This guide was created for carestockroom.com by the brilliant Joanna Morgan who was until recently the Chief Operating Officer for a small group of CQC-registered residential respite centres. We asked her to write the guide she wished she’d had when she was at the start of their journey in implementing a Digital Care Management System.
Guide – How to implement a Digital Care Management System
In this guide we’ll cover:
- Choosing the right system for your organisation
- System design and build
- Implementing a new system
- Benefits and feedback
1. Choosing the Right System for YOUR Organisation
The good news about selecting a Digital Care Management System is that there is lots of choice in the market. The bad news about selecting a Digital Care Management System (DCMS) is that there is lots of choice in the market! Check out some of the available systems here to get an idea of the wealth of providers available here.
There are many significant quality and efficiency benefits to having a DCMS installed within your operation. The embedded processes and control mechanisms within the system help ensure that quality care assessments are made and followed for all service users and practices are consistent across all locations. The move away from hand written paper processes to a modern digital based platform enables significant efficiencies by reducing the time spent on administration therefore allowing more time to be spent with residents delivering high quality care interventions. Additionally, a DCMS will enable a level of real time operational oversight both onsite and remotely which is not possible via a manual system.
The system choice process will firstly involve identifying exactly what your organisation really wants from a DCMS; there is a myriad of things they can do. As well as recording medical and personal care interventions and setting alerts to ensure that care is delivered in a timely manner, a DCMS can also host documentation, log activities, and record photographs and videos of residents. Systems can also be used for indirect care management such as managing staff scheduling and attendance, tracking maintenance issues and cleaning schedules or hosting policies, procedures and training. Some of the more sophisticated systems can even link to local pharmacies to order medication and repeat prescriptions and links or apps can be given to residents themselves, their families or external practitioners to log in and record or review notes and progress. All these capabilities are available in a DCMS, it is important to establish exactly what system functionality you need for YOUR organisation. All the bells and whistles are great but they can cost a lot!
A good way to conduct this is to discuss the objectives for investing in a DCMS with your team – are you looking at efficacy when delivering care and writing up notes, are you looking at promoting more self-directed care or do you just want better management information when it comes to care records? It is likely that each functional area within your organisation will have different priorities when it comes to what the system can do for them! Standard functionality such as recording care and nursing interactions will be an expectation from any DCMS, however the nursing team may be interested in functionality around ordering medication, whereas a manager may want the system to be able to help with accurate staff scheduling – everyone’s needs will be different. It will be important to prioritise the functionality for your system into ‘MUST haves’ and ‘NICE to haves’. Costing is usually based on a monthly license fee and the more sophisticated your DCMS, the higher the cost each month.
Once you have established what you want your system to ‘DO’ it will also be important to identify ‘HOW’ you want the system to do it. Most DCMS are multi-platform, they will run on PCs, tablets, hand held devices, phones etc. What is important for your organisation is how the system will be operated by the end user(s) within your operation. It is likely that there will be multiple users in different locations e.g. in different offices, residents rooms or out in residents homes if you are operating domiciliary care. The system will need to work in a way that suits your team(s). It is also worth considering the end user and their use of the system and devices. Many DCMS on the market now offer voice recording (where the device records a vocal update to the notes and this converted into text within the care records), this is particularly useful for staff where English is not their first language. Some systems even support the ability for the resident to record their own personal care onto their profile from an app on their phone, which is extremely valuable if your operation is supporting individuals with maintaining independence and self-directed care. It is a vital part of the choice process to gather user requirements from all prospective users to help with identifying the right DCMS for your organisation.
Finally, once you have established the required system capability and functionality, it is essential to narrow down those choices via system demonstrations from your selected suppliers and compare quotes for the system that you need. DCMS providers will try and sell you the ‘all singing, all dancing’ version of their system, refer back to your ‘MUST and NICE to haves’ and use these to help optimise quotes to get the best value for the greatest range of system ability for your operation.
