We talked with Owner/Manager Katy Trueman about choosing and implementing PASS at Enable Health Ltd, which the CQC has recently lifted out of "Special Measures" to "Good Overall".
How was your latest CQC inspection?
We just had an inspection in January, and we managed to turn the business right around; we’ve taken a really big stride. We went from “Special Measures” and “Inadequate” to “Good” in all areas and “Good Overall”. It’s quite a relief, I can tell you!
Do you feel that PASS was a contributing factor to your improvement?
Our inspector was impressed by our progress, because they were basically looking to deregister us. It was that serious! It’s quite rare that you turn it around once it’s heading in that direction. He was very impressed and quite surprised that we’d succeeded, but he could see all the hard work that we’d put in. And our auditing process was so much easier for him too: rather than going in and out of folders and files, he could just click to check and see the last time someone got assessed or the last time something’s been updated. That was really good for him to be able to just log in and see that so easily.
And now, we are going for “Outstanding” next!
From my CQC inspection days, I’ve learned the “And then what?” question, because to be “Good” in all areas, you need to ask, “And then what?” So you’ve done the MAR audit: “And then what?” We’re at the “And then what?” stage because we actually see what’s needed, we can change it straight away, so we’re already looking at the step ahead. Whereas before, we’d have to go through files to see what’s changed, we are now able to see straight away. It’s in the notes, it’s all there. It’s self-explanatory with PASS: previously there was a lot more paperwork to get to that point.
We’re now working on the “And so what?” question. Thinking about that makes you “Outstanding”, that real focus on outcomes-based care. How does that change their life? Does that increase it? Is it maintained? We’ve got the capability to do that now, so we can actually prove that Care Plans are outcomes-based. We’ve got a better system for tracking everything. We were talking about it yesterday actually, because we’ve got some clients who were end-of-life four years ago, and we’re still taking care of them!
I am confident that we can achieve an “Outstanding” rating now. We’ve got the systems and the process in place and a team that want to do that. They are a really caring team and we are working towards that and changing people’s lives, not just going out and doing the basic things.
Training and Implementation
How have you found the process of training and implementation? How many people were trained initially and how long did it take you to really get used to the system and start fully using it?
We did it quite quickly because it was quite an urgent situation. I think it was within a month that we actually got PASS up and running and really going. The Managing Director at that time spent a lot of time at home, setting up the Care Plans and everything, but once we had put them all on, it was a swift process and a case of just showing the carers what to do. They’re doing really well with it. You have to actually use PASS to work out what you need and what you don’t need. It wasn’t too long once we’d got it sorted.
Initially, the Managing Director, the Training Manager and I had training in how to set up the Care Plans and the care packages and the documents, and the structure of it. Then there was another day, out with the Care Coordinator and the HR Manager, learning how to use the actual app, and how to process all the alerts on an everyday basis. They got it quite quickly. It’s not too complicated once it’s set up and running; it’s quite self-explanatory really.
So, we had the initial training and then our trainer filtered that down to the carers, and now she takes care of induction training and all our care certificates, standards and mandatory refreshers. She basically went out with some of the carers and we had team leaders show other people when they were shadowing. We filtered it down organically.
Admittedly, some of the staff were a bit apprehensive of technology, maybe the older ones. They’re used to the pen and paper and writing it down. We had a pilot month, when we still kept our old systems going, while they were getting used to using PASS. You like to know that they are doing it properly, to make sure that they do know what they’re doing because we like to keep a close eye on medication errors. It was obvious that they’d got the hang of it within no time, so we just stopped using the paper altogether.
Everyday Use in the Business
What’s your policy concerning mobile devices? Do you give one to every member of staff?
We do have mobile phones if they’d like to have one of ours, but they often like to use their own because it’s just easier for them and their lives are normally on their phone, but we do have the option of giving them a phone if theirs isn’t compatible.
What about remote access for management? How has that changed or impacted your working day?
