Michael Phillips – PRO-MAPP

Standardising workflows and ‘Getting It Right First Time’: an overview of GIRFT

Posted on November 4, 2024November 7, 2024 by Michael Phillips

Backed by a range of Royal Colleges and professional associations, the Getting It Right First Time (GIRFT) initiative is part of a suite of programmes developed by NHS England. Bringing together powerful data analysis and reviews, it aims to enable healthcare services to improve patient care and pathways across the nation.

Let’s dive in to learn more about its origins, plans, and performance up to this point, as well as looking ahead to its potential future.

GIRFT’s original aims

GIRFT was originally conceived as a pilot methodology for reviewing orthopaedic surgery specialties by Professor Tim Briggs, with its landmark 2015 report coining the term. The research was hosted by the Royal National Orthopaedic Hospital NHS Trust (RNOH) and funded by NHS England. After his team covered more than 140 providers in over 200 hospitals, the subsequent programme (as we know it now) was launched in 2016.

The scheme aims to achieve standardisation for delivering quality patient care across NHS healthcare facilities. Often, clinical practice from site to site can differ greatly, affecting the efficiency of teams, their use of crucial resources, and the level of service they can deliver for patients already experiencing lengthy waiting times for orthopaedic assessments and surgeries.

GIRFT’s greater impact can be felt following the pandemic – a catastrophic incident for patients and NHS staff that faced a battleground each day. Covid-19’s ripple effect has unfortunately seen long physical queues for appointments, but GIRFT’s strategy places staff wellbeing and satisfaction as a high priority, acknowledging the dedication and mental health of key roles at NHS hospitals.

How does it work?

Making the most of data

To outline any discrepancies in operations across the country, GIRFT gathers and analyses national data in line with the methodology’s own benchmarking framework. Different arms of the NHS can compare their performance data against both regional or national standards; this allows them to gain empirical metric-backed evidence to inform the effectiveness of their clinical practice in adhering to patients.

Teamwork

Using the combined expertise and support of clinicians and management teams at various NHS trusts, the GIRFT’s recommendations can be put into practice and reiterated to determine the actionable, physical changes to healthcare services beyond the data insights. By encouraging meetings among practitioners, as well as data-gathering exercises and continuous learning, this hopes to rollout more standardised patient pathways no longer marred by diminishing variations. This alliance can contribute to the continual improvement of using GIRFT’s findings to foster better outcomes not just at one institution, but many.

Strategic plans

Designated ‘enhanced care’ areas have been established to provide flexible support to those requiring post-operative care. The scheme aims to improve patient management for a range of diverse clinical care scenarios, where appropriate and timely intervention can be applied to meet various degrees of clinical needs.

The results (so far)

The flag posts for better pre-operative assessments include reduced repeated testing, the removal of unnecessary face-to-face appointments, and fast-tracking high risk patients that urgently need to be seen by medical professionals. Plus, when resources and staff hours are implemented accordingly for the right tasks, it can have dramatic cost impacts for an NHS that is unfortunately facing financial burden.

Initial findings have seen that, particularly within orthopaedics, hospital trusts that have used GIRST’s assessments have saved outgoings ranging between £20 million to £30 million.

With greater uptake and collaboration involving other specialised trusts, these reductions look set to become more widespread for financial sustainability across the UK. In order to cover more surgical disciplines, GIRFT released 18 additional national documents in 2024 to analyse current procedures, and recommend improvements to deliver quality treatment to NHS patients.

Looking to the future

The environment for effective patient management has certainly improved through the GIRFT programme, and the post-pandemic era serves as a greater opportunity to be ambitious in getting more NHS trusts on board.

The initiative is constantly evolving as surgeries leverage the national data to hand and cross-collaborate to achieve a more effective ecosystem. With uniform pathways, not only can post-operative operations be smoothed for significant cost reduction, but staff and patient satisfaction can be essentially lifted too, revolutionising the running of a stretched NHS.

PRO-MAPP is pleased to have been chosen in GIRFT’s research as a vendor contributing to optimise patient pathways through our Pre-Assessment Clinic Triage product. Discover the full guide here, and chat to us to learn more about our inclusion.

