Author: Ekta Mehta
Ongoing training and competency management efforts are vital for organisations in maintaining effective service delivery. Keeping staff competent, via mandatory ongoing training for their role, is often a regulatory issue. Offering staff opportunities to expand upon their core competencies makes the same process beneficial to the development of your workforce.
Whilst training and competency management are closely linked, there are some differences.
Training management
Certain training courses are mandatory in most professional environments. For example, offices require a number of trained first aiders and fire wardens. Such training needs refreshing every three years, so having staff with those competencies in the office requires them to be trained on an ongoing basis.
In more public facing and safety critical roles, ongoing mandatory training in aspects of health and safety is required. Not fulfilling these training obligations leaves firms at risk of staff carrying out their tasks improperly.
Keeping on top of these courses is vital. A central system helps firms to set reminders and book in mandatory courses for their employees. Such a system can also help to keep track of attendance, ensuring that courses have been attended and completed.
Using the same system, organisations can also make their training courses open to their employees for them to book onto when it suits them. This makes your training management more flexible and opens up training opportunities to employees who may find them interesting. By offering the opportunity to expand on their professional interests, training management can help with staff morale and career development.
If you can train and bolster the competencies of your existing workforce, it makes life easier if you need to move staff around tasks to keep project and service delivery on track during times of strain.
Running training courses also incurs an expense. It makes sense to monitor attendances and interest in certain courses, so that you can offer tailored and more relevant courses to your workforce. Where spaces are likely to be free in arranged courses, having robust oversight of this enables you to open course registration within your organisation, or even sell spaces to other industry firms, the employees of which also need to attend such a course.
Competency management
Competency management is closely, even inextricably, linked to training management. Where it differs in the first instance is in the recruitment of new employees. If an employee says they have the necessary qualifications to fulfil the role for which you are employing them, competency management is the simple act of ensuring that they are indeed appropriately qualified.
For example, if you’re employing someone to do a driving job, it’s prudent to check that they have a driving licence. Where competency management would link with training management in such a scenario would be if you need that employee to further their driving credentials at a point in the future. So, for example, you may need to enhance their competency and send them on an advanced driving course.
Ongoing training plays a crucial role in competency management, too. As mentioned above, in many industries ongoing training is mandatory. This keeps your workforce competent for the tasks that you need it to be competent for.
Where competency management extends this is by linking to performance. If a certain employee is involved in a certain number of similar incidents, it can be a good idea to try and find out why and assign them to an appropriate training course. This means that you are taking reasonable steps to provision for both employee and customer safety, whilst also keeping your services running smoothly.
Assessing staff competencies on an ongoing basis, therefore, is crucial. In the same way that you would schedule an employee, assessors need to be scheduled to staff members and teams to periodically check their work. On the rail network, for example, such assessments take the form of an assessor conducting a ride along with a train driver to check that they are carrying out their job appropriately.
If all is well, this can be logged instantly in a central system. Similarly, if errors are detected, these can be logged instantly, with any follow-up tasks, such as another assessment or the requirement for further training, being actioned straightaway. This helps to ensure that the competencies of your staff are covered, whilst linking directly to your training management for mandatory and remedial courses.
Maintaining a central database of your workforce and its competencies fundamentally helps you to ensure that your have the right people performing the right tasks. A robust competency management framework benefits your scheduling efforts, too, since your administrative teams responsible for scheduling can assign tasks with peace of mind that those employees being rostered are appropriately qualified and/or experienced for the role to which they are being assigned.
Furthermore, a central competency management system feeds into other areas of your organisation. In being able to swiftly and accurately assess the strengths and weaknesses of your workforce, you can make informed decisions in other areas such as recruitment.
Training management and competency management for your entire organisation
The benefits of having robust training and competency management across your organisation are clear. Fulfilling mandatory ongoing training obligations whilst at the same time opening up opportunities across your workforce to expand upon their competencies is hugely beneficial.
Keeping staff competent is one thing but offering career progression boosts morale and helps to keep staff working for your organisation rather than having to seek opportunities elsewhere.
Ultimately, your workforce is your point of project and service delivery. Maintaining and understanding the array of skills and experiences drives effective and efficient delivery. Plugging this into other areas of your business, such as scheduling, enables your organisation to be agile in the face of short-term changes and responsive in remedying medium and longer term issues which are more easily identified with a bird’s eye view of your workforce.
Getting your training and competency management frameworks to dovetail will help drive understanding of your workforce, which in turn will help effective and efficient deployment to projects and services.
CACI has recently published a whitepaper, Effective workforce management to improve outcomes across your business which explores this topic in more detail. You can download your free copy here.
Fatigue management regulations are implemented in the rail construction industry to ensure not only that workers are treated fairly, but also that they are sufficiently rested to carry out what can often be dangerous jobs which require full focus and attention. Any impairment to their work can result in expensive mistakes, injury and, in the most extreme circumstances, death.
