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Taking Time Off

When you spend all of your time looking after the health of others, it can sometimes be difficult to take time to look after yourself. There always seems to be one more patient to help, one more report to write, one more bit of paperwork to file before you can step out of the office and into home life.

In this, health professionals are not alone. A recent report by Simply Business revealed that 20% of the UK’s small business owners say they can’t afford to take a single day off work this summer whilst a further 30% plan to holiday near home to keep an eye on their business.

In fact, this problem of work-life balance is seen in many countries. A recent report by German researchers revealed that working outside of core hours on tasks such as checking emails can limit the ability to feel detached from work, leading to higher levels of the stress hormone allied to a feeling of increased tiredness.

Whether working as a sole trader or in a small business it can sometimes be hard to see where you can turn to reduce the workload. The last thing you want to do is to reduce your client base as that will reduce income so instead it is tempting to save up all those administrative tasks for the evenings and weekends. Of course, there is the option of taking on a part-time member of staff to help with the workload, but this can be a tricky balancing act.

Obviously, if you have a regular volume of extra administrative tasks to complete then a new member of staff may well be the answer. However, when the workload is irregular then you may not be able to justify adding to your team on a permanent basis and temporary members of staff will always be around to answer the telephone when it is ringing and you are with a patient.

But there is another way. Virtual assistant services can help to reduce the workload by taking on tasks such as telephone answering, appointment booking and records and diary management. Better still, by using a virtual assistant service you gain the flexibility which you require. For example, you can switch telephones over to the virtual service when you are with clients or on holiday, switching them back when you are free to answer calls.

Tasks such as phone answering and appointment booking can easily intrude on daily business life and create a pressure point which can add to stress levels. Not having to answer the telephone when you are treating patients or meeting with clients, being able to access client notes online rather than spending time in preparing for meetings, even having someone to screen out unwanted sales calls can all make a difference to the working day and to peace of mind.

Of course, at the end of the day virtual assistant services can only go so far in helping to improve the work-life balance. The bottom line is that as a business owner you owe it to yourself, to your family and to your clients to take the time off that you need to refresh the mental and physical batteries. If you don’t, your work will suffer and that helps no-one.

Card Acceptance

Has the idea of a cashless society finally moved away from the theoretical and into the plausible? It would certainly seem so if a number of surveys in 2015 are to be believed. According to the Payments Council, in 2014 for the first time cash became less popular than cards as a means of payment although it still did account for 48% of all transactions.

A separate survey by the Halifax in April of this year revealed that amongst its customers cash withdrawals accounted for just £18.33 of every £100 spent. Debit cards at £30 and faster payments at £15 were also proving increasingly popular according to the Halifax analysis.

The UK may not have gone as far as Denmark which earlier this year proposed a law which would allow businesses to refuse to accept cash for transactions but it does seem that we are well on the way towards seeing cash as simply one method of payment rather than as the main payment option. The launch of Apple Pay in the UK last week can only add to the range of payment options and encourage people to choose the most appropriate payment method for each transaction.

The increased acceptance of cards as a payment method is also good news for those organisations which seek to move their customers away from cash and cheque and towards alternative payment means such as credit and debit cards. Being able to take card details at the time of booking helps those businesses which rely on appointments to secure payment. This is particularly appropriate in the independent health sector where no-shows can cost physiotherapists, osteopaths and others both time and income.

Interestingly it has been found that taking card details at the time of booking helps to improve attendance rates.  It seems as though there is something about having handed over card details that acts as a reminder to attend booked appointments.  Add on an appointment reminder either by SMS text or phone and the chances of clients turning up for treatments are increased; or at the very least clients may be prompted to get in touch to cancel, enabling replacement bookings to be made.

For those few who still fail to make it to their appointment, the fact that card details have been taken in advance enables the practitioner to take a no-show fee in accordance with advertised practice. Once card details have been taken either on the telephone or via an online booking system, the card can be pre-authorised, effectively reserving a balance to be taken once the appointment has been completed. Should the client opt to use a different card or pay by cheque on the day, the preauthorisation can simply be cancelled.  Either way, the invoice delay time is effectively eliminated, helping to streamline cash flow.

We may have some way to go until we are a fully cashless society but the more that options such as secure card payment processing move into the mainstream, the closer we will get; whilst at the same time having the added bonus of enabling businesses to reduce no-shows and smooth out their cash flow.

Osteoarthritis Quality Standards

The National Institute for Health and Care Excellence (NICE) has released new quality standards for the diagnosis and treatment of osteoarthritis. The standards have been drawn up after consultation and are supported by bodies including The Primary Care Rheumatology Society and the British Association of Prosthetists and Orthotists.

