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IT Strategy 2014 - 2017
Document Control:
Document Author: Head of IT
Document Owner: Board of Directors Electronic File Name: IT Strategy
Document Type: Corporate Strategy Stakeholder
Consultation:
Reader Panel (as described within this document) and Trust Board
Approval Level: Board of Directors
Approval Body: Chair of the Board and Directors Version
Number: 1.0
Reference Number: Version Issue Date: Sept 2014 Effective Date: Review Frequency: Four years
Method of
Dissemination: Intranet
Search Keywords: IT Strategy data information
For Use By: All Staff
Version History:
Version Date Author Reason
V0.1 May 2014 Head of IT To originate document
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CONTENTS1.0 EXECUTIVE SUMMARY ... 3
2.0 INTRODUCTION ... 5
2.1 BACKGROUND ... 5
2.2 SETTING THE SCENE ... 6
2.3 NATIONAL, REGIONAL, AND LOCAL STRATEGIES ... 7
2.4 TRUST VALUES ... 10
2.5 DISTRIBUTION CONTROL ... 10
3.0 TRUST STRATEGIC OBJECTIVES ... 10
4.0 STRATEGY ROLES AND RESPONSIBILITIES ... 11
5.0 STRATEGY LAYERS ... 12
6.0 NARRATIVE ... 12
6.1 THE PEOPLE (PATIENTS, COMMUNITY AND STAFF) ... 14
6.2 ACCESS MEDIA ... 16
6.3 APPLICATIONS AND TOOLS ... 18
6.4 KNOWLEDGE ... 22
6.5 INFORMATION ... 24
6.6 INFRASTRUCTURE ... 26
7.0 SERVICE DELIVERY MANAGEMENT... 28
8.0 IMPLEMENTATION AND MONITORING OF THE STRATEGY ... 29
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1.0 EXECUTIVE SUMMARYThis IT strategy is intended to underpin the Trust’s five year strategy, and assist the Trust to deliver the vision and objectives that it presents.
It recognises and supports the Trust’s strategic intention to:-
Be an excellent healthcare provider delivering local acute and other patient services to the highest quality to the residents and visitors of Great Yarmouth and
Waveney with our community as well as being part of an integrated healthcare service which includes education, research and training.
It has taken into account the major drivers both externally (National, Regional, Local) and internally (Trust, Divisional). Central to these drivers is the need to move towards integrated care and the ‘digital roadmap’.
This strategy is intended to both support the Trust in the delivery of its strategic aims and secondly to offer up new opportunities for innovation within the Trust; IT acting as both enabler and activator. The department recognises that IT must become a means to improve efficiency across the Trust, to be a ‘catalyst for change’, and to bring opportunities that can change how the Trust carries out it’s work.
The new strategy is presented through a layering model, reflecting how IT services are built, with each layer building on the former and enabling the next. Within each layer, everything proposed is developed with the view maximising benefits, return on investment, savings, efficiencies, improvements in care, improvements in information sharing, and the safety of our community, clients and staff.
THE PEOPLE (PATIENTS, COMMUNITY AND STAFF)
This is identifying those that need access to information and IT, extending access so that we can provide the appropriate information to those with a legitimate need
to access it.
THE TOOLS IN THE HAND (ACCESS MEDIA)
Having access to the right devices that provide the capability to access services in the appropriate format (PCs, own Devices, Tablets, Smartphones).
THE APPLICATIONS
Providing the right software to enable the information to be used to it’s best advantage.
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KNOWLEDGEThis is providing as complete a picture as possible in order to improve clinical and care decision making.
INFORMATION
Providing the capability to collect more complete and accurate information that we need, from as many places as required and at the right time – enter once, use
many.
INFRASTRUCTURE
The invisible engines that keep everything running: The Trust needs to have efficient, effective and reliable core that will keep information safe and secure, and
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2.0 INTRODUCTION2.1 BACKGROUND
The purpose of the IT strategy is to provide the systems and services that will assist the Trust to deliver its strategic objectives. It is for the IT department to both provide the tools and information, to where they are required, and to present new ideas that will enable the Trust to continually improve its services to our patients and community. The key message from the Trust strategy is one of transformation; a transformation that leads to improved patient care, reduced costs, improved efficiency, reduced length of stay, better working with our partners, and information being provided to the carers and management to better enable them to make decisions.