Having components of any given job improperly carried out can be an administrative headache that sets work back days, weeks or even months, and can potentially have severe knock-on safety consequences. The chance of human error leading to this is heightened when workers are fatigued, so deploying a tired workforce makes little sense.
DEFINING FATIGUE AND ITS CONSEQUENCES
The Health & Safety Executive describes the consequences of fatigue as follows:
Fatigue results in slower reactions, reduced ability to process information, memory lapses, absent-mindedness, decreased awareness, lack of attention, underestimation of risk, reduced coordination etc. Fatigue can lead to errors and accidents, ill-health and injury, and reduced productivity. It is often a root cause of major accidents e.g. Herald of Free Enterprise, Chernobyl, Texas City, Clapham Junction, Challenger and Exxon Valdez.
The implications of fatigue can be vast and, like any other hazard in the workplace, fatigue needs to be properly managed.
This is something that was brought home to the rail construction industry earlier this year when Renown Consultants Limited was fined £450,000 by the Office of Rail and Road, with £300,000 in costs as well, for failures in managing its fatigue protocols which resulted in the tragic deaths of two of its workers when they crashed their van on the way home from a job.
For safety critical work, there is a requirement that there must be a minimum of 12-hours rest between booking off a turn of duty before booking onto the next. Having this requirement is one thing, actively implementing it is another.
IMPLEMENTING, ASSESSING AND MANAGING FATIGUE PROCEDURES
Many companies do not have adequate systems in place for monitoring and implementing fatigue management procedures. In the case of Renown it was noted that, “Operations and managers knew what they were supposed to do in relation to fatigue but lip service was paid to these systems. Senior operations cut corners.”
This is where technology can help firms, with procedures modelled into business systems that can plan, guide and monitor staff, ensuring fatigue is always being considered. Rosters and shifts can be planned in advance based on the work to be carried out. The systems can include rules to consider factors related to both the time of the day that the shift is occurring and the travel time involved for the staff to potentially be deployed. This helps prevent allocation of resources to jobs that contravene the 12-hour rest period because of the travel time to get to or from the job.
There also needs to be improved recording of shifts, overtime and any shift swaps that have occurred. A management system can help by allowing staff to confirm or clock actual time spent, which again may trigger a knock-on warning for future planned work from rules configured to consider fatigue. The Office of Road and Rail (ORR) have also said that companies should be far more proactive in talking to staff and finding out their own concerns on fatigue and how it is affecting them. This could be done by capturing information directly onto questionnaires within a system. When completed these can automatically be flagged for management review and any remedial action required can be instigated, with all information stored against the staff record.
Capturing all this information into a single system allows risks to be automatically flagged to planners. They will then be able to amend and adapt the rosters based on the information presented to them. Having this data to hand ensures companies can comply with their risk assessment guidelines and not plan jobs when they do not have resources to safely do so.
SAFETY FIRST
The ORR was also critical of companies accepting jobs without carrying out proper risk assessments as to whether they have the staff to carry out a job safely. Having systems that can model ‘what if’ planning scenarios to indicate whether it is safe to accept work based on all elements of a risk assessment helps this decision making.
Furthermore, if accidents do occur, having auditable systems in place demonstrates that correct risk assessments were undertaken, helping pinpoint causes quicker and helping co-operation with any third-party investigations.
The RSSB has highlighted that fatigue is a factor in some 20% of high risk accidents in the rail industry. This high percentage suggests that many firms are underestimating the seemingly intangible impact of it. Implementing robust management procedures around this will help firms to see the full scope of the problem and align their workforces correctly to mitigate it.
It makes no sense from a financial, personal or moral standpoint to facilitate fatigued workers carrying out intensive, dangerous and important work. Deploying the correct technology is a major step in the right direction.
For more information on CACI’s Cygnum software, which helps organisations to gain a holistic view of their workforce and processes, please visit: caci.co.uk/cygnum.
A collision between a train and tractor in Kisby highlights the importance of training, briefing and communicating with all workers and operators to enhance rail safety.
Setting out safety guidelines and effectively communicating them with the workforce is paramount to creating a safe and accountable working environment. If staff aren’t briefed on safety procedures and processes whilst conducting their work, then mistakes are likely to happen. This was brought into focus on 19 August 2021 when a freight train collided with agricultural machinery being towed by a tractor at 04:10. The incident happened at Kisby, at a user worked crossing. The train was travelling at 66mph. So, how did this happen?
According to the report released in October 2022 by RAIB (Rail Accident Investigation Branch), the accident occurred because the driver of the tractor didn’t telephone the signal operator to check that it was okay to cross. Rather, they assumed that it was safe to look at the tracks to determine whether or not a train was approaching. With the train travelling at such speed, they didn’t see it, resulting in the collision.
