Background
This case study relates to a GP surgery called Alexander House. It sits in the Frimley health system in the county of Hampshire. At the time of writing, the surgery had just over 10,000 registered patients, although an expansion of services is currently underway. In terms of demographics, the population served is slightly older than average and consists of both areas of deprivation and affluence.
My name is Patrick Denston. My link to Alexander House is through my role there as Practice Business Manager. As the author of this piece, I was keen to convey how our experience, working with a transformation partner, changed our preconceptions. I should also declare that, like many NHS colleagues, I wear several other hats, including: PCN Digital Transformation Manager; NHS Frimley Connected Care lead; NHSE peer ambassador and Kent, Surrey and Sussex innovation panellist.
Driving Change in General Practice: The Context
Our surgery had already enjoyed a period of intense transformation, which realised many improvements. As a team, we were really proud of what we had already achieved. Changes had brought fresh innovation that included: improved process, redesigned pathways and shifts from analogue to digital workflow. We’d forged valuable partnerships, imported best practice techniques, realigned our MDT, improved access and enjoyed rising patient satisfaction. All whilst securing some flattering recognition for the rapid modernisation. In summary, we’d got our surgery into a comparatively strong position.
The Challenge
Unfortunately, that impetus we’d experienced had gradually began to plateau. We’d tried getting right people in the room and work through things together. But this time the breakthroughs weren’t coming as they had before. We’d reached a stage where we’d hit a temporary wall and didn’t know how to move forward with the same purpose, momentum and results in that moment.
Why Continued Improvement Was Essential
And we couldn’t afford to just accept that we’d got as far as possible or just wait for something to come along. The reality was that the surgery had not reached a sustainable position. And we had to find more efficiencies without delay, or risk not being able to keep to the pledges of improving care and addressing inequalities. We knew it wasn’t a culture, or system, or buy-in issues stopping us. We needed a spark, something external to help us. That was the point when we committed to work with Xytal.
Partnering with Xytal
Despite the impasse we’d reached, when the opportunity with Xytal came along, it must be acknowledged there was a fair amount of scepticism. I admit my own thoughts included: ‘we are already a bright team, nobody knows the surgery and system like us, we already have great established productive partnerships and we definitely can’t afford to spend time holding somebody’s hand.’
Consequently, there were low expectations prior to the process to realise improvement getting underway. However, when our Advisor arrived any of those negative feelings quickly evaporated. Xytal had matched and assigned us an Advisor called Daniel. And he proved from the word go, to be attentive, unassuming, professional and determined. We quickly took to the systematic approach he brought to us and found that it opened our eyes to new possibilities again.
The Xytal Approach: Practical, Systematic Solutions
Dan probed, listened and identified gains. It was structured, practical and each idea was thought through before being applied. He brought a framework of tools that rooted out the changes, without burdening the stakeholders involved.
There were no big bangs, just a steady series of modest changes to take greater advantage of what we already had in place. Little improvement steps were uncovered in a way that was both painless and rewarding. Enjoying the benefits and collective positive impact, we grew in confidence, trusting and looking forward to Daniel’s suggestions and taking each new step.
Implementing Change: Step-by-Step Transformation
Since the changes were modest, they were easy to make. It’s healthcare, so there are always inevitable snags to iron out, but the controlled introduction allowed the changes to bed in without fuss. Having this professional support, a proper transformation partner, to facilitate things also brought that transferable knowledge. This meant knowing where any pitfalls were likely to occur. And this sense where to look made minor issues easier to address. We found the pace and progress gave the whole surgery a lift and with the respect earned, Daniel fast became one of our own.
Measurable Results: From Patient Access to Workflow Efficiencies
So what’s better now, following Xytal’s support? Well the sum of the changes, took us to another level of improvement. And how do we know? Besides the impact list of measured improvement, both our patients and staff were quick to acknowledge the results and better working conditions.
The impact
The first example I’d share was a 7% reduction in phone calls for a tweak that Daniel suggested from one of our tech providers. Basically, this was an update that had been released and I’d missed. The improved call flow that followed didn’t happen gradually. It was overnight. We turned on check and cancel with Surgery Connect. Very easy, very useful and with immediate impact. And that’s how Xytal and us started out.
Another example was a 20% reduction in manual subscription requests by getting different messages to the patients. Cases that were still handled on paper, were gradually transferring to the app. This was a communication task, explaining why a digital request through the app, or through one of the pharmacies was a much better way of doing things for all parties. We helpfully transferred the learning honed from other initiatives to accelerate our own results. A welcome short cut, that became another hallmark of our support. It was all about framing the honesty in the change. Improving the doctor’s workflow accelerated their care.