Osteoarthritis affects some seven million people in the UK and can be a life-limiting condition. Although its prevalence increases with age, osteoarthritis can be caused by a mix of genetic, environmental and lifestyle factors. This new quality standard covers the management of the condition from initial diagnosis and assessment through to ongoing management and support including the consideration of remedial joint surgery.

In recognition of the fact that extensive investigations, including x-rays and MRI scans, add little to the treatment plan, NICE recommends that a more practical and simple test should be enough to deliver an initial diagnosis. The standards therefore recommend that a simple test of having activity-related joint pain and any morning joint stiffness lasting no longer than 30 minutes should suffice.

As osteoarthritis is a condition which generally develops over time, the quality standard recommends the use of a self-managed plan wherever possible. This will include a multi-level approach including pain control, a weight management plan if required together with an exercise plan. This last should include a mix of muscle strengthening and aerobic exercise.

Although the plan is primarily written for the benefit of patients and the NHS; it is likely that physiotherapists, osteopaths and other health professionals may be called upon to help with treatment plans. Commenting on the Chartered Society of Physiotherapy website, Professor Krysia Dziedzic who helped to develop the standards said “We know that patients want access to non-pharmacological therapies and physios should be leading the way in the delivery of these.”

As people increasingly look for blended solutions, which include ongoing non-pharmaceutical management of conditions, the demand for physiotherapists and other health professionals can only grow; even if the incidence of osteoarthritis were to remain unchanged. However an Arthritis Research UK project has predicted that between 2010 and 2020 the number of people with osteoarthritis of the knee will increase from 4.7 to 6.5 million. It is little wonder therefore that NICE comments that the majority of hip and knee replacements in the UK are due to osteoarthritis and that currently treatment varies across the country.

This places an increasing demand on physiotherapists and others, both in the ongoing management of conditions and in assisting patients to recover from joint replacement surgery.  Whilst some of the burden may be taken up by new entrants to the profession, the challenge is still to find ways of working which will maximise treatment time.

Quoting a cliché, that means learning to work smarter not harder; taking full advantage of technological solutions in order to reduce time spent on the non-treatment elements of patient management.  These solutions include opening up the diary to enable patients to directly book online appointments, the electronic filing of patient records or taking card payment details at the time of booking. To borrow from the NICE standard, the more the health profession can take practical and simple measures to reduce the administrative burden, the more time can be spent on helping patients to manage their condition and get on with their lives.


On Your Feet Britain

On April 24th 2015 (29 April 2016) the Get Britain Standing campaign in association with the British Heart Foundation is challenging British workers to sit less and move around at work more whilst raising money for heart research. Studies have shown that even those who are active at some times in the day can still damage their long term health by sitting for prolonged periods during the day.

This means that the daily jog to work may have benefits on one level but if you then sit without moving for hours at a time you are in danger of developing heart disease, type 2 diabetes or even some cancers.

Released in connection with the challenge, a survey of office workers revealed that 45% of women and 37% of men spend less than 30 minutes a day on their feet at work and that more than half regularly eat lunch at their desk. Apparently sitting for long periods affects the way in which the body controls areas such as sugar levels, blood pressure and the breakdown of fat so the challenge is on to regularly stand up and walk around.

That doesn’t necessarily mean that work will suffer as we look to our health. Suggestions from the On Your Feet team include standing up to take phone calls, walking to a colleague’s desk instead of phoning or e-mailing them and having standing or walking meetings.

Having said that, there are some professions in which having the chance to sit down for a few moments would be welcome. For example, when health professionals are faced with a continuing parade of patients through their practice, any time spent away from treatment can easily be taken up in paperwork rather than in looking after oneself. Whether you stand up a lot and need to sit down or sit down a lot and need to stand up, taking a few minutes out every now and then can help to reduce stress levels as well as give the body a much needed change of position.

This means that anything which can be done to reduce time taken on routine paperwork is time which can be better spent, either on further treatments or on ‘me time’. Online bookings, card payments, electronic patient notes, automatic appointment reminders; the list of potential time savers goes on.

But the best thing is that not only do these measures save time, they can also help to smooth out the working day. For example appointment reminders help to reduce no-shows whilst electronic note filing saves all that time looking for misplaced records. Given the pressure that the health service is under, it is tempting to plough all of that saved time back into patient treatment.

However, in the spirit of ‘physician heal thyself’ it is important that health professionals take regular breaks in order to stretch and move around, or simply to unwind the mind. It is inevitable that over the course of the day fatigue may set in, but the more we can take time to refresh the better we will feel at the end of the day and the better and more focused treatment we are able to give to our patients.

