Correspondence Management and Workflow Optimisation Workshop Your - - PowerPoint PPT Presentation

Welcome to the Correspondence Management and Workflow Optimisation Workshop

Your Facilitator is Nick Sharples From DNA Insight

Correspondence Management Workflow Optimisation

Productive Workflows

Correspondence Management

Correspondence management involves clerical staff receiving, sorting and coding incoming clinical correspondence. The Admin team then follow an approved and audited protocol for deciding which letters need to be sent to a GP for action/review, and which letters can be safely and more effectively be dealt with by another member of the Practice team.

Workflow Optimisation

Workflow is defined as a process involving a series of tasks—how tasks are accomplished, in what order, and by whom. Workflow Optimisation in the Practice analyses each task and sub-task within the correspondence management process to see how it might be completed more efficiently.

Today’s Objectives

• To provide the means for both Practices to agree on and

implement a common, consistent and safe model of correspondence management

• To kick start the process by agreeing the protocols for 18

‘quick win’ correspondence types

• To introduce and practise the techniques of Workflow

Optimisation for correspondence entering the Practice

• To provide you with the tool kit to audit, review and

introduce an effective process of correspondence management to the Practice within 5-7 weeks.

The Workshop Approach – What’s coming up!

• Look at the background and context to Productive Workflows
• Identify the channels used to get correspondence into the Practice
• Identify and capture all the types of correspondence that are

received into the Practice to identify the ‘universe’ of correspondence that can be subject to correspondence management

• As a Practice team, discuss and agree the new protocols for 18 x

‘low hanging fruit’ correspondence types

• Tea Break
• Look at Workflow models
• Analyse workflow for an identified item of correspondence as it

flows though the Practice system – then optimise it

• Look at the 5-7 week correspondence management

implementation process and ‘Secrets of Success’.

Principles of Correspondence Management

• It is the GP, who bears the clinical risk within the Practice, that decides which

items of correspondence can be dealt with safely and efficiently by a more appropriate member of the Practice team – it is not for anyone in the Admin team to decide for them.

• Any item of correspondence, not specifically covered by a protocol, goes to

the GP for action if it did so before the introduction of Correspondence Management.

• Where there is any element of doubt on the part of the Admin team as to

the appropriate destination for a particular item of correspondence, it should be sent to the GP for action.

• Protocols for individual types of correspondence are written down in a

Process Map that is followed by every member of the Admin team.

• The new Correspondence Management protocols are audited effectively to

ensure safe clinical and governance processes are being adopted in accordance with the new protocols.

Does This Look Familiar?

A Timeline of GP Correspondence Management

Introduction of Scanning Postal Service Introduction of Typewriter Micros for GPs

1993 1990 1980s

Introduction of ISPs and Email

1839 1874

Social Media Docman Hub

2005 2004

Fax becomes mainstream

20??

The Paperless GP Surgery

Correspondence Management Case Studies

Lincoln Practices

• Brant and Springcliffe Surgeries in Lincoln
• Four GPs (3 part time and 1 salaried GP)
• 10,000 registered patients
• From up to 70 pieces of correspondence

to less than 20 per GP each day

• Each GP has released at least one hour

per day = 15% reduction in total hours. Brighton & Hove Practices

• Mini trial involving six Practices
• Results showed a reduction in time

averaging 45 minutes per GP

• No significant events having occurred in

the first 15,000 letters

• Staff describe it as ‘the best thing that

has happened to their job’ Wembley Practices

• 14,500 list, dual site Practice struggling

with managing correspondence.

• Problems with scanning delays and

process

• Results showed that after introducing

effective workflow / correspondence management they saw a reduction in letters dealt with by GPs of 77% Park View Medical Centre

• Manchester based 3 x GP Practice
• Went from daily average of 135 items of

correspondence to 4-5 per GP

• Reduction of 94.7% in correspondence

needing to be seen/actioned by GPs

• “The GPs are delighted with the outcome
• f the workflow programme.”

The Document Journey – “How Does it Get Here”

• By Hand – from patients
• Post – Royal Mail, Whistle / Courier
• Internal Mail from Local Hospitals
• Fax
• Email
• Electronic Document Transfer (EDT): Hubs, Docman
• Social Media?

What Types of Correspondence Received?

Correspondence Scoping Exercise

• By identifying every type of correspondence that comes in to

the Practice one can determine the universe of the correspondence that needs to be considered for Correspondence Management

• Take a piece of flip chart paper and stick it to the wall. Then

work individually to list on a separate Post-It note every type

• f correspondence you can think of that you personally

receive or are exposed to as part of your role within the Practice.