How data-driven solutions can empower remote healthcare NGOs

Posted on September 10, 2024September 30, 2024 by Michael Phillips

Non-governmental organisations (NGO) are mostly associated with social or humanitarian work, including a range of worldwide groups focused on the health and wellbeing of populations on the fringe of national health services. All of these charitable groups, health NGO or not, face tough conditions, and rely on trained voluntary workers and monetary support as just two factors to carry out their respective causes. Add in healthcare’s notoriously tricky, cumbersome systems and advanced medical specialisms, and the job for these remarkable organisations is made evermore difficult.

Alongside the goodwill of generous donations, technological advancements are making exponential differences to ways in which healthcare NGOs can treat underserved patients, even in the globe’s more remote regions. When medical and resources are tight, operational innovation becomes key. But healthtech has even greater knock-on effects in transforming the ways volunteers, medical professionals and patients interact with each other throughout their clinical paths.

The unique problems for remote healthcare

Even the most trusted health systems in developed countries struggle with the pressures of growing populations and modern ailments. If you transfer these troubles to regions without skilled doctors, or even a hospital or small surgery, and healthcare NGOs’ importance is obvious. Like many NGOs, there’s a high level of cultural and social understanding they share with local communities, some of which may be less trusting in doctors, or feel there’s bias against those that can afford their treatment and those that can not.

A healthcare system should, in a perfect world, give equal quality of care to every patient and prioritise those most in need. Not all providers can achieve this in less economical places, however. NGOs in the space do excellent work in providing as much special care as they can and educate local staff that can build rapport with patients. But unlike non-health-related NGOs, there’s a problem in being able to provide regular health check-ups with the same doctors and nurses, and to cross-reference health records (if any) with existing systems. Despite providing a bridge between patients and access to healthcare materials, NGOs can face difficult relationships with these healthcare facilities already in place.

This is why grassroots health NGOs, with enough economic backing and government agency support at their areas of work, must aim to put training procedures in place to improve preventative healthcare solutions for patients until public or private providers can better serve their needs.

From access to tracked pathways

Accessibility is the first hurdle to anyone seeking healthcare, which NGOs strive to provide at the basic level. But their continued success relies on sustaining projects (even with the rising cost of training, delivery, and infrastructure). There’s no immediate magic wand to provide everyone with more stable and regular healthcare, yet through partnerships with research institutions and technological partners, a focused grouped effort goes some way in optimising the clinical paths that work best – without wasting medical resources or the valuable time of voluntary staff.

For one, technology is an outstanding educational tool. Through sharing audio and video training, it’s quicker to raise awareness about ailments, or to onboard local professionals or staff members that can learn the ins-and-outs of their specific roles for efficient procedural workflows at regional or pop-up surgeries. The same applies to support video calls between doctors and patients, where mobile or tablet is applicable, reducing queues of in-person appointments. WhatsApp is becoming an increasingly popular tool for reaching patients in remote areas, who are able to stay updated with doctors that can monitor their condition from wherever they are based.

When documentation is captured digitally, there’s consistency across care teams to track patient pathways – something we’ve experienced working with NGO Faith In Practice in Guatemala. This is why data is becoming such a key asset for remote health work; going beyond areas where paperwork is the only log for any health records, collecting real-time data on appointments or procedural notes is paramount to provide feedback, referrals, and to help each patient understand the next steps required. Ironing out these operations makes it more affordable to allocate fees to host clinics in remote areas, and helps account for only the materials needed with far less repeated manual labour, too.

A brighter future

Beyond this, data has the power to change healthcare systems outside of their individual surgeries. Collecting patient data builds up a reliable picture of the work of health NGOs’ in giving primary care, providing ample kudos to these services when they search for potential funding to better their healthcare programmes, a region’s infrastructure, or even to influence policymakers.

Maintaining health records provides better trust and communication between surgeries and patients for any pathway, no matter where they are in the world. Healthtech is certainly a cost-effective and vital lifeline to do just this, strengthening the great work health NGOs complete every hour, every day.

