During the COVID-19 pandemic, Douglas Macmillan Hospice could only carry out mandatory audits due to demands on the clinical teams. This meant it was difficult to keep up with the wider audit schedule.
When the hospice came to reinstate the audit system, it became clear the existing process was inefficient. It involved printing off audit sheets on paper and handing them to someone to complete. Results had to be sent off for analysis and it took four to five weeks to receive the reports (by which time the situation on the ground had probably changed).
The hospice decided to implement a digital tool to make audits more streamlined and free up staff time.
Outcomes
Using digital software has improved compliance. Staff are able to use their own initiative to look at the auditing app, find out which audits are due, and complete them. Reporting is instant, so managers receive a compliance rating straight after the audit has been finished. This means they can act immediately to solve any problems.
A full audit trail is now available, as all actions can be logged on the system.
Audits can be completed more quickly, having less impact on the workload of clinical staff.
There has also been a significant reduction in the amount of paper being used.
Facilitators, challenges and advice
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Key facilitators
Douglas Macmillan chose to use the Tendable app. This has templates which align with NHS standards, but the hospice can also develop its own audit templates and Tendable will upload them onto the system. The hospice can also adapt existing templates to meet its needs.
Tendable provided a lot of training and ongoing support to help the hospice implement the system, both face-to-face and online. They used a train-the-trainer model so that staff can support each other.
It has been easy for staff to learn how to use the system as it is intuitive. The hospice has invested in touchscreen tablets that staff can carry around when completing audits.
Challenges
One person cannot set up a new digital process on their own! It’s important for colleagues to get on board and support implementation.
Tips and advice
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Have a clear vision of what you want to do, then take incremental steps to get there. It’s fine to start small then build up a suite of digital audits.
Get key stakeholders on board early. Build a small team of people who have knowledge of audit requirements and who can be champions for the new system.
Share and build on existing knowledge. You don’t need to reinvent the wheel!
Future development
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Douglas Macmillan would like to look at benchmarking their compliance data against other hospices in the future. They are also working towards using their data on a wider scale, for example by feeding it into the local Integrated Care System.
The hospice has trialled a patient experience audit and is investigating ways to reduce courtesy bias (when people say positive things to be polite). This might include using volunteers to ask patients questions or giving patients a QR code that links to a questionnaire.