Firstly, the incident could have been significantly worse. The train driver sustained minor injuries in the collision, with the driver of the tractor uninjured. From a collateral perspective, the locomotive and one wagon derailed, whilst the rail infrastructure sustained significant damage.
The cost of repairing the infrastructure, whilst not noted in the RAIB report, will have been significant, whilst there’s also the time the section of rail will have been out of action for to take into consideration. The stretch of line of was out of action for four days whilst the train was recovered and the tracks were repaired. This will have resulted in delayed and cancelled services.
A Class 66 locomotive, the type of locomotive involved in the accident here, has a value of around £1.5m. This is based on GBRf spending £50m on a fleet of 37 such locomotives in 2014. It’s fair to assume the repair bill won’t have been cheap.
The short-term planning, to assign engineers at short notice to track repairs, will have taken them away from other projects on the rail, resulting in other projects being affected by this incident. This, too, will have had cost implications, as well as creating scheduling issues for engineering workers, since their rosters will have had to be re-jigged.
It’s clear that the cost, time and resource implications of this incident were vast. That’s before taking into consideration just how much worse the incident could have been.
In its report, RAIB notes that the driver of the tractor wasn’t aware of the requirement to phone the signal operator to check it was safe to cross. They had not been briefed. RAIB concludes that this is most likely a result of the land owner on either side of the crossing failing to brief users of the crossing in a way which resulted in its correct use. Rail staff were unaware of this until shortly before the incident.
So, significant upheaval, in terms of time and cost, was created because of a simple lack of communication and safety briefings. How can such a situation be avoided?
Having the ability to evidence that training has been delivered, briefings have been given and that communication is recorded, is a major step in the right direction. The RAIB report notes that they were unable to find evidence of any call from the tractor driver to the signal operator, nor that the tractor driver had been briefed on the need to do so. Creating an evidence trail of such activities enables organisations to determine where failings have occurred and rectify them, preferably before an accident happens.
The technology exists to underpin such processes. Keeping a robust record of training and briefings can help to ensure that incidents such as this are avoided. And they are a lot cheaper than repairing a Class 66 locomotive.
Complete workforce management solutions can support your training, competency management, recruitment and scheduling. This helps organisations to keep a complete audit trail of activities, ensuring that tasks, such as safety briefings, are conducted. Human error, however, is inevitable, so they can also assist in the short-term rescheduling of staff to emergency activities such as track repair in the wake of such incidents.
Operating the UK’s rail infrastructure is a complex process which requires the monitoring of several moving and independent parts, as this incident highlights. It involves everyone from land owners to rail operators and anyone who needs to cross the tracks. Keeping tabs on the communication with all parties is difficult. Having a system in place to record communications and aspects such as safety briefing enables operators to keep track of who needs to know what and when.
The cost of not having such a system in place can run beyond the financial. The incident at Kisby could easily have been a fatal one. Is it acceptable that such an avoidable incident occurred through simple ignorance of the required process for safely crossing a railway track? The process can be managed and alerts can be created to ensure that everyone receives the briefings they need to receive. The cost of not doing this can be far greater than the cost of implementing the software that helps to avoid such incidents.
For more information on CACI’s Cygnum software, which helps organisations to gain a holistic view of their workforce and processes, please visit: caci.co.uk/cygnum
What does a good procurement process look like? Something we often see in the market are knee-jerk reactions. A problem within an organisation has been identified so a tender has gone out to market in a bid to rectify it. Whilst this can work, it pays to have an intimate understanding of what your problem is, how you would like to solve it and the impact the solution will have on your team and the future of your service.
Ultimately, understanding your procurement needs is the first step of your new project.
Once understanding is established, it makes life a lot easier (for you and a provider) when the implementation phase of the project gets underway.
Understanding procurement to understand the project
At CACI, we use our proprietary FUSION project management methodology to underpin every implementation that we deliver to customers. The first phase of this is to shape the project. Working closely with your team, we establish what the project will look like, what your needs are and what success will look like. This is the stage where buy-in needs to be established across your teams, from management to end-user levels.
Having a fundamental understanding of why you’re purchasing a new technology solution makes this stage far more straightforward. It’s very difficult to elaborate on vague concepts and ideas.
Helping your chosen technology provider to help you is half the battle:
- What are the long-term, strategic aims of your service?
- What areas of practice do you need the technology to assist with?
- How will it positively impact your team?
- How you will resource the project internally?
- What timelines are you aiming to achieve?
- How will training be conducted?
- How will the system handle departures and new starters?
- What do you want the system to look like in five years’ time?
Starting with the why
What do you want and why do you want it? It sounds like such a simple question, but a failure to grasp this point creates major issues over the lifecycle of a project. It makes it difficult to obtain buy-in internally, whilst making it difficult to explain to a provider what you need their technology to achieve for you.