Another area of note was reduction in mistakes. There isn’t one accountable person at the surgery tracking this and it’s hard to manually measure what mistakes we were making. However, we could logically deduce a reduction in errors by their absence. The administration team noticed several hours a day returned that had previously been spent on activity misdirected by poor information and effort seeking to correct records.
We continued to go from strength to strength with the gains fast accumulating. Some small, some more impressive. Another 8% of NHS app uptake, naturally fell out the Xytal approach. 78% of our population have the NHS app and use it regularly now. And I’d been thinking it had reached its natural ceiling. But my faith in transformative improvement has now grown to the point I know that more gains are always possible.
Again, I’ve learned it’s tiny tweaks, different communication methods with patients, which can often employ blended communication formats. All of the edges from small changes, just add up to move the overall status.
There are changes that seem small on the surface. For example, Daniel helped us achieve a five-second waiting time reduction. Obviously, on the face of it, quite minor. But we only had 1 minute 40 as an average wait time anyway. Given the accepted target benchmark for good points to under two minutes, the gain demonstrates you can always keep going, no matter the starting position. And our patients responded in kind, with rising satisfaction scores which in turn spurred us on to do more, such as reduce our callback options.
That meant if there was more than three people in a queue, then they’d get the option to call back. Recently, trying to reach for a four-star rating led as to scrutinise all manner of ways we operate and finding more change opportunities to make patient’s lives easier and improve their care.
Patient and Staff Experience: How It Felt on the Ground
Following the Xytal way never feels uncomfortable, or judgemental. The objectivity takes the emotion out of things and helps the right answers emerge. And the methods find layer, after layer of improvement steps.
The other part is the infectious positivity. Colleagues visibly become happier. Enthusiasm levels rise. They’ve time to do other stuff. There’s a sense of getting proactive rather than reactive. And that means you can start dedicating time to find those patients that are currently avoiding the system. And those new initiatives help chalk up another 0.4 stars on Google – so we’re now at 4.2, our latest personal best. It’s a series of gains. The way it happens is like: “Oh, did you know you could do this now?” Then: “No – we didn’t.” And turns out that’s just a tiny tweak to make. But it’s another win. And all of these wins feel really good.
Local inspiration
I should also state that we are also fortunate to have motivation and learning in abundance on our doorstep. There’s a particular practice in our system we’re still trying to catch up with, who have blazed an impressive trail of change. But our transformation partner experience means that we are confident we’ll get there as well!
Our learnings: Collaborative Change
The lesson working with a transformation partner taught us was: just take the support. Beforehand we genuinely felt we didn’t have many wins left to get. It felt like the big shifts for us were done. But my takeaway from the experience is that we’ve all got to make time for change. By that I mean we’ve got to make time to sit with the right people. And change transformation people of the calibre that Xytal insist upon are absolutely worth their weight in gold. They just know how to listen and find those wins. The other bits I’d add are:
- It’s got to be a collaboration between your managers, your partners, the people answering the phone. It’s got to be a bit of everybody.
- And that’s something that you really can’t do in your own closed environment. You can’t take that step away or have a look at what’s going on in your own practise very easily. The truth is it’s impossible not to go native to some degree and see the whole picture with true objectivity. That needs to come from outside the organisation. And for successful, lasting change needs real qualified transformation skills focussed on people.
- Most of the processes that we changed were reactive to a certain sort of element. Like somebody said: “This is something that’s not working for me, can you change it?” You then review the process and you come up with something better. But you’ve got to continually review those processes. And that’s another aspect that I’ve learned from having a transformation partner. We are starting to recognise these kinds of comments from colleagues. And rather than weighing us down, slowly but surely, we have begun to celebrate that they are the start of fresh opportunities for change. Many aspects of the ‘Xytal way’ have now embedded across our practice community. And we’re asking ourselves, what would Daniel do?
Again, the intention of sharing this experience was to reach people like me who might be harbouring some reluctance. Having witnessed how professional transformation partners operate and support lasting positive change made it tough to face up to my own scepticism from the outset.
Overcoming Reluctance: A Personal Reflection on Change
How this record came about is particularly unusual. I can reveal that it wasn’t asked by either the Xytal management team or indeed our lead advisor, Daniel. Instead, the motivation came from my own experience from the collaboration itself. My own transformation had inspired a need to tell the story. First, I gate crashed a Primary Care conference in Manchester and then later converted that presentation into this narrative.
On reflection, sometimes I think we get tied up in tech, integration, compliance and all the other consuming obligations to the extent we forget that people are always the biggest success factor of all in any change.
The experience has also impressed upon me that a transformation partner can realise value that will outstrip initial ambition and objectives in surprising ways. As you will anticipate, I wholly recommend Xytal’s services and fully endorse the benefits of the PLS program. And I wish you all the best of luck following your own paths to improvement.
