As part of our IPC webinar, Cody Long showed us how they have implemented a standardised approach to conducting quality audits, reviewing outcomes and tracking improvements across 55 hospitals at speed and at scale.
"..our quality assessments that circle have been doing for many years needed to continue and be responsive.. we needed to work with an organisation that could do that and work at the same speed as us, which was InPhase."
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So, it was a cool little quick introduction. We were founded in 2004 by two entrepreneurs who wanted to deliver health care in a slightly different way. The first Circle hospital opened in 2008 in Nottingham, and it was part of the first wave of the independent sector treatment centres. We delivered the contracts until 2019 when it went back to the NHS, as per the plan.
During that time, we also commissioned and opened two other hospitals - one in Bath, one in Reading - and we just opened up a new-build hospital for Nero and MSK rehab in Birmingham, which is really exciting because the building is absolutely wonderful. Circle has always put quality at the forefront of of health care delivery. Since inception, we conducted and developed our own internal quality visits alongside the CQC, but slightly different, which meant that we could change when the regulations changed, as they do as often, as we have now acquired BMI. This year, we needed a system that was intuitive, easy to use and could adapt to quick changes as we do in Circle. We did review other systems, and then we did a pilot of InPhase in our Bath hospital in February 2020. And you can imagine that was quite interesting because that's when COVID was just starting to make an impact into the sector.
It was our preferred system and the pilot was really successful. So when the acquisition was approved, we could move really fast with InPhase. We kept in communication with them, we prepped them, we told them what was coming down the line. So once it was ready to go, we were all ready to go. We then adopted the first module for college reviews from day one. It was really fast from day one - we just acquired a big... the largest independent sector organisation in the UK. We have hospitals in Scotland and Wales as well. The estate is massive... it's... there's new builds and there's also older buildings, and we didn't have the time to dedicate to a written manual report that we used to do in Circle, which could take two to three weeks once we've got all the information back from the assessors, and with quality checked, we needed a live system from a company that understood the approach that we wanted to take.
So we built the system over a few weeks - and it was literally a couple of weeks, as Robert will attest to. We set everybody up with usernames and passwords, and the next stage will be to link everybody to Active Directory, so that we don't have to do that, then we need to do training. We decided to do a short training exercise with the Directors and the senior leadership, our Circle Health Group. And then we did the senior team on each side, as we assessed them, because that was the best way that we could do that. This meant that the site team could see their assessment, literally as we left, after we've just quality checked it slightly. So then any immediate actions could be started straight away and any areas of good practice could be shared regionally or nationally. It's not just about the things that we need to improve on - it's also about the things that we do really, really well and when we need to share. So that was another really important aspect of using the system - the good practice, sharing the improvements for other areas.
Progress so far. So we've conducted five quality visits so far, with two of them being virtual because we've been to the two sites, a few weeks previously having done the environmental reviews.
Obviously, being in pandemic, it is a little bit different than what we would normally do, but we've had to adapt, and the systems adapted with us, actually, so that we could make that work. The feedback from the sites around the state has been really positive The use of the system, the approach that we've taken, how they can manage their actions. So we've got actions and they put actions in, we can see at a glance how well they're doing, if they need help and support or if they need any corporate support or anything that we need to do that we can support them. And some of the actions have been closed off in a few days of actually visiting, which I think shows responsiveness to the max.
Just want to show you a few screenshots on the system, and the way that we set up and the way that we've used the sunbursts - which we really like in Circle Health Group - with sunbursts are a bit of a hot topic, and a lot of copying and pasting into other reports.
So as you can see, we've got a sunburst and then we've got our quality review systems with our compliance rates underneath, then on the right-hand side you can see that's how we will record our compliance with evidence, and also photo uploads. Obviously no PID, but photos of environment and other things that we may find on our on our assessments.
So... benefits of using InPhase as a system. So, real-time. That's... that's the big buzzword for us - real-time assurance for the site, for the region and for the group, and ultimately the board. That's what we're here to do - immediate actions that have immediate view of actions and their status, so that we know how they're getting on. Do they understand the action? Do they know what they're supposed to be doing? Multi-user access was a big requirement for circle. So, if we were to use Excel, only one person could edit the Excel spreadsheet at a time. And lastly, we're using 365 but we weren't at the time. So multi-user access so that everybody can import into the system at the same time, was a... was a key element for us choosing InPhase.
Connected reporting. It can link to other dashboards, it can link to systems such as Power BI. We can create dashboards. We can export information as we need to.
One of the key elements for us was the responsiveness from the InPhase team. Sometimes they may change literally overnight. We would email one evening and it was done to the next morning, the response from the team has been fantastic. I really can't ask for more.
