Qualitative interviews with experts provided an opportunity to further explore staff perceptions of how they spend their free time. We will use these interviews to explore how different disciplines, professional groups and the wider NHS can reclaim time, enabling it to be used in different ways. We investigated the factors and barriers.
Spend more time on patient care
Several interviewees noted that technology could be used to increase productivity and the amount of care to some extent as service pressures increase. Toni Branning, a consultant anesthetist at Worcestershire Acute Hospitals and a Trustee and Trustee of the Royal College of Anesthetists, says that if processes can be “streamlined” within her specialty, “you can save more time in your day. “We will be able to handle more cases and more people will be able to participate.” Please undergo surgery in a more timely manner. She thought this would have a “direct impact” on selection backlogs and waiting lists, and would be “satisfying” for theater teams who sometimes experience “delays and waiting lists”. Stephen Harden (University Hospital Consultant Radiologist) southampton (Vice-Chancellor, Clinical Radiology, Royal College of Radiologists) explained how technology is an 'enabler'. [radiologists] Interpret more scans within a set time period and increase patient throughput. Both interviewees linked the increased amount of care to the nature of their work.
While overall productivity gains can depend on the efficiency of the entire care pathway, referral-based or list-based specialties, such as anesthesiology and radiology, are better able to utilize free time in this way. It may be more appropriate to do so. Workforce planning around the use of technology therefore requires a nuanced understanding of how workloads and the nature of clinical processes in different specialties can impact time reuse. there is.
However, interviewees cautioned against assuming that more patients would be able to get through the system if time were available. They warned that focusing solely on “throughput” is not a solution to rising patient demand and increasing case complexity. They highlighted that expecting staff to handle an ever-increasing number of complex cases puts considerable pressure on them and creates a clear risk of burnout. Additionally, it was noted that technology typically supports rather than replaces clinical staff, so it does not eliminate the need for continued workforce expansion.
Importantly, for our interviewees, time of care can include two important aspects. One is an increase in the amount of care (e.g., more appointments/interventions) and/or an increase in the quality of care (e.g., by spending more time with the patient and providing more services). comprehensive, proactive or preventive care). Joseph Alderman, Registrar of Anesthesia and Intensive Care at Birmingham University Hospitals NHS Foundation Trust and Postdoctoral Fellow at the University of Birmingham, said the ideal scenario would be to “talk to patients and do the human work that only we can do. He suggested that the idea was to give people free time. Meanwhile, Bernie Kennedy (Assistant Physiotherapy Service Manager at Belfast Health and Social Care Trust and Vice-Chairman of the Board of the Chartered Physiotherapy Association of Northern Ireland) imagines “being able to have better conversations with patients.'' But for him, it was inevitable. He said, “I want to be able to promote a broader range of health.''
The topic of personalization and prevention was raised by Asif Bakrani, Consultant Psychiatrist at the Priory Group and Associate Non-Executive Director of Kent and Medway NHS and Social Care Partnership Trust, who in his spare time We imagined how this could help fundamentally change our approach to care. Perhaps if we had more time to think about patient care, and if we had more resources in terms of both time and capacity, we could provide more direct and beneficial treatments for disadvantaged and marginalized populations. It could be done, but I don't think we've done it very well. moment. Going further, in a hopefully ideal scenario, there would be a mix of focus on population health, broader health determinants, better personalized care, and potentially early intervention. think. ”
Freeing up time for better care may be an important benefit of technology, but it is not the same as freeing up time for more care.
In policy development and public debate, clinicians often spend more time with patients as a surrogate for improved quality of care. But, as our interviewees attest, how you spend that time is very important. A study examining the impact of implementing electronic health records on nursing practice and care effectiveness in U.S. hospitals found that after implementation, the rate of nursing interventions performed per hour increased, and the amount of time nurses spent seeing patients increased. was found to be significantly longer. room. Nevertheless, nurses reported a slight decrease in nursing effectiveness. This study suggested that changes such as the addition of computers to patient rooms may have disrupted nurse-patient interactions. We must be careful about assuming that technology will always enable clinicians to provide higher quality interactions.