The IT department will do this through a vision as stated by our Chairman; ‘For IT to deliver the right information to the right place, at the right time, and in the right format’.
The IT department recognises that to improve patient care, information needs to travel with the patient, throughout their journey within the NHS and supporting community. For this to happen, the IT department must provide the tools and information that will enable:-
• Excellent care to be provided by the James Paget University Hospital, and the local Health economy
• Accessibility from the patient’s home, bedside, or in a care environment • The capability for information integration, analysis, and activity wherever it is
needed
Central to the IT department’s strategy is to develop methods of utilising information so much more than before. Taking information gathered from across many new and existing systems and information collection points, integrating and analysing it, and presenting it to where decisions are made; ultimately, to provide carers with up-to-the-moment information on a patient, or a ward, or a service, where and when it matters. Ideally it would also provide a single view of all relevant patient information.
The IT department recognises that patient experience is also very important to us all. So IT must also plan to improve patient experience, looking to enabling patient access to the Internet and entertainment services, ideally on their own personal devices. It must also work to enable patients and carers to access their information from home, and to enable families and friends to contact and communicate with those in our care. The IT department also recognises that IT has to step forward in order to help the Trust deliver upon its savings. IT must automate and speed up processes that can cause delay in patient journeys. IT will continue to work across the whole of the Trust, and with the Transformation team, to identify where IT services can be applied to help meet the challenge. Equally it must help ensure that systems are in place to collect and utilise all forms of data.
The IT department understands that to attract and keep key personnel, it must help the Trust to be an attractive place to work. Clinicians and carers should be given the freedom to use whatever devices they want from wherever they want. Feeling positive about the tools in the hand, leads to more confident and capable members of staff, which then results in a better care experience for all concerned. Students too, must be able to access the learning aids that they need, in a manner that suits them best.
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2.2 SETTING THE SCENEThe IT department consists of 28 members of staff, split into teams focussing on ‘Service Delivery’ (service desk, desktop support, applications support and training), and teams focussing on ‘Service Development’ (programme management, software development, and infrastructure). Currently the department supports in excess of 116 core, clinical and departmental systems. This figure continues to grow as the Trust adopts increasing amounts of technology. The department supports the systems and services from two on-site and one off-site main equipment rooms, hosting the majority of the services, securing the data, and providing resilience and backups. The estate of client devices consists of in excess of 2,400 PCs, laptops and tablets. The department receives in excess of 2,200 calls per year; a mix of service affecting incidents, and requests for new services. The department also has an extensive development programme, which is directed and prioritised by representatives of the Trust.
Throughout 2010-2012 the IT department built on it’s investment in infrastructure and training, and focussed on embedding change, creating the positive service culture, and providing the stable platforms that are now seen as the norm.
Throughout 2012 and 2013 the IT’s efforts were directed at implementing the electronic Health records (e-HR) system, and working with the Trust to deliver changes in
Pathology, Radiology, and in many other departments with smaller projects.
The environment in which the Trust now finds itself is one of rapid and uncomfortable change. The economic environment necessitates, that in delivering increased Health services, we must work differently in order to maintain and improve upon what we do. The NHS has recognised these changes and is adapting to them, this is leading to increased collaborative efforts across the care and social services sectors. This changing environment has to be adopted and enabled by changes within technology and it’s provision.
The new strategy is for a five year period. But five years in IT and the changing environment is a long time. So it is expected that this strategy will evolve over this period.
Mindful of these issues, the new IT departmental strategy has been developed through the phases outlined below.
1. Liaison carried out with our customers and partners at a National, Local, Trust and departmental level.
2. The development of a clear vision of the IT department and its roles within its environment.
3. A rigorous review ensuring all aspects of the strategy are aligned with the Trust objectives.
4. A review of new and emerging technologies that may bring innovative products to the Trust.
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However, once signed off, it is acknowledged that both the NHS community and IT environments will continue to change and therefore future phases will be to5. Regularly review, challenge and refine the strategy. 6. Refine and renew aspects of the strategy.
7. Re-publish as required.
The outcome is that the strategy is a ‘living’ document, able to adapt and evolve with any changes; and yet still hold true to the greater objectives of the Trust.
