otherwise – achieve effective change simply by telling a consultant or department that there is an overspend? Or by routinely disseminating an incomprehensible spreadsheet?
The key must be to combine the financial and performance information with clear insight into where the overspend is occurring and how practice compares with others – such as length of patient stay, post operative infections or level of complications; and to provide information in a manner that is relevant to clinicians, not finance or information experts.
Critically, the challenge is to create an environment that values information transparency, rather than one that fears judgemental performance evaluation. Information must be transparent and accepted by all parties, and organisations must engage in real debate on the pros and cons of existing clinical practice in order to realise improvements.
The good news is that there is a raft of information in place today that could, and should, be used by clinicians to support essential change. The challenge for CCIOs is not only to encourage finance and information teams to share that information with clinicians in both primary and secondary care, but also to put in place an education process that explains the data constructs around HRGs and how this is derived from their own patient treatment records. It is key to show how it influences funding to enable sometimes sceptical clinicians to better understand the value of the information they are the source for.
There has been too much emphasis in the past on creating a ‘perfect’ information resource. This is, simply, not possible. Data error will always occur at some point – even more so when clinicians responsible for recording that information can see no value from doing so.
By educating clinicians as to the data value, asking them to flag up clear errors, organisations can ignore the irrelevant and focus on the rest whilst also improving the overall data quality. This will provide invaluable insight into variations in performance and into best practice innovations that are delivering quantifiable value to patients and budget holder alike. If clinicians are also empowered to act on this information, changes to clinical practice in both primary and secondary care will deliver both budget reductions and an improvement in patient outcomes.
For example, enabling consultants to look at the duration of stay, complications and on-going treatment requirements of a group of post-operative patients, revealed that one consultant achieved consistently better patient outcomes and less post-operative bleeding. Discussing their treatment protocols together, these consultants discovered that the difference was simple – and cheap: prescribing a daily iron pill for patients for one month prior to operation. This practice was immediately embraced by the other consultants resulting in a rapid improvement in clinical outcomes.
No one is underestimating the challenges facing those tasked with healthcare provision in the UK – or any other country. The NHS delivers a broader and more expansive range of clinical procedures and treatments than ever before to continually increasing demand, yet within ever tighter financial constraints.
But if the NHS is to move forward, clinicians must be empowered to make decisions based on fact not anecdote. CCIOs clearly have a strong role to play, but they must be supported with access to trusted information. With this insight, managers and clinicians can together focus on variations in performance, looking at best practice to improve the overall quality of patient care, highlighting key problem areas, reinforcing accountability and focusing on quality as much as cost.
CEO of medical provider Westhouse Medical, Jack Kaye, explains why mammograms aren't enough in the fight against breast cancer.
There has been much debate in the news recently regarding the below average UK cancer survival rates, coupled with breast cancer screening concerns. Here in the UK, British women have to wait on average five months from testing before they are given a complete diagnosis.
The NHS breast-cancer screening programme, which allows all women from the age of 50 to have three-yearly mammograms, has been said by some doctors and researchers to ‘do more harm than good’. One in eight women will at some point in her life develop the disease - which is being diagnosed 5,000 more times a year than a decade ago.
Unfortunately this is the reality of the situation and it helps no-one to lay blame. The question is – what can be done? Statistically, the best way to improve breast cancer survival rates is to have a national scanning policy which allows early detection for better survival.
It is evident that breast screening saves lives; however, affordability seems to be the issue. Mammograms, which forms the key component of the UK’s breast cancer screening programme is expensive, costing an average of £53.62 each. There are currently 2.3 million scans performed each year, which is expected to rise to 3 million between the years 2013-2014, due to the aging population and shift in demographics. This in turn raises concern for the NHS, as the cost for screening will rise to £160m per year as opposed to the current £120m. If scanning is done more frequently and covers a wider footprint, then this number will significantly increase – as will the cost.
Current technology available for breast cancer screening is expensive, and at a time when healthcare budgets are increasingly tightened, more affordable options need to be explored.
Breast screening should be deliberately non specific – aiming to indicate a wide range of pathologies, which mammograms unfortunately do not. That way, should a pathology be identified, it can be investigated with more specific diagnostic test. This would result in a layered system of diagnostics that would identify the specific pathology involved and so allow more efficient targeting of treatments - reducing the potential harmful and costly effects of unnecessary procedures.
