Using SharePoint to meet the QIPP Challenge NHS Improvement Programme

2013

Business Case

Executive Summary

As most NHS Trust’s advance in their commitment to deliver high quality services such as those illustrated by the Service Improvement Programme, it is essential the organisation is able to support good quality services through well informed decision making for services users and carers.

This whitepaper looks at ways in which Trusts can improve how they share knowledge and work collaboratively towards the main goal; quality patient care. Amongst other things we will show how SharePoint can meet the following QIPP objectives:

• Quality and Recovery Ensure staff have access to the latest, legitimate information informing better decisions on patient care, leading to quicker recovery times.

• Improving OutcomesImprovements to outcomes can be achieved through numerous means, which can include ensuring staff have access to the latest policies and procedures, guidance on best practice, and outcomes from research.

• Process Automation and Audit Process automation is a great way to improve productivity and ensure compliance and auditability. We will show you the relevant features in SharePoint 2013 and the latest versions of Nintex Workflow.

“All those who work on the frontline should be thinking carefully, and imaginatively, about how we can do things differently. The QIPP process is a home for this in the NHS and the way that we can implement the best and brightest ideas across the service. As the Prime Minister said: ‘Don’t hold back – be innovative, be radical, challenge the way things are done.”

Andrew Lansley, Secretary of State for Health – 2 July 2010.

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SharePoint; Quality, Innovation, Productivity, and Prevention

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Business Case

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• Electronic Document Management (EDM) Version control and robust security for access are mandatory requirements for any healthcare organisation. SharePoint includes document management, providing you with a secure way to manage your sensitive information

• Sustain and develop new servicesPlace your Trust in a strong position with respect to commissioning, paving the way for the future.

• WorkforceProductivity gains must be made to ensure Trusts can demonstrate value for money for the services they provide. One of the greatest advantages any collaborative tool offers is its ability to automate manual processes.

• Knowledge Management Sharing of information and knowledge is a critical success factor in any Trusts commitment to the Service Improvement Programme. We’ll look at new collaboration tools to facilitate team work and improve patient care.

Why Healthcare leaders need to move away from a Silo mentality

There are three main sources of information currently existing in most Trusts, the Intranet, network file shares and e-mail. These three disparate applications are used independently of each other, resulting in silos of information, no real means of verifying the integrity of documents, laborious processes to search for relevant information or people, and a lack of modern technology whereby information can be presented according to relevance.

In line with the QIPP (Quality Innovation Productivity and Prevention) challenge, Trusts are committed to lean working. That is, removing unnecessary administrative overheads to optimise the Trust’s workforce and thereby enable staff to focus their time and energy towards client care. Much of this can be achieved by providing ready access to relevant information and knowledge, building clinical networks to allow sharing of best practice, and by using technology to support efficient ways of working.

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Image Source: http://www.improvement.nhs.uk

Business Case

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This strategic outline case for SharePoint covers three main sources of information currently existing in most Trusts, namely the Intranet, network file shares and e-mail. These three disparate applications are used independently of each other, resulting in duplication of information across Trusts, no real means of verifying the integrity of documents, laborious processes to search for relevant information or people, and a lack of modern technology whereby information can be presented according to relevance.

Moreover, lack of integration across current information systems prohibits staff from sharing information and knowledge across the Trust, that is, across directorates and professional groups. There is also a “boundary” around Trusts’ existing information sources, in the sense that partner organisations who work collaboratively with the Trust such as GPs, CCGs, PCTs and Local Authorities have no real means of accessing key Trust information relevant to them for example policies and procedures, or updates on key programmes or initiatives, other than through e-mail.

Many procedures are still largely manual; they are reliant on people remembering to submit information, in the right place, at the right time, and to the right person. Examples of these are audits, recruitment, payroll, Human Resources, Finance, I.T. etc. This reliance on manual processes inevitably leads to errors, carries an administrative burden, and can result in poor use of manpower.

Business Case

While most existing intranets will offer some opportunity for staff to obtain information from a known location, chances are it has either approached the end of its useful life or has grown uncontrollably, becoming unstructured, unreliable and performing badly.

In summary, if a Trust wants to make the required efficiency savings, develop and deliver new ways of working to support best quality care, and position itself for the future by demonstrating and promoting its achievements, it must work towards the following:

In 2013 many of our clients’ intranets will become powerful communication and collaboration tools for connecting users with information, and users with other users. A new concept of intranet beyond the mere management of documents and processes. Traditional static and centralised intranet is evolving to become both decentralised and collaborative.

