Correspondence Management and Workflow Optimisation
The ‘CorrespondencePlus™’ Program
What is Correspondence Management? In most Practices, the GP typically sees the vast majority of clinical correspondence that enters the Practice, and then sends it back out to the most appropriate member of the Practice team for further action as required.
Much of this correspondence (up to 90%) does not need to be seen by the GP and can be more effectively and safely dealt with by another member of the Practice team, saving up to 50 minutes of GP consultation time as a result.
Our CorrespondencePlus™ Program introduces the Practice Team (Lead GP, Practice Manager and Admin team) to the concepts and techniques needed to safely introduce a program of Correspondence Management to the Practice. We provide a detailed and fully documented Action Plan that will allow the Practice to introduce Correspondence Management over a period of 5 – 7 weeks.
We can also provide coding training for members of the Admin team, but we recommend the completion of the CorrespondencePlus program first, as it often highlights which member of the team requires additional coding training, and to what level.
Workflow Optimisation is a complementary concept central to the Correspondence Management Program that addresses not just the safe and efficient workflow of correspondence through the Practice but also addresses the optimization of the Admin team’s working protocols and conditions. It includes ergonomics, structure, sequencing and concurrency, so that the team’s routine working protocols are also optimised.
There are many proven workflow optimisation tools, such as Six Sigma and Lean, but these are unnecessarily complex and theoretical for use in a GP Practice. Our Workflow Optimisation module is instead based upon the highly successful philosophy of Incremental Improvement that was used by Sir David Brailsford to transform British Cycling into a world-beating, multi medal-winning phenomenon.
The philosophy of identifying every single step in a process and then improving it by at least 1% works exceptionally well in a Practice setting and is well suited to team working in a Workshop environment. Admin teams find it engaging, exciting and very rewarding to deliver. It also has longevity and sustainability, as the concept is an attractive one and, in our experience and in 6 month evaluations, team members continue to find 1% improvements to workflow long after the program has been successfully embedded in the Practice
Given the Win-Win nature of such a comprehensive Program, it is not surprising that Correspondence Management/Workflow Optimisation has been identified by NHS England as one of its Ten High Impact Actions that can transform General Practice as part of the GP Forward View strategy.
Ring-fenced funding has been allocated to CCGs in 2019/20 to allow every Practice in England to carry out training to introduce Correspondence Management.
The ‘CorrespondencePlus™’ Programme for Correspondence Management and Workflow Optimisation
Our CorrespondencePlus Programme has been developed by highly experienced Practice Managers and workflow experts, and is delivered by DNA Insight’s experienced and accredited trainers. The Programme comprises a half day Workshop with the Practice Team, followed by extensive consultancy and support to help the Lead GP, PM and Admin team members introduce the programme to the Practice as efficiently as possible. The broad agenda of the Workshop includes:
- An over-view of the concept and purpose of medical records
- Introduction to the relevant legislation; Data Protection, Access to Health Records Act, IG, Caldicott, ICO etc.
- Overview of basic construct and purpose of Clinical coding – data quality, audit, etc.
- Urgent, admin, clinical /non clinical correspondence etc.
- Correspondence allocation exercises
- Signposting and the triage of documents
- Process mapping techniques for correspondence, and practical exercises
- Practical guidance and conduct of the 5-7 week Correspondence Management implementation process
- Auditing the program to ensure safe and effective working and good governance
- Questions and next steps.
Ongoing Consultancy and Support
DNA Insight provides 12 months of ongoing telephone support and documentation to Practices to help them embed the Correspondence Management philosophy in the Practice and to support GPs who are introducing the concept.
How the 5 – 7 Week CorrespondencePlus Program Works
Week 1 – 2
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 missed Cancer appointments.
Over a two week period 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 start of Week 3, 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 marked for redirection. Caveats/Exclusions are also discussed and added where needed to secure consensus from all GPs. If consensus can be secured, these items are also marked for redirection. In our experience, 80% of the achievable savings of the Program are made following this initial review of correspondence by the GPs.
During the remainder of Week 3, the Admin team build a Process Map that includes each of the items identified for redirection. This map then becomes the master set of protocols for dealing with all items of correspondence of that type.
A the start of Week 4, the Admin team implement the Process Map, redirecting items of correspondence that come into the Practice away from the GP, and instead to the destination or clinician identified in the Process Map.
At the end of Week 4, the first weekly audit of the new workflow (as represented by the Master Process Map) takes place. The PM, Lead GP and Admin Lead take 10% of the correspondence from that week and follow its journey through the Practice to ensure that the protocols have been correctly implemented and that the new process is safe and effective.
Weeks 5 – 7
To fully exploit all the savings possible from the Program, a second two-week iteration should now 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 for 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.
Identify a ‘Go Live’ Date and Book All Meetings in Advance
For the Program to deliver on its potential, all key players need to be present and fully engaged in the process. Try and identify a 4 week period when key players are not on holiday and when the Practice is not going through a particularly heavy period of work that will cause distraction. Identify a ‘Go Live’ date at the beginning of the settled period and book all of the team meetings and audit meetings ahead of the Go Live date to ensure that the Program stays on track.