• Add the Post-Its to the flip chart paper, grouping similar or

identical types

• Retain/photograph the result as it forms the universe of the

correspondence types your Practice needs to consider

A review of the Types of Correspondence Received

• Patient Generated; Notes, requests for re-referrals, medication changes
• Prescription/Repeat Prescription requests
• Clinic Letters: routine, follow up
• Appointment Confirmation Letters
• Hospital Discharge Letters
• UCC, A&E attendance letters
• DNA Letters
• Admission Notifications
• Death Notifications
• Safeguarding requests
• Solicitor reports requests, DWP etc.
• Insurance/Indemnity/Buildings/
• Regulatory/CQC/Complaints
• CCG/Board/Federation/Locality communications
• Invoices/Bills/Subscriptions/Office Admin

Future Correspondence:

• PCN admin, logistics, clinical correspondence
• Social Prescriber reports, referrals and evaluations
• Practice Pharmacist correspondence

Correspondence Allocation Exercise

Correspondence Allocation Exercise

• Working as a table, discuss each of the 18 commonly

received documents in order and decide:

– Whether the GP needs/wants to see the correspondence – If not, who should deal with it – Any caveats/exclusions/restrictions you may wish to apply to certain items

• Record your decision on the GP Data Collection Sheet. If

from different Practices, each Practice team should record their own decisions on their own Collection sheet.

• This then forms the framework for the management of the

correspondence your Practice receives.

DNA

DNA

Death Notification

Newborn Summary

DWP Letter

Diabetic Retinopathy Screening

Opticians Letter

A & E Letter

Outpatient Report

Minor Injuries Attendance Letter

Discharge Summary

Repeat Prescription Requests

Treatment Summary

Diabetes Consultant’s Report

Patient or Practice Responsibility

Patient or Practice Responsibility

Patient Referred Back to GP

Endoscopy Report

• 5 - 10 minutes

Time for Tea

Workflow Optimisation

• Workflow is defined as a process involving a series of tasks—

how tasks are accomplished, in what order, and by whom. Clinical workflow simply refers to the process of delivering clinical services.

• Workflow Optimisation analyses each task within the

process to see how it might be completed more efficiently.

• There are a number of sophisticated optimisation tools such

as Six Sigma and Lean to optimise industrial and business workflows.

• For the Admin/scanning role within Primary Care a simpler

model is appropriate.

Incremental Gains – Find the 1%

Workflow Optimisation Exercise

Follow a Document through the Practice to Final Filing

Capturing your Current Workflow

• Identify the process and every step taken by an

identified item of clinical correspondence, which normally arrives by post, from entering the Practice to final filing.

• Break down each step into sub-steps and put each

sub-step on a Post-It note and then on the flip chart

• Use Post It Notes to note every distinct step in the

process and create a timeline from start to finish.

• Once completed we will look at ways to optimise

the workflow

Optimising your Admin/Scanning Workflow

• Analyse each step/sub-step in the process to

eliminate instances of inefficiency and improve every step of every Process

• Seek to identify a 1% incremental gain in efficiency

from each step - consider the Who, What, Why, When, Where, How Focus on the 1%

• Waiting:

– Do you need to wait? – Can something else be done while you are waiting? (Kettle) – Concurrent not sequential activity

Workflow Optimisation – Making Tea

We helped one large Practice save a total of 10 working days a year through optimising the workflow of making tea:

• Staff wait as kettle takes 2 minutes to boil
• 12 instances of staff making tea/coffee per 10 hour day
• 24 person/minutes wasted per day = 2 hours a week
• 100 hours wasted per 50 week year = 10 days a year

Solutions:

• Descale the kettle to minimise boiling time
• Refill and reboil the kettle once used
• Buy a boiler!

Optimising your Admin/Scanning Workflow

Eliminate Areas of Inefficiency and Improve every step

• f every Process

Focus on the 1%

• Waiting:

– Do you need to wait? – Can something else be done while you are waiting? (Kettle) – Concurrent not sequential activity

• Ergonomics:

– Is the environment designed to help the process? (Kitchen triangle)

The Ergonomics of Workstations

Optimising your Admin/Scanning Workflow

Eliminate Areas of Inefficiency and Improve every step of every Process Focus on the 1%

• Waiting:

– Do you need to wait? – Can something else be done while you are waiting? (Kettle) – Concurrent not sequential activity

• Ergonomics:

– Is the environment designed to help the process? (Kitchen triangle) – Would ergonomic changes make a difference? – How many times up and down stairs?

• Over-Processing:

– Is there more than needed? – Could we streamline the process?

• Duplication

– Identify and eliminate

Correspondence Management Timeline

Correspondence Management Process

Each Practice decides on a start date that allows 5-7 weeks for implementation:

• Week 1 – Team meeting to brief Practice
• Weeks 2-3 GPs monitor and record each type of

correspondence they see. They record:

– Number of each type of correspondence – Whether appropriate for GP to receive – If not, who should deal with it – Any caveats/exclusions/restrictions they wish to apply to certain items

Correspondence Management Process

Each Practice decides on a start date that allows 5-7 weeks for implementation:

• Week 1 – Team meeting to brief Practice
• Weeks 2-3 GPs monitor and record each type of

correspondence they see. They record:

– Number of each type of correspondence – Whether appropriate for GP to receive – If not, who should deal with it – Any caveats/exclusions/restrictions they wish to apply to certain items

• Admin team collects and collates entries from each GP to

create a daily summary.