We must also talk here about the concept of “social” intranets. Far from this referring to staff posting funny pictures and comments all day, Social Intranet has been proven to increase staff productivity and teamwork.

To help address the above, Raona believe that Trusts would benefit from a platform such as Microsoft SharePoint

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• Improving access to, and sharing of, knowledge and information, both within the organisation, and externally with its partners

• Automate and streamline processes to collect and process data and information with minimum effort to support lean working

• Deploy good collaboration tools to encourage participation and harvesting of new ideas

Your Intranet can change with SharePoint 2013

1 to 1Static Intranet

1 to "many"Dynamic Intranet

"many" a "many"Social Intranet

Business Case

At Raona, we are ready to help our clients evolve their intranets from static or dynamic intranets to intranets which inspire teamwork and inform better patient care. As always, the success is not just in applying the adequate technology, but also consists in how it is applied.

The purpose of this document is to highlight technological and functional features that will make meeting the QIPP challenge possible. The contents of this document are the result of analysis carried out by our experts during the early adoption programme of these technologies to which only a few privileged Partners have had access. We will see many important changes and new features in the world of intranets thanks to the launch of the new version of SharePoint, Windows 8 and other complimentary solutions provided by Raona.

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User experienceA totally new look & Feel, more visual, clean and simple, in line with the new Windows 8 operating system. Compatible with most mobile devices and browsers.

• Mobility.• Multi-device - Multi-browser• MyCo.• Components and viewers. "made by Raona"

Web Content ManagementNew tools for facilitating information management when you use your SharePoint as a web platform.

• Multilingual.• Cross-site publishing.• SEO strategy.

Collaboration SpacesNew tools are appearing for site level collaboration to facilitate the exchange of information and working in teams.

• One Note Integration• Project Newsfeed• Task Timeline• Site Mailbox• Areas & Workspaces

My Social IntranetSharePoint 2013 incorporates powerful social communication tools to connect users to the information on your Intranet and with other users.

• Follow.• Microblogging.• My Newsfeed.• Communities.• PiuPoint.

Compliance & GovernanceNew tools are incorporated to assist compliance with legal regulations and to facilitate SharePoint management.

• Centralised management of policies.• eDiscovery.• Self Service Site Creation.• Sharing.• Governance Plan.

Applications and productivityA new marketplace is created SharePoint Store from where users can download countless applications. Important improvements are incorporated into the BI, search and workflow area.

• SharePoint Store.• Skydrive-Pro.• Search.• Workflows in SharePoint .• Business Intelligence.• Nintex Worklow for SharePoint 2013.

Business Case

The Structure of the NHS is changing. Some organisations such as Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) will or have been abolished with new organisation such as Clinical Commissioning Groups (CCGs) taking their place.

These changes mean that more organisations need to work together, in some cases these are newly formed groups who know nothing about each other. For example, local authorities will be taking on a larger role, assuming responsibility for budgets for Public Health. Health and Wellbeing Boards will have to encourage integrated working between commissioners of services across health, social care, public health, and children. They will also be encouraged to work more closely with other health and care providers, community groups and agencies, using their knowledge of local communities to tackle challenges such as smoking, alcohol and drug misuse and obesity.

It seems that not a day goes by where there isn’t some new initiative to engage on a wider scale to improve Public Health. No bad thing, but historically, interdepartmental communication and collaboration has proved challenge enough without expanding this to the public, public health bodies, other healthcare professionals, local government, the voluntary and community sector and many more.

There are many examples of NHS Trusts and partner organisations working in new and innovative ways to improve their communities’ health and reduce health inequalities, however the overriding message seems to be that is difficult to spread good practice into new areas because people say their area are “too different”.

Now that we have looked at some of the new features around “sharing” and working in a new way, please allow us to look at some context around using SharePoint to meet the QIPP challenge

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The Importance of Communities

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* http://www.nhsconfed.org/Documents/1000697_QIPP_final_report_101208.pdf

Business Case

The QIPP agenda remains high profile within the NHS, i.e. Quality, Inno-vation, Prevention and Productivity. A publication * (Kike, pon un asteris-co aquí, y abajo de la página pones el link que hay abajo en azul), by the NHS Confederation on Back Office Efficiency and Management as part of the QIPP challenge reported the following:

With developments in commissioning GPs (CCGs) will hold a much stronger role in this arena. Trusts will need to collaborate and engage in dialogue with multiple interested parties, effectively, and efficiently. A demonstrable means of promoting its achievements to ensure existing services are sustained and new business secured is crucial.