Success by degrees: how to overhaul inefficient healthcare with Small IT

Posted on July 12, 2024September 30, 2024 by Michael Phillips

In the tricky pursuit for next-generation healthcare technology, the NHS has often found itself entangled in the complexities of ‘Big IT’ programs. For decades, these large-scale nationwide programs, often championed by consulting giants, promised transformation but delivered little more than frustration and inefficiency. The time has come to pivot towards a new, and arguably better, notion: Small IT.

The allure of Big IT solutions, with their expansive scope and proposals of comprehensive integration, once held sway over healthcare decision makers. But bloated budgets, delayed timelines, and systems plagued by interoperability issues have become all too familiar hallmarks of these grand endeavours.

For the NHS, another fundamental flaw of Big IT initiatives lies in their top-down approach. These monolithic projects often attempt to impose standardised solutions across a diverse landscape of healthcare providers, disregarding the bespoke challenges and workflows of individual institutions. This ‘one size fits all’ mentality inevitably leads to adaptation struggles and, ultimately, suboptimal outcomes.

Adjusting to a nimbler evidence-based approach and building from proven localised successes allows for innovators to partner with the so-called integration giants in subsequent phases of rollout. The tail stops wagging the dog. Innovators lead, partnering with scale-out enablers at the right time and only after ROI proof-points have been demonstrated. This is where Small IT comes in.

The ethos of Small IT centres on leveraging modern technology stacks to empower innovators to tailor solutions to the specific needs of healthcare providers and patients alike. It marks a tactical pivot towards agile solutions delivered by passionate teams with a focus on both service and profitability.
Small IT also thrives on collaboration and customisation. By working closely with healthcare stakeholders, operations heads can gain a deep understanding of their needs and pain points, crafting solutions that seamlessly integrate into existing workflows while addressing specific challenges head on. This bottom-up approach fosters a sense of ownership and engagement among end users, driving adoption and ensuring that technology truly enhances, rather than hinders, the delivery of care.

The agility inherent in Small IT allows for rapid iterations according to evolving healthcare requirements and emerging technologies. Rather than being shackled to outdated systems and cumbersome bureaucracies, healthcare organisations can embrace change as an opportunity for growth and improvement. Dynamic responsiveness is crucial in an industry that changes as rapidly as healthcare, where the ability to swiftly respond to new challenges (spikes in patient admissions and evolving ailments, for example) can mark the difference between success and stagnation.

Critics of the Small IT approach may argue that it lacks the scale and robustness of Big IT solutions. But the goal is not to build massive systems that attempt to solve every problem under the sun, rather to create flexible, modular solutions that can be easily modified and scaled as needed. Small IT embraces the concept that solutions can’t do it all, yet are pragmatic, cost-effective, and, most importantly, deliver tangible value to end-users.

Plus the rise of modern tech stacks – cloud computing, microservices architecture, and open-source software – has democratised access to powerful tools and platforms for all Small IT users who can rapidly prototype and deploy solutions with minimal upfront investment. It levels the playing field and empowers a new age of healthcare entrepreneurs.

The era of Big IT dominance in healthcare is coming to an end. Decades of failed initiatives and wasted resources have demonstrated the limitations of top-down, holistic approaches. Software development efficiencies only add to the case. It is time to embrace Small IT’s agility, collaboration and customisation to revolutionise the delivery of care throughout the NHS.

By harnessing the creativity and passion of smaller IT teams, we can finally realise the promise of technology to improve patient outcomes, enhance clinician satisfaction, and drive efficiency throughout the healthcare system: a fundamental change meaningful to us all.

PRO-MAPP for joint replacement surgery: a slicker digital approach to preoperative assessments

Posted on June 21, 2024September 30, 2024 by Michael Phillips

As an application merging surgical experience, leading academia and software design, PRO-MAPP is specifically tailored to innovate and improve patient pathways. With healthcare systems under pressure from tight budgets, lengthy waiting lists, and evolving (and often complex) methodologies, the time to solve unnecessary operational lags has never been more striking.

