The trials and tribulations of implementing mobile working into a nursing workforce

Published: 09 December, 2015
The trials and tribulations of implementing mobile working into a nursing workforce

18 months ago, Care Plus Group senior management team got their heads together and started looking at ways of making our workforce more efficient and ways in which we could save time and money. There was a light bulb moment from the team, suggesting, “Why don’t we make our nurses more mobile?”

Well what does that actually mean? Give them a new phone? Make them bike to work? Nope! It means chuck them a new laptop with a Sim card in it and tell them to get on with it!

Of course I’m joking and there’s far more to it than that. Previous experience of poorly managed mobile working projects have shown us that chucking technology and mobile connections at nurses just doesn’t cut it and there is far more involved in a successful mobile working rollout. Asking a workforce of experienced, skilled nurses and clinicians to completely change the way in which they approach their working day was always going to be a big ask, and let’s be honest, was always going to be met with an element of trepidation. With this in mind, we had one opportunity to nail this project and one chance to get it right.

A new approach for successful implementation

So how could we approach this? What could we do differently this time round to make this project a success? A small team was pulled together including IT Staff, Nurse Managers and Senior Clinicians. This project team had the task of sitting down and working out a fundamental approach to the project that would ensure a successful delivery, and bring measurable advantages and benefits to the nursing team. No easy task in the slightest!

The approach decided on was a combination of things that we hoped would result in a successful project. Any one single element of these would be difficult enough on its own, but ultimately wouldn’t give us a successful outcome. We had to ensure the project was approached as a package with the key points below being included.

  • New laptops: A lightweight laptop with excellent battery life. Touchscreen and detachable tablet style screen that would ultimately reduce any barrier between clinician and patient. Something that is quick to start up, high powered and the best performing laptop we could purchase. While we had to be conscious of price, we weren’t going to penny pinch on this and wanted to make sure we bought the correct devices.
  • Mobile toolkit: this would include a trolley bag (we were conscious that the nurses already carried a lot of kit, so giving them more kit to carry around could be an issue) and an in car charger so they could stay charged on the go. Large monitors, keyboards and mice would also be issued for drop down spaces at their base.
  • No Sim cards: Previously, mobile working projects were pushed with a reliance on having a mobile sim card in your laptop. As we’ve seen historically, it just isn’t reliable enough. Signal black spots, low speed connections and unstable software would cause it to crash, drop and lose your work more often than it would work. Not only is the solution unstable, it’s very expensive paying for a £15 a month sim card for over 100 nurses.
  • SystmOne Mobile: while the new laptops would considerably improve and help the nurses ability to work in a more mobile manner, it needed to be coupled with a system that would help them access patient records offline.

TPP released a new version of systmOne that would allow nurses to access records on their laptop, WITHOUT a mobile connection. This improvement and development in technology has dramatically improved our approach to mobile working. The system would allow nurses to access and update patient records in a patients’ home, in the car, on the move and from home.

  • Support Support Support: previous experiences around mobile working projects has always shown that it’s been rushed and staff aren’t supported enough. It’s all well and good spending half an hour to with someone showing them their new laptop, but if you disappear off the face of the earth and it’s easier arranging a cuppa with the queen than it is getting some additional IT support, then something is wrong. We all agreed a slower paced rollout would suit the workforce, and we’d spend more time with all of the staff, supporting them every step of the way.

The kit arrived … then what?

So we decided on a project approach and we ordered the kit. Boxes and boxes of the stuff turned up, and we sat there looking at it all thinking, my god, where do we start with this lot!

We drew up a project plan, staging a slow and methodical rollout to each team based at each health centre. We knew every site would have some staff that love using IT, are comfortable with new technology and would embrace the change. We also knew every site would have, let’s say, slightly more challenging staff J. Joking aside, we understand that not everyone is going to be comfortable with massive changes being made to the way they were told to approach their working day. We also knew that there would be a very wide mix of skills when it came to IT. Not everyone is a whizz with computers and not everyone is comfortable with using new IT technology.

We kept this in mind all the way through, knowing that we’d have to support our staff more than we’ve ever done. Extra sessions, 1:1 to support, site visits, documentation. These lucky nurses were about to get Grade A IT support that once upon a time they could have only dreamed of!

A schedule of work was created, with Weelsby View being chosen to be our pilot site.

Then so it began…

D Day

The day arrived; the IT Team woke up that morning with butterflies in their belly, a nervousness and excited feeling, normally only felt by a bride to be on their wedding day. We walked into the site, armed with laptops, bags, monitors and the kitchen sink for good measure. We faced a room full of nervous looking nurses, and strangely, the odd hyper active and over excited nurse waiting to be given a new laptop.

We approached the support with this site exactly how we’d planned it. A couple of staff at a time, slow and steady, step by step, making  sure they were soaking up the information like a great big knowledge sponge.

For some, the knowledge sponge was more of a knowledge sieve. Not only having to learn how to use a brand new laptop, with a new operating system, they were also being shown a brand new version of systmOne and being asked to completely change their working day. We found it could be too much in one go for some staff, and they struggled taking it all in. This was something we anticipated, and something we had planned in to our support schedule.

