Ekta Mehta, Author at CACI

Fatigue management – a matter of life or death?

Posted on: 27 March 2023

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.

The importance of communication in rail safety

Posted on: 24 February 2023

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

Working with providers to help your procurement process

Posted on: 2 February 2023

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.

One workforce and the success of ICSs

Posted on: 31 January 2023

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.

What can ICSs learn from the pandemic?

Posted on: 24 January 2023

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.

How interoperability will be vital across ICSs

Posted on: 17 January 2023

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.

The importance of change management in project delivery

Posted on: 9 January 2023

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.

Effectively planning and scheduling district nursing across the NHS

Posted on: 1 December 2022

Like so many industries and bodies, the NHS had to adapt in several ways during the Covid pandemic. The frontline of its efforts to tackle the virus made the headlines, but away from Covid wards there was a necessity for the NHS to adapt its processes and practices around the threat posed. One such example regards district nursing – how was the NHS able to effectively and efficiently plan and schedule its nursing workforce in the face of meeting the challenge of delivering vital services away from hospitals?

In short, there was something of a struggle across some NHS Trusts to meet this challenge. The usual routine of bringing vulnerable patients into the hospital environment for the administration of care had to be reviewed in order to reduce the risk of exposure to Covid for such patients. This meant putting more nurses out on the road to deliver care in residences and care homes. This change also fulfils part of the NHS’s Long Term Plan: “Over the next 10 years, health and care will change significantly. We have a roadmap in the NHS Long Term Plan which sets out a new service model for the 21st century: increasing care in the community; redesigning and reducing pressure on emergency hospital services; more personalised care; digitally enabled primary and outpatient care; and a focus on population health and reducing health inequalities.”

There was a sudden increase in demand for domestic patient visits thrust upon NHS Trusts with the Covid pandemic, meaning that processes and protocols had to be drawn up and adhered to in a short space of time. The process of planning and scheduling district nurses to carry out these additional tasks meant that a vast number of clinical hours had to be diverted to scheduling and planning. On top of that, there was the inevitable rescheduling of appointments to contend with, too.

This is a largely manual process at present for many NHS Trusts, with others relying on old software which isn’t suitable for handling the modern scheduling demands of district nursing. Operating hundreds of nurses to fulfil thousands of appointments in an efficient and effective manner is a huge undertaking. Doing this manually requires a monumental effort on the part of those responsible and using outdated software only makes the challenge harder.

Furthermore, each appointment must also take into consideration the skillset of the nurse conducting the appointment, ensuring that they are appropriately qualified to undertake the task. This requires careful planning and oversight and was a process that could be shattered in an instant with a positive Covid test for a district nurse. Operating this manually, simply put, is unsustainable given the hours being diverted to it, the strain of efficiently managing the workloads of every district nurse and the requirement to consider each nurse’s competency for each visit. So, there is an opportunity to implement new technological systems which will bring about lasting benefits – the healthcare world will be a different place even once Covid is a memory.

Automated planning and scheduling software can bring about a multitude of benefits for NHS district nursing including:

Reducing the clinical time spent on scheduling appointments – automating the process massively reduces the workload, leaving administrative time to focus on exceptions
Reducing travel time and expenditure – efficiently scheduling district nurses to maximise the number of appointments they can fulfil reduces the burden on the Trust by ensuring each nurse is fulfilling as many appointments as possible
Enabling demand and capacity modelling – identifying demand gaps and knowing exactly how many district nurses are required at any given time based on actual demand
Supporting the identification of skill gaps – spotting skill shortages based on future demand means a proactive and accurate approach to future workforce training and recruitment can be adopted
Meeting Lone Working Policy requirements – where staff are working alone there is the potential for them to face hostile situations; having a robust system in place enables them to raise an alarm where such scenarios arise
Increasing assurance that service delivery is meeting the requirements and needs of patient demand – reports can be generated to see the effectiveness of service delivery and to identify any shortfalls in staffing required to deliver services in line with patient demand
Reduction in missed or delayed visits (and associated clinical incidents) – by efficiently planning rosters, travel time allowances can be factored in, lowering the risk of external factors disrupting your schedule and making it more likely that appointments are met, reducing the risk of clinical incidents occurring as a result of staff scheduling
Improved communications with patients and carers regarding visits – automate messaging through your system to inform patients and guide nurses

All these benefits from a system can be used to shape a more consistent and reliable future for NHS Trusts in delivering vital services. CACI works across the UK with community care teams who use our Cygnum software to help deliver a huge range of centrally and domestically located services, helping to keep vital care and community services running. The software is also used by the Care Quality Commission to schedule their inspection workforce.

Why NHS costing systems can’t stand still

Posted on: 18 November 2022

The NHS landscape is constantly evolving – it’s the responsibility of trusted solution partners to keep pace with NHS organisations and contribute expert data knowledge to help them on their journey

Everyone’s talking about finance collaboration in the new Integrated Care System (ICS) structure, but it’s not easy for anyone to make headway in this unfamiliar landscape. It’s not as if the decks have been cleared to make time and space to understand and address the opportunity: NHS leaders and finance teams are still grappling with everyday pressures and priorities within their own Trust. ICS is another challenge to add, albeit one that offers excellent opportunities to improve patient care and experiences.

Up to now, costing data has been used by NHS Trusts for national cost collection (NCC) and internal service line reporting. Solutions like CACI’s Synergy 4 help Trusts to make this happen in the most efficient and integrated way possible and to gain greater value from their data for service design and improvement. But now, there’s a new challenge level. How can Trusts also share and embrace costing data from other Trusts within their ICS?