The Get Britain Standing campaign wants is to stand up, sit less, move more. Whether we need to follow their advice or whether sitting for a few moments would be a blessing; the important thing is that the campaign makes us think more about how we approach our working day.

Advancing Recovery through Electronic Filing of Medical Records

Not so long ago a broken hip would result in weeks or even months of hospitalisation as the bones were left to slowly knit together. Nowadays the broken hip is simply replaced, leading in many cases to discharge in a matter of days followed by recuperation at home.

Admittedly that recuperation requires the help of support services with physiotherapy and exercise advice being supplemented by aids such as walking frames but the new regime is far more effective and far better for the long term health of the patient. The patient is spared the challenge of being confined to bed for weeks and scarce hospital beds are freed up quickly.

But this new regime does bring with it the challenge of moving support services away from the hospital and in to the wider community.  Local health practitioners including physiotherapists are now seeing an increase in demand from patients who previously would have relied on in-hospital services. Depending on the health authority, those requiring rehabilitation and physiotherapy treatments may be offered outpatient appointments at a central or local hospital, treatment in local specialised centres or even home visits from mobility specialists. Whilst this range of options is designed to improve patient outcomes, it does require an increased focus on effective patient treatment plans and the sharing of information.

Luckily, whilst technological improvements have enabled swifter treatment of patients, they have also enabled health practitioners to remove some of the burden of non-essential tasks as well as streamlining data and information sharing. Take patient records for example.  Paperwork has been a perennial challenge for the health profession.   Countless hours which should have been spent in patient treatments have been wasted as records are transferred from one treatment centre to another or are stacked up on administrator’s desks whilst skilled typists struggle to interpret scribbled notes.

Even simply filing and retrieving records can take up time which would be better spent in focusing on patient needs whilst the mobility of patients around treatment centres has increased the danger of patients being lost in the system. Now, thanks to the advent of electronic filing, much of the unproductive time is no longer wasted.  Electronic filing not only reduces instances of mis-filing, it also enables records to be transferred between treatment centres and then brought to hand swiftly as and when required.

With clinical notes organised and important test results and x-rays available on screen at the touch of a button, health practitioners can not only maximise patient treatment times, they can start treatment programmes in a timely manner without having to wait for records to be transferred by post or hand delivered.  Link in online diary management or on-line booking services and yet more time which was previously spent on administration is freed up.

Such is the pace of technological change that medical breakthroughs are coming thick and fast, transforming health services and enabling patients to recuperate at home where once they blocked beds.  With administration also reduced thanks to technology, the face of the health service in years to come will be a very different one from that which in the past was bedevilled by paperwork and the delays and frustrations occasioned by filing, retrieving and transporting patient records.

Seasonal Flu

Autumn may have started with a blaze of sunshine but hopes of lingering summer weather have now been well and truly dashed by the arrival of storms and heavy rain. It’s a stark reminder of the longer nights, dwindling temperatures and gradual descent into frost and slush that we will have to endure before summer once again peeps over the horizon.

The arrival of Autumn also heralds the start of this year’s flu jab campaign.  According to Public Health England, only 52% of those with an underlying illness took up the free jab offer last year (2013) and PHE are keen to increase that percentage as much as possible this winter.

So the call has gone out for young children, the elderly and those with underlying conditions to take up the challenge and get protected.  Professor Dame Sally Davies, the Government’s Chief Medical Officer said “I would urge those who are offered the free flu vaccination to visit their GP early in the flu season. I also urge all health care workers to make sure they are vaccinated to protect themselves, their patients and their families.”

When we think of the flu jab we naturally tend to think of it in terms of prevention of the flu itself but there are a number of other consequences of flu which put a strain on our health services. One of the more common of these is the need for some form of osteopath or chiropractic treatment as muscles or ligaments become strained thanks to the effects of coughing. When we cough or sneeze we put a tremendous percussive force on our bodies and this can lead to back and other injuries.

The effect of this is that not only do health practitioners need to stay healthy themselves to continue to treat their normal patients, they also have extra calls on their time to treat these flu-related injuries. And really these couldn’t come at a worse time.  One good bout of overnight frost and icy pavements add to slips and falls whilst icy roads lead to crashes.  These too put a strain on our health services with physiotherapists and other health practitioners having to cope with the aftermath of broken bones and strains.

Of course, if we all took up the flu-jab challenge then our health service would be far better off but as that is an ‘ideal world’ scenario it means that once again our health services may be stretched this winter.  Anything which can help to mitigate that pressure is therefore welcome and that is why numbers of health practices are adopting ways of working which will reduce the strain on their own resources.  Areas such as electronic filing of records, appointment reminders and the use of virtual assistant services to answer calls and book appointments can all help to smooth out administration time and therefore add to the time available for treatment.