Westhouse Medical is currently developing a primary breast scan which responds to a large variety of pathologies due to temperature sensitivities within the tissue. Nationwide adoption of this breast scan will reduce the number of mammograms necessary by more than 80%, making screening easier for the individual and the medical practitioner. The effective saving to the current NHS budget would be over £100m a year.
Developments of breast cancer screening technologies are crucial to reducing the NHS spend as well as help woman detect abnormalities easier and quicker. As populations increase and demographics change, breast cancer screening needs to move beyond first generation measures such as mammograms – which is why we welcome the national review of the current breast cancer screening programme. Medical devices that allow women to test at home or at the GP’s will be the next step in revolutionary screening.
With a growing and ageing population the need for new care models such as mobile and telehealth technologies to support long-term healthcare, has never been greater. Yet, there remains an identifiable ‘chasm’ between early adoption and the wider uptake of mobile and telehealth technologies. Dr Jean Challiner, chief medical officer at Clinical Solutions, highlights some of the key barriers and how they can be overcome for wider acceptance.
In recent years we have seen mobile and telehealth innovations provide opportunities to support self-care and deliver services closer to or in people’s homes. We have also seen these services improve quality of life for users and reduce hospital and care admissions.
Healthcare technologies have also demonstrated real cost benefits. An NHS National Mobile Health Worker Project report showed that over an eight-week trial at eleven locations across England in the summer of 2010, semi-ruggedized Panasonic Toughbook laptops saved an average of £462 per clinician, equating to £3,002 annually.
Clinicians also estimated that the devices allowed them to save 507 referrals, equating to a saving of over £21,000, nearly nine per cent. It also enabled clinicians to avoid 49 admissions, resulting in a saving of over £85,000, or approximately 21%.
In the market for home health care technology, experts agree that the current model of care delivery is ill equipped to deal with future challenges, particularly the rapidly increasing demand for care due to an aging population.
The study suggests experts also see the potential value of home health care technologies to relieve pressure on health care systems and to promote a shift in care from high-cost institutions to patients’ homes.
These changes would not only would decrease cost and improve the sustainability of health care systems but would also be consistent with patient preferences for more active aging.
Despite these clear benefits, the national uptake and use of mobile, telehealth and home care technologies remains low. It seems there are a number of challenges to widespread service adoption and it is imperative these are overcome through concerted efforts from all stakeholders, if we are to transform healthcare delivery in the UK.
Overcoming the barriers
There is an impression that mobile and telehealth innovations have yet to provide significant evidence of cost-effectiveness. There are also concerns that health organisations must present their own business case to adopt the technology, rather than accept recognised findings from elsewhere.
Mobileand telehealth innovations have been proven to provide evidence of cost-effectiveness, with some results being so outstanding that I believe it is imperative that these recognised findings be taken seriously when considering introducing change within an organisation.
This was the experience for an end of life care service provided by Healthcare at Home Ltd (HaH) in partnership with NHS Birmingham East and North (NHS BEN). The service resulted in fewer unnecessary admissions into acute care, shorter bed stays and better end of life choices for patients, and in addition saved the PCT more than £1m in its first year. The year-long pilot exceeded expected referral numbers by 12% and exceeded targeted savings by 51%.
In light of these results, it is clear that overcoming barriers to adoption starts with highlighting the practical benefits of mobile health technology more effectively. We need to help front line nurses see the benefits technology introduces to their work environment, such as enabling them to treat more patients in a shorter time span.
As well as highlighting the practical benefits, it is also important that we encourage organisations to analyse their current systems, carry out audits, evaluations and obtain stakeholder feedback on where processes can be improved.
We can start this process by providing information from examples such as the NHS BEN end of life service. These findings showed that across England, savings from home-based end of life healthcare for approximately 88,000 such patients could total in the region of £160 million.
NHS BEN also worked with HaH to deliver home healthcare services for patients with long term conditions. Results from all four pilots show that adopting these models nationally could generate savings in excess of £1 billion, benefiting 550,000 patients. These statistics cast doubt on the suggestion that mobile and telehealth innovations have yet to provide significant evidence of cost-effectiveness.
Evolving the paper trail
In our experience change has proven to be another barrier to the adoption of new technology. It takes real commitment to break from systems that have been in place for many years, even if these are sometimes unreliable or cumbersome.
Paper-based systems are an example of outdated procedures which are still favoured by many health organisations. We have seen these manual processes lead to confusion, as records can be lost, or mistakes made and not easily traced. Paper-based systems also require a significant amount of storage space compared to digital records.
