By Jenny Blundell, general manager, Women’s Services, Guy’s and St Thomas’ NHS Foundation Trust
I’ve worked as a general manager at a London NHS trust for five years. It’s a very rewarding but incredibly demanding job. I am judged on getting the basics right: ‘How’s the money?’, ‘Are 18 weeks and cancer waits on track?’, ‘Have you addressed that governance issue?’
We all want to improve the services that we manage but ring-fencing enough time for this is a constant challenge. We are acutely aware of the opportunity cost of working on something new and exciting versus focusing on the basics. It is even harder to make time to experiment with new initiatives that may not succeed.
When a digital health SME comes knocking at your door, I know what goes through your mind, ‘Sounds interesting but what is the financial return?’, ‘How can I persuade IT to support me?’, ‘What’s the information governance process?’, ‘Will this company be around next year?’ or just simply, ‘Great idea, but the impact is small and I have too many other things to do’.
I want to tell you a story that may change how you think about digital health SMEs and how you prioritise your time.
To all the NHS general managers out there: I imagine, like me, you spend a lot of time trying to reduce did not attend (DNA) rates and increase outpatient productivity. You probably have completed surveys to find out why patients are not attending, have set up reminder letters, text messages and phone calls. I imagine you will have also given some thought as to how you can make it easier for patients to book and change their appointment. Most likely DNA rates reduced somewhat following these interventions but ultimately it remains a problem.
In 2013 I met a digital health SME called DrDoctor. They were confident they could reduce DNA rates. The team explained to me that they give patients access to a website on desktop and smartphone containing administrative and clinical information about their appointment and pathway. This is complimented with a sequence of emails and SMS messages, which patients can reply to and interact with to change appointments using a conversational workflow. I thought it had to be worth a shot. I knew however, that even getting a pilot up and running might be a challenge. For starters, I would have to convince our IT department to do some integration work, change workflows in my department and make the case to information governance. At that time DrDoctor were a relatively new company and had just started to work with one or two other hospitals. I knew there would be a lot of questions about their track record and the likely return on investment.
Over the course of the next eighteen months I encountered a lot of barriers to getting started. Taking time out to push the initiative forward was difficult when the potential impact was unknown. Like me, you probably do not work in an environment conducive to experimenting and failing fast. The reason I kept pushing was simply because our DNA rates were not reducing and we needed a solution.
Last summer my team and I started to use the DrDoctor software without an IT integration and conducted a pilot using a manual process. This pilot resulted in DNA rates reducing, giving us the evidence we needed to convince IT to integrate. Over the last six months our DNA rates have reduced by 40 per cent and our outpatient income has increased by the equivalent of £300k per annum. As the results speak for themselves, there is now a huge push to role out the DrDoctor solution across the organisation. We’ve calculated that if the same results can be generated across all services in the trust, the net financial benefit would be over £4 million.
So next time a digital health SME knocks at your door, think about it, this could be your DrDoctor! If you are facing implementation barriers stick with it. In the meantime I recommend rolling out DrDoctor in your department.
As general managers across the NHS, we face very similar problems. Let’s learn from each other. After all, diffusion is much cheaper than innovation, it’s less hard work, and you still get the same results!