make the process more effi cient but does that mean that some people then just twiddle their thumbs or do you get them doing other things? If you make the process more effi cient, do you cut back on your workforce because you don’t need so many people?” he said.
Dr Whatling recommended that Trusts consider this aspect in their business cases, as they must have plans for their productivity enhancement. Some options include using natural attrition, an active plan to diminish that part of your workforce or redistributing work, he suggested.
This could raise concerns with the workforce and brings up the old debate of technology replacing humans in certain roles, but Dr Whatling believes the third option could be the best solution.
He said: “What you’ll see is an increasing diversifi cation of staff , and people morphing into diff erent roles. In general practice there’s been quite a lot of response to getting practice managers and nursing staff and others to do diff erent types of jobs. Clinicians can give those duties to others and it’s not necessarily clinical work – they’re just conforming to a process which takes a burden off clinical staff to get on with other things.”
packaging up of post, and they’re all on patient record systems. It’s easier to fi nd a record because it’s all online, and secretaries and doctors will save a lot of time by not running around everywhere wondering where their notes were,” Dr Whatling added.
So what?
Discussing the benefi ts of these advances, Dr Whatling said he applies the ‘so what?’ factor, to consider how the time freed up by digital dictation or voice recognition can be best put to use.
“You’re eff ectively trying to increase the effi ciency of your processors and improve accuracy. A lot of this is actually orchestrated around productivity. What do you do with the time you’ve got back? You can
As well as saving time and allowing staff to work on diff erent tasks, Dr Whatling explains how the elimination of human error can radically increase accuracy, and therefore safety.
He said: “Having been a practitioner, you can dictate a note and then go and review the letter itself – it’s Chinese whispers. By the time you’ve dictated it and someone has listened to it and laid their interpretation over it there’s plenty of room for error to creep in and that could actually be quite dangerous. Some medical terms are similar to each other – you can imagine how easily that might come up.”
Pay-as-you-go
In terms of return on investment, whether the savings are fi nancial or not, Whatling suggests that digital
dictation is “a no-brainer”.
But with some services requiring specifi c devices and others compatible with a range of diff erent technologies, including smartphones, which to buy and how to buy it is a key question for Trusts looking to implement digital dictation and speech recognition.
Dr Whatling explained some of the cost-cutting benefi ts of diff erent business models.
“If you don’t need to spend capital money on equipment, then that could be advantageous. On the other hand, doctors have had devices for years so keeping that might manage the change process better. Some of that technology can be put through a secure network so that it’s all checked with confi dentiality– that’s an important factor.
“One of the interesting things for other business models, like pay as you go, is that organisations who don’t have that much money to spend can get going quite quickly; they can also terminate quite quickly and move on to someone else if they don’t like it or can get a better off er. It helps them spread their costs and enables them to do it within an aff ordability envelope so they can get to their cashable benefi ts, or even non-cashable, within their time limit and this is something we are looking into at BT.
“You can scale it up and down the organisation depending on size, which is another benefi t. If you’re a small clinical commissioning group, a small health provider or even an individual practitioner, you might not have that scale. With all the other demands on your budget, you can’t aff ord that investment and it might be better just to rent the service. There are choices available to people now,” he said. With more doctors owning personal smartphones, individual devices can be integrated with Trusts’ software. While the IT department may be unwilling to buy such expensive equipment that carries a high risk of theft, Dr Whatling noted: “If the individual’s bought it, that’s at their own risk, not the Trust’s risk.
“Also they haven’t had to spend
the money on that equipment, and the clinicians have the technology to change their work. There are obviously some things to work through with that. Part of the power of these conversions is getting the tools into the clinicians’ hands.”
Orchestrating the workfl ow
Coordinating workfl ow is another service that some solution providers now off er, incorporating clinicians using dictation and transcription teams to manage work eff ectively.
Dr Whatling said: “It has been the case that you have medical secretaries who are mapped almost one-to-one, or one-to-two, with consultants, or one medical secretary to a clinical team.
“If they can work more effi ciently, you might want to balance workload when those team members are around more dynamically. Some of these providers can help with the orchestration of work fl ow as well.
“On the conversion side, you’re not only making the best use of the equipment that’s out there, you’re starting to give one stop shop solutions.
“That’s the power of smartphones and tablets these days – you can start bringing new things together – a lot of the work we do is unifying communications together much more seamlessly.”
Dr Justin Whatling
Dr Justin Whatling, vice chair of Strategy & Policy at BCS Health, is Chief Clinical Offi cer at BT Health and a visiting professor at UCL’s Centre for Health Informatics and Multiprofessional Education (CHIME).
For more information
www.btplc.com/health www.bcs.org/health www.chime.ucl.ac.uk
national health executive Jan/Feb 12 41
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