2.3 NATIONAL, REGIONAL, AND LOCAL STRATEGIES
The IT strategy has been developed to ensure that the objectives of the Trust, the NHS (at all levels), and its patients and partners have all been considered. The technologies, systems and services presented have been very much influenced by the following reports and directives.
‘Equity and Excellence: Liberating the NHS’ – 2010
The white paper from the Department of Health, has had a major impact upon the NHS and the delivery of services. It has resulted in an environment without the Strategic Health Authorities and Primary Care Trusts, with financial guardianship passed on to GP consortia.
In January 2012 The NHS Future forum presented its second report to the then Health Secretary Andrew Lansley, which set out a series of recommendations to improve the quality of patient care and achieve better outcomes. In summary this included:
Data sharing is vital for safety, quality and integrated care. There must be a clear presumption in favour of hospital discharge summaries being made available to GP and patient (or their nominated carer) at the point of discharge and of GP referral letters being made available at the point of referral.
Information is a key enabler of integration. Every individual should own their own patient record and be able to share it as they wish. All care records should be electronic and accessible at the point of care throughout the whole journey, regardless of Sector or Provider.
The Power of Information: Information Strategy 2012
In 2012 The Government set out its ten-year strategy for transforming the way patients get and use information about their health. The Power of Information set out plans to give all patients easy and continuous access to their own health records by 2015. Key objectives included:
A commitment that, by 2015, anyone in England will be able to access their GP health record online as well as book appointments with their GP or request repeat prescriptions online.
A longer-term commitment that all health and care records held by hospitals and other service providers will be made securely available to patients, enabling them to become much more involved and in control of their own healthcare.
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The way information is recorded in patients’ records will be accurate, consistent and standardised. This will both improve the quality of data available for patient care and also reduce over time the need for time consuming and costly
additional data collections.
There will be clear national standards in place to ensure that locally developed IT systems can “talk” to each other and exchange information effectively and securely.
Technology will be used to give patients high quality and convenient care – whether this be telehealth monitoring equipment that can be put in people’s homes or equipment such as digital pens or clinical websites that make the working lives of NHS staff much easier and more efficient.
Health Secretary Jeremy Hunt – January 2013
More recently, in his speech to the Policy Exchange 16 January 2013, the Health Secretary challenged the NHS to go paperless by 2018.
The Health Secretary said “that patients should have compatible digital records so their health information can follow them around the health and social care system”.
In meeting the 2018 goal, the Health Secretary wants to see:
Adoption of paperless referrals.
Clear plans in place to enable secure linking of these electronic health and care records wherever they are held.
Clear plans in place for those records to be able to follow individuals, with their consent, to any part of the NHS or social care system.
By April 2018 – digital information to be fully available across NHS and Social Care services, barring individual opt outs.
The NHS number to become a patient’s primary means of identification within the health and care system, enabling all of their records, wherever they are held to combine around the individual person.
The NHS Commissioning Board has set clear expectations which require all Hospitals to ensure they are sufficiently prepared to exchange patient information in a secure digital format by March 2015. Alongside this, further targets include Hospitals being able to accept e-referrals by 2015, patients being able to have online access to their GP records by 2015. Supporting these milestones is the target to ensure that by 2013/14 the NHS Number becomes the primary identifier for NHS patients. The Health and Social Care Information Centre Strategy 2013-2015
The new HSCIC strategy has identified four priorities for this period, in order for it to fulfil its responsibilities. These are to:
Promote trust through secure and interoperable services – to provide the safe and secure movement of information to where it is required across the whole health and care system.
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Deliver the National technology services – These include the ‘N3’ network, Spine, NHS mail, Summary Care Record, Choose & Book, Secondary Services, amongst many other systems and services.
Provide information to support better care – This is making information more accessible to those that need it, and in a more timely and effective manner.
Support the wider economy – Helping to promote local community care, partnership and innovation, and to develop the market-place through a shift to more medium –sized suppliers.
Regional and Local Drivers
Previous strategies have tended to be primarily within the bounds of JPUH; however there is now the growing acceptance that this can no longer be the case. In the development of this strategy, a growing number of factors and constraints became increasingly clear.
Many future business requirements will need active support and inclusion of partner agencies in order to bring the changes to fruition.
