Digitizing the traditional outpatient appointment letter has prevented 900 wasted appointments at the Northern Lincolnshire and Goole NHS Foundation Trust, the first CIO of the trust reveals. CIO Shauna McMahon has stated that technology will play a key role in the improvement of patient care at the healthcare provider she has been CIO at since November 2020. McMahon explains:
We are in special measures, and the CEO and executive team are focused on improving the care and operations of the organization, and advancing our use of digital technologies will support our improvement ambitions.
The NHS trust was described in February 2021 by a local BBC news team as ‘in and out of special measures since 2013', when the Care Quality Commission - effectively the UK's regulator for the publicly-owned NHS - raised a number of concerns about the trust, including insufficient numbers of trained staff, waiting times for cancer diagnosis, outpatient and diagnostic imaging appointments and inconsistency in treatment for some types of patient.
On the programme of change she and the Northern Lincolnshire and Goole NHS Foundation Trust (NLaG) aim to deliver, McMahon says:
I am the first CIO at the trust and a member of the executive team, and we have a chief medical information officer (CMIO) and chief nursing & Allied Health Professional Information officer (CNIO) joining me, and that demonstrates that the board sees how digital will deliver the right type of care.
An early win has been the introduction of digital outpatient appointment letters. She adds:
I'm fortunate to be supported by a very forward thinking patient services team, which has been instrumental in taking a number of digital innovations forward. In addition we have a strong digital & IT services team that is collaborating and working with our operational and clinical leads. You cannot successfully do this work without strong teamwork.
The appointment letter is a stalwart of the NHS, but in a digital economy and society, it is outdated and expensive to produce in terms of printing and postage. Digitizing the appointment letter has enabled Northern Lincolnshire and Goole NHS Foundation Trust to reduce those physical costs, but closely tie the digital letter to the running of the trust and further reduce expenditure.
Patients are able to reschedule and cancel appointments via any device following the implementation of the Healthcare Communications appointment management system. As a result, the Trust has seen a significant reduction in appointments where no patient attended. At the time diginomica spoke to McMahon, the trust had 900 appointments used by waiting list patients following the cancellation or rebooking of appointments by other patients, and 60% of eligible patients were choosing digital letters over traditional printed communications.
Healthcare Communications is a UK-based health technology specialist providing patient communications solutions including digital first messaging, surveys, virtual assistants, eForms and waiting list management.
Delivering the letter
On beginning with the Northern Lincolnshire and Goole NHS Foundation Trust outpatient community, McMahon says:
We began with the outpatients as this is the largest number of patients and would have the greatest impact. In addition, the number of processes for an outpatient is less complex.
The CIO believes the success with outpatients will see other areas of the trust want to adopt the technology and methods and the plan is to move to inpatient letters next.
McMahon says appointment ‘did not attend', as they are dubbed in the NHS, has a major impact on the efficiency of a hospital. Digital appointment letters have empowered both the trust and the patient; just as patients can cancel and rebook an appointment, Northern Lincolnshire and Goole NHS Foundation Trust is able to provide up-to-date information to the patient, for example, informing a patient to come in at 11am rather than eight am if there is an issue that means staff are temporarily redeployed. McMahon explains:
The most important benefit for us is that it allows us to be much more patient-centric. In addition, patients come in and sometimes have to do a pre-assessment questionnaire for surgery; they can do that at home now and send it in, rather than spend 30 to 40 minutes sitting in the hospital carrying out that procedure.
I really do believe technology can impact the patient experience. Being able to use digital means we can fill all our appointments, and we can reduce the waiting list.
Deploying technology is only one piece of the digitization of an organization and its service. Increasingly CIOs and CTOs are working with comms teams, storytellers and writers to ensure the new ways of working or booking an appointment are understood and broadcasted. McMahon adds:
We did a targeted communications campaign and worked with other health stakeholders in the area about how the move would be positive on many fronts.
The Healthcare Communications platform also allows Northern Lincolnshire and Goole NHS Foundation Trust to ensure it is communicating with its patients in their first language, which in a diverse community will improve the patient experience and therefore reduce missed appointments through miscommunication.
Digitizing in the wake of COVID-19
We rolled out a huge amount of technology in months, and the uptake has been phenomenal. For example, virtual consultations, five or six years ago they were discussed, in four months people were using them and we are looking at major efficiencies in time, reducing carbon impact, and increasing use of virtual can help reduce operational costs over the long term..
As with many of her peers, McMahon reports that the pandemic has increased the pace of digitization of the UK's health care system that was already taking place. She says:
There's a change in the air as digital has had so much attention. Patients want that experience. Also, we are undergoing a generation change, and we have workers coming into the NHS that don't know about working with paper. So it is a sector that is having to change really quickly, but also be sensitive to those that are not from a technology only orientation.
The CIO believes that health communications will be an important part of the change. Obesity was proven to be a major factor in the severity of COVID-19, and the UK has one of Europe's highest levels of obesity, the highest COVID-19 death rate, and an inactive population. McMahon adds:
If we can use digital to create a relationship and work with people when they are at their most vulnerable, then we can prevent a serious incident, for example. With monitoring, we can provide a better life experience.We can find ways to focus on health and preventing illness.
In this way, the National Health Service (NHS) would live up to its name and original purpose and keep the UK healthy.
Asked if ensuring all appointments are filled is placing increased pressure on the nurses and practitioners of Northern Lincolnshire and Goole NHS Foundation Trust, McMahon says the trust makes sure there is flexibility for its staff and says that improving communications with the patient means that there is better information on hand for the clinician, which improves the working environment. The CIO says:
With a paper chart, only one person can look at that chart at a time, for example, so now we get a team approach to care, and that is better quality care and safer for the patient and the professional.
Also, with elderly and mental health patients, they can have family members that are helping them see the appointment letter by being able to share that knowledge. I refer to this as a more holistic circle of care.
After the letter, the robots
Northern Lincolnshire and Goole NHS Foundation Trust is amongst a growing number of NHS trusts exploring or implementing RPA to reduce process overheads. McMahon says:
We are in the early days of working with Hull University Teaching Hospitals NHS Trust on the use of RPA (robotic process automation), with some Digital Aspirant funding we have received from the NHS.
Digital Aspirant is a funding cycle provided by government body NHSX to boost digital maturity, in the words of NHSX. McMahon is also driving a range of technological infrastructure modernizations at the trust to improve access to applications for health professionals and the infrastructure underpinning the hospital.
McMahon began her career in financial services and management consulting in her native Canada but has spent 18 years now in health technology leadership with roles in Halifax, Canada, CIO for Frimley Health NHS Trust in Surrey, UK, Director of Digital Transformation at South Central & West CSU, and now Northern Lincolnshire and Goole NHS Foundation Trust.