Correspondence Management Process

Each Practice decides on a start date that allows 5-7 weeks for implementation:

• Week 1 – Team meeting to brief Practice
• Weeks 2-3 GPs monitor and record each type of

correspondence they see. They record:

– Number of each type of correspondence – Whether appropriate for GP to receive – If not, who should deal with it – Any caveats/exclusions/restrictions they wish to apply to certain items

• Admin team collects and collates entries from each GP to create

a daily summary.

• Week 4 – Admin team presents results back to GP/PM/Admin
• team. New protocols agreed and Process Map created as the

Master Process document.

Correspondence Management Process

Each Practice decides on a start date that allows 5-7 weeks for implementation:

• Week 1 – Team meeting to brief Practice
• Weeks 2-3 GPs monitor and record each type of correspondence they
• see. They record:

– Number of each type of correspondence – Whether appropriate for GP to receive – If not, who should deal with it – Any caveats/exclusions/restrictions they wish to apply to certain items

• Admin team collects and collates entries from each GP to create a

daily summary.

• Week 4 – Admin team presents results back to GP/PM/Admin team.

New protocols agreed and Process Map created as the Master Process document.

• Week 5 – Other clinicians informed of changes to previous protocols.

Admin team implement new protocols – GPs no longer receive documents covered by the new protocols.

• Week 6 – ongoing regular quality/safety audits

Correspondence Management Action Plan

Quality Assurance and Audit

Information Governance/Data Protection:

– Appoint a Correspondence Management Lead GP – Involve the Caldicott Guardian – Define and write the protocol

Vicarious Liability and Indemnity:

– Generally no impact on indemnity as Workflow is regarded as a delegated function and upskilling is perceived as positive. Contact MDU if unclear.

Quality Assurance and Audit:

– GP/PM/Admin audit together – Once a week for first month – Once a month thereafter

MDU General Guidance on GP Forward View

Provide adequate training

• Make sure staff are comfortable taking on additional responsibilities and are working within their level of competence.
• For example, correspondence management requires staff members to be confident in making decisions about how to code a letter and

its contents in the patient record, how to use an approved protocol for deciding which letters are sent to a GP and with how much urgency, and when to ask for help.

• The GMC expects doctors to be 'satisfied that the staff you supervise have the necessary knowledge, skills and training to carry out

their roles'.

• The CQC expects practices to regularly review the training needs of their staff and maintain a record of all staff training and

development.

• NHS England has outlined details of training for reception and clerical staff under the GP Forward View on its website.

Supervision

• When delegating tasks to a colleague, GPs are still responsible for the overall care and management of patients.
• The GMC's guidance to delegation and referral states that 'you must be satisfied that the person providing care has the appropriate

qualifications, skills and experience to provide safe care for the patient.'

• A senior doctor within the practice should oversee non-clinical staff taking on enhanced roles.
• Make sure there are clear procedures in place to guide clerical staff and provide consistency in how tasks are carried out.
• Provide staff with a way of raising concerns if they are uncomfortable with performing a task.
• Conduct regular audits to monitor and improve systems and training.

Indemnity

• GP partners are jointly vicariously liable for the actions of practice staff under their employment.
• It's important that any staff undertaking enhanced roles within the practice are fully trained, working to up-to-date protocols and

closely supervised.

• Staff should also have access to clinical guidance and support when they need it.
• If you're implementing an upskilling system in your practice, contact the MDU to ensure you have the appropriate indemnity. We can

also advise on the relevant medico-legal implications.

Secrets of Success

• Agree a ‘Go Live’ date and book all team meetings, Audit

and Process reviews in advance

• Be prepared to compromise and build consensus -

agreement is ideal but where consensus exists, consider what caveats and exceptions can be put in place to allow for each category to be agreed upon.

• Pick the low hanging fruit where there is consensus and

implement first to get a quick win

• Iterate the process to optimise the benefits
• Focus on the 1% process improvement and maintain as a

continuing objective for each member of the team

• Save 50 minutes a day per GP!

Workflow Management – Online Toolkit

Your Online Workflow Management Toolkit can be accessed at: https://bit.ly/2LRXv2e

Contact Details Please call Nick Sharples when you are ready to start implementation, or if you have any questions We are available 24/7 info@dnainsight.co.uk 0800 978 8323

Keeping in Touch after the Course

• Weekly support calls as needed with Practice Leads once

implementation starts. Please fill out the form to nominate your Practice Lead

• Certificate of Training for CPD
• Opportunity to provide feedback on the workshop

Closing thoughts

• “Show me the paperless practice and I’ll show you the

paperless loo roll!” - Unknown

• “We may not be able to do away with the paper trail

altogether, but we can certainly be more efficient on how we manage it”. Sheraz Khan, CQC Examiner/Inspector