Freedom of Information (FOI) Current filing systems are disparate across directorates, with few stan-dards for version control. An orderly filing system, enabling easy identifi-cation of documents, with true version control and good search facilities will help the Trust to meet FOI requests efficiently, within statutory time limits, and with integrity.

Care Quality Commission (CQC) All Trusts must comply with the requirements of the CQC, and as such, requires a tool that will support:

• Robust data gathering for evidence to support compliance with core standards. • Compliance with policies and procedure

“Workflow - Workflow is a process tool which delivers the right work to the right people at the right time and, in doing so, optimises the processing time within your operations. Workflow solutions manage, distribute and monitor work as it progresses through pre-defined business processes and therefore assist with the efficient running of an organisation’s operations. Workflow enables a range of benefits including process visibility – which is essential for tracking progress and improvement. The benefit of workflow technology is that it streamlines and simplifies clinical and business proces-ses, connecting providers directly to the information they need – where, when, and how they need it. By managing care transitions and information gaps between diverse systems, departments and facilities, workflow techno-logy can deliver crucial patient information with speed, efficiency and logic. It bridges the gap between the business and the clinicians.”

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Strategic case - National contextQUIPP

Business CaseCurrently, much of the above is accomplished using manual processes. A tool that enables automatic notifications to be issued to relevant staff when a document is near expiration will help ensure policies (or indeed any documents) are kept up-to-date. Similarly, automating some of the steps associated with action plans and the ability to prompt and track actions on-line will go a long way towards strengthening governance.

The Information Revolution Liberating the NHS - An Information Revolution published recently, highlights the need for good quality information, that is relevant and accessible, and establishing an environment where using information to build knowledge becomes the norm.

Strategic Case Local contextWith the QUIPP headings in mind, Trusts objectives must be to:

Quality and RecoveryCollaboration is a critical success factor in any Trusts commitment to the Service Improvement Programme.

Implementing a new recovery model will require colleagues to readily communicate with each other across a variety of professional groups, and geographical boundaries, share latest ideas and examples of good practice, and obtain feedback quickly. Using familiar means of communication that is web-based with the ability to search for the right

How does SharePoint help support Trusts objectives?

• Improve the quality of the services, we deliver, underpinned by the recovery approach (Quality and Recovery)

• Develop and deliver a modern model of service provision within appropriate building environments (Modern services)

• Support existing services to thrive and become more competitive to encourage participation and harvesting of new ideas

• Develop the capacity and capability of the workforce to deliver our vision and strategic objectives, while operating efficiently and effectively (Workforce)

• Grow and develop mental health knowledge and practice and its application for current and future generations (Knowledge Management)

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Business Casepeople and engage in dialogue for example through blogging, along with the capability to push information targeted to the relevant audience will make a significant contribution to this requirement, while allowing the momentum of new and innovative ideas to be retained.

Improving OutcomesImprovements to outcomes can be achieved through numerous means, which can include ensuring staff have access to the latest policies and procedures, guidance on best practice, and outcomes from research.

The use of dashboards can also help support improvement in outcomes by highlighting progress with particular initiatives, and alerting staff to changes required in the configuration of services if certain areas are shown to be weak. The Trust is in the early stages of developing an in-house dashboard solution. Ideally, these would be available from a common user interface, reducing the need for additional training, while taking advantage of the ability to push information that is relevant to staff.

Audit can also be a valuable source of evidence which can demonstrate both the strengths and weaknesses of services. Electronic forms and workflows, and on-line surveys can both be used to support audit.

Electronic Document Management (EDM) The primary objective of any EDM project is to convert paper documents to an electronic format, which in turn, requires an efficient document management system to maximise the benefits electronic documents can offer. Version control and robust security for access are mandatory requirements for any document management system. SharePoint includes document management, which in turn can provide access to historical documents which can inform the best way forward for the future.

Sustain and develop new servicesNoting the innovative nature of the Service Improvement Programme, the Trusts would benefit from the capability to publish its services and outcomes both internally and externally to its key stakeholders. In turn, this would improve transparency, placing Trusts in a strong position with respect to commissioning, paving the way for the future.

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Business CaseWorkforceA standard and consistent document library available through a web browser, together with excellent search capabilities, not only releases staff time to find information, but will widen access to relevant documenta-tion, which can further support training and encourage cross fertilisation of ideas without overwhelming staff through information overload.