It is telling that in our interviews, experts characterized scenarios focused on quality of care as “ideal” or “aspirational.” Many people differ between how they believe their free time should be used and how it is actually expected to be used (i.e. 'throughput', i.e. the number of patients passing through the system). expectations that numbers will increase significantly). These demands were sometimes portrayed as challenges to improving quality of care and quality of work. An example of this was brought forward by Laura Rawlinson (Clinical Lead Physiotherapist, East Lothian Health and Social Care Partnership, East Lothian Rehabilitation Service), who said the NHS is currently responding to demands by He explained that he is struggling with how to navigate between a “safeguard'' response and a more proactive “preventive'' response. ' is approaching. By spending more time, you may be able to focus more on the latter.
Frees up time for a wider range of professional activities
Many interviewees also believed that current service pressures presented a challenge to devoting time to broader professional activities such as teaching and training, research and quality improvement. Our interviews show that both national policy and local leadership are seen as important for fostering a culture in which the value of wider professional activity is recognized, including its contribution to increased productivity. I did. Anesthesia and Intensive Care Registrar Joseph Alderman said the change was aimed at “making the case at the highest level within the health service” that this type of work is “mission critical” and a “systems requirement”. However, Susan Shelmerdine, Consultant Pediatric Radiologist, Great Ormond Street Children's Hospital, and member of the Royal College of Radiologists' AI Clinical Radiology Working Group, said the system “doesn't do all of this… “We need to reach a mindset of being important,” he said.
Several of our interviewees also emphasized the importance of clinicians having time to think and reflect. Sandy Jackson, specialist trainee in anesthetics and intensive care medicine and NIHR postdoctoral fellow at the University of Southampton, has developed a cognitive therapy that helps clinicians “take five minutes to think and engage by simply taking a breath”. They wanted technology that would “lighten the load and reduce fatigue.” '. Think time was variously considered important for supporting patient care, improving health and enabling service redesign. Paul Bradley, Consultant Psychiatrist and Chief Clinical Information Officer at Hertfordshire Partnership Universities NHS Foundation Trust and Specialist Advisor in Mental Health Informatics to the Royal College of Psychiatrists, said: 'Learning about new technology and preparing for the future. “It will take a lot of effort to adapt the way we work towards this goal.” Faith Ndebele, Consultant Psychiatrist at Solent NHS Trust and Chair of the Digital Psychiatry Special Interest Group of the Royal College of Psychiatrists, said she would like her time to be “more focused on giving”. explained. [clinicians] You can spend a little space thinking a little more strategically about your work. […] We're spending more time looking at their caseloads, finding new and innovative ways to do things, and thinking about how we can change the system..
More broadly, the fundamental question of how we use our free time is thought to be interrelated with the quality of work, staff wellbeing and retention. Ben Jeeves, Deputy Chief Clinical Information Officer, Clinical Safety Officer and Advanced Practice Physiotherapist, North Integrated Musculoskeletal Service, Midlands Partnership Universities NHS Foundation Trust, said: Whether it's leadership, education, training or digital. ” He felt that “a variety of tasks” helped “avoid burnout.” Consultant psychiatrist Faith Ndebele said having “flexibility” in how they spend their free time “goes a long way towards improving staff retention within the NHS,” as it makes different jobs “better and more fulfilling”. It might be helpful.” These statements include clinical staff who want policy makers and employers to understand how to improve the quality of their work – how to make their work more manageable, more meaningful and a better experience. Desire is implied.
The need for stakeholders to jointly decide how to reuse time was highlighted by several interviewees. For physical therapist Bernie Kennedy, this approach would require “shared decisions between those providing the service and those receiving the service.” [is] is provided for. Faith Ndebele envisioned a scenario where she would have a “conversation” with clinicians to get “buy-in” on how to increase capacity using the system “giv.”[ing] It is about “getting something back'' through an agreement in which clinicians set aside a certain amount of time for health and professional development activities. Similarly, radiologist Susan Shelmerdin felt that staff would be “more likely to agree” to the change if it meant “protecting” time for other activities. Interviewees again suggested that supportive leadership and sensitive policy-making are key factors in enabling a more collaborative approach to utilizing free time.