This needs consideration of everyone involved, from those responsible for the procurement through to those who will be working with the technology and service users. Across this spectrum, what does good look like?
This is when knee-jerk reactions can hamper the success of a project, where it is deemed to be important to be implementing a system in response to a situation, rather than considering the value proposition and impact of new software thoroughly. If a decision has been made in haste, without due consideration as to how it will impact end users and service users, then the definition of success will likely deviate from the originally intended definition. They may well feel that the existing solution works well for them, too. Change management is another important consideration from the outset – FUSION change management.
It is also important to understand your existing technology infrastructure. Often we see cases of competing influences within an organisation, whereby a decision is made as to the infrastructure based upon cost and/or convenience for the IT team. Whilst these are undoubtedly important considerations, it can leave organisations relying upon software which doesn’t meet the required outcomes for staff and end users.
Understanding why you need new technology and focussing on those outcomes, before taking a tender to market, helps the lifecycle of the project.
How CACI can help
If you are looking for new solutions, it is worth speaking to providers before entering a formal procurement process. Of course, procurement needs to be conducted along specific guidelines set by your organisation but speaking to providers to gauge an understanding of their technology and how it might benefit your organisation is a good idea.
Furthermore, at CACI we have worked with countless customers on implementation and project management. We developed FUSION based upon the understanding of project delivery accrued over thousands of projects. We can work with you and your team outline how the project would be developed and delivered, outlining each step to help you achieve project buy-in across everyone affected.
Procurement frameworks
The final step, once you’ve understood what the project is and what success will look like, is understanding how you can procure. CACI is listed on several public service procurement frameworks. Going through this route can help to avoid lengthy tenders and legal wrangling over contracts. Talking to providers in advance will help in gathering this knowledge so that once you’re ready to move, the procurement process runs as smoothly as possible.
Bringing together healthcare services within an area to the betterment of patient care is the central aim of integrated care systems (ICSs). We’ve explored how technology can support interoperability of services in a previous blog. Here, we’re taking a closer look at the one workforce idea and how it can be implemented and support patient care across an ICS. The workforce, after all, is the frontline of patient care, so ensuring that everyone is scheduled appropriately and efficiently, is competent for the jobs to which they are being assigned, have ongoing training opportunities and that recruitment is working to strengthen the areas that need strengthening, is vital.
Bringing all this understanding together in one place requires the interoperability of systems that we’ve explored previously. Data and information sharing between different facets of the ICS is crucial to meeting so many aspects laid out by ICSs, including the one workforce ideology. It’s impossible to envisage everyone using the same technology system, so the ability for systems to interact with one another, or share data into a central repository, will be essential in understanding the workforce across an entire ICS.
Right people, right place, right time
Shift work is commonplace in the health industry. Effectively rostering people within applicable regulatory guidelines is one part. Understanding shift patterns, who will be where and when, opens opportunities to create insights into work patterns and more effectively deploying staff across an ICS.
For example, the agency versus bank staff debate is never far from the surface, with the added expenditure but increased flexibility of agency staff being utilised to fill gaps. Is there a more efficient way of rostering bank staff to available tasks? Creating insight that drives efficiency in this way will help to reduce expenditure.
Technology will play a fundamental role in this via auto-scheduling and suggestions based upon staff profiles. Auto-scheduling reduces administrative time on assigning staff to tasks, creating efficiency and freeing up administrative time to focus on other areas.
With the aim of sharing staff to fill in short falls elsewhere in an ICS, technology will have to be implemented to support this, otherwise it will be almost impossible to achieve. Checking available resources across an ICS can be done manually, or via spreadsheets, but requires significant resourcing in terms of personnel and time. Implementing effective scheduling software, that supports the aims of the ICS, will be crucial.
Training and integration
Of course, agency staff will always have a role to play, and their integration into their department is crucial to them being effective. Clear management of them and their roles will ensure that they achieve the results required of them.
This also plays into bank staff. What training opportunities are available to them? Career progression within the healthcare industry is outlined in the implementation of ICSs, so understanding the skills, experience and qualifications of staff will help in suggesting training opportunities to them that can help them evolve an advance their careers.
Having a central record of staff, running parallel to scheduling, creates these insights into your workforce. Upskilling from within is often more cost effective and more efficient than recruiting from outside. It also helps to keep your workforce upwardly mobile and motivated.
Operating training courses, too, goes beyond upskilling and retraining to ensuring that mandatory ongoing courses are undertaken by staff where appropriate.
Competency management
This plays into the competency management efforts across an ICS. Whilst similar to training and workforce management, competency management is a specific function which ensures aspects such as mandatory training courses are delivered. It also helps to ensure that appropriately skilled, experienced and qualified staff are undertaking specific tasks.
