Switching from paper-based to online systems at nursing homes in Cardiff and Newport

What is the project?

Linc Cymru is a non-profit provider of housing, social care and support.

It has three nursing homes in south Wales, all of which were operated and administered using paper-based systems.

This project aimed to bring the nursing homes online as part of Linc Cymru’s plans to modernise its nursing home services. It did this by focusing on care planning, staff rostering and electronic medical administration systems.

All of these improvements aimed to give staff more time, which they could spend providing quality care and support to the people living in the nursing homes.

They made sure the technology systems could integrate so that information would flow between care planning and medication systems. This meant they could build a full picture and save duplication of staff time and effort to input data.

The project aimed to improve:

• compliance - by creating prompts for social care workers and nurses when a task is due or more information is needed, such as highlighting if a person was due to take some medication
• accuracy of information - by using digital audit logs to highlight gaps and allow for automated processes
• efficiency - through less time being spent on lengthy administration processes, such as staff rostering
• access to useable data - by enabling digital reporting and real-time audits.

Why was it carried out?

Social care workers and nurses spent far more time completing paperwork than spending quality time with the people living in the care homes. It meant the people working in the homes couldn’t provide the service as efficiently as they wanted to.

The three nursing homes all worked differently and there was no consistency across the business. This meant there were gaps in reporting and auditing information, which could have an effect on operations and compliance.

Digitalisation could help both increase the time staff spend providing care to people, and improve the consistency and quality of data. There was also a drive to modernise business processes across the organisation.

The project benefited everyone who worked in the nursing homes and had the potential to create huge amounts of time that staff could spend with residents.

Where and when did the work take place?

The work took place at Linc Cymru Housing Association’s nursing homes in Cardiff and Newport from May 2022 to May 2023.

Who was involved?

The people leading the project spent a lot of time understanding what nursing home staff needed from any system that would be chosen.

They shadowed their workforce and hosted workshops to understand what was needed by all roles. The staff group were involved in testing out different technologies along the way and made the final decisions about what was needed.

The programme board included a range of people working at different levels of seniority, such as executive directors and care staff who were the subject matter experts. Monthly board meetings helped them work through challenges.

What have they learned from the work?

It’s important to build a foundation of trust from the beginning. Challenges came at the beginning of the project with the idea of 'tech acceptance' and challenges that naturally come with creating change. The user research and co-design approach helped people understand that their voices would be heard. They built trust in the care teams and the system was built with them.

They secured buy-in from the workforce and managers by showing that the digital system was easy to use, and that those who found it more difficult would be supported.

Good communication was important to the programme board, directors, managers and staff. They recorded the voices of people working in the care teams to give real-life feedback, which proved really popular with the programme board. They used these to communicate with teams who were about to go through the same changes.

To support implementation, they identified champions in each team who had shown an interest in technology or this project. Champions were buddied up with people who had less confidence, which really helped.

The technology team also maintained their presence in the homes so they could support staff to use the new technologies.

They shared findings along the way, which helped build trust, and listened to feedback so they could tweak their approach as the project continued to the next site.

The digitalisation project has helped improve services in several ways:

1. Increased time spent with residents through digital care planning and delivery. The reduced paperwork and ease of digital systems has increased the time care staff can spend with residents. Time savings for each nursing home so far are a combined four hours per shift across all staff. This has improved the quality of care and engagement between staff and residents.
   
   
2. Increased governance around care planning, delivery and regulatory compliance. The digital system enables managers to look at compliance in real time, which keeps them informed and allows them to take action quickly when needed. This is more responsive than a paper system, where there would be significant delays in identifying non-compliance. The digital system has increased compliance and assurance.
   
   
3. Reduced waste of medications. Automated stock control and count down has reduced overordering of medications and wastage.
   
   
4. Reduced pay errors and administration. Staff commonly pick up additional hours and shifts, which led to monthly errors through the paper-based system. Same-day payments to rectify errors had become part of the monthly procedure. Since the digital rostering system has been implemented, pay errors have reduced by two thirds. This has increased workforce well-being.