Productivity gains must be made to ensure Trusts can demonstrate value for money for the services they provide. One of the greatest advantages any collaborative tool offers is its ability to automate manual processes. For example, intelligent forms can be created, with users being prompted to select data from drop down lists, and through business rules, the form is passed to the correct person for processing. The status of the process can be monitored through audit trails, and staff can be confident they have submitted the correct information, and to the correct person. Electronic workflows can also help reduce mistakes, and reduce the time taken to chase after and correct errors; and taken one step further, can facilitate the electronic uploading of information to other systems (e.g. Electronic Staff Record (ESR)) thereby removing the need for manual transcription.

It should be noted that this concept of automating workflows can apply to both standard procedures, and to actions resulting from meetings, workshops or consultations.As with any development programme, new proposals inevitably involve documents, discussions and approvals, often over a large population dispersed over a wide geographic area. Strong version control will help ensure consistency and currency of information with clarity on the status of the document (including approval status) thereby avoiding risks associated with miscommunication, while the ability to review documents collaboratively can reduce travel, and offer staff far greater flexibility and more time in their working day to focus on the true nature of their job.

Equally, through the use of modern technology and collaborative soft-ware, staff can benefit from up-to-date skill set, enhancing staff develop-ment opportunities. Collaborative software can also support action learning sets, allowing staff to come together on-line to share their experiences without the need to travel for face-to-face meetings .

Finally, increased participation in Trust events and consultation processes through the use of on-line discussion forums or surveys, can give staff the confidence that their voice has been heard.

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Business CaseKnowledge Management

Sharing of information and knowledge is fundamental to knowledge management. A good knowledge management strategy requires the following:

• System to capture and share new ideas and information

• Ability to connect people with common interests

• Ability to find information according to relevance

• Informed decision making by integrating information into a single trusted source

Reflecting on the current challenges facing most NHS Trusts in relation to retrieving and using information to maximum effect, to help staff perform day-to-day duties and to build knowledge to support the Trust going forward, there are key areas where improvements can be made.

The key areas for improvement are summarised as follows:

• Reduce the administrative overhead to collect, store, retrieve and dispose of information

• Access to information, that is relevant to the user, through a common user interface, from a trusted source

• Compliance with governance arrangements through policy controls such as retention schedules and notifications of updates and expiration

• Ability to engage in dialogue with colleagues regardless of the geographical location

• Managing the technical overhead to maintain information sources

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Summary of Benefits

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Business Case

For the purposes of analysis, the above are described more fully in the table below:

Productivity

Overhead in technical support

Governance (compliance)

Isolated mobile workers

Up to date skillset for staff

Partnership Working

Effective organisationthrough streamlinedprocesses

•Time to retrieve and maintain information such as documents through i) intelligent and intuitive search facilities ii) single information source using a common user interface and iii) accessing information according to relevance

•Time to find the right people through intelligent searches and a single information source (staff directory)

•(Reduce) need to travel through on-line document reviews for MS Word documents and MS PowerPoint presentations

•Administrative overhead through integrated information systems, and reduced need to transcribe information

•Workload to create on-line forms (no more paper forms or programming)

•Avoidance of multiple departmental systems and databases, most notably an Electronic Document Management System EDM (reader for scanned clinical notes)

•Turn-around time to provide users with access to relevant document libraries

•Eliminate costs to maintain a legacy system

•Governance through true version control for documentation, and a central repository for policies and procedures

•Compliance with procedures through automated workflow management and alerts

•Staff are trained in use of modern technology, facilitating staff development

•Access to information, for external parties e.g. PCTs, CCGs and Local Authorities.•Collaboration and sharing of good practice through on-line discussion, and communities of practice

•Standardised data collection through intelligent forms, reducing errors in data entry and delays in authorisation•Proactive approach through dashboard facilities and managing risks effectively

•Access to information and on-line dialogue

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Benefit Description

Business Case

There are potential cash savings, improved governance and improved operation to be gained from automating business processes. Most NHS Trusts’ administration is currently distributed across the Trust. Adoption of a collaborative tool with automated processes will see a minimum of 2 hours of time being saved for each staff member per week and this saving will rise considerably for those heavily engaged in administrative duties such as processing forms and transcribing data. This cumulative saving has the potential to consolidate and rationalise the administrative effort across the Trust as a whole, thereby introducing potential cash releasing benefits.

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About

Raona is a multinational company specialising in custom software development and consultancy. Wth offices in London, Spain and Argentina, we help our clients pinpoint where technology can really provide more value. We consider ourselves a boutique company thanks to our high level of specialisation in Microsoft technologies.

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