Bringing business and IT together

A number of public institutions are turning to Lombardi to leverage tools that bring business and IT together

Public Sector enterprises share the same operational frustrations as their private sector equivalents. On the one hand, business is not equipped to drive and react to change using an incremental approach, whilst on the other hand IT is struggling with maintenance of core applications, despite striving to deliver a service-orientated delivery platform.

Very often there is frustration on both sides at their inability to work together in a common goal that adds value to the business. Whilst IT has now learned to use Lean methods and deliver projects in an iterative manner, the average business project sponsor still has a mindset of waterfall and big projects instead of addressing the most important business issues to deliver quick wins.

To address the gap, a number of public institutions are turning to Lombardi to leverage tools that bring business and IT together. Lombardi’s Software as a Service (SaaS) Blueprint tool enables users to define process and prioritise delivery. Subsequent delivery in 90-day iterative phases is executed in Lombardi’s Teamworks product.

Teamworks BPM suite provides a common shared model for business, IT and analysts, and it is unique because it enables them to deliver value to their organisation in month by month chunks. At the same time it gives them visibility and control of the process.

Generating belief
Lombardi has been working with the University College London Hospital’s NHS Foundation Trust on a patient tracking system to enable it to comply with the Government’s 18 week Referral to Treatment Target (RTT). This mandate meant that UCLH needed a management system that could:

handle high volumes of data,
pull information from disparate systems,
model patient treatment pathways
provide real-time notifications and alerts.

UCLH began working with Logica (formerly LogicaCMG), its managed IT service provider in June 2007, to investigate the possible technology solutions. By November, it had created a new patient tracking system for two patient pathways, using Teamworks, which in the words of James Thomas, ICT Director of UCLH: “Enables us to better manage our clinical pathways and resources, [and] also helps us improve the patient experience by reducing uncertainty in the scheduling of treatments”

On Lombardi’s recommendation, UCLH initiated a two-prong approach of focusing one team on pilot processes for acute knee surgery and urogenital pain and in parallel getting a second team of ICT and business resources to participate in a series of collaborative workshops to define and model additional processes.

The Lombardi business process management system permitted UCLH to model patient pathways and link directly to those core IT systems which hold information about patient appointments, diagnostic tests and treatment. The system enabled them to capture and manage the first point of treatment, whether therapeutic or a period of advised observation.

Significantly different
To achieve 18 week RTT, the system needed to be significantly different to a manual process and work seamlessly with a variety of existing core information systems to access real-time details about the patient. About 35 per cent of the Trust’s referrals are direct from GPs, so in many cases the 18 week treatment pathway has already started before they get to the hospital. Patient tracking is imperative so that the clinicians can intervene and react as soon as delays, blockages or lack of progress in the patient pathway are highlighted. UCLH has many different specialties making the pathways particularly complex. It can be difficult to know where a patient is in their pathway as particular complaints and conditions can be dealt with by different individual specialists.

James Thomas says: “As an illustration of the magnitude of the task, our Trust Cancer team currently tracks every one of its cancer patients (approx. 270 per annum) manually through their treatment pathway from outpatient, through diagnostics and therapy. There is a target of 62 days for the treatment of cancer patients and the management of this process takes a team of six to eight people. If we extrapolate that then we are talking about the Trust needing to employ an extra 800-900 people to manage the treatment of our 500,000 patients annually.

“A vital part of the PTS enables parameters to be set and creates the notifications and alerts, allowing us to know what stage the patient is at in their pathway and how long they have been at that stage,” explains James Thomas.
For example, the time between a patient being seen in outpatients and receiving a diagnostic MRI scan cannot take longer than, for instance four weeks. An alert will be sent if two weeks has lapsed without the MRI being booked. The Trust at this stage already knows that it is going outside the pathway it has set in order to deliver 18 Week RTT for this individual and this allows it time to get back on track. Previously, each appointment list was managed individually by the department concerned with no awareness of where a patient had to wait in the pathway or for how long. As an automated process, it is much more efficient and allows much earlier rectification of issues.

Compliance
At the base level, the UCLH Patient Tracking System offers a better chance of complying with the Government 18 Week Referral to Treatment Target, but as a by-product, the intelligence the hospital gets from pathway management will tell it where it can refine its patient process and become more efficient. It may indicate the need to increase capacity in diagnostics and gets away from the trap of assigning resources simply on the basis of who makes the most eloquent or loudest case.

Patients should experience an improvement in the way they progress from outpatient through to treatment. In time there may even be a web-based patient portal so that individual patients can engage with their treatment process, and improve its efficiency by rescheduling their own appointments, thus helping to reduce the number of missed appointments and wasted clinician time. For the time being though, James Thomas and his team are focused on implementing their PTS and looking at how the business process management lessons learnt in this area could translate to the Trust as a whole.

For more information
For further information, contact Don Marsh at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it or call
020 7868 1970

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