This is relevant to the deployment of agency staff, too. Do they have the necessary skills to carry out the tasks that you need them to? Against the idea of pooling resources across an ICS, competency management will play an important role in matching skills to vacant tasks.
It is all part of creating a thorough and robust understanding of the workforce across an ICS, which will help create flexibility and efficiency.
Recruitment
Another aspect of the one workforce philosophy is the creation of a pipeline for the future workforce. Recruitment is central to this, with one aim being working more closely with local schools, colleges and universities to engage with young people who might be interested in a career in healthcare.
By creating relationships in this way, ICSs can promote careers within them. Also, there is always a need for ongoing recruitment into senior roles. By having a holistic view of the workforce, understanding recruitment needs is made easier via identifying skills, experience and availability issues. Where these gaps cannot be plugged by sharing staffing resources, outside recruitment is inevitable.
Is this more efficient than relying on agency staff? What are the timescales? What training will new recruits require? How much management time will be diverted to the recruitment process?
By having a bird’s eye view of your entire workforce, making calculated decisions is easier. This then helps to understand and justify the decision to recruit or use agency staff.
Conclusion
Technology will play a central role in implementing the one workforce philosophy. Having oversight of the entire workforce, in one place, from disparate systems will facilitate the traversing of schedules, availability, skills and experience required to drive efficiency. Creating robust rules and auto-scheduling will improve administrative efficiency; having training and competency management processes in place will help with staff retention and progression.
None of this is possible with a manual way of working. If schedules are managed on spreadsheets, it’s impossible to effectively share them with the wider ICS. Gaining valuable and purposeful insights that can help drive efficiency are also incredibly difficult to achieve in a manual way.
Using the technology that works for you is important. Then making the data that you hold useful across an ICS will help to fulfil the aims of the ICS. Can your technology provider(s) do that?
With comprehensive oversight of staff, their skills and experiences, the one workforce aims of the ICS can be met. It’s one thing focussing on improving outcomes for patients, but improving outcomes for staff is just as important, since they will be the ones driving services and care.
We explore the relationship between ICSs and technology comprehensively in our recent white paper. You can download your free copy here.
One of the few bright spots of the Covid-19 pandemic was the response we saw from society and its services. The NHS and health services in particular were placed under great strain, having to reconfigure, almost overnight, how vital health services would be maintained, how Covid patients would be treated and how staff would be kept safe. The NHS rose to the challenge, giving cause for optimism around the implementation of integrated care services (ICSs).
ICSs will bring about changes in IT and software infrastructure, namely in the way that services are aligned and data is shared. The aim is to provide a more joined-up patient care experience whilst also equipping each service within an ICS with the information that they need on a patient. This will reduce duplication of work, driving efficiency through the care ecosystem.
As ever, theory and practice can remain divergent from one another, so getting each facet of an ICS to become interoperable with the rest of the services will be a challenge. The pandemic, however, shows that interoperable services can be achieved.
Why is the pandemic relevant?
With society closing down, hospital admissions spiking and other care services suffering from the knock-on affect of the redistribution of professionals and services, health services changed dramatically in a breathlessly short space of time.
PPE had to be provided to frontline workers. Beds had to be made available to Covid patients. Super hospitals were built in London and Birmingham, although thankfully weren’t needed.
Then there was the rapid response of producing a vaccine. That vaccine then needed administering on a basis of vulnerability. The elderly and unwell were vaccinated first, then the rest of society in descending age brackets.
Village halls were turned into testing and vaccination centres. A whole new technological ecosystem had to be created to record the administration of vaccines and note how many cases were being experienced. From testing to vaccines to deployment, the response was immediate and brilliantly executed for the most part. When the chips were down, health services responded.
How can ICSs learn from this?
The rapid redeployment of resources, as well as the creation and implementation of a technology ecosystem to record outcomes was impressive. Health services can respond at short notice to new challenges.
The roll out of ICSs isn’t nearly so dramatic. There is planning and oversight in place, but it will result in changes to the way data is recorded and shared. Change isn’t always something that we embrace, but the sentiment of improving and enhancing the delivery of care services can only be a good thing.
We’ve also seen that the way in which we approach healthcare has changed. Phone and video appointments are now more commonplace, creating efficiency in the process. Vaccines are still being rolled out to combat Covid, a reminder of the pace of change and how it has altered the healthcare landscape.
Change can be embraced and implemented quickly. The pandemic has shown us that. It’s one of the few positives to emerge from the episode.
How can technology help?
Technology is fundamental to how ICSs go about meeting the challenge of creating interoperable services (something we explored in more detail here). The response to handling Covid test results and the roll out of the vaccine required intelligent use of technology to underpin the process. It also kept other services moving, with the switch to video calls and so forth for routine appointments. The upheaval in staff schedules also required a systems response to manage it.
