Transforming Community Nursing: From Hospital to Home

A gateway from hospital to community Transforming community nursing

Roisin Reade, product manager – health & care, Civica

The NHS 10 Year Health Plan for England sets a goal that the majority of outpatient care will happen outside of hospitals by 2035. This move, from the hospital to the community – one of three core shifts outlined in the plan alongside analogue to digital and sickness to prevention – will rely on joined up services and the support of technology and AI to ensure continuity of care.

An important case study for getting this right comes from the methods that are increasingly being adopted in community nursing to help teams improve process efficiency and free-up more time away from desks that can be spent visiting patients. This is where technology plays a crucial role in changing the way that healthcare is managed, while also supporting NHS staff and improving patient outcomes.

Let’s take a look at some of the key considerations in managing nursing in the community and see how digital scheduling solutions of today can pave the way for more out-of-hospital care management in the future.

Allowing community nurses to nurse

Band 6 and 7community nurses are essential for leading complex patient assessments, safeguarding decisions, actioning interventions and setting care plans to avoid patients being admitted, or needing to return to hospital.

As senior members of staff, they have also been responsible for managing team rotas and workload allocation. However, any time spent at a desk manually allocating patient visits is time away from managing caseloads and clinical practice. This is an issue. Some trusts have reported manual scheduling as taking upwards of five hours per day, per team.

Losing this amount of valuable time from experienced community nurses puts the continuity of care for priority patients at risk if they are not getting assessed frequently enough by the responsible caseload holder. Visits end up being deferred due to capacity issues and patient journeys to recovery become more prolonged than should be necessary.

The hours spent on this complex administrative task are costly, which can cause a strain on already stretched budgets and resources. There is also a cost on more junior nurses who lose out on valuable observational time with their experienced mentors, and this can act to stunt the growth and development of the sector as a whole.

In short, it’s extremely important to have community nurses out and seeing patients, not sat behind desks.

Let technology take on the administrative burden

The 10 Year Health Plan recognises the potential of AI and other emerging technologies to transform healthcare services. Taking a routine task such as staff scheduling and handing it over to technology to complete in a fraction of the time required to manage it manually provides a great example of where the benefits can be realised immediately.

Scheduling comprises a matrix of dependencies for optimising patient visits to deliver the best possible level of care. It starts with arranging the data by patient need and then mapping it against the availability and skill-mix of nurses across a mix of bands, as well as route planning and overall optimisation of resources. There is also the need to be flexible to changing circumstances throughout a day, a week or a month when schedules must be amended. Beyond this, performance tracking requires everything to be centrally documented to allow for helpful analysis and reporting as well as easy sharing of information. This is exactly the type of problem – with lots of moving parts – that predictive analytics and automation have been created to solve.

By adopting a digital approach to scheduling, community nursing teams have been able to release thousands of hours to clinical capacity, reduce clinical risk and improve patient outcomes.

So, how should this look when rolling out more care in the community?

Designing care around the patient

Without having the support of technology to manage community nursing schedules in a way focused on resource optimisation, anecdotal evidence suggest that decisions are often made based on individual preferences. This would be things such as routes that were chosen for convenience within a particular area, listening to which staff wanted to visit which patients, or selecting days or times of the week for staff to work around other commitments.

Electronic scheduling removes this level of subjectivity so that routes are instead optimised around the patients’ needs and in the interests of improving overall team performance.

Additionally, integrating with electronic patient records supports better continuity of care. Reviewing staff will have access to accurate, up-to-date information and personalised notes on individual patients’ experiences.

Ultimately, the centre stone of patient experience will be delivered via their interactions with the NHS App. We can expect wider integrations of tools that share important information and updates with patients about their planned visits and empower them with more choice in how and when they access community health services.

Bringing staff with you

Community nurses have needed to adjust away from holding the responsibility of scheduling and managing their own diary, but ultimately the benefits of releasing more time to care and building higher performing teams win through.

As with any change, it is vital to bring stakeholders along with you, especially when breaking down long established patterns of behaviours. Engage with staff very early on to let them know of the changes that are coming and then continue communicating as you move through the transformation. Perhaps ask staff to join a project group to test the new system and make it clear that it is an iterative process that will take a little time to hone before it fits the nuances of a local team.

Continuous improvement

One of the major benefits of introducing data-driven solutions into community care is that as demand increases over time, healthcare providers will need greater visibility of their capacity. The data provides this view, which also informs things such as recruitment or training and development needs, depending on the types of demand revealed in the data.

By freeing up more senior staff’s time, it also frees up more time to review challenging cases, manage staff wellbeing and explore more ways to enhance operations which, as we have seen, can easily get lost to admin when the technology is not leveraged to carry that burden.

Find out more information on Civica’s digital solutions for community services here.