Melissa Andison, @mjandison
Mobile technologies have demonstrated great potential in personalised and self-directed health initiatives. We have seen both public and private healthcare providers adopt mobility solutions. For many organisations the drive to introduce mobile devices is based solely on cost improvement objectives. This can constrain mobile working to a procurement and deployment exercise and risks ignoring the impact technology will have on clinical working culture and patient engagement.
Drawing from personal mobile working experience, I wish to highlight how critical the close collaboration between clinicians and health IT is to the transformation process. I wish share the challenges we faced and the lessons learnt from a mobile project. In a community setting, the pilot provided clinicians with Android tablets that had 4G sim cards. Via a mobile solution the clinicians had access to the patient record and the ability to document information at the point of care.
The project faced the following obstacles embedding mobile working into daily practice:
Hardware / software selection – The device and solution had to meet the needs of different rehabilitation teams and multidisciplinary health professionals. The clinicians used a large variety of paper based resources and interacted with patients in different ways, which influenced the type of kit, design of electronic assessment forms and outcome measures.
Expectations – The clinicians longed for ways to eliminate the need for paper based processes and unreliable communication methods such as faxing, telephone messages and mail. They desired reliable technology that would provide them with joined up working and an end to end digital system.
Mobile fears – Clinicians were worried the device may create a barrier in therapy sessions. They feared that using the tablet during interventions could change therapeutic body language and effect developing rapport with their patients. Clinicians were concerned about the ergonomic impact of carrying the device and the safety and security of using the devices in public places.
Staffing –Recruitment, rotational programmes and agency staffing challenged training schedules and timely device set up. This limited the mobile working continuity in teams.
Digital skills – An assumption that if a large proportion of the workforce used smartphones and/or tablets in their personal lives it would equate to a smooth adoption in a work environment.
Technical – The complexity of integrating a mobile solution that was not native to the core clinical record caused disruptions at times, which impacted the clinicians’ confidence in mobile working.
Mixed methodology was used to evaluate the mobile working project. This consisted of pre and post surveys, clinician interviews, patient questionnaires, performance and activity data. Despite the challenges, the formal evaluation of the project concluded that mobile working did make a positive difference in the average patient contacts per week. The qualitative analysis provided evidence that the clinicians perceived mobile working to improve their work satisfaction, performance and the quality of client interactions. My colleagues and I captured many valuable lessons learnt along the mobile working journey. These are summarised into ten transformation strategies:
- Clinician Centred Transformation
It is the clinicians who know their service and patients the best, so it is essential to understand their expectations from mobile working to avoid dissatisfaction. To achieve this you need frontline engagement from the beginning and ensure clinical consultation at every stage of the process. This includes the choice of devices, work flow analysis, solution design, testing and training.
- Appoint Mobile Change Agents
Disruptive mobile transformations require strong leadership. Identify clinical leaders to accelerate the change in daily practice. The champions will role model, support their colleagues and also act as a link between the project team, operations and the frontline.
- Capture Creativity
It is the creative discoveries that will inform the transformation and training for each subsequent service. Share the benefits discovered as it will keep clinicians engaged in mobile working. Shadowing clinicians is mutually beneficial for IT and end users to help identify issues and problem solve.
- Secure Buy In
Mobile working leadership needs to be established at all levels within the organisation. Having well defined roles to ensure stakeholder responsibility is paramount. Organisational commitment that defines the scope, plan, objectives, benefits and risks of mobile working will support collective buy in.
- Change Working Culture
The difference between embracing change and resisting it is how involved and prepared the clinicians are. Identify and address the fears of using technology. Changing work routines and behaviours takes time. Some clinicians are going to need protected time to adopt new digital skills. Use a variety of tools to help develop new working practices such as case studies, mobile working tips, cite examples of good practice, peer to peer challenges on adopting mobile working and set up a regular mobile working user group. Ensure mobile working is on the agenda at all levels of the organisation. Make it an item in board meetings, business meetings, case conferences, supervision sessions, staff induction and exit interviews.
- Monitor and Measure
Invest in regular monitoring throughout mobile working. This will help to keep track of user compliance, spot areas of concern and resolve issues more rapidly. Transparent measures ensure that clinicians, operational management and IT know what the key performance indicators are and how they are going to be captured. Collect qualitative and quantitative data to ensure a rich evaluation of the mobile working practice.
- Device Setup & Management
A flexible approach to the deployment and management of mobile devices including the ability to setup large numbers quickly without the constant intervention of a technician is beneficial. Test that using the device over Wi-Fi or the mobile network does not interfere with the clinical solution. Password protection should consider using a single sign-on, thumb scans as alternative security solutions. A requirements analysis should include the purchasing of a secure Mobile Device Management platform.
- Multi-dimensional Training
Give clinicians the mobile devices as early as possible so they can get use to them. It enables skill levels to be established and training needs targeted. Useful training techniques are using patient examples and provision of offline assessment forms to practice on the tablet. In addition, uploading support documents like a user guide on the device will help clinicians to be independent with trouble shooting and reduce dependency on the service desk.
- Holistic IT Support
A single line of support such as a static IT service desk will not be sufficient for a mobile work force. A holistic approach should include support via floorwalking, mobile calls and email. IT support hours of operation will need to reflect the changing needs of mobile clinical services. Producing a central repository to allow people to share their discoveries on using the device, ask questions and receive a response from their peers will be helpful. The information captured here can then be picked up and formalised to develop the training programme. Have a business continuity plan.
Finally, integral to successful mobile transformation is collaboration. Diversity of contribution from all areas of the organisation will ensure the skill mix needed and help to develop a common understanding of mobile working. Have an open, honest dialogue between all parties to establish good working relationships.
If the only incentive to ‘deploy’ mobile device is a financial one, organisations will miss the opportunity to engage and empower both the clinicians and their patients through the use of mobile technology. Mobile working transformations are challenging, but rewarding. The clinicians in this pilot demonstrated using mobile technology in both clinical and non-clinical tasks. They became comfortable with using the technology with their patients and they would prefer not go back to paper based recording. I encourage you to use these transformation lessons to guide future mobile working initiatives.
Melissa would like to thank and acknowledge co-authors of the mobile working transformation evaluation and lessons learnt: Mr Nigel Miller, Ms Liz Francis, Ms Helen Cherry and Mr Simon Benge
Melissa Andison is Director OTTech Healthcare Consultancy / Transformation Clinical Lead at Central London Community Healthcare NHS Trust / Occupational Therapist / Mobile Working Advocate