We quickly made plans with the team to come back in and provide that all important ongoing support. We knew that providing the extra support was going to be key to this projects success. We visited site again and again to provide 1:1 support and support with groups. We sat with the team over busy periods in the office fielding their questions and queries, moans and groans, and also listening to the positives that also came along with the new kit. We even went out with the nurses on their visits into patients homes. (Turns out us IT lot are a bit squeamish and the site of a leg ulcer in all its glory is enough to send us running for the door).

With the additional support to all staff on site, the rollout to Weelsby View probably took a month. No major issues were found, no massive show stoppers, and the majority of the staff were warming to the new setup.

The power of the Super User – positivity is contagious!

Something that came out of that first rollout was something that would set us up for success the remainder of the project…Super Users!

We found having one person on site that would really champion the new devices and new systems would really help. Not only could they be a first port of call for any questions, or an extra pair of hands to sit with those that were struggling, they did something much more important - they nipped in the bud, any negativity towards the project. Staff weren’t able to sit there and moan about the devices all day, they couldn’t look for an excuse to not use them, as they had someone constantly on hand to encourage them and push them to work through any issues. This proved to be a huge benefit to the project as positivity spreads quickly through the team, and those struggling could sit and watch others around them start to reap the benefits of the new devices and give them that extra push to get to grips with it.

As the next site came round (Clee Medical), we approached with a very similar approach to Weelsby View. We took our time with the rollout and didn’t do things too quickly. We trained staff in small groups and provided as much extra support as required.

The all-important Super User naturally seemed to fall into place once again. We had members of staff stepping up and taking on the role of the Super User. This was down to their approach to the new devices, their hard work and how quickly they seemed to pick up on the new ways of working. Again having someone on site was like having an extra member of the IT team always on site helping out.

Sometimes you have to be the ‘bad guy’

As time went on, we found that staff were using the laptops all day every day. They became an essential part of their nursing tool kit and the new ways of working became a massive positive. However, those that struggled naturally drifted back towards the desktop computers still in place at their sites. We had to bite the bullet, we had to do something that would put us in the firing line and make us enemy number 1 for a short amount of time. We removed their Desktops!

To say we were unpopular amongst some staff would have been an understatement, but it’s something that had to be done. Having a £1000 device sat in a bag not being used wasn’t part of the plan, so to push staff to use them, we had to make sure they didn’t have a choice of devices. If the desktop wasn’t there, they couldn’t use it and they were forced to use their laptops. We provided mice, keyboards and large monitors to ensure that anyone struggling with the new laptop keyboards or screen size had a suitable workaround.

So the rollout continued across all the nurse teams within the organisation. Site by site, team by team, we were successfully deploying new laptops and getting staff using the new version of systmOne. Thankfully no major hiccups or issues occurred throughout the rollout, and as time went on, the project continued to be a success.

So how has it panned out?

As the project came to an end, the feedback and general views of the nursing teams across the organisation were very positive. By George I think we’d cracked it, and we’d managed to successfully rollout ‘Mobile Working’ to our nursing teams.

Since the completion of the project we’ve had contact from several external organisations asking about the rollout. Several teams internally within Care Plus Group are also expressing an interest in going mobile with laptops and systmOne mobile. I think this is testament not only to how amazingly brilliant, talented, attractive and charming our IT team are (and modest of course J), but also the incredible amount of hard work and dedication put into this rollout across the whole of the community nursing teams. From the Super Users who gave us extra support, Nurse Managers having to manage the teams transitions and issues along the way, to the members of the team who struggled and struggled in the early stages, but stuck with it, worked hard, showed patience eventually reaping the rewards of the new systems. Every single member of staff involved in this project pulled together and the staff and organisation are now seeing positive results.

Some of the changes and positive outcomes from the project inlcude:

  • On average, members of staff are saving themselves 2 hours per day by carrying out updates on patient records on the go. This has removed the need to come back into the office to carry out all their admin.
  • Time saving as above has allowed staff to carry out some of the more time consuming tasks they’ve not had time for in the past (Elearning, ordering of supplies etc)
  • Rumour has it, some staff are now actually getting time for a cup of Tea and their dinner
  • Mileage costs are reduced due to staff being able to start their day from home and also finish their day from home. They no longer have to drive into the office to check their workload for the day as they have it all on their laptop.
  • An up to date record for each patient is accessible at the time of the visit. No more guess work or relying on admin to relay details down the phone
  • Notes no longer have to be written into a paper diary (and potentially lost), then translated into systmOne later in the day. It can be done at the time of the visit or straight after.

Staff now rely on their devices more and more, many saying they feel like they’ve had their arm chopped off if they’re without it for any length of time. While I’m sure there are still staff out there who would rather actually have their arm chopped off than use their laptops, we can’t win them all and can’t convert everyone. However the general feeling amongst managers, nurses and the IT team is that the project has been a success and we can confidently say we now have a more mobile workforce.

 

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Written by: Dave Whitfield

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