Read how the HSCIC are working with the NHS to reduce burden and bureaucracy. Presentation delivered at the Healthcare Efficiency Through Technology (HETT) Expo 2014 - areas covered included: - Tackling bureaucracy in the NHS - Auditing bureaucracy in the NHS - Testing the hypothesis - Report findings and recommendations - Top ten tips - Changes that make an impact - Self-assessment toolkit - What's next?

1. Busting Bureaucracy
Working with the NHS to reduce burden and bureaucracy
Healthcare Efficiency Through Technology 2014

2. Setting the scene
2
A statutory duty of
the Health and
Social Care Act
2012
“.. seek to minimise
the burdens it
imposes on others1”
The response to the
Mid Staffordshire
inquiry Hard Truths
“…minimise
bureaucracy,
enabling time to
care and time to
lead2”
• 1 Health and Social Care Act 2012
• 2 Hard Truths published by the Department of Health published January 2014
• 3 NHS Confederation report Challenging Bureaucracy
• 4 A Strategy for the Health and Social Care Information Centre 2013 - 2015
NHS
Confederation’s
Challenging
Bureaucracy report
“the effects and
impact of
unnecessary
bureaucracy from
national bodies3”
“HSCIC has a statutory duty to ensure that the amount of time and effort
involved in administration and bureaucracy is kept to a minimum to allow health
and care professionals to devote as much time as possible to providing care to
people who need it 4”

3. How do we define burden and bureaucracy?
• Burden - “a duty or
misfortune that causes
worry, hardship, or
distress”
• Bureaucracy -
“excessively complicated
administrative procedure”
3

4. Tackling bureaucracy in the NHS
• Audit of 16 acute trusts
• Busting Bureaucracy report
published
• Top 10 tips published
• Self assessment toolkit
• Working on a longer term
bureaucracy audit in collaboration
with two trusts: Royal Liverpool &
Broadgreen University Hospitals
NHS Trust Liverpool Women’s NHS
Foundation Trust
• Audits to be continued in Mental
health, Community and CCG’s
4

5. Auditing bureaucracy in the NHS
• 16 acute trusts
• Week long
5
audit
• Observation,
interviews and
structured
surveys
• Shadowing
clinical and
administrative
staff

6. Testing the hypotheses
Hypothesis Findings
“Nurses and doctors spend a
significant amount of time per
week on bureaucracy”
An average of 66 per cent of a
junior clinician’s time is spent
accessing or updating patient
notes1
“The use of technology and
smarter processes reduces
burden and bureaucracy”
77 per cent of Trusts type up
paper notes retrospectively into
an
electronic system2
“The use of technology
releases clinical staff time
(which could positively
contribute to the time
to care)”
The use of Computers on
Wheels has reduced ward
round times by 45 minutes3
6
1 Busting Bureaucracy Report, June 2014 - See Table 2, page 20
2 Busting Bureaucracy Report, June 2014 - See 2e, page 19
3 Busting Bureaucracy Report, June 2014 - See 3e, page 24

7. Testing the hypotheses
Hypothesis Findings
“The better the local systems
are, the better the acute
provider is able to meet
reporting needs”
It has taken some audited
Trusts two years to fully
implement a solution to
delivering a new return;
involving interim ad-hoc
solutions, requirements
definition, supplier quotation,
delivery, testing and
implementation. Until
developed, manual
bureaucratic processes
pervaded.
“A national concordat would
have a positive impact on
reducing
burden”
In the preceding 12 months, an
average of 10 external
datasets were introduced or
changed4
7
4 Busting Bureaucracy Report, June 2014 – See 1f, page 12

8. Report findings and recommendations
Controlling burden and bureaucracy
8
Implementing processes
Technology adoption to minimise bureaucracy

9. Top ten tips
9

10. Changes that make an impact
Review internal governance of data
collections and ensure that there is
a clear documented process for
implementing new data collections
and managing existing data
collections.
10
Organisational
ownership

11. Changes that make an impact
All data collections have a cost to
an organisation. Ensure that all
new and existing data collections
are supported by a business case
identifying the resource
commitments.
11
Cost of data
collections

12. Changes that make an impact
Ensure that investment decisions
are assessed against criteria which
drive clinical effectiveness, improve
processes and reduce burden and
bureaucracy.
12
Value of data
collections

13. Changes that make an impact
Management of
data collections
Ensure that all data collections
have: an identified owner; a review
date and process; explanatory
documentation and a support
structure.
13

14. Changes that make an impact
Consider the holistic
implementation of data collections
supported by efficient processes
and appropriate, available and
accessible technology.
14
Data collections,
processes and
technology

15. Changes that make an impact
Understanding
the impact
Use the self-assessment toolkit at
least annually to develop a
baseline view of the level of burden
and bureaucracy and to track
improvements.
15

16. Changes that make an impact
Driving efficiency
Review the implementation of
existing technology and its
effectiveness in supporting efficient
processes.
16

17. Changes that make an impact
Data collection
as part of
delivering care
Consider the implementation of
new technology and in particular
electronic patient records (EPRs)
to directly support care pathways,
care settings and data collection.
17

18. Changes that make an impact
Explore innovative approaches to
reducing burden and bureaucracy.
Consider ergonomics, accessibility
and availability of systems.
18
Embrace
innovation

19. Changes that make an impact
Staff involved in data collections
and the use of systems will have
valuable insights and suggestions
for improving efficiency and
reducing burden and bureaucracy.
Set up mechanisms to encourage
their input.
19
User
experience

20. Self-assessment toolkit
hscic.gov.uk/bb
20

21. What’s next?
21
Collaborative audit
report
Self assessment
toolkit
Top tips for trusts
Working with the
Burden Advice and
Assessment
Service
Two pathfinder
trusts …
Further audits –
Mental Health
Community
CCG’s

22. The journey so far…
“High quality data is crucial
to transforming care, which is
recognised by both health
professionals and the public.
However we want to work
with providers to stamp out
unnecessary bureaucratic
burden on those who provide
care.”
Kingsley Manning, HSCIC Chair
Source: BB press release issued on 6 June 2014 22

23. Connect with us
www.hscic.gov.uk
@hscic
www.slideshare.net/hscic