Ascot Solutions Case Study – Somerset Community Health

Somerset Primary Care Trust NHS Logo

NHS Somerset’s primary function is to commission high-quality health services to meet the needs of the population of Somerset, working with partner organisations in the NHS, local authorities and the voluntary sector. Health services are commissioned from Somerset Community Health (one of the largest providers in the South West), Acute Trusts and local NHS Independent Contractors that include almost 300 GP practices, dental surgeries, community pharmacies and optometric practices. Somerset Community Health is a new organisation which is now separate from the Commissioning side of the Primary Care Trust (NHS Somerset) as an arm’s length organisation of the PCT.

Somerset Community Health strives to provide and develop first-class community health services in Somerset. It provides a wide range of community services including, among others, district nursing teams, primary care dental services and community hospital provision; it boasts 12 hospitals and 4 minor injury units, numbers which are distinct to Somerset. These numbers are not only impressive but set to grow imminently; one of the new sites will be a centre of excellence for stroke rehabilitation. So, Somerset Community Health’s range of services is not only larger than most but diverse.

The organisation aims to be an innovative and dynamic leader of quality within the local health and social care community. Achieving a high standard of patient care is only possible by continually monitoring patient satisfaction, a task that places a heavy workload on all teams responsible for collecting survey data. This is why Somerset Community Health chose Formic Fusion supplied through their NHS specialist partner, Ascot Business Solutions, to help it achieve its goals.

Ascot has worked closely with the NHS for a number of years developing data capture solutions in areas such as Clinical Audit, Infection Control and Patient Surveys.

The Need for Efficient Data Collection

The accurate, efficient and cost-effective capture of information, its management, analysis and sharing, is critical to a health service’s ability to monitor and improve patient care and subsequently patient satisfaction. A solution that can automatically scan, read and extract information from any paper form and, with a click of a button, send it electronically to a project database or other clinical system will make huge efficiency gains for the data capture team and NHS targets. A solution that captures and provides data feedback remotely from a PDA, tablet PC or other handheld device can bring even more benefit.

Within Somerset Community Health, the importance of data collection cannot be over-emphasised. Sue Balcombe, Deputy Chief Operating Officer, explains: “We need to collect information to prove the value of our service to the Care Quality Commission and, perhaps more importantly, to improve the quality of care we commission for patients. So we contract with our service providers to report on patient satisfaction – we are committed to act on what we find, share the results with teams and make sure they get a real sense of what’s going on.”

Somerset Community Health has been using Formic Fusion for two years. Mark Stacey, Somerset Community Health Risk Manager, involved with incident management and patient safety projects, joined NHS Somerset in 2007 as Quality Improvement Manager, and, understanding the need for higher efficiency in data capture, was instrumental in the adoption of the software.

“When I first joined the Directorate at NHS Somerset we desperately needed to become more efficient and productive at conducting audit and patient survey work. I soon learned that the Provider Services Directorates at the time were also looking to find more efficient ways of measuring the patient experience,” recalled Mark. “Within Somerset Community Health, we have set an ambitious goal of asking for feedback from every patient that is exiting an episode of care; it will see all services completing patient satisfaction surveys by April 2011 and although this is a large agenda it will bring all our services up to speed with patient evaluation within Somerset Community Health.”

The Clinical Audit Team also needed to speed up the cycle of designing audits and questionnaires, collecting patient–staff responses and analysing data. This team seeks to improve patient care and outcomes through the systematic review of care against explicit criteria and the implementation of change. Where indicated, changes are implemented and further monitoring is used to confirm improvement in health care delivery. Stemming from the Patient and Public Involvement (PPI) strategy and Equality & Diversity Action Plan, the PPI and Patient Advisory Liaison (PAL) teams also needed to conduct surveys that would include the entire population of Somerset; a task with potentially huge resource implications. Mark quickly identified the many areas that would benefit from employing a data capture solution, saving time, resource and money.

Choosing Formic Fusion

In his search for a solution provider Mark invited three software companies to give a presentation and demonstrate their solutions. “It was immediately obvious that Ascot Business Solutions and Formic had a deep knowledge and experience of the NHS and this was a key deciding factor for us. The software looked like Word and Excel, so it was instantly familiar and versatile; we saw how it had been adapted to suit the specific needs of other Trusts so we were confident we would enjoy a similar, collaborative relationship. We were particularly impressed with its ease of use, the handwriting recognition function and the option to include anatomical images. The image capability means you can embed a picture and break it up into useable pieces, this means, for example, we could easily show the affected parts of the body or even take a map of Somerset and split it up to show the parts of the county we wish to refer to, it’s an incredibly useful function.”

Mark continued: “I saw enormous potential with the type of solution Ascot and Formic were proposing; not just the scope for adoption by other Directorates but the opportunity for the organisation to start to take advantage of the latest wireless technology to collect and receive data instantly for analysis.”

The Benefits of Using Formic Fusion

One of the main ways Somerset Community Health uses Fusion is to design a survey and choose how they want to publish it: print it to paper, put it on the web or send it to mobile devices. It has 27 wireless tablet PCs to collect responses from patients on the wards and 13 touch screens are due to be installed at outpatients and minor injury units of the community hospitals allowing patients to complete an exit survey. The solution also allows patients who have returned home to complete the survey online.