New technologies are expensive to implement; the Trust must look to its partners to share these costs and to benefit from the increased IT capability.
Where possible, and financially and operationally prudent, the Trust must look to align technologies and applications with its near neighbours; to reduce the risks to patients, from staff working across multiple sites.
The production and evolution of this strategy has to be aligned with strategies from within the Trust and with partner organisations. Proactive consultation with all stakeholders will continue throughout this strategy’s lifetime.
Information Governance and Information Systems strategies will need to be particularly aligned.
The IT department acknowledges that Trusts recognise that the ‘patient pathways’ are very important to joined up working and all share a vision of information flowing freely between GP, primary and acute Trusts.
The drive for cooperation across agencies is echoed by our partners. The strategic plan for the GY&W Clinical Commissioning Group is the creation of an ‘Integrated Care System’ (ICS); whereby agencies from the Health, Social, Voluntary and Council services are working to bring together patient care into a coherent patient-centric system. The strategic intent includes improving 7 day services, improving interventions and outcomes, and increasing efficiency.
Further Strategic reference:
Norfolk and Suffolk NHS Foundation Trust Service Strategy 2012-2016.
NHS Great Yarmouth and Waveney Clinical Commissioning Group – 5 year strategic plan.
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2.4 TRUST VALUESThis Strategy conforms to the Trust’s values of putting patients first, aiming to get it right, recognising that everybody counts and doing everything openly and honestly. The Strategy incorporates these values throughout and an Equality Impact Assessment is completed to ensure this has occurred.
2.5 DISTRIBUTION CONTROL
Printed copies of this document should be considered out of date. The most up to date version is available from the Trust Intranet.
3.0 TRUST STRATEGIC OBJECTIVES
The strategic intention of the Trust is to ensure that ‘our patients remain central to everything we do and they always come first’. It’s priority strategic aims are:
Strategic Aim 1: Be an excellent healthcare provider delivering local acute care and other patient services of the highest quality to the residents of and visitors to Great Yarmouth and Waveney
Strategic Aim 2: Ensure our patients receive the best possible experience
Strategic Aim 3:To remain a financially viable and strategically sustainable organisation
Strategic Aim 4: Further develop strategic partnerships and integrated care across the Local Health Economy
Strategic Aim 5: Develop our staff, ensuring they are supported to meet their objectives and to provide innovative and sustainable services for our patients The Trust’s 2014/15 strategic objectives to support the 5 year strategy are: 1. Implement the first year’s objectives of the Trust’s Quality Strategy
2. With our partners, implement the first year’s objectives of the Trust’s Seven Day Services transformation programme
3. Develop and implement the first year’s objectives of the Trust’s new Patient Experience & Engagement Strategy, closely linking with the statutory role of our Governors and the requirements of the NHS Constitution
4. Fully embed strategic planning within the organisation, with Integrated Business Plans produced and actively managed at Trust and Divisional level
5 Achieve all financial and performance requirements and comply with all governance and regulatory requirements
6 Continue to progress the site development strategy in consultation with our partners to enable an improved care environment for patients
7. Continue to build strategic partnerships, focusing on the further development of clinical and community networks to improve the care for our patients and the support and development of our staff
8. Develop and implement a leadership, management and transformation skills programme for our staff
9 Develop and implement a recruitment and workforce strategy to support achievement of the Trust’s strategic objectives
10 Review our approach to training to ensure all our staff receive the mandatory and developmental training they need, supported through regular appraisal 11 Further develop the role of the Academic Committee to ensure our research
and teaching supports innovative and sustainable services for our patients 12 Further embed the Values and Behaviours Framework as part of the
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Key messages from the Trust strategy 2013-2017, that are specific to IT include: “It will also require us to radically transform and redesign our existing services and staff will be required to work in different and yet more creative ways using theadvancements in technology available to us. This will ensure we use our resources to meet the demands of our patients, but also deliver them in the most cost effective, high quality and efficient way, eliminating waste and cutting bureaucracy.”
