Greenfield Project set up with Suzanne Young, TiB Associate
Covid-19 is changing everything. Few organisations are returning to business as usual. The marketplace has changed. The way we do business has changed. The way people work has changed.
Critical medicines delivery using volunteer drivers
Our local hospital needed to react very quickly to lockdown, focusing on services which were essential and questioning if they could take place away from the hospital premises. Volunteer drivers were to deliver critical medicines to patients. Initially these were primarily for cancer patients, people with HIV, and others in the shielded category. Some of these items were controlled drugs whose handling was covered by legislation and the whole process needed it to be traceable and auditable. There were many stakeholders involved. A new service had to be up and running almost immediately.
The Greenfield Process
Three distinct questions needed to be asked:
• Who are the stakeholders?
• What is the problem to be fixed?
• What does success look like from each stakeholders perspective?
I started by identifying the stakeholders; who was interested in the delivery project? Who were all the stakeholders? Not necessarily the end user, but all who are interested or affected by it. What was their personal requirement?
Secondly, I consulted the stakeholders to find two things critical to starting a successful project; what’s the problem we’re going to fix? What’s the desired outcome?
Stakeholders included clinicians. What did they need? They needed to know that their patients have their correct medication on time. How do we achieve this outcome?
What does the pharmacy need? They needed evidence from the drivers who deliver the medication. Which meant we needed a confirmation and receipt element to the system.
What does the patient need? I considered that a patient at home and shielding would probably be quite terrified. So, they needed to know that not only were they going to get their delivery, but they were also going to get it in a safe method. For reassurance and to assure quality we also needed to tell the patients what they could expect from the drivers, i.e. the process the drivers would follow at the doorstep.
We also needed to tell the drivers what they needed to do. Government guidance regarding PPE and social interactions were changing daily at this point, so each day the guidance was reviewed and the ‘instructions to drivers’ brought in line with that days advice.
Ultimately it’s all about the stakeholders and communication. You end up with a whole load of requirements and need to know that each element is being done. How would we know that standards were consistently met? What do we do when things go wrong? Where are the synergies in the in the requirements? Feedback loops and confirmations gave us knowledge of the quality and confirmation of the deliveries and ultimately identified improvements.
The program also had to involve the hospital wards. They didn’t quite need the level of granularity as the other stakeholders, but we still needed to meet their expectations.
Once I’d captured this information, we had a specification. From this the standard operating procedure was designed. This included instructions for drivers, tracing spreadsheets, a list of patients to ring, a check sheet to record all the deliveries to the driver co-ordinator and driver’s task sheets every day.
Unfortunately, many of the regular hospital volunteers couldn’t pass the health screening which meant that the current volunteer population was decimated. Fortunately, the hospital was approached by JLR Classic, a classic car restoration business who could offer drivers who had been furloughed. We were offered a fleet of drivers in addition to two people who had applied independently to drive for the hospital.
From a blank, green field site to trial within a week; we performed a trial with a small number of patients and then reviewed the process stage by stage with the significant stakeholders; We needed to know what else we could do at the trial stage to make easier for all concerned, we changed one department from morning deliveries to afternoon ones due to the time required to check their medications.
We originally planned to ring the patient on the morning to confirm their delivery and tell them their drivers name but the driver had a health check each day so there was a risk that if we named them and their health check wasn’t successful then we would create doubt or delay in the patients mind so the drivers suggested that we not name them. This was a fantastic suggestion, it meant we could ring the patients the day before the planned delivery and modify the delivery slot if needed.
A trial run of three deliveries all for the chemotherapy department was a good test of the process in action. The debrief resulted in tweaking collection times so these fitted better with the Doctors ward rounds and prescribing times.
All boxes were ticked; the objectives were hit.
The importance of good communications
It’s all about communication. We’d done the usual website, email communication and all the usual comms but none of them get the message across as quickly as speaking to people. For me, that’s all about context. I have a firm belief people really struggle to tell you what they need or what they want, until they experience something and can tweak it. This can result in significant improvements. Talking in person is the key way to achieve fast results, in our Covid ravaged environment, that meant having a debrief session from other ends of a waiting room.
Effectiveness of the program
The patient experience
I constantly underestimate the impact of the program, this project has helped save lives, it has brought comfort to anxieties. The project expanded and we enabled clinicians to fit orthotics by delivering them, waiting for a video consultation and then returning the orthotics to the hospital for final adjustment. We re-united bereaved loved ones with significant items; a mobile phone so the widow could contact her husbands friends to tell them the sad news when all the friends details were on his phone.
There are many stories of feedback from patients:
We delivered medicines to a chemotherapy patient. A requirement of the service is anonymity. Everything is packaged the same so that drivers wouldn’t know what they are delivering in order to keep as much patient confidentiality as possible. However, we did sample phone checks to ensure they had received what they were expecting. This patient was having chemotherapy. She’d lost her hair as a result of the treatment and she’d ordered a wig.
When lockdown happened and she had no idea when she was going to receive her new hairpiece. It arrived for dispatch and was delivered to her the same day. When I rang to ensure she’d had everything she expected in the package she was in tears. She said, we’d given her a lifeline. She could now go on video calls with her friends and family because she had her hair.
There have been multiple examples like this. I’ve talked to patients that couldn’t sleep for weeks because they were worried about getting their medication. Now they had a reliable service while they were shielding. Interestingly the same question came up again and again, “why haven’t you done this all along?”
The clinicians experience
The clinicians reported the service ‘has just been fantastic’. They were confident people received the medicines they needed. Urgent items were dispatched immediately. Importantly, the service was adaptable. For example, when hospital schedules changed and a patient was able to have their chemo the next morning their medicines were dispatched immediately.
Covid-19 is changing everything. A lot of organisations are engaged in new greenfield projects. The interesting thing about the health service is that it is notoriously reluctant to do new things. Coronavirus is creating an environment where they’re much more open to thinking differently. I was able to bring the TIB methodology to a life-threatening situation. This meant we were able to create, recruit and implement a greenfield project within days. Everything is possible if we are prepared to think it better.