And then other changes, such as the CQC change in the questions they'll be asking the independent sector. The new guidance was released on the 10th, a couple of days ago, around how they're changing their approach to assessing the NHS and also the independent sector, and that means they're also... working with InPhase means that we can change our system to be reflective of that.
So what's next for Circle Health Group and InPhase? So we have a plan to work with InPhase to use their cast, and nice ellipse module.
That's scoping-out phase at the moment. But there is a plan to go forward with that. We've also got a plan to use the action plan module a little bit more than what we're currently doing. So for every action in the organisation, not just from the quality assessments, but from things like incidents and audit and everything else - anything where an action would be derived from - we're going to be putting that into the system. And then the next step would be board assurance dashboards. So that's our next project to go forward. Obviously we have those and away at the moment, but we want to make them better. We want to provide board assurance better. And how can we do that within a system? So that's the discussion that we're going to be having shortly with the InPhase team.
And I think that's me finished. Thank you very much. Are there any questions? And yes, I've got a question, I suppose.
Just thinking about the current pandemic prime and all the things going on, and maybe how having a system has helped, compared to thinking about kind of normal "business as usual" processes?
Very interesting. So as we all know, it's a very trying time. And at the same time we acquired the biggest independent sector... biggest independent organisation in the sector, and trying to keep any element in business as usual. It's very difficult. However, the Director from our Clinical Chairman and the Chief Medical Officer was the quality and compliance needs to continue to be maintained, regardless. So in order to do that we have to have the usual checks and balances and our usual processes, and our quality system, our quality assessments, which Circle have been doing for many years, needed to continue. And we needed to be responsive.
In order to continue to do that, we needed to work with a responsive organisation, which was InPhase. They need to be able to move at the same speed as us, which you have done.
...also been regulated on slightly different frameworks...
Andrew means it's slightly different for us, so we have the acute side of the Circle Health Group, but we also have the MSK which is commissioned under a slightly different model in which comes onto the GP framework. So having that means that we have the system that we can use for different regulatory frameworks. And InPhase has been work with us on that so that we can do that. The interesting part of working video and having the privilege to work with you during this... this really hectic time and quite challenging period for us, is the scale and pace issues and the way you are addressing those and managing to make that work even during the pandemic. It really is credit to... you know... you and your team as to how that is working.
I think what would really be quite nice actually, as well credit, is just talking about the way in which you have operated and, as you said, that the feedback that you've been getting. Where has it actually had any noticeable and... and helpful benefit to you guys? Immediately, and you know already out of the reviews that you've done I think that will be very interesting for people to hear.
So I think the first thing that comes to mind, we did an assessment up in the North. It was one of the first assessments we did. And the feedback from the Director of Clinical Services there was, she was very open, you know. Come in, please. You know...;look around... tell us. You know what you think. And actually, once we gave feedback, her response was, she lives and breathes every day. She's there every day, she... she does her business as usual, and the things that we've actually picked up on, she'd also almost become blind to them. Because she sees them every day. And this system helps us be able to articulate and actually tease out all of those little elements, so that we can help the sites and become "un-blind" if you like, to those little things that we'll... we'll check them out that they need to fix. Yeah, I think that was really fantastic.
We've just got another question come in actually. Andrew, can you see that or Aden? We'll be interested to see how to handle...
Oh, how we handled the virtual visits...
But it was like... that was an interesting one. So what we did is, we set up a schedule of interviews with all of the key people, as we would if we were on site. What we also did, is we arranged for a person to have an electronic device on site so that we could do a virtual look of... of the site, so we could look at the environment, and really go into the... the areas where people wouldn't necessarily take us into. If we just asked for photos, etc. So we were able to direct them and say you know we'd like to go into that room or we'd like to visit that area, can you run your hand across the top of the door, you know, or we could direct them reading. And that's how we managed to get around to. But I love it, I kind of... remote control version... they're kind of doing the physical as well. That is... that is just a superb use of the modern technology as well as perhaps being able to have this kind of live action version as well as the... the digital online stuff that really is a combination of technology that... that works really well.
Cody, thank you ever so much, and I'm always on the last one, is there anything that we'd like to bring in from that site, or...?
The additional comment that I would add - and this comes down to the multi...the multi-use. So when we done quotes before in a manual process or when we done our assessment process or a manual process, everybody's got their notes. They're held with them - they're on their clipboard. And you have to come together at intervals to... what have you seen? What bit have you looked at when overseeing the quote process? Which... which me and Cody shared between us. it's really useful throughout the day to see the updates coming into the system and it enables us to direct the assessors to perhaps areas that we want to triangulate or areas that we've seen a theme coming across, and we can do that in real-time, rather than waiting two or three days later when we've collated everybody's notes together, and it enables us to look at areas that are perhaps of concern or of good practice or identify where we might want additional information, almost immediately, because we can see the assessors putting in their information as they're going through that process. So for us, overseeing the assessment, that's really key.