healthcare information Archives - Page 2 of 4

Improving patient outcomes

There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know

Donald Rumsfeld’s comments on the presence, or otherwise, of weapons of mass destruction may have passed into folklore but they do encapsulate the dilemma facing anyone who seeks to move away from the tendrils of speculation and into a position of certainty. Particularly so in the field of research where some studies result in ground breaking initiatives whilst others merely confirm unproven but seemingly obvious theories.

For example, a Europe-wide study into nursing practices has shown that a combination of nurse education levels and patient/nurse ratios can have an impact on patient outcomes. Whilst the initial reaction to this report may be to dismiss it as stating the obvious, an already known known; studies such as these are invaluable in both proving the theory and in quantifying the extent of the problem.

So whilst we may have thought that we knew increasing the workload of nurses may lead to poorer patient care, a study which concludes that increasing a nurse’s workload by one patient is associated with a 7% increase in patient deaths can only serve to sharply focus the attention. The report also concludes that in return for a 10% increase in nurses with degrees the risk of patient deaths falls by 7%; something which will be of comfort in the UK where with effect from 2013 all new nurses have to be educated to degree level.

Those working within the healthcare profession have always “known” that the more patients presenting for treatment equals the less time available for each patient and consequently the more likely that symptoms may be missed and care not be provided to the standards expected. But studies such as this one highlight the effect of time and patient pressure. For some the solution will be to educate further, to take on more staff; but when budgets are tight that is not always possible. Finding ways to work smarter, to automate, to outsource the routine, to free up time for patients is the way forward.

Before this study we knew that time and education equalled improved outcomes but we didn’t know to what extent. Now this part of the health service puzzle has moved from a known unknown into a known known and that has planning implications for all who practice healthcare and want to maximise patient outcomes.

Healthy advice

Stories of sandbags and dredging may have captured the headlines but lurking beneath the disasters is a danger which if left unchecked could cause even more misery for thousands. That danger is the health implications of excessive rainfall.

On a day to day basis we don’t pay much attention to our waste. Yes, we wash our hands but in general we don’t stop to consider where our waste goes. We just assume that it is dealt with. But with flood waters pouring into drains and septic tanks, our waste is suddenly a lot closer than we’d like to believe and that can cause long term health problems for the unwary.

In recognition of this Public Health England (PHE) has issued some guidance on “the potential health impacts before, during and after a flood as well as advice and support on the response and recovery.” In addition to warnings about the dangers of sharp objects hiding beneath flood waters and advice on packing an emergency bag in case of evacuation the PHE advice also covers areas such as sanitation and food safety. The PHE advice also brings to the fore the psychological impacts of flooding which can cause symptoms such as tiredness, distress, anxiety and sleeping problems.

Whilst the NHS is generally the first port of call for those whose health and wellbeing has been affected by the floods, in the longer term other health professionals will be drawn in to the mix. Those such as counsellors and psychotherapists may be required to treat psychological traumas whilst physiotherapists, osteopaths and others look after people who have been injured whilst coping with the floodwaters. Even the simple advice to move precious objects upstairs is going to result in a fair amount of back and other strains for those who are unused to such exercise.

With so many affected, in some areas already overburdened health professionals are going to be put under further pressure. Finding ways to defer some of the day to day tasks such as telephone answering, diary management and the maintenance of patient records could help to deflect some of this pressure as well as maximising the time available for treatments. Whilst at least the flood waters bring with them warmer weather which reduces ice slips and strains this is cold comfort to those who require treatment from weather related ills. With the Government warning that things may get worse before they get better this is one story which sadly may run and run.

Securing payment

Christmas may be the season to be merry but it is also the season when credit cards tend to receive a hammering. To help shoppers the credit reference agency Experian has put together seven tips on managing cards wisely. These include making payments on time, never withdrawing cash on credit cards and keeping an eye on the total amount of credit which you have across all of your cards.

But credit cards are not just for Christmas and used wisely they can be an important tool in financial management, both for purchaser and for provider. Whether spreading the cost of purchase or securing payment, credit cards can be mutually beneficial.

That is one reason why Clinic Appointments are now pleased to be able to offer a secure card processing service for offsite payments. The service accepts both credit and debit cards and can be used as a means of helping to ensure that payment will be collected from clients who book an appointment either online or via a call to one of our receptionists. At the time of booking we reserve a payment amount on the client’s card, with the payment either being taken in full once the appointment has taken place, or in the event of a no-show an amount being debited in accordance with a health practice’s stated cancellation policy. Should the client choose to pay by other means the reserved payment can simply be released.

