In conversation with… Glenys Lawson, Digital Matron at London North West University Healthcare NHS Trust
Glenys Lawson has been Digital Matron at London Northwest University Healthcare NHS Trust (LNWH) for over 10 years.
Prior to this role, Glenys was a nurse for many years working in emergency and acute care.
Glenys has been working with Infinity Health for several years, having worked on Infinity digital transformation projects within LNWH - most recently in the “STARRS” early supported discharge and rapid response team, that cares for over 9,000 patients in their homes each year. You can read more about our work with LNWH here.
We spoke to Glenys about how her nursing experience prepared her for her digital role, what she’d like to see every NHS Trust doing to make digital a reality, and what it took to get NHS staff to see going paperless as necessary.
Glenys was interviewed in June 2020 - this piece was originally published as subscriber-exclusive content.
Tell us a bit about yourself and what your role entails.
“I was one of the first matrons appointed when they introduced the role about 12 years ago. Prior to that I was a senior nurse at one of the first acute assessment units in England and then latterly a matron across central Middlesex. I’ve always been involved in the emergency sector and years ago I got involved with trying to find a better system for recording clinical information about patients. I was then involved in other digital projects like trying to develop an acute workflow and remove paper out of the system where we could. That’s really where it started.
“Later, in the acute medical department, we were getting more patients with more complex needs and I realised that we had to find a better way to record things other than paper. Six years ago I moved out into digital services.
“Prior to my role, there was almost zero clinical input in digital services, with all digital projects going ahead with a wing and a prayer - not necessarily what the clinicians needed or wanted.”
“I think they quite quickly discovered that having somebody like myself in the department was actually quite useful. It gave me the chance to be able to say: “Hang on, stop. That's not going to be of any use to a physician - it might give you some information but it's not going to make any difference to our day-to-day working on the patient flow.”
How did your background in nursing prepare you for your role?
"It definitely prepared me well. I’ve been a nurse for 32 years and I’ve seen it all - from the green screen in the sister’s office that nobody was allowed to go anywhere near, sitting next to the consultants’ tea tray waiting for lab results to come back by internal mail. A background in nursing has been vital.
“I have the experience and profile with my colleagues, so they know that if they see my name on a project, it’s going to be somebody clinically experienced looking at it.”
“Whatever project it is, there is confidence. Having a good working relationship with my colleagues is vital as they are also the experts, and I will tap into that expertise regularly.
"I still look at everything from a clinical view and have to make sure that things look right and will work well. And if they don’t, then my role is to say no if needs be. I’m able to cut down long-winded processes by seeing how we can do things differently."
How has LNWH adapted to the needs necessitated by the pandemic?
"The very clear thing that has come out of this is that prior to the pandemic, there was reluctance to look at digital as a working way forward. Some people were very keen, some didn’t know how to get involved, some felt too busy. Busy people don't have time necessarily to look at these things, even though it may save them time in the long run. They don't perceive that they have the time or the impetus. But suddenly they had to…and that’s what the pandemic did.
“It forced people to look at how they do things, and how they needed to do things differently to be able to continue to function and for patients to still get treatment.”
"Remote visiting and remote consultations have been the biggest thing to make people sit up and go 'Hang on, I've still got a list of 200 patients that I need to see next week, and I can't bring them into the hospital, but I still need to see them somehow.' The mindset changed to how they could do things differently, and still maintain standards and get the patients the care that they needed.
"The other big thing was people realising that using alternatives to paper is an efficient way of doing things.”
When you've got one of the largest takes in London, you've got upwards of 200 people a day coming in and you need to know as quickly as possible that they can be safely sent to a ward. You wouldn't know whether a COVID-19 result had come back or whether it was being sent or received. Somebody would have to sit there and plough through all the patients in the acute areas to see whether swabbing etc has been taken and what the results were. One of the first things that I did was to work with the developer to make that process simpler, get some alerts, and put a simple colour on our mini electronic record so that people can see the results. And then they manually took that off when they were either positive or negative.
"We've since then moved quite swiftly through automating that process. I spent quite a lot of time initially pulling information out and then putting it into the system so that the clinical teams had more time to care for patients.
"Supporting patients in the community and expediting the discharges safely was a clear priority, and working with companies like Infinity Health gave us back hours of time and facilitated us being able to process patients and move patients through the system quicker.
