Background
South West London and St George’s Mental Health NHS Trust is a leading provider of mental health services across south west London and is considered a beacon of excellence for many of the UK’s national mental health services.
The Trust serves 1.1 million people across the London boroughs of Kingston, Merton, Richmond, Sutton and Wandsworth and employs more than 2,000 staff who provide care and treatment to about 20,000 people at any given moment. It has more than 100 clinical teams whose aim it is to provide for the mental health needs of everyone living and working across its many diverse communities by focusing on three key elements: Quality, Improvement and Innovation.
In 2016, the Trust embarked on a digital dictation and back-end auto-transcription, or server-based speech recognition solution, to reduce its reliance on tapes and improve its processes around clinical correspondence, with the aim of improving governance, reducing the administrative burden on clinicians and improving turnaround time on items such as GP letters and risk assessments. A post-implementation review highlighted that, while there was a clear business case for digital dictation and speech recognition, the project faced challenges to deliver the desired benefits primarily because it was not clinically driven or had clinical ownership.
As Amallia Thomas, Transformation Project Manager, South West London and St George’s Mental Health NHS Trust, explains:
The initial auto-transcription project review made it clear that the Trust had not dedicated the resource on the ground to support user adoption. It became apparent that in many cases clinicians were still undertaking a significant amount of administration in liaising with administrative staff via email, reviewing and correcting lengthy dictations, or waiting for speech recognition transcriptions to be returned. We identified that the needs of many of our clinicians would be better suited to a process where they could be autonomous and in control of their own transcriptions in real-time.
In 2018, the Trust saw an opportunity to augment investment in its existing BigHand Clinical Correspondence and back-end auto-transcription solution with the M*Modal front-end speech recognition software ‘Fluency Direct’ - and turned to BigHand to facilitate the roll-out. The first joint undertaking was the appointment of a clinical Senior Responsible Officer (SRO) who helped specify which aspects of the solution would bring benefits to the daily working lives of clinicians and clinical staff.
Phased Approach
The second change in approach was in regard to the implementation methodology. Previously, the Trust had taken a ‘big-bang’ approach to the auto-transcription implementation. However, the Trust’s CCIO suggested a phased approach for the rollout of speech recognition and was adopted with BigHand’s expert guidance. This involved the identification of five clinical teams across the Trust, each comprising at least a doctor/consultant, MDT and an admin team member, for a total of 30 initial users. Process mapping was conducted with these five teams to brainstorm where speech recognition would fit best in the day-to-day clinical activities.
In addition, prior to embarking on the project, a lead clinician was appointed to try to “break the system,” as Amallia Thomas explains. “This initial phase was very quick, but very intense,” she says. “It was critical to ensure we had the right people to test the different capabilities of the system in order to pre-empt all potential issues we might encounter before we progressed to the wider roll-out.”
During the first two weeks of May 2019, the Trust instigated this pilot phase with intense user training. This was followed by two - three weeks of allowing the users free rein on the system, after which the teams were revisited by BigHand and refresher training provided.
South West London and St George’s Mental Health NHS Trust has handed over to ‘business-as-usual’ to continue deployment and support the consistency of the solution through a 3 tier support model: Auto Transcription & Digital Dictation – System Admin – Super Users.
The real success behind Fluency Direct has been that the project delivery team, led by BigHand, has been front and centre and have really worked hard to understand the stakeholders’ exact needs. What’s more, as a result we’re already seeing the benefits.
Improved Workflows
Defining the success metrics was key to the scope of Fluency Direct, with evidence that the investment is linked to the strategic objectives of the Trust and the NHS wider strategic objectives, including:
The Trust has been gathering data since May. It shows that the number of GP letters going out within two weeks of assessment has been steadily increasing by 5% every month. The number of risk assessments being completed within 48 hours has also improved month on month and clinicians are now able to dictate straight into letter templates, making corrections themselves.
Clinicians time spent doing administrative work has reduced saving an average of 20 minutes (doctors/consultants) and 15 minutes (nurses) per letter allowing more time for quality care of patients.
In addition, the feedback from clinicians has been highly positive. Dr. Thomas Dixon, Consultant Psychiatrist with the Trust’s Wandsworth Older People’s Services, comments: “I’ve been using Fluency Direct for the last few months and it’s made a massive difference to my working life. The speech recognition has vastly reduced the amount of time it takes me to write patient letters and notes, and there is additional functionality within the system that has further improved workflows.”
The BigHand solution allows access to templates, as well as enabling clinicians and administrative staff to save standard pieces of text they use frequently and insert them easily into a standard letter. In addition, integration with the Trust’s electronic patient record systems, RiO and IAPTUS, further streamlines the reporting process and provides staff with a better user experience.
Not only is the system increasing accuracy levels and improving the turnaround time of clinical correspondence, it has also provided clinicians with a choice of digital dictation and speech recognition solutions, depending on their workload and working preferences.
As Amallia Thomas explains, “Different clinicians and administration staff have different needs; teams with a very high volume of note-taking, such as our assessment teams and consultants, will have a greater demand for the front-end speech recognition than our MDT team, for example.”
The beauty of the system we have now is that we can tailor it for each team to their exact requirements, maximising the use of both our clinical admin resource as well as improving the overall staff experience, while ensuring that centrally we have full visibility of how the system is being used.
She concludes: “The main benefit has been around right-skilling the team and finding a solution that really works for them. The whole system means that we are now creating measurable efficiencies, which ultimately have a positive impact on the consistency of patient experience and care. The aim is to embed this into the culture of the organisation, and currently it continues to be successful in improving clinicians’ work/life balance by reducing the use of clinical paper notes and enabling them to update our EPR systems in real-time.”
We understand that healthcare is not like other industries. Your time pressures are more intense, the need for security and efficiency more pronounced – as shown in the Transfer of Care initiative – and the consequences of delays or breaches more serious than any other sector. From automated processes to streamlined correspondence creation, our solutions tackle some key challenges for the UK healthcare market.
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