Just by being asked to provide card details up front, clients are far more likely to attend their appointments; benefitting both the health practice and the patient. And as you’d expect from a Clinic Appointments service, the Card Processing Service is secure. So when your patients cancel their appointments with a flimsy excuse, simply don’t show up for appointments or promise that ‘the cheque is in the post’ you may want to consider secure card processing. It will help you to maximise cash flow potential but more importantly, especially if run alongside our appointment reminder service, you will be helping to ensure that your patients turn up for treatment; benefitting them and their health in the long term.

We continue to look for ways in which Clinic Appointments can help our health practitioner clients to streamline their businesses and maximise patient treatment times. In the meantime may we take this opportunity to wish all of our Clinic Appointment clients a Happy Christmas and a very prosperous New Year.

Booking time

The dawn of the ‘internet revolution’ may by now be lost in the mists of the past but it seems as though at last the benefits of internet connectivity have moved into mainstream living. This Christmas more than one third of all shopping will take place on line with features such as click and collect proving popular.

As we toast the end of the year with internet tills ringing we are also shortly to be waving goodbye to another British institution. The Government has announced that the paper car tax disc is to be phased out. With authorities relying on purely electronic records the move will save time and resources.

In fact way back in the early days of the internet the benefits to be gained from the saving of time and resources were widely predicted but in the intervening period it has sometimes seemed as though all that the internet has done is bring more work. In the early days ‘dial up’ was so slow that many people could get in their cars and drive to the shops faster than they could order goods online. Now thanks to improved internet speeds allied with programmes designed with ease of use and speed in mind, the internet has at last come into its own.

One benefit of this improvement is the way in which health service providers are able to manage their diaries. For the health practitioner the time spent in booking appointments is effectively ‘dead time’; time which is spent away from treatment and time which potentially impinges on another patient’s treatment. That is why practitioners turn to services such as those provided by virtual assistants who can take calls and manage bookings on behalf of the health practitioner.

Now there is a new service available from Callagenix which not only saves the health practitioner from taking calls, it also saves the client from having to telephone. Online booking enables clients to browse and book an appointment at a time to suit them. This quick and simple appointment service perfectly ties in with the general move towards using the internet as the first port of call. The service is flexible and practitioners can choose whether to accept new or existing clients via the online service as well as restrict online booking to certain treatments or to certain times of the day or week. Time saving, easy to use and flexible; online bookings are a perfect example of the way in which the internet can make life better for all.

Taxing times

From time to time HMRC decides to set up a task force to investigate the tax affairs of a certain business sector. For example in the past it has reviewed car dealers in the Midlands and fast food outlets in London. Now it is the turn of health professionals to come under the spotlight.

Announcing the initiative on 7 October, HMRC have given health professionals until 31 December to sign up for the campaign and until 6 April 2014 to pay any outstanding tax. By doing so they will face far lower penalties than if they fail to sign up and HMRC subsequently discover amounts of unpaid tax are due.

Doctors, dentists, nurses and social workers are not covered by the campaign but the HMRC announcement highlights other health workers who they will be looking at including:

Physiotherapists, occupational therapists, chiropractors, osteopaths, chiropodists, podiatrists, homeopaths, dieticians, nutritional therapists, reflexologists, acupuncturists, psychologists, speech, language and art therapists.

Whilst the vast majority of health professionals will already have their tax affairs in order, the campaign is a reminder that being a health professional is not just about treating patients. Managing diaries, booking appointments, invoicing and collecting fees, ordering supplies and preparing accurate accounts all take time out of the working day. Larger practices may have the benefit of a team of back-office helpers but health professionals working in smaller practices may find themselves juggling patient time and treatment time to the detriment of income and professionalism.

That is when the services of a virtual assistant can come in handy. Appointing a virtual assistant service to answer the phone, manage the diary, book appointments, invoice and file patient records can free up valuable time both for patient treatments and to provide some free time at the end of a full day. Of course there are some tasks that a virtual assistant won’t be able to perform, such as being there to receive medical supplies, attend CPD training or complete tax returns but with time freed up from other tasks, at least the health professional will not be under as much time pressure when other tasks need to be completed.

In announcing their latest initiative, Marian Wilson, Head of HMRC Campaigns, said “I urge health and wellbeing professionals to take advantage of our quick and straightforward way of bringing their tax affairs up to date. Help, advice and support is available.” Full information including a video and direct phone number is available via the announcement on the HMRC website.