As Public Health England says “Each winter hundreds of thousands of people see their GP and tens of thousands are hospitalised because of flu.” That puts a huge strain on resources so it’s no wonder that they are campaigning for as many people as possible to be vaccinated this year.

Staying active, boosting health

The adage that sitting at a desk for hours on end can be counter-productive has been given a further boost by a study carried out in America. It has long been claimed that being active, even simply by taking a break and walking around can help to reduce incidents of a range of health problems including diabetes and some forms of cancer.

This fresh study looked at the effects that sitting for long periods had on the femoral artery. The study observed that the way in which the femoral artery widened in response to blood flow deteriorated through long periods of sitting but that light walking breaks every hour significantly improved recovery of the artery.

This study, although limited in size, adds further weight to the argument for regular amounts of light exercise as opposed to sitting still all day and then hitting the gym. Whether the ‘standing desks’ which are growing in popularity are the answer is a debate for another time but from an employer, as well as a health practitioner point of view, the growing body of evidence would suggest that a sedentary work and home lifestyle is not a sensible course of action.

Of course, for the majority of health practitioners the opposite is true. The NHS Choices 10,000 steps a day challenge is scarcely a problem when someone is on their feet providing physiotherapy, osteopathy or other health treatments to patients. For them finding five minutes to sit down is the challenge and generally those five minutes are taken up in a rush to complete paperwork before the next patient knocks at the door.

If a sedentary lifestyle is not good for health, neither is one which is so packed with tasks that there is no time to rest. There is being active and being Active and if all of our activity is packed into continuous rushing around in response to must do tasks then being active can be counter productive. We all need time just to ‘stop and stare’, to rest our minds and bodies, to shake off what has gone before and prepare ourselves for the next activity. If we don’t give ourselves time then, rather like a student kitchen, the dirty cups of life pile up until it is difficult to see any clear way forward.

And when health practitioners naturally priorities patient treatment time, it is almost inevitable that administration creeps into leisure time. Taking simple steps to reduce the administrative burden can make a difference to stress levels. Tasks such as electronic filing of patient notes or sending out appointment reminders can easily be devolved to a virtual assistant service, as can dealing with routine phone calls and diary management.

Utilising the services of a virtual assistant not only removes the routine leaving the health practitioner free to concentrate on patient treatments, it also reduces the stress levels which can rise when a day is overfilled. Perhaps health practitioners need not worry about whether they are benefiting from regular exercise but in the interests of a balanced lifestyle, they also need some time to ‘sit and stare’.

Everything in moderation

Saturated fats, salt, alcohol, exercise, diet; the list of potential causes and prevention methods for cancer, heart problems and other life-threatening conditions changes on a daily basis. For every report which boldly proclaims that x is bad for you, another is sure to follow with a counter argument.

Even the idea of healthy exercise is under threat as a recent report reveals that working out at the gym may not help us to lose weight. With all of this contradictory advice it’s hardly surprising that some choose to ignore it completely whilst others present themselves at the osteopath or chiropractor with injuries from having jumped from one fad into another.

Calmer minds accept that the solution is to adopt the mantra ‘everything in moderation.’ Ignoring the fads and balancing a healthy diet with moderate exercise is arguably the best advice which anyone can have. Similarly, when it comes to a busy lifestyle, rather than flying from one extreme solution to another, the best advice is to take a good look at the schedule and find ways to reduce the overall workload.

When we encounter overload in our daily lives it is tempting to cut out some elements entirely. For example, a busy physiotherapy practice may take the decision to stop taking on new patients. Of course the danger in this is that we lurch from one crisis to another, cresting more problems with every ‘solution’ until we fall into some kind of stasis: just about managing but unable to grow or enjoy our work.

But one of the benefits of the internet age is that there are other options available which can take the strain without needing to resort to drastic measures.  Services such as diary management, phone answering and even electronic filing of patient records can all be handled by a virtual assistant service. And with today’s telephony systems enabling callers to be pre-announced, a virtual assistant service can answer calls in the name of the health practice even if they are looking after a number of practices at the same time.

Add in an on-line booking service allied to secure card processing and at a stroke the day to day administration workload of a busy health practice can be switched from overload to manageable. Not only that, by taking card details at the time of booking, clients are far more likely to attend appointments; helping to maximise treatment times and ensuring that the physiotherapist or other health practitioner is spending their time productively rather than chasing no-shows.

