University Hospitals Bristol NHS Foundation Trust (UH Bristol) is an acute trust with more than 8,000 employees who deliver over 100 different clinical services from nine sites, providing care to a population of 350,000.
In 2013, UH Bristol decided to embark on a transformational change project as part of an ongoing focus on Clinical Correspondence operations and increasing the quality of both patient and staff experience. The project brief paid particular attention to performance against savings targets, budgetary pressures, becoming paper-light, structuring documentation and increasing efficiency.
UH Bristol identified wide ranging issues throughout its outpatient Clinical Correspondence processes; from dictation and transcription to the distribution of letters. Problems identified included delays across the process, meaning that in some cases the Trust was spending money on outsourced transcription services to assist with backlogs. Patients weren’t receiving GPs letters in a timely manner nor was correspondence being generated in a standardised or structured way - each department was working differently.
Consequently, the Trust did not have a standardised process for producing clinical correspondence. In addition, staff were spending too much time on administrative tasks, including the manual transcription of dictations, and were subsequently unable to dedicate sufficient, quality time to dealing with patient issues.
A key part of the problem analysis identified that clinicians dictate 200 to 300 words per minute whereas the average medical secretary transcribes 65 to 90 words per minute; therefore an average medical secretary spends 4.5 minutes transcribing for every minute of a dictation. An objective was set to reduce the amount of time medical secretaries spend on transcription, from 4.5 to 2.5 minutes for every minute of dictation.
Other objectives included:
Underpinning a lot of the issues was the limited availability of information and data about level or distribution of clinical or secretarial workload. Evaluating the size of the issue was, itself, a huge task.
UH Bristol’s mission is guided by four values of which ‘Embracing Change’ is one. That overarching perspective was critical in gathering momentum for such a large and important project.
UH Bristol insisted the solution came from a proven supplier with enough skill and resource to manage a major project, with technology designed for both current and future Healthcare needs. It was specified that the chosen technology be fully operational and achieve a high level of medical-specific Speech Recognition shortly after implementation.
UH Bristol implemented workflow, Dictation and BigHand Speech Recognition technologies to streamline processes and reduce costs.
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