When paper records are stored in different locations, collating them to a single location for review by a health care professional is time consuming and complicated. This process can be simplified with electronic records. When paper-based records are required in multiple locations, copying, faxing, and transporting costs are significant compared to duplication and transfer of digital records. These complications mean organisations using paper-based systems have difficulty reporting performance levels and therefore justifying their existence.
Paper based records can also increase administrative costs; research from the National Association for Home Health Care & Hospice revealed that Care UK’s administrative expenses increased by 10.7%, from £12.2 million in June 2010 to £13.5 million by June 2011.
Homehealth care nurses spend a great deal of time on paperwork and dealing with reimbursement issues. One study revealed that 60% of their time is spent handling administration during the first visit, while further research stated that 25% of their time is spent on administration during follow up day visits. A recent study conducted by Outcome Concept Systems(OCS) found that agencies without automated documentation have reported 48 minutes of paperwork for every hour of care, which doesn’t include calls and travel time.
While paper-based systems may seem outdated, in our experience the move to digital records has still presented concerns, with some health organisations worried about the risk of data loss if the system fails, or potential security incidents such as breaches, theft or criminal attacks.
The introduction of technology may present risks, but it can also be used as a vital tool to monitor the quality of care delivered. Many organisations may resist the transformation from paper-based processes over concern that implementing new systems may disrupt existing services. While there may be some initial disruption when bringing any change into an organisation, this should not in itself be used as an excuse for ignoring innovation. Those that can accurately view how much time is wasted through current ineffective systems may well be more compelled to introduce and benefit from mobile and telehealth services.
Taking advantage of cost efficiencies
Another major barrier we’ve seen to the wider acceptance of technology-based care is the initial level of investment.
In this financial climate many health organisations have budget constraints and are looking to reduce costs wherever possible. Because of this, the focus may be on short-term cost savings and limiting expenditure where possible. This may explain why many are resistant to invest outlay on solutions which may disrupt the organisation in the short-term.
These concerns are understandable but the model behind mobile and telehealth services is designed to save costs, as well as improving the productivity of staff and providing the right care in the right place at the right time.
The use of technology can also reduce the cost of, and improve healthcare in the home. According to results of recent research, a specialist nurse-led telephone call can improve the home services and reduce hospital re-admission by 33%, cost associated with in-patient hospitalisation 42%, and cost of health care in the home services by 40%.
It is imperative that businesses plan ahead to the future requirements of the organisation. It’s worth considering not only the cost of implementation but the long-term potential savings and benefits, and whether these will offset the initial investment.
New ways of working
Change within organisations almost always introduces challenges, and employees that are resistant to this can present a major barrier to the wide-spread adoption of technology.
To overcome these challenges, I believe all stakeholders, from carers to patients, should be consulted and involved in the transition process. Key professionals need to be engaged and motivated by the prospect of a system that is easy to use, helps improve care services and reduces administrative burdens.
There may also be an impression that healthcare solutions may lead to professionals becoming ‘de-skilled’. This is certainly not the case. For example, in the case of frontline nurses, it improves their ability to carry out high quality assessments, by prompting what questions patients should be asked, and the actions arising from these. As providers, we need to convey the message that systems can support and improve healthcare skills.
An important problem for the home health care sector is the shortage of registered nurses and home health aides, as well as a high turnover rate. In the UK the latest data (September 2011) puts homecare at a turnover rate of 16.4%.
Attracting qualified workers and retaining them is therefore a high priority for many home healthcare structures. The assistance offered by telehealth technology can provide a healthier, less stressful work climate which is an important part of any retention strategy.
There are other areas that may be of concern for healthcare professionals, such as the skills needed to operate the technology, which if unfamiliar, or if there has been no prior training, may add to the time it takes to complete their task - increasing the cost to the organisation. I believe providers should work with front line staff to introduce them to, help them understand, and communicate the benefits of mobile and telehealth technologies.
Looking to the future
Technology-enabled care provides a wealth of benefits; from software which helps us to manage patient interactions, to supporting decision-making or leading the change to a more cost effective but high quality model of care that patients can benefit from.
While we continue to see changes throughout the NHS, the need to think and act strategically is now more imperative than ever. The chasm that exists between the adoption of technology can be addressed, as we see more evidence to support the benefits and the difference in the quality of care provided. The use of technology is prevalent in every aspect of our lives; now is the time to ensure it can be used to transform health services, allowing us to put the patient at the centre of care.