Heritage Healthcare Windsor operates in and around the Windsor area and is closely involved in the local community. They have 20 care workers and 3 office staff caring for 40 service users. We talked with Owners Romola Ganguli and Adrian Greensmith and their Registered Manager Carole Henderson, about choosing and implementing the PASSsystem.
What was your motivation for going digital?
Adrian: Yes, we always knew that we wanted to record things better. Getting physical evidence when someone is onsite is invaluable.
Initially we didn’t really understand the marketplace. We started our digital journey with rostering and actually went with another care planning system which tied us in very closely with Staffplan. It didn’t allow us to go completely paperless and we were still stuck with paper MAR charts, which was a nightmare! The challenge of bringing in paper records of visits stayed with us.
At what point did you begin to realise there was a better way?
Adrian: Some of the other Heritage branches were starting to use PASS and were coming back with positive responses, so we visited two or three branches to have a look at how they were using it.
Romola: Yes, we were still having problems with the documentation side. The number of copies, the filing, being able to respond quickly and efficiently to calls that were happening were all an issue. Carole’s audit process was month on month, instead of instantaneous like now.
Adrian: After finding out more about PASS from the other branches, we arranged a demo to see for ourselves just what it would do for our business. By then, we had a pretty clear picture of what we wanted it to provide and we were not disappointed!
How have you found the process of training and implementation?
Romola: It was so well planned. It was very clear as to what the process would be and how it would map out: what would happen when, how it would happen, who should attend, and the agenda. Even before that, we could ask about any issues so there was always contact, which was really good.
Adrian: Our challenge was that we had to go live on the first of October, when our previous contract came to an end. We didn’t want to go back to paper rotas in the interim, so there wasn’t any leeway in the transition.
We realised though, that we didn’t have to put every part of the client detail into PASS. We could just put enough on there to get us started, so the actual project piece worked quite well.
Romola: We were taken through what would happen at each stage, how much time to allow. I had great guidance from Mitch. We created our own little mini project plan with dates and times, specifying who would do what. I then ran the plan past Mitch, and he said, “Yes that looks great. Don’t forget steps X and Y, you’ll need to put those in too.” So, then everyone knew what we were doing, when we were doing it and our deadlines, which really helped.
I was also able to easily clarify key information, like the specification of devices and details about the Android version or iPhone version, so I could then broadcast that to staff.
How long did it take you to really get used to the system and start using it and how many people were trained initially?
Adrian: For the initial training it was pretty much Romola, myself, and our Care Coordinator. That went really well. There was a lot of flexibility from everyLIFE. In terms of getting staff on board, we decided to take it slowly. We gave them two weeks and said, “have a play” with some test clients. We have five care manager roles and those ‘care managers’ were all given a trial. We phased it in over the course of September so that they had time to get used to it.
Romola: Our staff then knew exactly what to expect and when to expect it, so it wasn’t a surprise or too daunting.
Our Care Coordinator had a further training session after we went live. That was so that Carole could understand more about documentation etc, having got everybody on to PASS with just a broad outline of each service user’s needs.
Has anyone joined since you introduced PASS? How has the training gone?
Carole: Yes, one carer has and actually she had already used PASS in her previous job!
Romola: We also have an Induction Programme set up now so that our Healthcare Trainer will train anyone who’s new and as part of that, she goes through what new staff need to download and how it works. Then Carole keeps any eye on how they’re getting along with it.
Overall, it’s been fairly painless to implement PASS. The training was excellent and the End of Project Report was very valuable.
From sales, implementation, product launch and training, to using and ongoing support – all in all it’s been fantastic. Thank you!
How have you found our customer service and support team?
Romola: I think in terms of technical support, it’s good to know that you can call somebody whenever you may need them. I’ve found them really helpful. They’re always there on the phone; we have also been encouraged to use the messaging channel now. Communication’s been very good. We have had lots of questions and they dealt with it all with such patience!
Carole: Yes, they have been very quick to come back to us and it is good to know that they are always there, just in case.
What's your policy concerning phones and mobile devices? Do you have to supply anything or do staff just use their own?
Adrian: Previously we had invested in 20+ phones and SIM contracts, but when the old system finished we phased that out. We now have a “use your own device” policy and we make a small monthly contribution for data, which is a cost saving for us. We thought there might be some resistance to this, but it’s been fine.
Romola: As early as the interview stage, we will mention that we use the PASS mobile app and ask if that is okay. If somebody says, “Actually no, I haven’t got a phone,” then we can supply one.
Carole: Yes, most of our carers probably prefer their own phones anyway because they already know how to work them.
Romola: I do keep saying this, but it’s not rocket science. Staff are used to using their own smartphones. Prior to this, the majority of them were using two phones and even then, they’d still be communicating with Carole through their personal phone because it was easier, and they could text more quickly. With one phone it’s all there, it’s much more straightforward, and they’re used to it.
How does PASS help you manage your business?
Carole: PASS makes everything quicker, and pinpoints something when it happens rather than two weeks later when somebody says “Oh, by the way…”
Romola: It’s so responsive.
Carole: Yes, not only in managing staff, but also clients. We’ve had a problem the last couple of days with a new client. There were some discrepancies with the information about medication changes. First thing this morning, I went to the pharmacy and sorted it out at the source. Once I had the correct information, I just changed it on the system there and then. If that situation had happened before PASS, the confusion would have continued with every visit. Now, I could solve it between last night at five and the pharmacy opening at nine this morning. It was done, dusted and it’s all back on for tonight. I’ve even confirmed it with the on-call for tonight.
Rather than doing monthly MAR charts, we can also update them weekly now. One example is a client whose medication is changing every week, it’s just so much easier to keep up with that using PASS. I can flag last week’s medication as inactive and start afresh, then if it goes back to a previous week’s dosage, I can just reactivate it and change the dates.
