3. The practice environment

This chapter covers small but effective changes in the waiting room, different systems like check-in screens, call boards, and health monitors

3.1. How to achieve a healthy and relaxed environment

First impressions count. Your waiting room can leave a lasting impression. Using simple design principles and techniques can make the waiting room a more relaxed and calm environment, as well as provide educational opportunities for patients.

3.2. Self-service Check-in screens

Time is precious for receptionist staff. At busy times, patients can sometimes queue for several minutes to let staff know they have arrived. Automated touch-screens allow patients to check themselves in for an appointment quickly.

Some considerations

• Is there a need for this technology?
• How do receptionists feel about it? Do they often see queues forming, particularly at peak times?
• Have you tested this with your PPG to see how patients feel about these systems?
• Have you checked with your PCT to see if they are thinking about supporting such products or have any learning they can share?
• What kind of check-in system would work best in your practice – freestanding, desktop or wireless clipboard?
• If you choose the wireless clipboard or desktop version, make sure it is far enough away from the reception area, but within viewing distance of reception staff and patients walking through the door.
• Consult your GP system supplier to check whether they offer their own systems, or that the systems you are considering are compatible with your software.
• Is this the most cost-effective solution?
• Agree an installation date with the supplier. Ensure you have an agreed communications plan for both staff (you may need a member of staff manning the system for the first couple of weeks to train patients) and patients ensuring patients are made fully aware of the system through newsletters etc).
• Ensure you assess the impact of the new system through patient and staff reaction. Have reception staff seen queues reduce?

3.3. Electronic display systems

These are large screens that can be used as information gateways, promoting health improvement messages for patients as they wait for their appointments. The screens can also be used to publicise services and call patients for their consultation.

Some Considerations

3.4. Waiting room health monitors and surgery pods

The time available during a clinical consultation must be divided between a number of tasks. Some can be delegated to members of the practice team other than GPs, for example collecting routine clinical information, conducting simple tests and updating patient records.

Many GP practices now share these tasks across practice nurses, healthcare assistants (HCAs) and administrative staff. This optimises GP time. This principle of delegation can be taken one logical step further – can patients be asked to complete some of these tasks for themselves?

Making a difference

Before investing in waiting room monitors, each practice should consider how it might integrate the system into their existing patient management processes.

In a sense it is no different from taking on an extra member of staff. It needs a room or space in which to operate, a private area with a desk where patients would feel comfortable taking clinical tests. The practice needs to work out which information, tests and data it will be set up to collect.

Both the practice clinical and administrative staff need to understand how using the ‘pod’ fits into the patient journey. Questions to consider include ‘what type of patient and when?’, followed by ‘how many times might this happen?’. The answers will help to assess the likely benefit and return compared to the effort and investment required. At the end of this section there is an account of a practice that has realised significant and tangible benefits from using the technology.

How to make it happen

This section describes a series of practical steps for practices and discusses what is   involved in each step:

• Agree the need.
• Assess practice compatibility.
• Obtain a quote.
• Make an investment decision.
• Design new processes.
• Install system.
• Embed new processes.
• Measure benefits.

Step-by-Step Guide: Waiting room health monitors and surgery pods

1. Agree the need

Practices will need to judge, or better still measure, how much consultation time might be saved by the system generating and collecting data. Similarly, they need to describe accurately its use in a screening or health management programme context. System manufacturers list a number of variables it can be used for: weight and body mass index (BMI), oxygen saturation, pulse, blood pressure, clinical questionnaires etc.

2. Assess practice compatibility

Practices should assess compatibility using three criteria: patients, staff and technical. The practice’s existing clinical software system may not allow the ‘pod’ to write data directly into the electronic patient record. Practices should check this with the surgery pod manufacturer.

Practices will know immediately if space can be found for such a system to work. The practice team will sense whether their patients would find this acceptable and usable. If only a limited number of patients use the system or large numbers of patients need extensive help from staff, then potential benefits are reduced. In order to realise these benefits, an assessment also should be made of the staff’s ability to change processes and working practices where necessary.

3. Obtain a quote

Contact a manufacturer and get a quote for providing the system and maintenance.

4. Make an investment decision

On the basis of the previous three steps the practice should make their investment decision.

5. Design new processes

Once the purchasing decision is made, work should start immediately (before delivery and installation), to design new practice processes. Staff should work out where and how the system will be used, the training which will be delivered that allows all staff to understand the system, and how to help patients use it. The practice will need to ensure that the system is checked regularly and that testing materials are disposed of. You might wish to consider writing these duties into a role or job description. A key point in this design step is to ensure the system can completely replace current ways of working. Without ‘complete replacement’ a practice may run the risk of running multiple and potentially inefficient processes.

6. Install system

The system is delivered, installed and tested in accordance with the manufacturer’s policy.

7. Embed new processes

Following staff training, the practice must maintain momentum. When staff are busy and under time pressure in a practice, there is a risk of reverting to ‘the old system’. Extra effort will be needed to support staff so this does not happen and the new investment pays off.

8. Measure benefits

Revisit the original thinking in step 1 ‘Agree the need’ and collect data with the system in place and operating steadily. Assess any effects on consultation time, the number of patients that have used the system, the amount of data that has been collected and the degree to which staff may have had to help the patients use the system. Review successes and plan any adjustment or extension to the system.