Technology can be sourced and implemented quickly. With the drive to data sharing, other aspects such as data regulations must also be considered, so the main challenge is selecting the right partner for the needs of your services. The needs of each facet of an ICS are bespoke, so a technology solution that fits your requirements is paramount, to ensure that data is utilised your way and that rules are adhered to.
It’s inconceivable that a single technology system would be appropriate across an entire ICS, so selecting the right technology is important. It will, however, need to support the wider aims of the ICS in creating knowledge and information sharing across services.
Conclusion
Technology will be vital to the success of ICSs, as it was to the response to the pandemic and the ongoing vaccine rollout. As we start to emerge from the shadow of the pandemic, there is a cost to be realised by our health services of the necessary response to it.
Many routine appointments and surgeries were delayed and delayed. There is a backlog of tasks that must now be tackled. Out of the frying pan and into the fire? It is certainly a major challenge across health services but far from an insurmountable one.
The aims of ICSs, in creating a joined-up health service which thrives amid mutual knowledge sharing and understanding, will create the necessary efficiencies in process to combat these delays.
There are positive lessons in the healthcare sector to be gleaned from the pandemic. The pooling of resources and talents kept health services afloat at a time of previously unimaginable strain. Putting those lessons and experiences to effective use will stand ICSs in good stead.
We explore how ICSs drive improved patient experiences and outcomes in our latest white paper, Integrated care systems and the role of technology to support patients across the UK. You can download your free copy here.
The aim of integrated care systems (ICSs) is to bring together the healthcare operations within an area to consolidate and improve the patient experience and outcomes. This, clearly, is a major undertaking, bringing disparate facets of the healthcare industry together in order to improve services. The aim is a simple one; achieving it will require a lot of hard work and common understanding. This blog takes a closer look at how interoperability – of systems, staff and functions – will support ICSs in achieving their intended aims.
The NHS Long Term Plan states that, “ICSs bring together local organisations in a pragmatic and practical way to deliver the ‘triple integration’ of primary and specialist care, physical and mental health services, and health with social care. They will have a key role in working with Local Authorities at ‘place’ level, and through ICSs, commissioners will make shared decisions with providers on population health, service redesign and Long Term Plan implementation.”
In order for ICSs to achieve this, the use of technology within them needs to be well thought out. Whilst it’s not essential that every facet of an ICS is using the same technology provider, it will be essential that the technology they each use is capable of being interoperable with the other systems deployed across the ICS.
What is interoperability?
Starting with the basic question, this is something that NHS England has outlined in its vision of creating more efficient and effective healthcare solutions: “With new models of care emerging and evolving, there is a clear need for more effective information sharing between care settings, organisations and geographies, as well as between professionals and citizens, to optimise patient outcomes and quality of care. This is reliant on the ability of IT systems across health and care to be interoperable with one another and is key to the delivery of the future vision of care in England.”
How can interoperability be achieved?
This is reliant upon the technology ecosystem within an ICS. It is not reliant upon everyone using the same system, rather that everyone is using a system that can be integrated with the other systems being used across an ICS. Most modern systems operate with an application programming interface (API), meaning that they can be configured to send and receive data from other systems according to the specific rules required around data sharing. A basic of example of this is being able to use your Facebook login details to login to other services – your data is shared between Facebook and the other service, meaning that you don’t have to spend time registering and inputting details.
Data can either be sent to a central data repository, to then be appropriately managed by other facets of the ICS, or direct system-to-system integrations can be established. The former provides a central view of all activities, whereas the latter establishes real-time data sharing between two or more entities directly.
It sounds simple in theory, but interoperability is only as good as the technology supporting it.
Siloed data
ICSs aim to break down data siloes. For example, if a patient has visited their GP and the GP surgery has no means of sharing this data with any other point of healthcare provision that the patient might interact with, then that data is useful to that GP surgery and that GP surgery only.
This works to the detriment of the patient’s healthcare experience, since they will have to duplicate their effort in explaining any problems to the next service, whilst that service will have no oversight of the issues faced by the patient. This is an extreme example and doesn’t exist in practice, thankfully, but serves to highlight the issues with data becoming siloed within specific sections of the healthcare service.
Away from frontline NHS services such as GPs and hospitals, however, there are significant hurdles to interoperability across all ICS activities. The National Care Forum (NCF) notes that, “The government aims to have shared care records in place for everyone by 2024. Only 40% of social care providers have fully digitised records and there is no detailed plan to bridge that gap.”
How can the 60% of social care providers that are reliant upon pen, paper and filing cabinets for recording patient activities share this information with other facets of the ICS within which they operate?
Interoperability is only as good as the technology supporting it
This presents a significant issue in achieving interoperability across an ICS. Manual records cannot be shared into a data repository nor directly with another provider. The data in these social care providers is siloed and inaccessible outside of the individual organisation. It is, therefore, unknown to other healthcare providers and hampers progress towards achieving the goals of ICSs.
