A Guide to Effective Fast-Track Implementation
In the General Practice Forward View, the High Impact Action of Productive Workflows focuses on managing clinical correspondence more effectively. This is achieved by redirecting correspondence away from the GP when it can be handled safely and more efficiently by another member of the Practice team. Correspondence Management and Workflow Optimisation programs, often combined as a single program, deliver significant reductions in the amount of correspondence reaching the GP’s desk (about 80%) and savings of around 45 minutes per GP per day. Long-term evaluation of our own Programs have shown that the benefits are both substantial and long lasting.
Closely allied to Correspondence Management, and often used as a substitute term, is that of Workflow Optimisation. Managing correspondence more effectively is in itself a form of Workflow Optimisation, but it can be taken much further to impart greater benefits to the day to day working of the Practice.
In our discussions with Practices, Federations and CCGs we have identified a fairly widely held view that introducing Correspondence Management and Workflow Optimisation is a long drawn out affair that can take months to implement effectively. The reality is much more encouraging, in that around 80% of the achievable benefits can be secured within just 3 weeks, and the remaining 20% within the subsequent 3 weeks – all of which can be achieved without any disruption to the normal day to day working of the Practice. In this article we outline how this can be achieved and offer some hints and tips to ensure success.
Any administrative system that evolves over time will inevitably become more inefficient as more and more elements are added or changed. A system like the one prevalent across General Practice, where the 1970’s technology of the Fax still sits alongside the integrated scanning and document management capabilities of the modern GP IT system, is destined to be inherently inefficient. As we have found in our own training programs, levels of duplication, over-processing, unnecessary double handling of correspondence and unaddressed incompatibilities across systems can lead to bottlenecks that severely inhibit efficiency.
This is why, in our training Program for Correspondence Management we also help Practices to identify and address these workflow inefficiencies. The results deliver benefits to the Practice which extend far beyond just the savings achieved by managing correspondence more effectively, and lead to a better working environment and much greater job satisfaction amongst Admin team members.
So how do we help Practices to achieve both objectives in just three weeks?
Starting the Monday after the Workshop, to allow for the necessary admin to be put in place, GPs start to audit the correspondence they receive by annotating each item on a tally sheet, indicating whether they need to see the item. If they don’t need to see it, they identify an alternative member of the team who can deal with it safely and more appropriately, and add any caveats they may wish to apply. For example, they may be generally happy for DNA letters to be dealt with by the Secretary, but would wish to personally see and/or action those that relate to safeguarding issues.
The Admin team collates the tally sheets from each GP each day and builds a spreadsheet that reflects each GP’s view of each item of correspondence they have seen.
Meanwhile, the Admin team use the process mapping techniques taught during the Workshop to optimise their own processes and pattern of working so that it is as efficient as possible.
At the end of Week 2, the Admin team feedback the consolidated results of the audit to the GPs in a team meeting attended by all GPs, the PM and Admin team. ‘Low hanging fruit’ items are quickly identified and redirected to the appropriate destination, the Admin Team’s Master Process Map being updated accordingly. These items will no longer be sent to the GPs. Consensus is then sought for those items where a majority of GPs have indicated that they can be better dealt with by another member of the team.
Caveats are discussed and added where needed to secure consensus from all GPs. If consensus can be secured these items are also redirected accordingly. Items where there is less agreement are identified and then held over for discussion at the next team meeting following the second audit iteration.
The start of Week 3 sees the redirection of all correspondence agreed by the meeting as not needing to be seen by the GP. In our experience, 80 % of the achievable savings are made during this first two-week audit and some Practices see that as a sufficient saving.
To fully exploit all the savings however, a second two-week iteration should be started, this time with GPs auditing a much reduced flow of correspondence. The team meeting at the end of this second iteration will normally secure an additional 20% of savings through redirection, although the discussion can become more involved, as the low hanging fruit has already been picked and consensus on remaining items is more difficult to achieve. This is where caveats and other criteria should be considered if it will allow consensus to be reached.
Hints and Tips to Ensure Success
Full Workshop Attendance
It is essential that GPs and the PM attend the training workshop with their Admin and scanning teams. The number of ‘light bulb’ moments that happen when GPs and their Admin team sit down together to discuss workflows is a revelation, and many inefficiencies are resolved during the course of the Workshop itself.
Go for GP Consensus rather than Total Agreement
In a large Practice with many GPs, one can almost guarantee that there will be a difference of opinion amongst the GPs as to which items of correspondence should come across their desks. This should not come as a surprise, as GPs are independently minded and have differing approaches, and this difference of opinion is certainly not a show stopper. On the flip side, there will also be a general consensus amongst them on which items of correspondence thEy do not need to see. This is the ‘low hanging fruit’ which will deliver a quick win for both GPs and Admin team, and which will encourage further discussion between them on the those items of correspondence where there is less agreement.
Book Meetings in Advance
The all-team meetings, particularly the one at the end of Week 2, are an essential element of the Program, so booking team meetings well in advance is key to ensuring that the Program stays on track.