“In order for us to deliver on many of the challenges already mentioned in this plan, it will be essential for us to use the next generation of IT. It will require the integration of existing systems internally and with our preferred partners externally. It is also about enabling our staff to bring in their own IT devices such as smartphones, laptops etc. This will, in turn improve efficiencies and enable clinicians and managers to access emails and other information off-site. In essence, we want to make information available to those that need it, in the format they require, where they need it and on whatever device they need it on.”
“There will be greater partnership and integrated working between the hospital and our community colleagues to help people manage their own conditions as far as it is possible.”
“Changes to our healthcare services that will impact on…Investing in technology that reduces the need for patients to travel”
Further Strategic reference:
James Paget Quality and Safety Strategy 2012 - 2015 4.0 STRATEGY ROLES AND RESPONSIBILITIES
The owner of this strategy will be the Head of IT, who will have responsibility for implementation and delivery of the technologies.
The Service Development Manager will support the Head of IT by developing detailed delivery plans, benefits plans and overseeing the project governance process.
The IT Management team will encourage all of the IT staff and partners to work together and be confident to take the right steps to reach collective goals. All of our staff are IT professionals and as such have the competence, commitment and support from their colleagues to work for the common purpose.
All of our stakeholders must understand that to maximise the benefits of services and systems developed with IT, they must fully engage with the department and lead on appropriate changes to business processes. Departments will be responsible for changing their business processes so that the benefits can be realised.
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5.0 STRATEGY LAYERSIn the development of the technical and system layers, the components have been considered both:
individually to ensure that they contribute to the overall strategy.
and to ensure that the holistic vision is the best possible fit in consideration to the Trust strategy.
6.0 NARRATIVE
At the heart of this strategy is the recognition that the Trust needs to change how it accesses and utilises its IT. It must understand that information is a fundamental medical instrument, which must be worked for the patient’s health and benefit.
The next section looks in more detail at the building blocks that make up an IT system. Each block in the strategy must be built upon the former, and must support the blocks above.
The building blocks are wrapped around certain core themes that are carried right through the strategy. These core themes are:
The Trust must move through becoming ‘paper light’ to becoming ‘paperless’.
Information must be made available to those with a valid reason to seek it.
The information must be made to as wider audience as possible.
The information must be made available to where it is needed.
The information must be made available in the format and on the device required.
The information must be quick and simple to access.
The applications used must fit the business and operational processes and tasks that require them.
The applications must be effective, efficient, and reliable.
The data must be easily manipulated into knowledge, so that sound clinical decisions can be safely made.
Real time data collection – the Trust must look to collect complete and accurate data at source.
The core infrastructure must be reliable, fast, and present; wherever it is needed.
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Critical to the successful delivery of the strategy will be proposals to: Provide a robust mobile and flexible access capability that will make systems:
o Accessible from a range of fixed and mobile devices
o Via connections from a range of local and remote locations
o Through a safe, secure, and controlled gateway
o To a quick, efficient, and reliable infrastructure
o That provides the access to an integrated patient centric view of the information required
To provide integrated patient, ward, and clinic views, taking data from a range of sources, and presenting them through a ‘clinical portal’.
The development of a comprehensive data warehouse, that will capture broad and detailed information from a range of sources, which can then be utilised across the Trust and with partners, for clinical and corporate purposes.
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6.1 THE PEOPLE (PATIENTS, COMMUNITY AND STAFF)THE PEOPLE (PATIENTS, COMMUNITY AND STAFF)
This is getting the information to those that need it, recognising that we must provide the appropriate
information to those with a legitimate need to access it. The NHS and care sector environment is continually changing, the IT must be able to reflect and enable these changes. It can do this through portals and shared information repositories.
This need is very much reinforced by Department of Health, NHS England, and partner initiatives, extoling the virtues and requirement to move towards an integrated care sector that better meets patient’s needs.
It must also be recognised that the Trust generates revenue from being a teaching hospital. As such it must also ensure that it’s students and trainees are able to have access to the services necessary to successfully complete their courses.
Initiatives Benefits
Consider potential changes to 7 day services
IT will look where it is beneficial for all parties to supply the services, with the intention to both save all organisations costs, and to generate income for the JPUH
Improve the IT skills and literacy across the Trust
Enable wider secure access to information for those with a legitimate need :-
other Acute providers
Health East CCG
Community Health
Care sector
for patients, partners and families
Work with other parties in order to enable new and improved ways of expanding access
Informed stakeholders
Improved care and continuity of care
Online access to key information – booking in Collaborating with partners to enable information to be accessed by those that will benefit from it
Improving communication and understanding of business issues.