It’s not all bad news, though. There is an opportunity for social care providers to be guided as to how best to implement technology for both themselves and the wider ICS. It is also possible for them to leverage the technological investment of others.
Budgets are always a hot topic of conversation. With an impending cost of living crisis looming, soaring energy bills and no clear direction coming from government, it is unlikely that social care providers currently operating without technology systems to record patient care and activities will suddenly find the cash down the back of the sofa to fund it.
It’s also unlikely that this will be top of their priority list, especially as “there is no detailed plan to bridge that gap.”
The ability to open up technology systems internally will help. If licences from a system already invested in within an ICS can be made available elsewhere, this will help to not only implement the requisite interoperability, but also to manage costs more efficiently and effectively.
This will then help those facets of an ICS such as social care providers who are not currently utilising technology, and are therefore holding siloed data, to open their data up to the benefit of the ICS. It will also help them in realising efficiencies across their own processes – removing the reliance on manual methods of recording data will facilitate staff being able to focus more of their time on patient care.
Conclusion
Interoperability will open the door to delivering the ‘triple integration’ of primary and specialist care, physical and mental health services, and health with social care. It will be the bedrock of the interaction between them, enabling data to be shared seamlessly for the benefit of the health service and its patients.
There are many health specific technology solutions available to the market, so working with providers that support interoperability is crucial for each facet of an ICS. Understanding how your data can be shared and working with your provider(s) on this will help in meeting the central aims of an ICS.
Most modern solutions will support interoperability, but it’s crucial that they can work and integrate with multiple solutions. It’s inconceivable that every facet of an ICS would be using the same technology solution, so this point is paramount. Working with the technology that’s the best fit for your area of the ICS, whilst at the same time making the data that you generate available to the other areas of the ICS that need it to enhance their services, is the fundamental aim.
We explore the subject of interoperability, as well as a number of other areas where technology will play a fundamental role in the success of ICSs in our recent white paper, Integrated care systems and the role of technology to support patients across the UK. You can download your free copy here.
People don’t inherently like change. We don’t trust it. We take comfort in the familiar and generally respond well to routine. That’s how we train ourselves. So, when well established processes in our lives are altered, resistance is a natural state of mind. This is something we’ve seen a lot of inside our own company, let alone with customers.
When implementing our Cygnum software with and for customers, change management is one of the key aspects that we focus on at the outset. Forming a guiding principle behind our proprietary FUSION delivery methodology, change management is something that we work closely with our customers on to ensure that those affected by the project – affected by change – have robust, accurate and timely oversight of what it means to them, as well as having people in place that they can talk to.
The role of people in change management
Having a direct line of contact in the form of project sponsors is vital in achieving effective change management. Project sponsors form the public face of the new solution being implemented within your organisation, acting as focal points and keeping lines of communication open at all levels. They will know the project inside out, being vocal about its benefits and explaining to those affected what it means for them.
It is the responsibility of other senior members of the project team to get involved in the change management process, too. People managers must be passionate advocates of the project and its outcomes, being able to convey these to staff impacted by the changes and help them in realising the benefits. A change practitioner helps at every level of the project to facilitate change and enable others within the project to have fair oversight of the changes and what they need to do in order to facilitate them. Then there’s the project manager, who assumes ultimate responsibility for the benefits of the project being realised – it’s crucial that the project manager ensures that communications and training are covered with those who will be impacted by it.
How CACI helps in your change management process
With the benefit of the combined experience of thousands of projects, our team of experts is trained to help every step of the way. As outlined in our FUSION methodology, we work with our customers to create a clear, achievable and structured path to project success. Even within that, however, change is always around the corner!
If things always went as we would like and expect, project management would be the easiest job in the world. But it doesn’t and, alas, it’s not. Having seen a wide variety of situations and circumstances, from the well structured to the less so, we help you to shape the project. This gives us both the best chance of achieving success.
Often there is a disconnect between procurement, management and those who will be utilising the software. Bridging these gaps is the ultimate aim of change management.
By following our FUSION methodology from the outset, we can establish clear outcomes and timelines, thereby helping you to communicate with your relevant teams and colleagues.
Change management underpins project success
The point of all projects is to implement some form of change. If everything was working harmoniously, efficiently and cost effectively, there would be no need to undertake the project in the first place. And no one wants to spend time, money and effort on implementing change unless it will bring about tangible benefits to the organisation.
Getting to the root of this sits at the heart of change management. A clearly defined project, with achievable timelines and outcomes, is far easier to sell to a team than a vague concept of success.
We’ve put together more detail on the change management process in this brochure. It outlines the five key aspects of change, the importance of people and communication throughout a project in order to manage the changes being implemented, how change management is fundamental to project success and an outline of effective change management.
Hopefully this offers some insight into the change management process and how you can consider change management in your next project.
