How the NHS Needs to Plan and Deliver Its Service More Effectively - Article Example

How the NHS needs to plan and deliver its service more effectively The case of NHS Direct and its growth described below will be used as an example to explore how NHS can plan and deliver its services more effectively. Initial Plan and Concerns The introduction of NHS Direct was high on the priority list of the Labour Government. According to NAO, 2002 the idea of NHS emerged as a result of the need to off load the pressure faced by Ambulance and accident and emergency services. It was believed that the telephonic advice service manned by nurses would help "improve the accessibility of appropriate information to patients in the event of a perceived emergency". There was a strong top-down pressure at the regional level that used "local champions" - proactive and forward thinking mangers and executives, with strong visions of what the service could deliver. (this helps us talk of political drivers) The way NHS Direct was envisioned, it allowed Chief Executives to set new parameters since there were no pre-existing policies or procedures. It enabled the organization to be exploratory and made the organization staff receptive to new ideas. (so we can talk of facilitating further innovation and development). The goals for NHS Direct were well understood by those involved in the project. When the plan was rolled out, the team also pointed at the obstacles and the drawbacks in the plan. There were concerns especially regarding patients' safety, the ability to carry out triage at a distance with no visual reference, and a belief that A&E presentations would increase as the NHS Direct used it as a default response (culture of skepticism, issue of buy in to be discussed) The other issue was that of recruitment. There was a general perception that NHS Direct would attract the most skilled A&E nurses. However this was overcome as noted by NAO (1999):"In 2002, NHS Direct employed approximately 0.4% of all full-time equivalent qualified nurses in the NHS, with 20% of its nursing workforce coming from outside the NHS. 'It was also seen as an opportunity to encourage back into the workforce nurses who had left the NHS, particularly those who had left due to an acquired physical disability". (threat converted to an opportunity'it became the strength of NHS Direct in the way staffing was done). Nurses laid off, as a result of hospital mergers were also recruited into NHS Direct. Other than that those working in NHS could also work part time in NHSD. NHS Direct Spread The first pilot for NHS was very successful and when politicians saw the good results, they wanted to accelerate the growth of NHS direct under a very tight timeline. This gave hardly any time for preparation and there were no "champions" identified to push this idea at the local levels. As pointed by NHS Direct Case "the course of visiting regional GPs to inform them of the forthcoming service, many were highly negative as they erroneously thought that they were being sold a service from outside the NHS". According to the NAO (1999) report, "ministers decided that implementation would proceed alongside piloting and were concerned with how rather than whether the service would be implemented. Short lines of communication between the project team and those implementing the service at the local level enabled lessons to be learnt quickly as the projects progressed". (idea of champions needed to diffuse innovation can be discussed, short lines of communication helped too) The NAO review also pointed out that customer satisfaction was high with NHS. While targets were being achieved two causes of failure to meet performance targets were learning curve problems associated with the introduction of the national CAS system (AXA) and staff recruitment shortfalls. But networking, which allowed the workload to spread from high demand area to lower demand area and procurement of automated staff rostering tool (NAO, 2002) helped in overcoming this weakness. The software also went through several iterations and was adjusted to respond to local conditions. There was regular collection of patient information to gauge participants' reactions data and for safety checking (all calls were logged and recorded). Overall performance of the system was monitored using "mystery shoppers" who made controlled calls and tested the system. (use of resource/ flexibility absence of rigidity/ clinical audit) Numbers of callers to NHS Direct increased steadily to over 500,000 a month by the end of 2003. According to recent documents, NHS Direct now represents a "substantial national service handling over half-a-million telephone calls and half-a-million internet visitor sessions every month (NAO 2002). Service Delivery On the service delivery front case NHS points out that "nurses may have access to patient records and the system allows the development of a patient database which may be used to track previous contacts". Responses are entered in free text format and symptoms are entered based on an available list on the system. Based on the history, the nurse has access to 1,000 protocols to advice the caller. The way NHS Direct works, the final advice cannot be down graded by the nurse, but can be upgraded. In this sense the system is more cautious in the advice met to the patient. The system also allows for voice recordings of calls. In case nurses want senior staff to review their advice, the voice recording facility can be used. They may also be used to clarify any discrepancies that arise with the advice or the outcome of the patient's response to the advice. During the initial launch of the service, it the nurses often sought confirmation on advice provided from their seniors. This helped in providing valuable feedback and input also to the software which was readjusted to best meet the requirements. As pointed by NHS Direct case "thus risk aversion was overcome with the implementation of strong feedback loops at the local level". NHS Direct also allowed for flexible work hours and job sharing. (problem of clinical risk and the perception that uncertainty can be equated with professional failure- cultural shift in how nurses approached their seniors). The NAO (1999) report noted that "Public satisfaction with NHS Direct was consistently very high at over 90%" Offshoot of NHS Direct The scale at which NHS Direct operated allowed for other advantages like: logging of calls under NHS Direct system for incidence of infectious and other diseases, such as the spread of outbreaks of mumps or measles. This helped to track such outbreaks effectively and the information gathered was fed into epidemiological studies. NHS Direct also assisted with emergency help lines set up in response to disease outbreaks or health scares, like hepatitis. This helped in shifting the responsibility from hospitals Arranging GP out-of-hours cover (as was planned) Besides there was possibility for NHS Direct to assist in telemedicine applications and provide alternative ways into measuring health, and chronic disease management (This helps us talk of complexity and how one system is embedded in the other) Read More