Faster access to information
More convenient ‘contact’ through remote diagnosis/monitoring
Improved relationships and satisfaction
Action points
Patients The Trust must move towards enabling patients to access their own records. The IT department must work across the Trust to develop methods of enabling patients to access the telephony, television, and the Internet. It should also recognise the particular needs of our patients, and be able to tailor services for a wide range of needs. For some, modern ‘tablet’ based technologies may be suitable, whereas for others, a more traditional radio, television and telephone solutions may be better.
Visitors, Guests and families
The IT Department will aim to enable Internet and Clinical access to visitors to the Trust. These may be guest speakers, commercial partners, students, and families visiting our patients.
NNUH and other Acute providers
In recognising that both patients and clinicians work across multiple sites, IT access must be reciprocally extended to partner Trusts.
Health East & Community Health
The IT Department should look to improve ‘evidence based best practise’, through developing capabilities for information exchange and access within the CCG and
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ECCH.In recognising the direction of travel to a new Integrated Care Organisation approach, information must be able to be moved across platforms, so that those with valid medical need, can see as complete a picture of patient information as possible.
The strategy recognises a strategic intent of the CCG to provide more localised care, minimising travel for all concerned, sharing common support functions, and working closely with Social Services.
Staff In general, staff are becoming more IT literate, this through the wide adoption of multi-media devices such as PCs, smartphones, and Tablets. The Trust can benefit from this increased skill-base, through providing better and more complete IT access and solutions.
IT must look to develop and explore new methods of enabling staff access to technical services – from home and remote locations. Plus exploring methods of utilising voice and video for remote and mobile communication.
The IT department must be able to better target key sections of the Trust. It must look to focus on areas such as Nursing, Operations, and A&E, and to look to provide services that will benefit their specific needs.
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6.2 ACCESS MEDIAAccess Media
This layer is about having access to the right devices that provide the capability to access services (including PCs, own Devices, Smartphones). Patient care will improve from having the appropriate data
capture/presentation device at the point of care, so that information can be collected and disseminated quicker, without error, by a skilled practitioner, and in the right format.
At present, the Trust uses approximately 2,400 PCs and Laptops across the campus. It is recognised that many of the current frustrations are with regard to the number of devices, their locations, and their general operating speed.
The objective is that the service user/department/organisation is able to choose the device that best suits their need and budget.
Patient access could be through a PC and clinical device to access their records and for ‘telemedicine’
facilities. For a care worker this could be a laptop, to access patient records, their diary, and the facility to enter information directly. For a clinician it may be a tablet type device that gives access to the same suite of services currently provided by a desktop PC.
The actual medium of recording information has also to be considered; it may be voice, video, textual, e-form, or any other format.
Further consideration has been made to other stakeholders within the Trust; the strategy must look to understand who our patients are and what are their needs: modern technologies may not be what all of our patients and partners need.
Initiatives Benefits
Provide access from as many locations as required
Develop methods that will enable a wider range of device selection
Investigate and develop the provision of Internet access for patients, visitors and partner organisations
Develop the ability of users to utilise their own devices
Ensure that there is the appropriate level/method of security and validation
Increased availability of systems and services
Making information available quicker to assist in decision making processes
Freeing up choice of devices
Improved real-time collection and dissemination of information Reduced length of stay
Lower client operating costs
Action points
Trust Devices The IT Department will enable a wider range of Trust supplied devices to be used, and that these will include mobile and ‘Thin client’ solutions. It is expected that these products will utilise Microsoft operating systems, so that a wider range of
applications can be utilised, though this shouldn’t be at the exclusion of other solutions.
Partner organisation devices
The IT department will look to provide solutions that improve the ability for partner organisations to access required information, using their own devices. This development is part of the drive to reduce barriers to information access.
This initiative should be developed in partnership with external colleagues, matching the development of Integrated Delivery Teams across community services.
Telemedicine Access from home – for patients (telemedicine), carers, and remote/mobile workers will require shared initiatives across agencies. These may include remote broadband
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devices, used to measure regular clinical conditions.Community Care devices
Mobile working – explore demand, and opportunities to emulate or integrate with Community mobile capability.
