4th July 2022
Cwm Taf Morgannwg University Health Board (CTMUHB) district nurses outline how they’ve implemented Civica Scheduling to great effect.
What was the problem you were trying to solve, how did you go about fixing it? What challenges did you face and what outcomes did you achieve?
Scheduling of home visits in District Nursing was incredibly labour-intensive and pulled experienced District Nurses away from clinical activity. It was also riddled with the clinical risk of missing visits, duplicating visits and reducing clinical efficiencies. We sought a solution and piloted Civica Scheduling (formerly Malinko) in two district nursing teams.
Whilst any change management presents a challenge, the teams adopted the new software with enthusiasm to revolutionise the way they schedule their activity. This has resulted in efficiency benefits, patient and staff safety benefits, a boost to staff morale and has provided rich data to inform workforce planning.
What was the challenge you were trying to solve?
Caseload management was an area of concern for the district nursing service in CTMUHB. This was evident following an audit of non-clinical contact time which showed that caseload management was very labour-intensive and the presence of clinical incidents relating to visit scheduling (missed visits and duplicate visits). Senior members of district nursing teams often took three to four hours per day scheduling manually, which took them away from clinical care and team leadership.
Capturing clinical activity of the district nursing service required duplication of effort for staff who needed to input their visits onto a basic database every day. This led to chronic under-reporting of activity as staff would often not get around to recording this data due to pressures from patient facing care.
These manual processes and duplication often left staff feeling deflated and frustrated. The teams embarked on a wider Neighbourhood Nursing Pilot funded by the Welsh Government, which presented an opportunity to pilot an e-scheduling system. We took inspiration from elements of the successful Buurtzorg care model in the Netherlands, one of which was the need to upgrade our digital systems to enable more efficient care management.
What were your aims?
We aimed to:
1. Release senior nursing time from caseload management to be redirected into delivering complex care, supervision of staff and caseload oversight. It was evident that senior members of the district nursing teams spent large parts of their working day producing lists of visits as opposed to utilising their experience and skills in care delivery and team leadership.
2. Reduce clinical risk associated with scheduling of visits. Previous methods of scheduling were heavily reliant on the memory and local knowledge of the Team Leads. Due to the large volume of visits being manually scheduled, errors often crept in, resulting in missed or duplicated visits.
3. Improve data capture within the service to evidence demand on the service. Previous methods of data capture were labour intensive and often not completed due to conflicting priorities for clinical staff. Under-reporting of activity was a big problem for the service.
4. Improve staff morale by reducing the administrative burden placed upon them and minimising duplication where possible.
How did you go about implementing a change?
The project was led purely by the district nursing management team with input from the Civica Scheduling implementation team. As the project was led by nurses, it helped with the change management process as the system was tailored to the needs of the nursing service.
We engaged with the nursing teams early and often, gathered feedback and amended our approach based on this feedback. This included a service wide engagement exercise prior to go live to understand concerns, dispel myths and set expectations from an early stage.
An implementation group was set up with representation from the district nursing teams, management team, Civica and specialist advisers when required such as HR, finance, workforce etc. The team met weekly to plan implementation, roll out the system, and then evaluate and learn from each phase of implementation. A phased approach to rollout was taken across the Health Board resulting in a locality-based rollout plan. Early adopters and champions of the system were utilised in the rollout process to provide encouragement and peer support to colleagues. We sold the benefits that the system brought to each user, but also discussed some of the difficulties encountered by other areas tempered with a measured solution to prevent similar problems happening again.
The biggest challenge we faced was related to change management, but we felt our approach of being honest and realistic about the challenge ahead garnered trust in the process and buy-in from the staff.
What were the results? What did you achieve? What meaningful data or evidence have you got to prove the success of your project?
Following the successful pilot in two district nursing teams, the system was rolled out across all our teams in a period of four months (some of which were during the first wave of the Covid-19 pandemic). This helped equip the teams with technology to aid the service meet the challenges of the pandemic. For example, the district nurses could respond more quickly to changes in demand by moving available capacity around to accommodate patient needs.
There has been a demonstrable increased demand on the service and there is now reliable data to demonstrate the challenges faced by the service. Our data shows a 152% increase in patient contacts from 2019/2020 to 2020/2021. We estimate that around 66% of this increase is due to accurate reporting, but the remaining 33% is due to a rise in demand.
The software helped boost morale within the nursing workforce and identified the district nursing service as an innovative, forward-thinking service. Due to the successes of Civica Scheduling within Cwm Taf Morgannwg University Health Board, in 2021, the Welsh Government secured a national procurement of e-scheduling software across all district nursing services in Wales.
Civica Scheduling’s use in CTMUHB has featured as part of a wider Neighbourhood Nursing evaluation – click here for more information.
Empowerment of nursing staff to lead an innovation project
Data to inform demand and capacity in a complex service delivery model
Boost to staff morale
No missed patient visits since the software’s introduction
National roll out of e-scheduling software across Wales.
What are your future plans for this project?
The future plan is to work with Civica to guide future developments for the scheduling software. This will help inform national initiatives for district nursing in Wales.
There are developments currently underway, including integration with e-expense claims systems to automate mileage claims for nurses. This will reduce duplication for staff to reinvest time into patient care. In CTMUHB there are plans to utilise the data produced by Civica Scheduling to drive a demand and capacity exercise which will ultimately allow for forward planning of resources based on demand on the service at any given time.
Planned future development of the system includes the ability to allow teams to capture a nationally agreed acuity score (Welsh Levels of Care) for patients they visit using Civica Scheduling. This development will help demonstrate the acuity of community patients across Wales and facilitate analysis of the relationship between patient acuity, the length of time a visit takes, and the grade of the nurse required to visit.
There is also future work to explore integration with clinical documentation systems for a more streamlined experience for district nurses and link schedules with clinical records held on other systems.
What advice would you give to others implementing a similar project?
From our experience, it has proved vitally important to engage with front line staff early and often to set realistic expectations for the project. We have learned that a nurse led project can be a powerful way of implementing change as nursing staff engage with and respond well to nurses endorsing a new way of working. Strong nursing leadership has helped drive our project to success and is key to allowing the project to reach its full potential.
Good and thorough engagement with the supplier is also key. A good working relationship to work towards a singular vision for the project will enhance the effects of the project.