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 Postal Service Social Media Introduction of ISPs The Paperless GP Surgery Fax becomes mainstream and Email 1980s 1839 2004 2005 20?? 1874 1990 1993 Introduction of Scanning Docman Hub Micros for GPs Introduction of Typewriter
Correspondence Management Case Studies Brighton & Hove Practices Lincoln Practices • Mini trial involving six Practices • Brant and Springcliffe Surgeries in Lincoln • Results showed a reduction in time • Four GPs (3 part time and 1 salaried GP) • 10,000 registered patients averaging 45 minutes per GP • No significant events having occurred in • From up to 70 pieces of correspondence the first 15,000 letters to less than 20 per GP each day • Staff describe it as ‘ the best thing that • Each GP has released at least one hour has happened to their job ’ per day = 15% reduction in total hours. Park View Medical Centre Wembley Practices • Manchester based 3 x GP Practice • 14,500 list, dual site Practice struggling • Went from daily average of 135 items of with managing correspondence. correspondence to 4-5 per GP • Problems with scanning delays and • Reduction of 94.7% in correspondence process needing to be seen/actioned by GPs • Results showed that after introducing • “The GPs are delighted with the outcome effective workflow / correspondence of the workflow programme.” management they saw a reduction in letters dealt with by GPs of 77%
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 of 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
Time • 5 - 10 minutes 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
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