Clinical engagement vital to Waitemata DHB's innovation success
Digital Health story - Clinical leadership
Clinicians are leading a range of successful health IT projects at Waitemata District Health board as part of its LeapFrog programme and i3 Institute for Innovation and Improvement.
Waitemata DHB's journey of transforming its approach to health IT projects began in 2014, when CEO Dr Dale Bramley and clinical director of innovation, Robyn Whittaker, travelled to the United States as part of a Commonwealth Fund initiative.
They had the opportunity to visit some of the country’s top performing institutions and see how they were successfully incorporating digital technologies into their health services.
Whittaker says that many of the implementations had made clinicians’ lives easier and created good outcomes for patients, both in terms of their health and their experience of the health system.
Whittaker and Bramley returned full of enthusiasm and started work on what was appropriate and feasible in a Kiwi context.
“We started to think about how we could have a programme that would fast track some of these things and that would have a really good impact for patients and staff. We wanted to learn from what others had done,” says Whittaker.
“Clinicians leading it was always a really big part of it – the projects had to be clinically led and based on what clinicians thought would be really good and helpful,” Whittaker explains.
Waitemata leapfrogs IT
The DHB started its the ‘Leap Frog’ programme in early 2016, which focusses on the fast roll-out of a range of technology projects that are identified as providing the most value for staff and patients.
Each of the projects has a clinical lead, who works full or part-time on ensuring a successful delivery.
Projects include; a mobility strategy; electronic ordering systems; clinical decision support tools; patient experience reporting; and improving primary care connections.
“A lot of it is about clinical change, so it’s really important to have clinical leads on board, and you need to give them the time out from their clinical role to lead these projects,” Whittaker says.
She adds that clinical leads are vital for understanding the degree of clinical change involved in a project and talking to other clinicians about what the change will mean for them in their day-to-day job.
“There’s a general understanding that a lot of IT implementations had been treated as IT projects and not as clinical change. It was recognised that this wasn’t a particularly good way to go about it as it caused projects to drag on because they hadn’t had clinical leadership from the beginning,” says Whittaker.
Leapfrog is a CEO-sponsored project, which has allowed for some upfront investment in the programme. The project team reports weekly to the CEO and fortnightly to the organisation to keep everyone up to speed with progress.
“It was difficult initially, but we built it up over time and the support and priorities and visibility provided by having a CEO-sponsored programme is really important,” Whittaker says.
Many of the initial LeapFrog projects are at their end of their first phase and the DHB is now looking towards phase two.
This will include working with the outpatient department on streamlining processes and use of telehealth. Also, the possible roll-out of a patient engagement system that was trialled in 20-16, in which all patients were given an iPad and free WiFi.
The launch of i3
This is a hub for “all of the great people and innovative work being done across the health board”, to ensure their work is co-ordinated, well supported and resourced, explains Whittaker.
The success of LeapFrog led Waitemata DHB to launch an Institute for Innovation and Improvement called i3.
Its programme of work is driven by clinicians and approved by senior management, ensuring it is closely aligned with the services’ needs.
The institute does not have an annual budget to implement its projects, but must take each one to the DHB Board for approval.
“We are looking for improvements in day-to-day clinical processes: for example, how much administrative/ wasted/ duplicated time can we take out of the system to allow staff to spend more valuable time with patients?” explains Whittaker.
The overall priorities the board is always looking towards is whether a project improves patient outcomes and patient and whanau experience of the health system.
“There’s quite an acceptance now of a move to digital. The programme has been portrayed to staff as incremental steps towards a more digital and mobile way of working,” she says.
e-Vitals clinical lead Peter Groom with Tina Moulynox, Implementation – technology services
Waitemata DHB’s e-Vitals project went live in October 2016. It covers all adult inpatient beds except ED and maternity and has nearly 3000 users. It will go-live in maternity in November 2017 and ED in 2018.
Clinical lead for e-Vitals Peter Groom has been working full-time on the project for most of 2017. However, he describes himself as a “novice”, who is still finding his way.
Groom’s background is in clinical care outreach where he would use Early Warning Scores (EWS) and saw the problems created when they were not completed correctly or on time.
“I was looking for a way of improving patient safety and improving patient satisfaction and compliancy with these systems,” he explains.
He was unsure at first as he is not a natural “techy” and still does not understand much of the jargon used.
“At first, I thought I’m so behind the ball, but I realised what they needed was not someone with technical knowledge: they needed someone to say, ‘how will this integrate on wards?’”
Groom says the use of clinical leads has really helped the Leapfrog projects to be accepted by clinicians.
“We have a relationship with clinicians from SMO level right down to healthcare assistants on the ward. It’s the ability to know people’s names and what’s happening on their ward and the pressures they are under,” he says.
“We want to get to a point where it’s safer for the patient and easier for the nurse. It’s recognising the pinch points that really hurt us as clinicians and thinking: ‘if I do this as a project, will this make it better or worse’?”