With administration time cut, the health practitioner is freer to concentrate on what they do best; helping those who are in need of some form of therapeutic intervention. Best of all, the virtual assistant service is flexible and can be switched on and off as required. So if ‘pinch points’ only occur at certain times of the day, week or month, the virtual assistant can step in then, leaving practices free to self-manage at other times.

Everything in moderation? With a virtual receptionist service on standby, health practices can smooth out some of life’s pressure points and that can only be good for the health practitioners and for their patients.

Mustn’t Grumble

In a survey to mark Dementia Awareness Week (18-24 May) the Alzheimer’s Society revealed that 54% of people had waited for six months or more before seeking professional help  for signs of dementia.  The time delay appears to be fairly similar in respect of all health conditions with a separate YouGov poll reporting that 57% of adults who had had a health problem in the past year had put off asking for help.

Reasons given for the delay include a reluctance to make a fuss (47%), the fear of having a serious health problem (23%) and embarrassment (22%).  Delays in reporting in particular relate to dementia, heart and digestive problems.

Commenting on the survey, Alzheimer’s Society Chief Executive, Jeremy Hughes acknowledged the difficulty which people have when confronting diseases such as dementia but went on to say that “the sooner you know what you are dealing with, the sooner you can feel in control again and get on with your life.”  But the delay factor doesn’t just affect those with potentially serious illness.  For every patient who seems to live in the surgery, another will hold off reporting even persistent complaints.

This can lead to minor strains or injuries being exacerbated up to the point at which they become debilitating.  When patients do finally pick up the phone, if they don’t receive an instant answer, they may drop the idea of further help.  This means that prompt telephone answering is not just vital for health professionals such as doctors and dentists; other professionals such as chiropractors, podiatrists and physiotherapists all have a responsibility to ensure phones are answered as swiftly as possible.

For smaller practices this isn’t always as easy as it sounds.  Curtailing a treatment to answer the phone is not only unprofessional, it can in some cases result in further damage occurring.  And whilst some patients may be prepared to leave their details on an answerphone, many will be reluctant to do so. This is particularly the case when someone has delayed asking for help; the unanswered call acting as a trigger to retreat away from the decision to seek help and back towards trying to manage the condition without outside intervention.

The solution is to link up with a virtual receptionist service.  Virtual receptionists can answer the phone and make appointments on behalf of the health practice, leaving the practitioner free to concentrate on what they do best, helping people to recover from illness or injury. Not only does this help to ensure that treatment plans are carried out smoothly and without interruption, it can also free up vital time which can be used in treating additional patients.

One in three people over the age of 65 will develop dementia and it’s a fair bet that almost 100% of people within the same age bracket will develop strains, foot problems or other similar treatable problems at some time or other.  Taking steps now to help them to contact a health professional easily and swiftly may just help to prolong their overall health in times to come.

Back to basics

A global research study has concluded that lower back pain is the leading cause of disability and work absence across much of the globe.  Researchers from institutions in Australia, the US and the UK including the Royal Cornwall Hospital found that whilst there is no evidence linking back pain with a higher risk of early death, it can cause long term disability.

Across the world the study estimates that nearly 1 in 10 suffer from lower back pain with the figure rising to 15% in Europe.  An increasingly aging population is only going to exacerbate the issue which can cause emotional and financial as well as health problems for sufferers.

Although lower back pain has no one common trigger point, typically causes include poor posture when sitting or standing, bending awkwardly or failing to follow lifting guidelines.  Acute back pain can also cause leg pain which adds to the difficulty of moving and walking.  In its extreme form it can also impact on everyday tasks such as washing or dressing.

With the incidence of lower back pain expected to increase alongside an ever-aging population this condition places a strain on all health professionals.  Whilst doctors and health visitors are more likely to be in the front line, others such as physiotherapists, osteopaths and chiropractors will all take up the burden of day to day treatment.  Maximising patient time and minimising administrative burdens will therefore form an essential part of the way forward in treating this debilitating condition.

For the health professional this will require a switch to “always on” technology which will help patients to book appointments and stay in touch without taking up clinical time.  This includes taking steps to ensure phones are covered by internal or external support staff, appointment booking online and automatic appointment reminders.  These simple steps can make a huge difference both to treatment times and to ease the strain on overworked health professionals.

In its review of the study, the NHS Choices website concludes that it may be a cliché to say that doctors don’t understand the back but it acknowledges that lower back pain is a “poorly understood condition.” The site therefore calls for further research into the ways in which back pain can better be prevented and managed.  Pending the outcome of such research it will fall on health professionals to take steps to manage their back pain management in the most effective way possible.

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