COMMENT: Using technology to mitigate risk in elderly care services

Following the Care Quality Commission’s attack on elderly care services in England, MIL MILOJEVIC, director of product strategy at Allocate Software, explores how technologies exist that can ensure trusts are risk aware and ensure they are meeting minimum standards

IN June 2011 the Care Quality Commission (CQC) criticised five NHS trusts for failing to meet basic standards of respecting patients in two scathing reports on elderly care. The inspections will continue through to September as part of an England-wide review of 100 hospitals and the findings will no doubt lead to speculation about the state of elderly care in today’s healthcare system; and at a time when hard questions are being asked about the impact of budget cuts and the potential repercussions on patient safety.

One should hope that the review into elderly care will drive home the message that complying with minimum standards is an ongoing concern rather than an annual assessment

One should hope that the review will also drive home the message that complying with minimum standards is an ongoing concern rather than an annual assessment. In the present regulatory landscape trusts are now coming under more pressure than ever before to continually demonstrate compliance, not just at the point of inspection, or even worse, once an incident has been reported and the damage has been done.

As the CQC broadens the sources of information it uses to identify flaws in quality care, trusts will be subject to even greater scrutiny and exposure. Once a service has been red flagged, the NHS trusts concerned will need to spend a huge amount of time and effort demonstrating that the source of the problem has been fixed. While this is a valuable and necessary exercise, it does put trusts on the back foot and trapped in a cycle of exhausting considerable resource proving compliance before apportioning adequate attention on actually practicing compliance on a day-to-day basis.

In the present regulatory landscape trusts are now coming under more pressure than ever before to continually demonstrate compliance, not just at the point of inspection, or even worse, once an incident has been reported and the damage has been done

In this scenario, the best defence is transparency. Given the escalation of the CQC’s activities and the imminent emergence of new tools and methodologies to track quality based risk profiles, healthcare managers need even greater visibility about how their trusts are being run and confidence in the information they receive. And yet a sizeable proportion of healthcare trusts currently only task one or two people with ensuring compliance across their entire operations. Ironically, in these instances, that individual actually poses the greatest risk to the organisation they’re trying to protect. By residing all knowledge and responsibility with one person, the consequences of any disruptions to the person’s day-to-day duties, (ie holiday or sick leave) can be hugely detrimental.

Full compliance can only truly be secured by seeking cross-organisational support from managers and frontline staff and spreading accountability across the board. The breadth of this undertaking is achievable through modernisation. The technology already exists to provide complete transparency of how wards are being run, to indicate when a hospital is at risk of breaching a minimum standard, and to enable trusts to take pre-emptive action before patient care is compromised. By assigning responsibility for each individual task and providing a single lens through which to assess risk and patient safety, trusts have an opportunity to reduce human error while protecting the patient.

The technology already exists to provide complete transparency of how wards are being run, to indicate when a hospital is at risk of breaching a minimum standard, and to enable trusts to take pre-emptive action before patient care is compromised

However, it is also important to recognise that the processes and culture are as important as the tools required to provide this transparency. While a management dashboard will reveal the organisation’s own assessment of what actions need to be carried out and by whom, ultimately the responsibility rests with the staff to fulfill their duties and the onus resides with management to ensure processes are put in place to support staff with their tasks.

With compliance rising up the healthcare agenda, evidence of accountability, ownership and risk management are emerging as number one priorities. Good governance will cease to be a matter of sporadic form filling, but an urgent call to action implicit in everything a healthcare professional says and does. It will be a crucial instrument in preventing unnecessary patient suffering and the administrative burden that follows righting a wrong.

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