Reaching out

A study in the USA has revealed the benefits of automated telephone calls for patients with hypertension. Taking a sample of 64,773 hypertension patients, half were sent a recorded phone message inviting them to have their blood pressure monitored at a clinic whilst the rest received no such invitation.

After four weeks it was found that 32.5% of those who had received a call had controlled their blood pressure against a base of 23.7% for those who had not received a call. Although researchers did not collect data on measures taken by patients to control blood pressure it is believed the calls played an important part in raising patient awareness.

Certainly this study mirrors the findings of other surveys in the way in which patient care can be improved by a simple call. Whether by encouraging patients to have a check up or replacing costly health visits with a simple call, the telephone is increasingly playing its part in enhancing health care.

One particularly successful way in which phone calls are being brought into the front line is in reminding patients about their appointments. Whether issued via automated phone message or by text, a simple reminder can make a substantial contribution towards reducing the number of “no shows.”

This has two benefits. Firstly it encourages patients to attend booked appointments and secondly it encourages them to notify the health practice should they be unable to attend for any reason. With an early warning of a cancelled appointment the practice has the chance to book in another patient; thus benefitting the practice, the patient and boosting the overall level of patient care.

In our ever busier lives, it is inevitable that we will forget appointments from time to time and an automated phone or text message can be that vital memory jogger which we all need. Health care practitioners from opticians to physiotherapists and even vets are using messaging for everything from a reminder to pick up some new medication or book a check up to reminders about appointments which have been made. For example this writer received a text from their vet recently reminding them to pick up a fresh batch of worming medicine for a pet.

In summary, phone reminders can save “no shows, they can ensure patients receive the treatment which they need and they can help to keep health practitioners busy at all times.

Telephone triage

A survey of 1,195 GPs, practice managers and nurses by Campden Health has revealed that the use of telephone triage is gaining in popularity. 56% of practice managers polled revealed that some form of triage is used with 9% of practices triaging all of their patient calls.

Surprisingly those who practice triage reported a wide range of success with some reporting as much as 60% of patient problems being solved without the need to see a doctor whilst other practices only reported a 1% success rate. However 95% of respondents rated triage as either moderately or extremely successful so it is understandable why the practice is spreading across the NHS.

One drawback uncovered by the survey was the fact that in 13% of cases untrained receptionists were being used to conduct the triage and overall 48% had not received any telephone triage training. Nevertheless with surveys showing that doctors daily see 6-10 patients who have no medical needs, if triage can eliminate these unnecessary appointments it will free up valuable treatment time for those who are in need of care as well as more speedily directing patients to more appropriate resources such as social services or other health professionals.

When it comes to other health services, using the services of a trained receptionist to take calls and make appointments can also make a difference to the working day. Virtual receptionist services which use friendly and well trained staff can help healthcare professionals to provide the best level of service which they can to their patients. With no ringing telephone to interrupt treatments and a friendly receptionist taking care of appointment booking, message taking and appointment reminders, the health professional can carry out the task which they were trained for rather than become bogged down in administration.

Better still, a virtual assistant can help to keep the appointment book filled. Appointment reminders have been shown to increase attendance rates and in the event of a cancellation the receptionist will be on hand to take calls which could potentially fill the vacant slot. And with a trained virtual assistant the professional image of the health practice will be maintained.

Papering over the cracks?

The Government has announced a funding boost of £500m to help to relieve pressure on the worst hit A&E departments. Statistics have revealed that one million more people attended A&E in the last year compared with three years ago and this, particularly over the winter, has resulted in a virtual melt down of some services.

The funding is aimed at helping hospitals to prepare for the forthcoming winter and is designed to reduce or eliminate the “pinch points” which can so badly affect A&E services. This should enable A&E patients to be treated promptly and provide alternate care pathways for those who currently see A&E as their only care option.

Hospitals which have been identified as being most affected have been invited to submit their proposals for funding. These proposals may involve Accident and Emergency departments directly but could also cover areas such as taking steps to minimise hospital admissions from care homes by providing local specialists, increasing hours at walk in centres or pharmacies or increased social care provision or the provision of more services away from hospitals.

In announcing the proposals the Prime Minister, David Cameron, said:

“The additional funding will go to hospitals where the pressure will be greatest, with a focus on practical measures that relieve pinch points in local services. By acting now, we can ensure doctors, nurses and NHS staff have the support they need and patients are not left facing excessive waits for treatment.

Whether this new measure will be successful in reducing winter waiting times will be a matter for the future but it has to be said that it has not received universal acclaim. The Alzheimer’s Society commented that “while today’s proposals could bring short term benefits, they will do little more than paper over the cracks,” and their comments were echoed by the BMA and others.

