4th July 2022
Does becoming ‘paperless’ mean taking away control from community nurses?
The drive to reduce paperwork across NHS services forms part of the Five Year Forward View. A long-standing initiative which looks at streamlining working processes to produce better outcomes for staff and patients. As part of the Five Year Forward View (initially launched in 2014), NHS stakeholders proposed Paperless 2020, which aimed to completely eliminate physical paperwork from the health and care system by the year 2020.
Although some progress has been made, the sheer size and complexity of the NHS has meant that implementing organisational change can be a slow process. Clinicians and administrators are faced with the – often conflicting – tasks of juggling budgets, managing workloads and dealing with shifting priorities, such as the ongoing Covid-19 pandemic, all of which present their own unique challenges.
Digital Acceleration during Covid-19
Rather than stalling efforts, the pandemic has provided impetus in the drive towards digitisation. Drawing attention to the need to automate services and improve efficiency, but also to help patients manage their own care journey, limit unnecessary contact between patients and clinicians and reduce clinical risk. Since March 2020, innovation has been born of necessity and the acceleration of digital adoption has been astonishing, particularly in primary and secondary care.
Community nursing and the move towards a paperless system
One area of the NHS which has been left behind by advances in technology is community nursing. Many senior clinicians are still spending several hours a day manually scheduling patient visits. Even community teams using electronic patient record (EPR) systems still put in hours of work every day to match patient need with appropriately qualified clinicians.
While this laborious scheduling process will work, managers often don’t have a clear view of staff whereabouts, caseload distribution, capacity and demand, population needs / trends, or potential skills gaps within teams. And without supporting software to give the full picture, there’s an additional clinical risk to patients when visits are deferred or missed altogether, as often there is no robust process in place to alert other team members.
Furthermore, there is currently limited opportunity for intelligent care coordination and managing patients who have open referrals with multiple services, as different teams work independently using proprietary systems which cannot communicate with each other.
Clinical e-scheduling systems can help but can be met with resistance.
Supporting community nurses
The King’s Fund recently published its courage of compassion framework, which examines the problems faced by community nurses – particularly in the face of the unprecedented demands placed on services by the Covid-19 pandemic – and what must be done to address them. The report underlines the importance of three core needs, which must be met in order ensure the wellbeing and motivation of community nurses:
These needs incorporate factors such as improved working conditions and schedules; better team working with clear, shared objectives; compassionate leadership and support; a workload which facilitates the delivery of safe, compassionate care; effective management and development opportunities which promote continuing growth.
Clinical e-scheduling in community nursing
Making the leap from manually scheduling caseloads on paper, spreadsheets or via an EPR, to automated e-scheduling can be difficult for clinicians who have always been used to doing their own thing. Some feel that they’re losing their autonomy, resent route planning functionality (who hasn’t argued with sat nav at some point?) and that they’re not trusted anymore; that Big Brother is now watching their every move, rather than the system was brought in to help them feel safer.
There’s no getting away from the fact that it is very difficult to change ways of working overnight, even if everyone’s been kept in the loop from the start. Sometimes it feels easier to go back to the old ways than look at the future possibilities.
So how can the transition be made easier?
Here are some tips for clinicians who find the transition difficult:
- Accept it won’t be perfect straightaway – every organisation is different and new systems will need time to bed in. Everyone’s feedback is crucial to make it work.
- Understand the bigger picture – software follows clinical rule sets designed by the senior team so if you feel it’s not working as it should, talk to your manager.
- Think about the benefits for you – less time manually scheduling visits releases more time to care. Unplanned care is easily scheduled in. Lunch, break and appraisal times are protected, and lone worker features should help you feel safer.
- Think about the benefits for your team – with data that shows the true picture of your capacity and demand, your team has evidence to recruit new staff and provide training opportunities.
- Think about the benefits for the patient – clinical e-scheduling allows health and social care to be intelligently scheduled around the patient, strengthening continuity of care, reducing harm and keeping patients and carers up to date with next visit information.
Community nurses need effective tools and support to deliver the right care to the right patient at the right time – so patients with open referrals receive the best care. One way to achieve this is to embrace intelligent solutions which support community nurses to manage their caseloads effectively at the same time as improving patient outcomes.