Everyone knows exactly what’s happening all the time.
Romola: That’s brilliant. That’s a fantastic example of complying with CQC standards of care, safety and responsiveness and being effective in that person’s care. It ensures that the right medication is given at the right time, by the right person. You can see if it is being delivered or not delivered and determine trends, and you can see mis-medications from a directorial perspective.
There are reports which show how many issues and alerts are being resolved and which are the key ones: mis-bookings, mis-medication, hydration, nutrition, and so forth. Are they being addressed? What are we doing about it as a company? What’s care management team doing?
Do you think that there’s now less chance of little things being missed by carers? Do you think your care has improved in any way?
Adrian: It’s certainly allowed us to put tasks in there that we maybe didn’t have before. It’s not the things that are being missed but the addition of tasks. We now have a “greet the client” task – the first thing you do is say ‘hello’ to all family members. PASS allows you to put things like that in.
For example, we’ve got one client who’s living with dementia, who we see at lunchtime and then at around eight o’clock in the evening. We now have “put the lights on” as a task, as otherwise he’s going to be in the dark until the evening visit. I don’t think things were being ‘missed’ per se, but it has given us that ability to react quickly and put specific things like that in which were far more challenging before.
Romola: We also encourage staff to be prepared. We say, “before you go into a visit prepare yourself. Know where you are going.” It’s great that you’ve got the connection with Google Maps. It opens up the correct map up straight away, so that’s brilliant. We also say they have got to read Office Communications because Carole could have reported something that has changed overnight or last minute. They should read that, the Care Notes, and the Summary, which takes a little bit of getting used to.
PASS stops carers saying “I don’t know where I’m going, I don’t know who I’m seeing”. Those calls to Carole have reduced now that are people know beforehand.
Adrian: Yes, now our carers can also properly prepare themselves before they go because they can actually read the notes beforehand. Before PASS, we told them to go in and read the Support Plan first, but if you’re meeting someone for the first time and trying to get on with care, it doesn’t happen. Now, they can stay in their car for two minutes beforehand and build a picture. They know exactly what the first thing to do is when walking in the door.
Carole: And it means I can respond quickly and efficiently to complaints. The other week there was a Service User’s daughter who thought care workers were leaving early on Thursday. By glancing at the full report, we could see that actually, we’d been over-serving by 12 minutes and 9 minutes but that there was one slightly shorter visit. We could never have checked that off with any real accuracy previously. Whereas now, we can easily record and review the reasons why a carer might have left early.
We had one case this morning where the client was not feeling very well. She just wanted to go to bed. The care workers rang me and I said, “That’s fine, you can leave. Just record it in your notes and it’s there.”. Then, that will tie up with my journal which says the carer had permission to leave half an hour early.
What are the main efficiencies that you've gained from using PASS?
Romola: One thing we’ve absolutely felt the benefits of, is Carole not running hither and thither trying to keep an eye on everything, that has brought our mileage costs way down. The dashboard’s been great. I think the sheer ability to look at the care notes helps an awful lot when communicating with staff as well.
Carole: Yes, I’m not waiting until I get my documentation back and then getting on the phone and saying, “Right. I need you, you, you and you all to come in.” At the time that it’s all happening, you can ring them up and say, “Do you know what, I’ve just noticed that the last three days, you’ve done X, Y and Z. Can you do A?”
It cuts down my time having to chase them up, but it’s also just better for nipping problems in the bud.
You can keep an eye on everything right from the office and if something keeps recurring, you think, “Do we really need this? Maybe that just needs to be reviewed. They might not need that anymore, or what’s the reason they’re not having this anymore? Are we taking it off? Are we keeping it on? Or should we just promise to do our review earlier than we scheduled?”. It’s just quicker.
Romola: Our print requirements have reduced significantly too. I’m just about to order some paper actually, but not an awful lot and there’s been a gap in ordering. We’re printing a lot less.
Carole: Yes, because Support Plans are smaller and they don’t always change that often.
We used to use quite a big folder for all the documentation to go in and that goes into their house. Now, it’s a smaller file and there’s a lot less paper. We just fill in what we need to fill in according to each service user’s need.
Have you found the care notes are better than before?
Romola: This process has been an opportunity to encourage carers to make their notes a lot more coherent. By saying that it’s regulated, it’s a legal document, and that other people will be reading your notes, it just gives a bit of focus and reminds you that you can’t write in shoddy language.
Adrian: Yes, carers are very aware that these notes will be read. When they’re just writing on paper that’s going to get filed in a box somewhere there is not much thought, now they’re so easily accessible staff are taking a bit more time on them.
Romola: It has raised the bar. I’ve been hugely impressed. I did need to say two or three times that these are going to be read by lawyers, paramedics, doctors, family members. That has helped to reiterate and emphasise just how critical it is to be well written. They’re not perfect, but written well enough.
Carole: Some people have predictive texts on their phones, which helps a lot.
Romola: I’ve also been able to look at care notes and I’ve sent a quick text saying “Please, can you just add the word ‘I’ at the beginning of the sentence, and use full stops”. For those where English is not their first language, just being able to see and point out corrections has been very helpful.
Carers can compare their notes with previous notes as well. I think that offers a demonstration of what they should be doing. It helps everyone to articulate themselves better.
How do you feel about your next CQC inspection?
Romola: Personally, I feel very confident. With PASS in place, I know that all our records are accurate, complete and up to date. With everything at my fingertips, I know that I can show them anything that they might ask for, quickly and easily. In a way, I am quite looking forward to it!
Would you recommend PASS to other businesses?
Romola: Certainly, without any hesitation!