However, this is but one stage in an overall plan to provide continuity of care within the community, thereby reducing the pressure on hospitals. This includes a £3.8 billion fund to “focus on joining up services, so that health and care services work more closely together, keeping people healthier and treating them closer to home.”

In the long term this will provide opportunities for health practitioners such as physiotherapists and osteopaths to provide higher levels of care outside the mainstream hospital system. Those health care providers who have streamlined their services to maximise patient treatment time are in a strong position to benefit from this new health care ethos and to provide increasing levels of care continuity to their patients and the community in which they serve.

Learning the lessons of 111

NHS England has reported that the 111 telephone service has successfully coped with the May Bank Holiday weekend without major problems. With providers taking on more call handlers in the run up to the weekend the early signs are that the 111 service responded to the vast majority of the 100,000 callers over the weekend.

However, chief nursing officer Jane Cummings acknowledged that improvements were still required before all forty-six 111 services were up and running as expected. Run by a mix of providers including private firms and ambulance services, the 111 service has seen some teething problems. This has resulted in some services being suspended or receiving special help.

Last week NHS England agreed to commission an external review to look at the problems which have beset the introduction of the 111 telephone service; both as a guide to actions required to bring the service up to full strength and as a learning point for future projects. Whilst some areas of the country seem to have experienced a fairly smooth transition, others have been beset with problems including calls not being answered and major delays experienced by those waiting for calls back from medical specialists.

Designed to serve the needs of those who are too ill to be able to wait until they can see their doctor within hours but are uncertain if they should call an ambulance the 111 service is designed to be able to direct callers to the most appropriate service for their needs including GP out of hours, A&E or calling an ambulance if required. This means that the service may receive a wide variety of calls from those who are concerned about their own, or a loved one’s, health and in those circumstances any delay in responding can lead to distress and anxiety.

In fact it’s not just the 111 service which can suffer from delayed call answering. Any call which goes unanswered can potentially lead to frustration on the part of the caller, whether the call is to a health practitioner or not. For those health practitioners who work closely with patients this can cause a dilemma. If the answer a call they may be interrupting an existing treatment but if they ignore the call they risk losing a potential patient or their goodwill.

The solution is to appoint a virtual assistant service which will respond to callers, book appointments, manage diaries and take messages. Appointing a virtual assistant service which specialises in health matters will also pay dividends as the call answerers will be able to talk knowledgeably to patients about their treatments with empathy and attention to detail and will better understand when messages should be marked as urgent. We will be keeping an eye on the NHS England review as well as the progress of the 111 service and will report on any findings which may be of interest to our health practitioner clients.

Innovation Grant for British School of Osteopathy

When finances and funding sit so firmly at the heart of the NHS it can sometimes seem as though every attempt to instil a culture of care is beset by financial restrictions. Not that care and compassion should be affected by finances but it can be hard to provide a quality service when time and energy is spent in scratching around for cash.

It is therefore good to be able to report on the British School of Osteopathy which has recently been awarded a significant innovation grant. Totalling just over £250,000 spread over a three year period the grant will enable the BSO to develop a new service called OsteoMAP.

According to the BSO website, “OsteoMAP is designed to support people with long-term musculoskeletal pain, which may be alleviated but is unlikely to be completely resolved by manual therapy alone.” The programme will initially be developed at the BSO’s clinical centre and then rolled out via training courses to students and qualified osteopaths across the UK.

In recognising and developing multi-layered treatments which address the physical and psychological effects of certain conditions this programme should both reduce the burden on hospital services and help the health services to deliver the Government’s aim of a more patient focused treatment regime.

One of the side-effects of this programme is that community osteopaths are likely to become more involved in the treatment of long term conditions and this could add to the patient mix. Those osteopaths who have switched to a more streamlined appointment, diary management and patient notes system may be in the best position to take advantage of this increased treatment requirement.

In effect, the more time which is freed up from administration the better. With phone calls answered by a virtual receptionist the osteopath or other health professional can concentrate on providing distraction-free quality care to their patients. And when it comes to a treatment such as osteopathy or physiotherapy, the less distraction the better. Interrupted treatments can not only be less effective, the very fact of an interruption can cause anxiety in patients leading to muscle tension.

Grants such as that announced by the British School of Osteopathy can only help to drive forward quality care in our health service. Targeted, patient-focused and aimed at providing long term therapies for lifelong conditions; treatment regimes such as OsteoMAP will reduce the day to day burden on hospitals and enable people to live a better quality of life.

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Tag: healthcare information