“When we started using Formic we had to re-train our thinking. Instead of designing a questionnaire and playing around with the data that eventually came through, we could design a questionnaire that would meet perfectly the standards we set and provide the correct data. Once we were used to thinking about the data we wanted to collect first and applying that to the design, it became much easier,” said Mark.

“The wireless tablet PCs have been a success in the community hospitals; we can send questionnaires and audits to these mobile devices, allowing staff quickly and easily to collect data for a variety of projects including patient feedback upon discharge. The nurses like them because they look and operate like a normal computer and are happy to show patients how to use the pen-like stylus and eraser. There is even a built-in camera and scanner for positive patient identification that could be utilised in the future.”

Fusion has played an important part in Somerset Community Health’s delivery on government targets for tracking patient response, designing surveys or questionnaires and reporting on them. “Fusion has dramatically improved the time it takes to do this,” says Mark, “reports that could have taken me weeks to design can now be done in a day and it’s a much easier process.”

“I have also saved time by tasking each of our services to administer the questionnaire themselves. We design it and send it to them and they can undertake the entering of data themselves using web forms, enabling the process to be handled remotely. Without Fusion we would have to wait for all the forms to be returned to us and they would have to be scanned in, with Fusion, we just get the results – it’s simple. Given that our surveys are so diverse in terms of content and geographically, it’s invaluable that the services can do this for themselves. Fusion is so adaptable, we have definitely adapted it to meet our needs, so it works for us.”

The ease of use and the remote access capability have made it possible for more people to respond with least effort: “we used to get response rates from paper forms of as little as 10 percent,” explained Mark, “now, we always get 85 percent or more.”

Fusion was installed by Somerset Community Health’s own IT team, which was also responsible for making part of the website accessible to patients so that they can access information and respond from the comfort of their own home. Training was carried out initially by Formic with key people. “It was really well run and our evaluation was good,” said Mark. “We all came away with the knowledge that we could understand it and how we could expand its use. We came away knowing we could call Ascot and Formic at any time. The relationship with Formic and Ascot has been incredibly good and they have worked with us to develop its tools to meet our needs. The training and helpdesk are also very well received by our users.”

Widespread Use

Fusion is also being used by the Clinical Audit team and the Public Health Directorate within Somerset NHS. When clinical audit started using it, it soon became apparent that the software would be useful in other areas of public health, like for training courses. Each area has its own agenda and each uses Fusion differently according to its needs.
“We now have the Public Health Directorate using Formic Fusion for its regional surveys and the PPI team for all manner of public awareness surveys. The Workforce Directorate is also showing interest. I found that the most effective way to get people using the new technology is to appoint IT as the subject matter experts and identify a lead within the Directorate to run the project and cascade the training,” Mark explains.

Formic Fusion has been in use within Somerset NHS Clinical Audit also for two years now. The software is used for clinical audits, evaluations, patient-directed audit and record keeping. Among its many activities and heavy workload, the department conducts about 50 percent of its clinical audits under a service-level agreement for Somerset Community Health. The department has already seen a steady rise over the previous year in the use of Fusion and uptake is on the increase. Joanne Bird is the Lead in the Nursing and Patient Safety Directorate of NHS Somerset with a depth of experience in clinical audit. Joanne remarks: “data entry is not only a time-consuming task but a duplication process that can lead to data entry errors. Our use of Fusion releases facilitators from the data-entry process and allows them to focus their time on analysis and reporting. Savings in time and resource, of course, mean savings in costs. To give an example, a standard documentation audit requires on average four hours of data entry, this equates to about £48 per audit. With approximately 25 documentation audits a year, this makes a saving of £1,200, or 100 hours of facilitator time.”

Given that documentation audit is just one of the processes that uses Fusion, others include record keeping audits of which 26 are scheduled for this year alone, this is a good indication of how the software can improve business efficiency. “Using Fusion primarily for web-based audits, both myself and the record-keeping team have found Fusion not only to be a cost-effective way of collating data, but it is more secure,” said Joanne.

“A great advantage of standardising across the NHS,” says Mark, “is that we can all share information. We can all see the same information, we can see each other’s designs of questionnaire, and we can share ideas and help each other. We can ask each other how they achieved a particular design or how they linked it to something else. Everything is visible to patients too. Somerset does pride itself in being transparent, all reports are as visible as possible. All evaluation is visible to the public and any interested party, fulfilling another of the government’s targets for the NHS going forward.”

Going Forward

Mark can also see plenty of opportunity to maximise the use of the technology in other areas “Formic Fusion software integrates with other systems, for example, our risk management system where we record PALs, complaints and incidents. Some information is collected on a paper form and it would be feasible to scan these paper-based incident forms using Formic, bypass the manual input stage and send the data straight to the system. It would also be useful to the community hospitals and locality leads who have approached me about their data collection pilot projects; I can definitely see the software being used there.”

Sue Balcombe also has ambitions to improve productivity using mobile technology “We employ some 1,700 full-time staff of which 50 percent are community workers. Currently, the only technology they carry is a mobile phone. A single assessment is five pages long but handheld devices would enable us to complete these electronically. We are also looking at how we can plan more efficient travel routes for GPs to reduce spend on petrol. The South West is a leading force at pushing change and it’s coming from people on the ground, which is so encouraging.”