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An increase in two home visits per nurse per day, and better patient and staff outcomes using Citrix and Microsoft
Delivering healthcare at the right place and time is essential for better patient outcomes. Lewisham and Greenwich NHS Trust’s smart use of technology makes it possible to deliver care at the point of need, even during a pandemic lockdown.
The trust operates two acute hospitals and community care services that serve a population of around a million people. Faced with increasing demand for services and an ageing population, it is finding ways to be more effective with the resources it has. Proactively addressing the needs of some patients at home can keep people independent and healthy, while also freeing up hospital beds.
As Director of Integrated Care & Development Jim Lusby says, “If, through the use of technology, we're able to intervene much more proactively, and help [patients] manage their conditions closer to home, or if we're able to intervene much earlier during a hospital stay in a way which allows them to return home much more quickly, all the evidence says that is much better for the patient.”
Lewisham and Greenwich chose Citrix Workspace and Citrix Cloud services delivered over Microsoft Azure to enable a more agile approach to its community services. It selected Platinum Citrix Solution Advisor Cetus Solutions to help design and deploy the solution.
CTO Justin Beardsmore explains the decision: “We wanted to deliver a solution that was more than purely transactional and we saw the linkage between Citrix and Office365. We saw a greater synergy between Citrix and Microsoft than with other vendors and Cetus had strong relationships with both.”
Protected Health Information (PHI), mandates that only healthcare providers and related professionals who need it in order to care for the patient have access to identifying data. With Citrix, clinicians can meet PHI requirements working from any device, anywhere. That means no more travel to the office to pick up case notes and check for updates before their day can start.
“Our staff now have a holistic, real-time picture of their clients’ care at their fingertips,” explains Dorett Davis, General Manager for Children's Specialist Services and Head of Children and Young People Therapies. “That includes referrals or interventions not just from the community clinical teams but from professional colleagues such as GPs or health visitors. That wasn’t possible, before. In the past, staff would have had to come back to the office to pick up new information. There may have been decisions that couldn’t be taken at the time of a visit because staff didn’t have the full picture.”
The children’s services team can spend three quarters of its time out of the office, working at schools or visiting clients in their homes, so remote, real-time access saves valuable time, enables staff to be more productive and gives them greater control over their working day. The time saved means that community nurses can now visit two more patients per nurse per day.
“All of our community services moved overnight to remote working.”
When the coronavirus pandemic arrived, Beardsmore explains, “With Citrix Cloud services, we were able to double our capacity, from 600 to 1,200 users, overnight. There’s no way we could have scaled so quickly if we hadn’t already been on cloud.”
“And, because we had the infrastructure in place,” he continues, “Community Services were able to reshape their own services without needing support from the center.”
“In Children's Services, we literally just upped and moved to remote working overnight,” says Dorett. “It quickly became our default setting and, as a result, community services continued to function. Families were very surprised and grateful that our staff were still able to interact with them during the lockdown period.”
Community staff like nurses and therapists used their trust-owned laptops to connect from their homes. Administrative and support staff often used their own, personal devices. In all cases, secure access was managed using Citrix, ensuring that staff could continue to work as effectively as possible in the circumstances.
“We kept going,” Dorett says. “We delivered care. We were able to respond. If this had happened two or three years ago, before we had Citrix, we would not have been able to function.”
Citrix has enabled Lewisham and Greenwich to pioneer new methods of delivering therapy and working with children.
Dorett explains, “We saw it as a great opportunity to explore different ways of working and to be able to embrace teletherapy. So, for example, we have a therapist who's based here at Kaleidoscope, and she's able [with Citrix] to deliver therapy to a school that's five miles away.”
The combination of Citrix, Microsoft Azure, Teams, Azure Virtual Desktop (formerly Windows Virtual Desktop), and therapeutic technologies has been very successful with pupils engaging well with their remote therapist and the technology.
Using teletherapy saves travel time in a busy urban environment and also means that therapy can be delivered to places outside its traditional scope.
The trust is also leveraging videoconferencing to improve patient experience. Where before, a second opinion would require a second appointment now, Dorett says, "We're able to do second opinions using video conferencing … we're able to have the therapist remotely join, observe the therapy session and give advice.”
Using Citrix, Lewisham and Greenwich is reimagining the way that community care is delivered, with consequent improvements for both patients and staff.
As her team moved to remote, virtual working during the pandemic, Dorett was careful to also use the technology to maintain team spirit and morale. Team and department meetings moved online, and Dorett also instigated smaller, more sociable, online gatherings for well-being and, as she says, to recreate those in-office water-cooler moments.
“We still celebrate when people are leaving or have virtual baby showers,” she says.
Citrix and Microsoft Teams also supports staff recruitment and retention. During the lockdown period, the trust continued to interview, recruit and on-board new staff while remote working enables the organization to retain staff even if they move home further from their place of work.
As Citrix changes the focus from places of work to spaces for work, Lewisham and Greenwich is finding new ways to use its existing real estate.
“A lot of our estate is Victorian. It was designed for very different purposes from what we use it for today. We have an opportunity with technology to co-locate different groups of professional staff, bring different teams togethers, use the estate differently and more imaginatively, allow people to work really, flexibly. That's a really exciting opportunity for us,” says Lusby.
Overall, he concludes, “It's really important that we're able to provide modern, forward-thinking, models of care, and provide people with the tools to provide that care in the right way.”
Our staff now have a holistic, real-time picture of their clients’ care at their fingertips. That includes referrals or interventions … from professional colleagues such as GPs or health visitors. That wasn’t possible, before.