COMMENT: Tackling the NHS surgery backlog

Kevin Fletcher, chief operating officer at Intouch with Health, discusses how a robust operational, organisational and tech-focused approach is needed to help the NHS restart elective surgery after millions of operations were postponed due to COVID-19

A new approach is needed to ensure the technology embraced during COVID-19 continues to help drive efficiencies and improvements within the health service moving forwards

Having spoken at length in recent weeks with NHS chief operating officers as they try to establish how best to resume and restart planned operations, the overarching theme is that striking a balance between meeting patient needs and addressing priorities will be crucial; and their biggest challenge.

There is an acute awareness of the huge backlog of clinic appointments and elective surgeries, and the possible overwhelm that this could create.

Trusts are trying to establish how to balance processing this backlog while preventing and controlling the possible spread of infection.

Organisations are reviewing and considering what needs to happen from an operational and organisational perspective, and are aware of the opportunity to embed operational improvements from here on in

They are also reviewing and considering what needs to happen from an operational and organisational perspective, and are aware of the opportunity to embed operational improvements from here on in.

Expectedly, there is a specific operational focus on segregating patients that have tested positive for COVID-19 from those that have not – and from patients who might not yet be diagnosed.

Many trusts have realised the benefits of virtual or remote patient interaction after having quickly adopted ‘digital-by-default’ processes including video consultations, and are now looking at how this can be further extended and integrated into secondary care pathways to support elective surgery and the management of long-term conditions.

Some patients who are required to physically attend hospital are being encouraged to wait outside the hospital in their car, for example, and check in or wait to be called for their appointment via a mobile app – therefore avoiding waiting rooms.

Some trusts I’ve spoken to are also exploring asking patients specific COVID-19-related questions when they check in using their mobile, which will then re-direct them if necessary, depending on their responses.

There is an air of concern that hospitals could be taking on too much, too soon, by deploying new technology in a bid to try and recover and re-start elective procedures

Patient flow processes like this are supporting social distancing practises within hospitals, minimising contact between patients and staff where possible.

There are also considerations about the permanent integration of solutions that allow for virtual consultations and home-based pre-operative questionnaires, spurred on by the benefits these solutions have proven they deliver as part of their rapid adoption by trusts in recent months.

For example, we have recently spent time working closely with two trusts to prepare for the introduction of our Synopsis Home pre-operative assessment solution as they move into the recovery phase and look to restart elective surgery.

In practical terms, this not only streamlines workloads for clinicians and staff who are already exhausted after the first wave of COVID-19, but it also helps to significantly reduce the number of patients that physically enter a hospital building for the long-term, thus helping to prevent and control any potential spread, and contributing to objectives in the NHS Long Term Plan.

Too much, too soon?

Inevitably, there is an air of concern that hospitals could be taking on too much, too soon, by deploying new technology in a bid to try and recover and re-start elective procedures.

This will be weighing on the minds of many trust staff, especially those in operational roles who are being challenged to balance finding solutions that deliver the ‘new normal’ ways of working while ensuring that any new technology deployed isn’t done so too quickly or with only a short-term perspective.

The pace of transformation driven by the pandemic has given the encouraging nudge of confidence some operational teams perhaps needed to realise what can be achieved, but we’re not quite out of the woods yet with COVID-19.

It’s up to health-tech suppliers to respond to this and adapt their solutions to help operational teams build confidence in what could be

Some trusts are looking for ways to test the water through phased introductions to new technology that can be scaled later to really ramp up their digital transformation.

It’s up to health-tech suppliers to respond to this and adapt their solutions to help operational teams build confidence in what could be.

Our own Reset Pathway is a result of our indepth knowledge of the nuances of the NHS and several consultations with operations teams who expressed a desire to try ‘lite’ versions of our solutions that deliver benefits immediately but don’t require huge amounts of resources, time or training to deploy.

Approaching things this way then gives trusts the flexibility to scale towards full product functionality and integration when they are ready to grow, using an eco-system of integrated solutions that facilitate long-term change.

Kevin Fletcher

Empowerment is key

The trusts I’ve spoken to and worked with realise that ultimately, the staff that use the technology every day are the key to its success.

They must be confident and fully bought-in to the solutions they’re using and able to clearly see how it makes a difference to their roles.

If we take a holistic view of the outpatient journey, patient flow management is a prime example. It is an area where many operational teams realise they can bring frontline clinical staff on board, by giving them access to technology that maximises their resources and minimises their unnecessary administrative tasks.

Take home-based pre-operative questionnaires as an example. Focusing specifically on the administration process leading up to elective surgery, home-based pre-operative health questionnaires can be completed by patients and then made immediately available to trust triage teams digitally. This allows staff to take decisive and clear action based on information made readily available to them directly the patient, and empowers them to help achieve targets such as driving down the number of patients attending hospital for a pre-operative assessment in line with the NHS Long-Term Plan, while freeing up more of their own time to focus specifically on patients who require care or intervention prior to their operation.

An opportunity for long-term change

So what comes next for operational teams as the NHS starts restart elective surgery and implement the ‘new normal’?

Many do not want to revert to the ways of working before the pandemic. Most are now seeing the opportunity to reset processes and make long-term change that has been kick-started with short-term solutions.

If new technology serves limited functionality within the healthcare environment, we risk ending up with a portfolio of disjointed solutions that will only serve to stifle change and impede operational efficiency, not deliver it

However, if new technology serves limited functionality within the healthcare environment, we risk ending up with a portfolio of disjointed solutions that will only serve to stifle change and impede operational efficiency, not deliver it.

Suppliers and trusts must therefore collaborate closely in the coming months to establish pathways to manage the backlog of appointments, setting clear and measurable objectives and using introductory, ‘lite’ versions of available technologies, where appropriate, to help test the water comfortably and ensure positive operational changes can be delivered and embedded for the future.

This phasing-in of solutions will deliver what is needed and build confidence for staff while improving ways-of-working and meeting patient needs, without applying yet more pressure on our already-stretched NHS.

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