The rewards of understanding and analysing patient pathways across organisations

In principle, it’s clear that a holistic approach to analysing patient pathways – spanning acute, mental health, ambulance and social care organisations and community settings – has the power to greatly improve patient outcomes and experiences as well as delivering better value and efficiency to ease the burden on NHS care teams. But the practical processes and channels for sharing data and insight are far from clear.

CACI’s NHS engagement team has been working closely with our NHS clients to understand the complex considerations around sharing data between Trusts in a secure way that produces reliable and meaningful information that can help develop patient-centric services and make the most of NHS resources.

Trusts are engaging with a range of new data challenges for ICS

Information Governance (IG) for shared data is a key concern for NHS finance teams. Data must be anonymised, in order to protect patient confidentiality, but Trusts must be able to match patient identifiers to understand the end-to-end pathway through multiple touchpoints and organisations.

Finance teams are also keen to understand more about the quality of data that could be shared by other Trusts. Data formats may be an issue: there are multiple systems and data sources in use, even within individual Trusts, which can make it hard to match data and adopt a holistic approach. With clinical decisions and budget allocation potentially riding on the analysis, it’s critically important that pooled data is accurate, de-duplicated and in comparable formats, to avoid inaccuracies. Reporting on insight from shared data can produce unfamiliar results in the broader ICS context: for NHS leaders to trust the integrity of the data and analysis, these results need to be clearly presented and explained.

These are uncharted waters for NHS Trusts, for the new ICS organisations and for data solution partners like CACI. It’s not surprising that most efforts to launch costing data-sharing projects have so far been tentative. We’ve talked to finance managers who have shared data to explore the opportunity – generally they’ve done this in manual and fragmented ways, such as emailing manually created data files. This is clearly not a scalable approach for time-poor NHS finance teams, even if the attendant data protection and security issues could be resolved.

Operational finance teams can see the potential, but many are worried about IG, concerned about undermining their own Trust’s financial priorities within the ICS and don’t have the time or the mandate to focus on unpacking the issues. It’s already creating frustration. Some NHS leaders have a management accountancy background: they don’t yet have the data literacy training or experience to champion or direct a completely new costing data-sharing approach with confidence. This is a challenge we’ve also recognised: CACI’s Healthcare Insight Success Cycle (HISC) includes data literacy training modules which can help increase knowledge and confidence.

Collaboration with solution partners can enable ICS collaboration

How can NHS Trusts and ICS organisations break down these barriers and access the resources they need to unlock the potential of data-sharing? Partners like CACI can help to shoulder some of the load by ensuring that technology and data solutions are continually evolved and adapted to handle the emerging opportunities and challenges. Driven by the feedback and hands-on experience we gain from our NHS colleagues, we’re working on our Synergy proposition to develop the data-sharing, analytics and IG capabilities that will support the emerging ICS data-sharing requirement.

We know that ICS organisations are at different stages of their thinking about Trusts. They also have diverse levels of capability, resources and experience in producing Trust-level service insight from costing data. Everyone has a different starting point for their new ICS data-sharing journey.

How does your Trust’s approach and experience to date match up with our current understanding of the ICS landscape? At CACI, we’re highly aware that priorities, issues and opportunities are constantly evolving within the NHS. We’re rising to the challenge of delivering a costing proposition that’s built for the complex demands of today and tomorrow, supporting better outcomes for patients, better decision information for clinicians and better use of resources for the NHS. We want to support Trust finance and analytics teams by sharing our NHS data knowledge to help build data literacy among NHS leaders, so they can champion ICS from a position of understanding.

That’s why we are working alongside our NHS colleagues, engaging with their current challenges and offering data strategy, process and capability insight to help them move forward on the journey, as we evolve our Synergy proposition.

Please join the conversation through our user groups and round tables or get in touch directly to share your priorities and issues and pose any questions that we could help you answer through our NHS data experience and expertise. Contact consultant Susan Brooks in CACI’s NHS team.

Cambridgeshire County Council and Peterborough City Council to support SEND services with IMPULSE Nexus

Posted on: 13 October 2022

Lucy Sweatman, Education Programme Manager for Cambridgeshire County Council and Peterborough City Council said: “We’re looking forward to working with IMPULSE Nexus. Most importantly, the new system means we can increase the quality of the service we offer to children and families, enabling both authorities to improve their SEND processes, with input from all agencies into each child’s plans and provision. It will also make the whole process more efficient, bringing everything to do with SEND into a single view. This means we will be able to help children and young people with SEND in a more collaborative way, driving and enhancing the partnership working between schools, professionals, authorities and parents. This will make the process of recording outcomes and requirements much more straightforward, enabling us to act more swiftly and efficiently.”

IMPULSE Nexus is made up of several modules, of which local authorities can use as many as they need to support their education services. Based upon an interoperable framework, IMPULSE Nexus modules can integrate with other services and providers to offer a joined-up view of each child and service.

“We’re delighted that Cambridgeshire County Council and Peterborough City Council have both chosen IMPULSE Nexus SEND solutions to support their ongoing work in this vital area,” says Phil Lucy, Director of CACI’s Children and Young Person’s division. “By providing a fully auditable trail of activities, with the ability for all stakeholders to record information, IMPULSE Nexus will help both authorities to enhance their SEND processes and provide efficient and effective support to those children needing their services.”