It’s great now; even at home I can just log on and have a look. It’s nice that you can see what’s happening in real time rather than waiting for bad news. We can be far more responsive with PASS.
And at last, I can sleep at night! We have on-call 24 hours a day, seven days a week, so clients and carers always have someone available to help them. Now, I can just have a quick look and see if anything’s changed or if someone’s put some big notes on. It’s great that it’s instantly accessible. Before, the on-call person had to be quite senior, one of the management team, because you just weren’t in control of what was happening until it was too late. Now though, we are in complete control and you can see, straight away, if one of the carers hasn’t turned up to a visit. You can actually look ahead and go, “Let’s fix this for the rest of the night.” Whereas before, you’d be waiting and that person might not even alert you at all.
It’s a lot safer now to be honest. We haven’t had any missed calls since we’ve had PASS and it’s very reassuring to have that certainty.
Our Care Coordinator is constantly monitoring during the day. He calls ahead if someone’s running late or there’s a problem going on. He checks the notes all the time, especially when we’re closely monitoring someone. Rather than having to phone up to find out what’s going on, it’s all just there. And when healthcare professionals call, we’ve got the notes right in front of us, rather than having to scrabble around and find out what’s happening.
How do you find the customer service and support from everyLIFE?
We haven’t even had any issues really, just the odd technical problems with logging in or something like that. Our Care Coordinator has managed to sort that out easily. We do use the chat box which is helpful. When there is a problem, they always get back to him really quickly to resolve it. It’s all been managed quite easily.
Advantages of PASS
Compliance and Managing Risk
Has PASS helped to improve these?
Absolutely, because we can respond to anything that’s happening out in the field straight away. Now, if someone’s medication changes, we can immediately alter it. It used to take a good week to get the Care Plan back, change it, take it back out again; and in that time, a course of antibiotics, say, might have already been completed, making all that activity redundant. Now it’s instant, so we are very effective there.
If someone hasn’t ticked a medication task, the Care Coordinator will call within 20 minutes or so and say, “What happened?”. He can send them back and say, “Actually, you need to pop back and do that.” We don’t have any MAR errors at all now.
It used to be a big concern, to be honest with you. Back in the “Special Measures” days, I could not really say, hand on heart, that it was safe at that time. There could have been serious implications that we couldn’t have picked up until maybe a week later, which might be too late! But with real-time information, we can see exactly who’s given what. Also, in terms of timings, if someone has missed their meds, you can see when they did have it last, so if you’re sending someone back out, you can see that they’ve had X at 12 o’clock and know when it is safe to give the next dose. Before, it would be down to leaving it to what was scribbled in a tiny box on a MAR sheet or written down on a comment sheet, so it’s a lot safer now. That level of detail just wasn’t there before. Now we’re very much in control.
What are the main efficiencies that you’ve gained through using PASS? How do you sum up the benefits?
It has saved us nearly a whole person’s wage. One member of staff spent about 80% of her time auditing comment sheets and MAR sheets each and every month. So I’d say we are saving at least £15,000 in the year on that salary alone. It has also saved so much time in terms of processing and the follow-up actions afterwards, which were bigger and more involved by then. Whereas with PASS real-time alerts, we can see any budding issues straight away and we’ve dealt with them before they have a chance to develop. PASS has saved a lot of time for the managers, so now they can concentrate on other things.
Hopefully we’ll see the benefits coming through this year, now that we are out of “Special Measures” and can take on new clients. We have invested a lot in training and developing our current team and setting up all the processes in the office. Now we’ve got a really firm foundation. Recruitment was hard due to our rating before, but my core care team has stayed the same, even though in the care industry generally, it’s a very high turnover. It’s really stable now, so that’s nice. They’ve stuck with it and they can see that we’re investing in them and in the processes and they value that.
And now, the phones aren’t constantly ringing like they were before. You can imagine that there was a lot of firefighting going on, but now we’re ahead of everything. We’re in charge of it rather than the business running away with us. It’s really nice.
