This case study features in the NHS Innovation Accelerator’s year three research report, Understanding how and why the NHS adopts innovation.

Description

DrDoctor is an online and text-based service that allows patients to confirm, cancel, and change bookings digitally. For hospitals, this means they can maximise and manage the volume of appointments to best fit their capacity. The technology can target long waiting lists and automatically highlight available appointments so that patients can be booked in. In addition, it provides digital assessments before and after appointments, saving time for both patients and caregivers.

DrDoctor needs to integrate with existing hospital systems for managing patients – the Patient Administration System (PAS) – to be able to deliver its service. The PAS manages scheduling and appointments for all outpatient clinics.

DrDoctor’s scheduling platform offers a range of functionality that can be adopted in stages. These are:

1. Improving communication with patients regarding appointments via a patient portal that can send notifications and text messaging
2. Using text messaging to offer alternative appointments if slots become available
3. Moving the whole patient booking approach to an automated system that accesses and manages waiting lists directly

Adoption journey

Engagement and Initial Pilot
Contact between GSTT and DrDoctor began in 2013 when the General Manager for Women’s Services in gynaecology identified the high number of missed outpatient appointments – ‘Do Not Attends’ (DNAs). DrDoctor was identified as a potential solution. However, the Trust was already underway with a procurement process for a text-only appointment booking solution, and DrDoctor’s functionality was broader than the procurement specification.

In 2014 the General Manager for Women’s Services developed a short business case that focussed on the reduction of DNAs and led to GSTT piloting DrDoctor in gynaecology in 2015. A small amount of funding covered the cost of the DrDoctor service as well as paying for IT integration.

Roll out across specialties
The pilot provided sufficient evidence that DrDoctor reduced DNAs to justify a broader roll-out across GSTT.

At the same time the Chief Medical Officer at GSTT saw the additional potential of DrDoctor to reduce the cost of postage by replacing letters with electronic communication. The Chief Medical Officer took a Senior Responsible Officer role (SRO) for the wider deployment of DrDoctor to all outpatient departments in 2016. A project board was assembled including the SRO, an operations lead and a finance lead. The data from the pilot was shared with the hospital general managers who then joined the project board as the rollout occurred in their departments. Each department and IT made funds available to deploy DrDoctor.

Integration with the PAS, recruitment of clinical and administration staff and training was overseen by the general managers.

DrDoctor created a bespoke training package for the setting up of clinics, allocation of clinical codes as well as for the booking administration staff. Each role was trained in a series of practical, on-site sessions delivered by the DrDoctor team. Training covered, not only how to use the software, but how to align appointment booking processes with the new system. During the go-live process, 142 ‘Super-Users’ received 1:1 training sessions and 224 booking clerks attended classroom training sessions delivered by the DrDoctor team to manage the transition to the new system. Weekly team meetings were held to feed back on progress and early benefits.

Extending the use of DrDoctor at GSTT
The successful deployment across the hospital of the text messaging functionality has helped highlight opportunities to use DrDoctor to deliver further benefits beyond reducing DNAs and reducing spend on postage. The General Manager for Women’s services shared the results of DrDoctor’s impact with other General Managers and Clinical Directors across the Trust acting as an internal champion. In March 2017, the GSTT dental service then began to implement the further stages of DrDoctor which offers patients the option to book alternative appointments.

Since April 2018, DrDoctor has implemented patient-led booking. The rationale for piloting these further uses in dental is because the service is not connected to other booking systems which can cause conflict in allocating appointments.

Next steps
Interviewees anticipate that GSTT will continue to extend the usage of DrDoctor so that all stages of its functionality are adopted across the hospital.

Enablers

Collaboration between DrDoctor’s team and multiple senior level champions at GSTT representing different functions: clinical, operational, finance and IT. To enable this close working, DrDoctor co-located with GSTT’s site, enabling DrDoctor staff to rapidly assist with problems at the hospital site.

Staged deployment: DrDoctor offers a number of different functionalities that can be adopted in stages depending on both the readiness of the organisation and the particular challenge one ward/speciality is looking to address. The fact that DrDoctor is an innovation that can be deployed in stages meant GSTT was able to develop the business case and justification to trial, roll-out the service, and also extend its usage to a second level, more-automated functionality.

Tailoring according to need: DrDoctor adapted progress reports according to the priorities and concerns of different staff groups, meaning information produced has been used to improve both resource management and allocation of clinics.

Impact

  • 30% DNA reduction equivalent to seeing an extra 2,440 patients per year, resulting in £317,000 savings in the Women’s Service
  • Together, GSTT and DrDoctor realised a £2.6M financial benefit from the first year of rollout
  • Since trialling patient-led booking, GSTT Dental Services have booked 6,000 new outpatient appointments through DrDoctor
  • GSTT saw DNAs reduced by 34% within the pilot phase, equalling £317,000 in increased revenue

Implications

Platform solutions, like DrDoctor, tend to have wide-reaching impacts across a whole organisation. As such, successful adoption is likely to be a collaborative effort, involving multiple champions (from different departments and levels of seniority) advocating for change.

Platform solutions also offer unique insights for adoption. Firstly, a platform that offers immediate financial benefits (in this case DNA reduction) can be used to create the initial business case for the intervention, allowing longer term benefits to be realised at a later date. Secondly, the ability of platform solutions to address a broad range of needs/benefits means early engagement discussions can be tailored to the specific priorities of different adopter sites (in this case either reducing DNAs, managing demand/waiting times, or increasing clinic efficiency or automating bookings). Finally, the ability of sites to adopt platform solutions in stages can facilitate sustainability as the innovation continues to deliver increasing value over time as more functions are deployed.

Interviewees

1. Dr Ian Abbs, Chief Medical Officer, GSTT
2. Simon Blazer, Finance Lead, GSTT
3. Donna Holder, Deputy General Manager- Dental Directorate, GSTT
4. Piotr Karczewski, Business Support Manager – Dental Directorate, GSTT
5. Emma McLachlan, Programme Director – Digital Patient Journey, GSTT
6. Jenny Thomas, General Manager for Women’s Services, GSTT
7. Tom Whicher, Founder of DrDoctor, NIA FellowRead the NIA’s 2018 research report,
Understanding how and why the NHS adopts innovation