In light of this, a programme developed by health economic research arm and consultancy York Health Economics Consortium (YHEC), in collaboration with Oxford Academic Health Science Network, placed four evidence-based digital solutions under the microscope for their transformative patient pathway abilities. PRO-MAPP was selected for its focus on preoperative assessment and digital patient outcome reporting, looking to showcase its digital effectiveness against standardised patient pathways for knee and hip replacement – one particular strand of clinical surgery blighted by long waiting times – at Nuffield Orthopaedic Centre.

The current healthcare burden

The pandemic’s hit on expanded patient waiting lists has been felt across multiple surgical cases, all equally difficult to solve in light of stripped-back resources and staffing. Existing pathways for joint replacement surgery suffers a range of challenges as a result of (or on top of) lengthy backlogs, including:

More than three preoperative appointments being undertaken before patients are deemed fit for surgery
Manual investigations being repeated unnecessarily
Expired preoperative checks (including blood tests)
Needless preoperative appointments being carried out on healthy patients

Digital pathway solutions can relieve the burden on the entire healthcare system’s human and material costs by simplifying each major step before surgery is carried out: lowering unnecessary face-to-face appointments; speeding up the steps between appointments, vital tests, and possible surgery; reducing the need for repetitive testing and data input; and fast-tracking those most fit or liable for secondary care (complex patients, e.g., those with high clinical frailty score that are over 65 years old).

Gaining the digital advantage

The PRO-MAPP application is designed to more swiftly and accurately identify patients fit for surgery and reduce numbers on backed-up waiting lists. Patients can be assessed via web or tablet, having been added to a waiting list following an outpatient visit. Health screening and occupational therapy questionnaires can be filled in on iPads by patients, with assistance available from staff.

Staff training, individually or in groups, takes 15 minutes on average, and this digital collection aims to accurately guide staff as to which investigations are required before patients leave clinics, including ECD, MRSA swabs or blood tests.

The digital interface speeds up diagnostics, operational decisions, and ensures complex patients can start preoperative investigations earlier, increasing the probability to be determined fit for surgery sooner. Optimising preoperative assessment can properly segment patients only requiring telephone appointments, saving resources and costs affiliated with necessary appointment visits.

Complex patients should start pre-op investigations earlier to avoid the risk of changes to health status or expired tests (and the need to repeat questionnaires and checks), as well as increasing the probability of being fitter for surgery.

In short: what we found

Based on a sample of 1000 patients, the investigation compared the PRO-MAPP pathway with a standard care pathway for those correctly (or incorrectly) identified as complex or non-complex patients. The number of tests undertaken (e.g. echocardiogram or chest x-rays) was dependent on this factor.

The study looked to identify the average differences between: patient management costs; the length of a patient’s hospital stay; the number of preoperative tests; the number of preoperative appointments; readmissions; cancelled surgeries; and repetitions for preoperative tests and appointments.

PRO-MAPP’s identification rate proved 98% correct for complex patients, and 95.4% for non complex patients. The length of stay was, on average, two days shorter for those on the PRO-MAPP pathway, while readmissions were lowered by 0.4%, and 1.3% fewer surgeries were cancelled.

In all, the PRO-MAPP pathway for knee and hip replacement saved £770 per patient in comparison to the standardised procedure. Per 1000 patients, this marks a difference of £726,944.

Future-proofing personalised patient pathways

Reducing the need for unnecessary face to face appointments, the lengths of hospital stays, and training and resources costs, the PRO-MAPP pathway is on course to speed up operations while alleviating budget stresses and achieving patient satisfaction. 92% of patients stated the questionnaire was ‘easy’ or ‘very easy’ to complete.

Staff similarly felt the bespoke application was helpful for the service, implemented according to speciality, workflows, staff numbers, and the level of training, support or technology needed. With reduced repeated health centre visits, health economic analysis also identified that PRO-MAPP has (so far) saved 51,381.6k of travel; a necessary step in improving climate issues through a reduced 8.8 tonnes of CO2 emissions.

Efforts are still ongoing to improve interactions between patients and staff, but PRO-MAPP has been included on NHS England’s website as a guide for providers on earlier screening, risk assessment and health optimisation in perioperative pathways. To learn more about our pioneering patient pathway solutions, get in touch with our team today!

Author: Michael Phillips