2. System Build and Design
Almost every supplier will tell you that their system is ‘off the shelf’ or ‘plug and play’, which is all very well and good if their standard system set up works for your operation. However, it stands to reason that a system that works well in a care home will need to work slightly differently in a domiciliary environment or a day centre. It is advisable to establish with your chosen provider whether their system does have customisable features (thankfully most systems do!) and how the system can be designed and built to suit your environment. At this stage it is again advisable to have input from a selection of end users; from carers who are recording care notes to managers who may want to run reports from the back end of the system, everyone will need to use the system for different purposes.
The simplest way to gather this data is to run through ‘Day in the Life Of’ (DILO) scenarios for each user e.g. what is a standard DILO a nurse in your organisation and how does that interact with the DCMS or what is a typical DILO a resident being cared for by your organisation and how does that need to be recorded in the system. The more DILO scenarios that can be considered, the better your organisation will understand how, when and where the DCMS will be used. This will also be vital when it comes to ordering the correct number of handheld devices or tablets (if applicable) and to determine access from PCs, laptops and potentially external users.
Once you have worked with your DCMS supplier on the programming and build it is important to test, test and test again – become ‘Testy McTest Face’! Run the system in a ‘demo’ mode against the DILO scenarios that you mapped out – does it work, is it simple and workable for the end user, does it make life easier (this is the hope!) or has it created more work?
Talking about the new DCMS coming in will be important to ‘set the scene’ for your team, at this stage you will have certain individuals who are really interested in the fact the organisation are doing this – these people are critical, they are your ‘Early Adopters’ – they are likely to be people who will want to test the new system out so use them wisely. Testing will be all-important before the system is rolled out ‘live’, to help iron out any potential creases and fix any glitches before you let the rest of your team loose!
3. Implementing Your New Digital Care Management System
Fact of life, nobody likes change! Yet change is inevitable so effective communication and a structured implementation and training plan for your team will be essential to help them navigate the change process that this new system requires. You will need to decide:
- WHEN to implement your DCMS – when is the best time to do this (avoid peak holiday times or other times of pressure such as financial year end)
- HOW to implement the system – all areas at once or certain functionality at a time, consider your priorities
- WHERE to roll it out first – is there a specific location or part of the organisation that you would chose first?
- WHO to roll it out to first – which group of users (remember your Early Adopters – use them to help spread the positive word!)
- COMMUNICATION – not just to staff but also to residents or service users (you don’t suddenly want complaints that your staff are always ‘on their phones’ if they are getting used to new hand held devices for the DCMS)
All of the above will need to be considered when designing an Implementation and Communication Plan. Liaise with your DCMS Account Manager or Key Contact from the supplier organisation – remember they will have done this countless times and therefore will have invaluable advice on a successful implementation. They may also be able to support you with collateral and communication documentation – remember it is in their best interest that this goes well too!
Training is a key part of the system deployment. Ensure that sessions are booked well in advance, attendance is scheduled, recorded and made mandatory and that trainees have to pass a level of competence before they are allowed onto the live system. It is wise to have one or more Superusers within your organisation who are the ‘go to’ people for basic questions and queries as this will help build up internal knowledge and expertise. Moving forwards DCMS training will need to be included within any Induction programme for new starters.
Set out an implementation timetable and wherever possible stick to it – if you have chosen the right system functionality, thoroughly tested it against DILO scenarios and taken test feedback from Early Adopters there should be no reason why the rollout of your DCMS should not go smoothly. However, always be prepared as you can never really know a system until you are using it in a live environment – where end users will unwittingly but inevitably try and ‘break’ it and technology will always surprise you!
Wherever possible agree a ‘bedding in’ period where your organisation has time to get used to operating with the new DCMS. This may involve a period of time where you run a digital and a manual system concurrently or you may choose to have more regular management oversight of the care records at a granular level for audit purposes. However you decide to manage this part of your implementation, ensure that you have a ‘scheduled date’ to aim for where the implementation is to be reviewed and should be considered as finished so you can confirm the execution of the project complete (and hopefully a success!)
4. Benefits and Feedback
Once you have completed the implementation of your DCMS you need to arrange a Project Implementation Review (PIR) session where you review and evaluate the rollout of the system against your original objectives. This also helps you report on the Return On Investment (ROI) for this project (after all, implementing a DCMS is a significant ongoing investment!).
