The need to prioritise valuable hospital beds has been magnified by the COVID-19 crisis. Moving patients that are medically fit out of the acute hospital environment and into a care home, community setting, or their own home, frees up space for new patients that require hospital care. But the process of discharging patients has specific safeguards wrapped around it involving many teams of people from many different community health and adult social care agencies.

Being able to drive efficiency and maintain quality of care for patients flowing through the various stages of a health system is crucial to the positive care outcome of individuals. So how can healthcare achieve a smooth flow of patients in and out of the care system? What change and tools are needed? And how can holding hands with a critical friend help?

New ways of digital working ushered in by COVID-19

Manchester is a major city in the northwest of England. It stretches north and south from the city core to its greater metropolitan outskirts and has a diverse population with a range of demands on local authority and care services. Two years ago, before COVID-19 had entered the vocabulary, Manchester’s forward-thinking leaders joined together to work as one health and social care services team. Its aim was to provide people with equal and compassionate access to health and social care. Manchester Local Care Organisation (LCO) was born in April 2018.

From the outset, the objective for Manchester LCO was to bring together the different elements of community-based health and care, such as community health, primary care, mental health and social care under one banner. It also focused on positive relationships with wider stakeholders such as neighbourhood groups, charities and voluntary sector organisations that support the physical and mental health of patients and wider citizens. The new organisation aimed to reduce process duplications, eliminate silo working, encourage the sharing of data via IT for better decision making and create more resilient community services. In October 2019, community health services in Trafford moved to a new model and Trafford LCO was formed. This sees both Manchester and Trafford’s out of hospital health and care services delivered under a single LCO executive structure, expanding the footprint for coordinated delivery of these services across the two neighbouring areas of Greater Manchester.

When COVID-19 arrived, the need for fast-tracked change became critical. Traditional ways of many in-person meetings per day had to change overnight into virtual working methods as staff worked at home to comply with government guidelines and clinical teams needed to minimise contact with patients as part of infection control. The delivery of care services had to be sustained.

The efficient discharge of patients from acute hospitals into community care

“Meetings that bring together medical directors from hospitals, GPs and social workers are essential to discuss patient cases and decide on the best next steps for individuals. However, getting people together over a wide geographical area was always a challenge. Before COVID-19, we tried to rotate meetings around the four key localities of Manchester and Trafford, but if a physical meeting was held in one area, we would have poor attendance from representatives across the city as workload time pressures outweighed the half a day travel and attendance required,” states Sohail Munshi, Chief Medical Officer (CMO) for Manchester and Trafford LCOs.

“When COVID-19 hit we were forced into making a rapid change in the way we met as an organisation"

“When COVID-19 hit we were forced into making a rapid change in the way we met as an organisation. Now by meeting digitally, membership of our meetings has tripled in size – previously we would get 50% of requested attendees, now it is 80-90% and another 150% want to join in! This has transformed the way we make decisions and speeded up processes. With the right people on the computer screen all together it has also reduced the number of sub-meetings we need to make the best decisions for a patient. This may include discharge from hospital into a care setting or providing additional care services to keep a patient at home. The advantage of virtual meetings is people can dip in and out of the parts they are required for and with no physical travel it has created so many working efficiencies,” he continues.

"We overcame interoperability issues of six different IT systems and brought our entire operational infrastructure online shortly after the UK outbreak of COVID-19 so that we could continue our business as usual. This was essential to keep patients flowing through care chains.”

Mark Edwards, Chief Operating Officer (COO) at Manchester and Trafford LCOs adds, “By working with GE Healthcare as a partner, we were guided to set up virtual meetings and create a command-and-control structure using existing Microsoft technology. We overcame interoperability issues of six different IT systems and brought our entire operational infrastructure online shortly after the UK outbreak of COVID-19 so that we could continue our business as usual. This was essential to keep patients flowing through care chains.”

He continues, “Being able to make rapid and important decisions about patients kept the impact of the virus pandemic on our function to a minimum. In the early days of the virus outbreak, and before any national edicts, online stakeholder discussions included the roll out of local COVID-19 testing before all hospital discharges – this collaborative decision making most definitely saved lives in the Manchester and Trafford areas.”

Keeping the patient at the heart of all decisions

“We don’t intend to go back to the old ways of working."

“We don’t intend to go back to the old ways of working. We can now have 40 people join a virtual meeting which would have never happened before – we would not have had access to a meeting room that size,” adds Mark Edwards, COO. “Virtual meetings have introduced a new style of open and collaborative communication that will keep on growing. For example, at present there are a lot of cross-organisation meetings about the roll out of the COVID-19 vaccination programme in our area. Keeping discussion inclusive for many people is crucially important as it has ramifications across the different care settings.”

"This triangulation of digital care communication – for example the patient, a GP and a district nurse – saves a number of repeat conversations or duplicated meetings and speeds up clinical decision making whilst keeping the person it involves at the centre of the conversation.”

“In addition to operational benefits, the digital transformation at Manchester and Trafford LCOs has enhanced the clinical standard of care we can provide to patients,” states Sohail Munshi, CMO. “Firstly, being able to offer safe clinical video consultations has inspired faith and trust on both sides during the anxiety of the pandemic. Secondly, we can use time more efficiently to speed up and simplify decisions. If we had to do physical visits to patients, the time would triple to put on PPE, have the consultation and then de-robe. Now we can meet on screen and widen participation by inviting appropriate representatives from neighbourhood teams of health and care professionals. This triangulation of digital care communication – for example the patient, a GP and a district nurse – saves a number of repeat conversations or duplicated meetings and speeds up clinical decision making whilst keeping the person it involves at the centre of the conversation.”

Partnerships to help shape new thinking and technology use

Operational resilience in healthcare is needed at all times, but most certainly when a crisis hits. Having an external pair of eyes through a partnership can help make answers to challenges more obvious, shape new thinking plus unlock the potential of technology and data.

“Do not underestimate the need for advice and guidance to bring about organisational change,” concludes Mark Edwards. “There is always a part of the journey where you need to bring in a partner to gain scale and pace.”