1. Re-imagine the process
After gaining board support for the project, the first thing the transformation team at Homerton did to prepare for the roll-out of Dragon Medical One was to reflect on current clinical workflows. A process mapping exercise ‘re-imagined’ the process and revealed unnecessary steps to current workflows which could be cut out by deploying speech recognition. A new electronic workflow map was designed, a pilot programme demonstrated proof of concept and the benefits of making the change.
2. Choose the right clinical leader
The choice of clinical lead can have a significant impact on how other clinicians engage with a project. The Transformation Team carried out interviews to ensure the clinical lead was pro-change, energetic, had trust-wide networks and was someone who people responded to positively. Dragon Medical was rolled out to the clinical lead’s department first, then remaining stakeholders were mapped out into three tranches:
- Engaged clinicians: those traditionally in favour of technology who would support the project.
- Most services: those people who accept change
- Dis-engaged clinicians: the few clinicians who had workflows which were different, traditionally needed more support or had responded negatively to previous change implementation.
3. Clinician engagement
When it comes to clinician engagement in new technology “there will always be people who are positive about new solutions and embrace change and there will always be people who are more skeptical,” says Katherine Adams, Transformation Manager and ED Senior Sister at NHS Homerton. In our recent webinar, Re-imagining outpatient services, she talks about some of the approaches the Trust had taken when it came to rolling out Dragon Medical.
4. Invest in training, support and communication to ensure clinicians feel safe and secure
Nuance worked with the Trust throughout the roll-out of Dragon Medical by holding classroom training sessions and giving practice exercises to reinforce learning.
Positive Change leaders provided floor support and a working group met regularly throughout the project. Transformation team members attended department meetings to provide updates and address any questions or queries.
Communication on how the project was progressing was reported through regular staff emails, blog posts and hospital magazine articles. Messages of support were sent from the trust medical director, operational director and both the clinical information systems and IT teams.
5. One to one
Despite the communication, support and training put in place, some clinicians remained reluctant to engage with the changes. Katherine had to ensure she devoted some one-to-one time with these clinicians so she could address their concerns and point out the benefits of the project. However, she says: “It was worth spending time with those people to bring them on board.”
Following the roll out of Dragon Medical across all adult services, letter turnaround time has reduced from 17.7 days to just 2.2 day with, on average, 80 per cent going out within 24 hours. In total 40,000 letters now go out per month.
The Trust has been able to save a third of its medical secretariat budget and reduced its outsourcing costs by £180,000 per annum.
However, the most significant impact of this change in workflow has been on the Trust’s patients. Clinical documentation and information is shared between the trust, GPs and patients much faster, which means any treatment a patient requires can be started earlier than before.