One of the suggestions of the recent SEND review was to overhaul EHCPs. We take a look at how this can be done and what it will mean
The Department for Education (DfE) commissioned the SEND Review in 2019. The aim of this review was to explore the challenges faced by children and their families with identified special educational needs and disabilities (SEND). In March 2022, after much consultation, a green paper was published which puts forward several suggestions as to how the SEND process can be better administered to improve efficiency and, ultimately, improve outcomes for those children and their families. In amongst the plethora of suggestion sits one around EHCPs (education, health and care plans). I wanted to use this blog to explore this area specifically, since the response to the DfE’s suggestions is already available to schools, children, their families and local authorities.
What does the DfE want to do with EHCPs?
In short, the DfE wants to streamline EHCPs. As things stand, there is a loose outline for EHCPs but the level of detail within them is at local discretion. This has resulted in inconsistencies at local and national levels, leading to inconsistent responses to them. This is particularly acute where professionals work across two localities: getting to grips with two interpretations of EHCPs takes time and increases the manual, administrative burden upon professionals.
As the SEND green paper notes; “There were inconsistences in the structure, length and formatting of EHCP forms, with the samples included in the analysis ranging from a maximum of 40 pages in one local authority to between 8 and 23 in another. The EHCPs produced by the local authorities in the sample would take approximately 50 minutes on average to read aloud to a child. This lack of consistency means that partners who work across multiple local authorities must navigate multiple processes and templates, reducing their capacity to deliver support and adding to their administrative burden… We therefore propose to introduce standardised EHCP templates and processes.”
Sounds sensible, how will it work in practice?
The central hook upon which EHCPs will be hung going forward will be via a template provided by the DfE. This will standardise the information captured and make it easier for professionals to traverse each EHCP, simplifying the interpretation of the information within them and making it easier to input appropriately into each child’s journey.
Another rule that the DfE is seeking to implement around EHCPs is that any changes to them will need to be signed off by the parents of the child. Their increased involvement is seen as central to the success of the SEND process going forward.
The fundamental change to the management and administration of EHCPs is that the DfE is looking to fully digitise them. This means that they will only be accessible digitally. This will make the process much more efficient and transparent, since each EHCP will have a fully auditable trail of activities and inputs. This will make interpreting each EHCP much quicker, too, since a complete record of professional and parental input will be visible to schools, professionals and parents.
Creating a central record will enable for greater control, ease of access and interpretation of data for everyone concerned. Children with identified SEND necessarily find themselves in a multi-agency scenario, so tying their record together digitally makes interpreting and understanding their journey easier.
This also makes the information pertaining to a child’s SEND status useful beyond the boundaries of education. For example, in a youth justice scenario, it’s useful for practitioners to have a complete view of the young people within their services. Having information on their SEND can be informative in painting a complete picture of their journey and understanding their life story.
Technology supporting the single view
In creating a fully digital EHCP, there is a tacit acknowledgement of the involvement of technology. The vast majority of schools, local authorities, parents and professionals have the ability to access and record information digitally. How the DfE will implement this will be the interesting point.
A number of different technology solutions exist across the education industry, so there’s no chance of every authority and school deploying the same software. Nor should there be. Each school and authority should be free to select the technology and partners that work best for them.
Where the DfE will need they systems to work for them is in regards of interoperability. How can the information in an EHCP be shared between systems in multi-agency scenarios?
Most systems support this, with the ability to establish the set of data fields that will be outlined by the DfE and can communicate with third party systems to send and receive information. This will be vital in achieving the SEND aims of the DfE for EHCPs.
Conclusion
Achieving this single view of a child is something that we fully support, and our recent white paper covers the topic across children’s services more broadly. In multi-agency scenarios, such as those presented by SEND, it is imperative that all parties can access and record information unilaterally whilst contributing to the ultimate goal of improved outcomes for children with SEND.
A standardised response to SEND and EHCPs will also make the entire process more transparent, without local interpretations causing issues for children moving schools, region or for professionals picking up disparate cases. The response to SEND should not depend upon where you live and the process should be transparent and consistent for everyone.
As a technology provider in the education sector, we have long seen the benefit of interoperability with third party software providers in the sector. The ability to send and receive data seamlessly creates efficiencies in the process that will be to the ultimate benefit of the end service user, in this case children with identified SEND.
Creating a rich, single view of every child can only be beneficial in data mapping, understanding behaviours and tackling the challenge of improving outcomes for all children. We too often see information, systems and processes siloed into regions and sectors, so the aims of the DfE are welcome in tackling this. Education is a right for all children and young people, ensuring that the process is open, fair and easy to understand makes it a lot easier for everyone.
Creating a single view of the SEND journey is an important step. Making their information available to the multiple agencies that interact with SEND children, will only enhance the ability of each agency to interpret and record data on them, sharing their professional insights with others involved in their journey.