Patients, Pillows and Pounds

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Stuart Rankin
Cayder's Managing Director
Patient Flow Management (PFM) can help solve these problems. It focuses on the practicalities of admitting, discharging and transferring patients, as well as scheduling and tracking a wide range of planned activities including nursing procedures, such as catheter changes, therapy sessions, portering and cleaning. This reduces the level of administration and unnecessary interruptions for front-line staff, allowing them to concentrate on the patient's needs.
In this article Stuart Rankin, CEO of Cayder, discusses why some healthcare providers are slow to adopt a patient flow management system. This is despite various efficiency-driven Government initiatives and continuing pressures on frontline staff to deliver improved, safer patient care. With the NHS in England needing to find between £15 and £20 billion in efficiency savings by 2014, there is clearly a very immediate case for helping ward staff work as productively as possible. In addition, there are concerns over shortages in frontline staff, including a potential shortfall of nearly200,000 nurses, reported by Nursing Times back in February this year. Something needs to change; healthcare organisations are currently taking too long to deploy solutions to critical andwell-publicised problems.
Making IT work for frontline staff
My involvement in PFM was derived from a strong healthcare influence in my family; both my mother and grandmother were nurses. It was my mother who convinced me to try and find a way to make IT work for frontline healthcare staff. I have listened to their frustrations and understand the need to give frontline staff the appropriate systems to enable them to put the patient first; this is why I am passionate about making administration invisible for care teams and know that PFM can make such a difference.

If you look at the private sector, the customer is always (or should be) put first. Large restaurant chains and major retailers maintain excellent customer service by deploying technologically-enabled business processes that support the front-of-house staff/sales assistants. By installing technology that helps track orders either online or via an outlet, commercial companies can coordinate a smoother customer journey. This aids staff motivation and customer satisfaction, with the incentive of retaining custom and, in turn, increasing revenues. Innovative companies also recognise frontline teams as instrumental to the development and implementation of such processes. They actively include staff in supporting technology development to improve on a continuous basis.

There are similar commercial parallels between the NHS and private companies, even more so in light of recent reforms – the new NHS 'market economy' has incentives for healthcare providers looking to reduce costs. The Releasing Time to Care (RTTC) scheme, part of the Productive Ward programme from the NHS Institute for Innovation and Improvement and the Department of Health's Quality, Innovation, Productivity and Prevention (QIPP) large-scale programme both focus on the innovation of service provision driven by the frontline. The RTTC states it "focuses on improving ward processes and environments to help nurses and therapists spend more time on patient care thereby improving safety and efficiencies", citing financial savings as a key benefit for participants.
The scheme closely aligns with, and promotes, the practice of effective PFM. It has helped many clinical teams identify the need for a PFM solution – so why is uptake so slow?
Seeing is believing, as with any new technology, there are varying degrees of adoption. The NHS is an overwhelmingly large organisation, one where IT acceptance will take time. With failed national programs and increasing pressure on the frontline, you can sympathise with many healthcare workers who are yet to be convinced about the potential day-by-day benefits of IT systems. I have experienced first-hand UK communications how some nurses struggle to see how technology could support their day-to-day tasks until they see it for themselves – so I showed them.
Interfaces are an integral element of PFM and the ability for frontline staff to see key status
information on all aspects of patient care from admission to discharge, clearly and concisely, is very powerful. As I demonstrated what PFM could do on large touchscreens (also referred to as electronic whiteboards), I could sense the nurses realising the potential to embrace technology on the ward using a language and processes that they could design themselves.
They watched as I easily navigated through a bed management module on the touchscreen, which provided real-time accurate information on bed statuses across the whole hospital. The nurses started chatting amongst themselves about how they would not need to phone around each ward for bed availability, and how they could easily request and allocate beds when admitting or transferring patients.
Equally important is the ability for PFM solutions to be accessible across multiple interfaces such as tablets, smartphones and laptops. After seeing the large touchscreens in action, the nurses identified mobile technology as a way to further the ward's productivity levels by reducing journeys back to desks/bases to update data. Real time information on-the-go is about giving front-line staff the right tools to do their job – something the nurses expressed as a huge benefit to their daily routine.
Minding the (technology) gap
Whilst technology is becoming increasingly adopted amongst healthcare professionals, there still remains a large proportion that are reluctant to move away from traditional tools such as clipboards and whiteboards. The issue here is one of control and comfort; care teams are used to working with paper-based equipment.

How is this issue overcome? By ensuring that frontline staff feel empowered to use PFM
technology. Care teams need to feel a sense of ownership of PFM technology and be comfortable using it. A rigid, one-size-fits-all solution is not appropriate for every ward as each has its own set of requirements, making it clumsy and difficult for the end user to operate. The trick in any technology solution is to take a product that is quite light touch but very rich in data enablement for the organisation to use to its advantage – which is why we upgrade our PFM software based on discussions and conversations with customers.

Time-consuming and technical software training is also another issue for frontline staff. To remove this barrier, PFM software needs to be easy-to-use, intuitive, with shallow interfaces to manage patient information using only a few touches or keystrokes. This technology encourages sharing of information that anyone in the team should be able to digest and understand at-a-glance, at any one time. This approach empowers staff to make the work environment their own, supporting them to make better decisions.
More time for the frontline
Care teams are under immense pressure and after spending time with them I am reminded of the difference that technology can make. For example, we provided a print function that allows carers to print patient lists with statuses. For us it was a relatively simple addition to make, but for the nurses it has removed a repetitive administrative task from each and every shift handover.

When you consider that writing out a handover note will take around two or three minutes on a typical ward of thirty nurses, that is an hour saved everyday. A fifty-ward hospital would save fifty hours-per-day, the equivalent of an extra nurse for a whole week. What a difference that could make across the whole NHS!
The time is now
Many IT personnel will dismiss the immediate need for PFM after buying into a global company
roadmap that has promised this functionality in the future. This, in their eyes, excludes the need for deploying a niche supplier, as the solution is already on the shopping list. The problem is that it is too far down the shopping list, as frontline staff need the technological support now. In some cases, these large organisations are simply not delivering what they promised. They rarely provide tools that allow carers to design the solution they want with the ability to continuingly improve it as they move forward.


I recall speaking to frontline carers at one hospital who had a system supplied by a large IT
provider. Their disappointment with their current system was very visible; they were asking for simple reports that the system could not deliver. Another example was a pastor who was
responsible for patients in a hospital was finding it difficult to allocate patients who were on an 'endof-life' programme. These patients were missing out on an important service, and nurses were being interrupted from their medical duties to track them down.


These are just a few examples of how PFM can make wards more productive and support the NHS to achieve national targets. The challenge is deploying the technology it desperately requires now, not in the future.