"Our STARRS and early supported discharge teams were taking a significant amount more patients out of the hospital early. I call it a ‘hospital in their living room.’ They were the first attenders in patients’ homes who became symptomatic avoiding GP and hospital attendance. We've got direct lines of communication back in.
If someone is shielding, they can still manage to do their jobs at home because they use the Infinity platform to communicate back into the system and coordinate activity remotely which is something that we would not have done before at such speed.
"Our critical care areas have also adapted very quickly to documenting digitally as the traditional notes could not be held within COVID-19 positive areas. ‘Let’s make it happen’ was a phrase we used frequently, though we now need to go back and re-evaluate what went well and what didn’t.
"We were constantly monitoring activity and patient flow in bed meetings and daily safety briefs pre-pandemic, and these required a physical presence at meetings. These are now conducted via MS Teams which is paying dividends and will continue."
Are there any elements of the digitisation trajectory that you think have changed forever due to Covid-19?
"Well, we can be sure that it’s not going to go backwards! For example, we are making continued progress towards digitising portering, and we just need to get that rolled out to the rest of the trust. This was in place prior to COVID-19 in both emergency departments (ED) and assessment areas. It has really hammered home that when the ED was split into red and green areas it was vital that we knew where our patients were and porters knew what they needed to move safely.
"Solutions and processes need to be sector wide, so it doesn't matter where you go and work or receive care, you're going to be met with the same system. Things like remote clinics work and will continue. The benefits of doing things remotely now can in some cases completely outweigh the need for some people to come into the hospital and reduce the risks. However, this is not one-size-fits-all by any means and the patient experience must remain our central focus.
"Staff are working more remotely thanks to an investment in kit and remote licences. We are ready if, heaven forbid, we have another surge and we now have the knowledge and experience for the future."
What are the most important digital solutions that you are currently working on at LNWH?
"I’d say that virtual visiting with MADETECH is a really important one. When the world shut down there was no visiting, full stop. Very quickly we realised that we needed to implement a solution as this was causing distress to both staff and relatives. I remember going up to one of our wards and there was a distressed member of staff in the infectious disease unit which was experiencing the first brunt of the pandemic. There was a patient who was extremely unwell, and their relatives were outside and couldn't come in. The patient sadly died, and it was really distressing to know that their loved ones couldn’t be with them.
"Now every ward in the in the trust, and some of the non-clinical areas have got virtual visiting capabilities on our iPads, so at least twice a day we have loved ones that have booked in for virtual visits whether the patient is in hospital for COVID-19 or not. They can now see Granny safely, and in some cases more frequently than they would have previously. Our critical care areas use this as part of the daily routine now.
"We're also now using this for other purposes, such as virtual consultations for potential nursing home assessments. It means that the assessors don’t need to come up to the hospital and we can do it virtually at the bedside and invite families in. It not only makes things a lot easier for us, but it speeds the process up for the patient.
"We are working towards a full electronic paper record (EPR) with Cerner at LNWH, so the challenge to maintain the progress we have made migrating staff to thinking more digitally and including them on this journey is exciting for me and will create some new challenges as we move forward."
What steps can NHS organisations take to better support digital implementations?
"Now that we’re trying to get back to a normal way of working, we want to work on new initiatives. But once the pressure comes back on again, the time goes.
“I think we need to recognise that people need time and support more than anything to be able to make change. There are some fantastic ideas out there and we need to make it easy for them to progress with them.”
"Staff are forever coming to me to ask whether we could adapt specific types of technological solutions. We’ve got pilot areas and I know that there are areas that I can use for pilots, but we need more time to ‘play’ with possible solutions. Playing with solutions is a very important part of digital. It gives us time to see if we can break it, and if we can’t break it then it’s probably going to be a relatively good thing to use."
If the NHS could do one thing tomorrow to make digital a reality, what do you think it should be?
"I would like to see every hospital in every trust having one pilot ward that is able to implement a full digital everything and from which we could benchmark everything else.”
“Having that would mean that all trusts would be on a level playing field with appropriate investment.
"We need to push piloting digital implementation a little bit more in every trust. We're working on that with test beds and trying out new things, but we need to ensure we get operational and board level support locally and nationally. We need to shout about what we do, share it and learn from it."
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