We’ve got an off-site storage facility, which we hardly need now too. Previously, if someone questioned something from last year, say, you’d have to look back, work out which box it’s in, go out to the storage and physically get it. Now, even if they’re inactive clients, you can still pull them up and look back and see what happened on that date, where it happened and be sure that it is accurate. That is a real improvement.
PASS has definitely more than paid for itself.
Has PASS helped to improve your care? Do you feel that PASS has helped you to avert any situations from becoming crises?
Yes, it is so much simpler right from the start. We can go out and do assessments, set someone up, go through the risks etc and it’s all signed and agreed while it is still fresh in their minds, instead of having to come back, type it up, print it out and return some days later for signatures. It is much more person-centred and thorough right from the start, and you are not doing the same thing twice anymore. It’s a lot slicker.
Here’s one example where it feels like we are really making a difference is for a new customer. This is someone who has been waiting for a cataract operation that couldn’t happen until he had an after-care package in place. All he needed was someone to do his post-op eye drops four times a day for four weeks, but his op has been delayed because no one could fit it in. Although it’s small, that’s pretty significant for his daily life. But with PASS, we could step in and arrange it all for him, because we could turn it all around quickly and efficiently. He now has a much better quality of life.
These days we are now performing some quite complex, high-level tasks, where the district nurse comes out to train our staff. PASS can then keep track of it all so we can see who we can place into which packages. That way we can be more efficient with our resourcing and match the right carers to the right customers. It’s all there in one place.
I think we are now delivering altogether better and much more person-centered, safer care.
Carers feel more valued too, because they can see that what they report in PASS is acted on immediately and they’re supported, so they can feel confident, rather than just wondering if anybody will even see their note before it disappears into the paper filing. It’s a world apart, isn’t it?
Actually, it’s quite nice to see their input into the care and how they take more pride in the care packages. We’ve got quite a few more carers who now take the lead in certain clients’ packages. They feel a bit more ownership and they know that the next carer will look at what they’ve done, that their work is under scrutiny, not just from the office, but from their colleagues too.
And now with openPASS, the families can see it all as well. So they are aware that it’s no longer just a piece of paper that’s sitting around in a pile or file out there somewhere. There are people that will access it and it is a legal document. They know they need to put everything down in a professional, accurate manner, but they’re even going a bit beyond that as well. I can see that my workforce has that sense of pride in their work. I’m very proud of them actually. They’ve done well.
How have your customers taken to having the digital technology going on around them? Is that something they’ve warmed to?
It’s been a bit of a change for them, because they thought, “Oh, she’s on the phone.” If there are two carers in, the lead will be filling out PASS while the other one’s caring. At first we had complaints saying, “One of them is just playing on their phone all the time.” No, actually they are doing their job! Now, they’re used to it. They’re happy. They know why we need to know what’s happening, and it’s for their benefit really.
How do people like openPASS?
They love it! We’ve got some clients whose families live abroad. I’ve got a lady whose son’s in Australia and he logs in. We’ve set that up so they can see that from there.
We’ve also got a family with three children that have all got the same genetic disorder where they are basically bed-bound, and highly dependent. We’re doing quite high-level tasks for them. We’ve set up the doctor’s surgery so they can log in and keep a close a look at what’s happening with them so they can monitor their situation.
Would you recommend PASS to other businesses?
Yes. Yes, I definitely would. Definitely. Especially for smaller companies like us, because they’ll just be like, “We won’t be able to afford it.” They’re probably a bit like us. We were just thinking, “Oh my goodness, we couldn’t afford to have that.” But actually, we couldn’t have afforded not to have it!
Top Tips for Using PASS
Make the most of PASS for domiciliary care by:
- Logging in online every morning to download your bookings and ensure all your customers are up to date;
- Logging in offline whilst in areas of low signal to enter the app and view data downloaded from your last online login;
- Tagging in on arrival, as your visit time doesn’t start until you do!