Use the PIR to look back at the original goals and objectives for installing a DCMS; was it time saving, promoting person centred care, improving care and medical records, better managing staff performance? Whatever the reasons behind implementing your new system you should ideally be able to demonstrate that now the DCMS is in place, these objectives are being met and the project is showing (or at least starting to show) a positive ROI. Gather feedback from staff, ‘it saves me so much time now I don’t have to hand write notes, I have more time to talk to the residents’, from residents ‘I like the fact that I can record my own care on my phone’ and from other users ‘It makes the monthly reporting on accidents and incidents so much quicker and more accurate.’ Consider associated metrics such as documentation audit scores or related cost savings. Ensure that you have measurable objectives for the project from the start so you can sit back and reap the rewards of all your hard work when you declare your DCMS rollout a success!
- Did you actually make all the cost savings you thought you would at the beginning of the project? Once the system was live we saw cost reductions in overtime as staff were not working additional hours staying behind completing care note paperwork and reports, cost savings in stationery from less printing of manual notes and care plans and a huge saving in time across the team
- Roughly, what’s the kind of budget I should be looking at? To implement a basic system including hardware an estimated budget would be in the region of Set up costs at £5,000 per site and Annual costs of £3,000+ per site (albeit this will depend on the number of licenses required and also any ‘add on’ features that an organisation would choose.
- Any tips on getting the best price from a supplier? Be very clear on what your requirements are so that you can ascertain whether they are included in their standard functionality. If the organisation is planning on implementing this at multiple sites then use the other sites as ‘leverage’ to reduce the overall cost. Conduct a thorough tender process and let the suppliers know they are in a tender selection which is price driven
- Any tips on how to bring less enthusiastic staff round to the idea of a DCMS? Focus on the ‘What’s in it for me?’ WIIFM! Sell the benefits of the system such as time saving, no wore writing notes, forgetting to write notes, missing care interventions/meds/turning etc as these can all be set as automatic reminders to support their work. Make sure that there is proper training workshops set up so they realise that this is an investment in them as well as for the organisation
- What were the functions that ended up being the most useful? And what were the least? The most useful were the voice recognition (recording of verbal care notes which translated to text on the system – this was particularly helpful for those staff who do not have English as their first language or staff that were less than familiar with using a text function on a mobile device. The ability to look at all the care plans, notes and records remotely as a manager was invaluable – no longer did you have to call the site, find someone to talk to and get them to update you on the status of a resident – you could see this from wherever you were via the portal
- Roughly how long did it take to…
– Choose a system – 2 months – we saw numerous at The Care Show (highly recommended post COVID) and then we picked the ones that had the functionality we were looking for and arranged proper demonstrations, we then asked the short list from that to tender
– Work with the supplier to develop the spec – this was done in two stages so took at least a month in total – don’t rush this part
– Test – we did full end user testing which took approx. 3 weeks including initial training workshops at the beginning
– Full deployment – for one site allow a month, for multiple sites the first site will take a month but subsequent roll outs can be expedited faster if the organisation uses internal system champions, SMEs etc
- What was the thing that tripped you up? – trusting that the ‘off the shelf’ product would suit the operation, it didn’t at first and it took time to reconfigure to get this right (it wasn’t helped by the first lockdown!) – that additional time was really worth it as we were able to fully customise the system in conjunction with the supplier so it delivered exactly what we needed and our internal knowledge and expertise grew even stronger
- What ended up being a genius move? – as above getting senior people involved in the reconfiguration at the second stage meant that the system was not only fit for purpose but staff were more accepting of the change as they knew the system had been constructed for their use by people they trusted
- Are there any circumstances where you think it probably wouldn’t be worth the effort and expense? – If you are one small site with a suitable paper or standard computer based process that works for your organisation then you would really need to consider whether this investment was worth it long term – a Business Needs Analysis process would help with this
Joanna Morgan is an independent consultant advising clients on operational and strategic project delivery. You can contact her at firstname.lastname@example.org