‘Bring your own device’ The IT Department recognises that for many employees, the ability to use their own devices can lead to improvements in information access, and reduce the demand for Trust supplied equipment. The Department will look to develop the capability for non-Trust issued devices to be used.
Patient devices This should be a mixture of Trust provided services and individual devices. The Department should look to work across the Trust to deliver bedside services that could be used by both patients and staff; this could be a multi-media devices providing access to television, telephony, and clinical systems. The Department will explore commercial options to provide television, telephone and Internet services; to provide access and communication to those who may prefer more traditional
facilities. Any implementation should be coordinated with Estates in order to minimise ward disruption and cost, and be scheduled along with other works if possible.
The Department should also look to enable Internet access, so that patients can bring their own devices to access the Internet.
Voice and video It is expected that there will be a growth in the demand for voice and video
capabilities. Such demand could be from recording clinical procedures, and storing the videos for Students to carry out their studies and research. It may also include the capability to record voice recordings to transcribe into letters.
The current video-conferencing capability is currently provided within the Education and Learning Centre, but should be developed to allow a more flexible service, that would include mobile and desktop based conferencing.
There could be opportunities for GP-to-Consultant video consultations, or for developing a remote healthcare provision of services.
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6.3 APPLICATIONS AND TOOLSApplications and Tools
The application environment is currently in a rapid state of change. National agreements have come to an end, plus short term capital initiatives are coming from central Government and NHS England. The market is also moving, from technologies traditionally based around static services, to applications that are becoming increasingly mobile.
There is also a major movement towards both systems and multi-agency integration. An acknowledgement that parties must look towards sharing information in order to improve upon patient care and efficiencies.
In driving access improvement and the integration of clinical system requirements, the Trust has previously explored the Electronic Patient Record (EPR) approach. The recent offering from CSC Lorenzo was considered and rejected. The Trust has instead opted for a ‘best of breed’ approach, in selecting the best individual
systems, and bringing their information stores together into a new clinical viewer.
Therefore the central core of the application part of the strategy, which is intended to be the development of a Clinical Portal. A presentation facility whereby the major clinical system information is presented in a new combined ‘picture’. Information from systems such as the Patient Admin System, e-Health records, PACS, Pathology, and others (including from other NHS sources), would be presented in a single ‘patient centric’ view. This would mean a lesser need to log into individual systems and access the same patient across all of them. Views could be based upon individual patients, wards, clinics, and patient lists.
Included in the strategy of developing a Clinical Portal, facilities such as ‘single sign-on’, ‘patient centric
viewing’, ‘session persistence’, and extensive information access and reporting, are expected to be developed.
Initiative Benefits
Increased the capability and benefits of Electronic Patient Records and their integration across multiple systems Work with the Trust in the development of a ‘paperless’ or ‘paper-lite’ organisation
Ensure the timely and efficient replacement of ageing systems when they become end of life
More integration of systems, and integration with partners Research new technologies, liaise with stakeholders and look how IT can improve on current ways of working Further improvement of existing systems (Bed Management, PAS, etc.)
More complete patient views – improving clinical analysis and decision making
Efficiencies through collect once, use many Improving the speed of accessing clinical information
Sharing costs Reduced Risk Reduced errors
Action Points - The Applications
Digital roadmap There are a large number of paper records and paper based processes that are in existence across the Trust.
Where suitable, the IT must look towards the adoption of electronic services, moving towards a paperless environment. The Trust is committed to the reduction in paper records moving around the organisations, and recognises that this needs to change. However, with increased adoption of IT services, the Trust recognises that the services must be very resilient, and further that fall-back and business continuity plans must be effective, well established, and understood by all parties that could be affected.
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Clinical Portal With an EPR not being adopted for some time, the Trust should look to implement a portal or viewer, that will give patient/ward/clinic centric views of integrated records. The IT department would look to develop technologies linked to a Clinical Portal, in order to better develop a more flexible, faster, and intelligent solution. This could include individual improvements such as single sign-on, patient centricity / ‘context launching’, and ‘session persistence’.
The Portal would look to incorporate external systems, such as the Summary Care Record (or MIG), to provide a more complete picture. Equally this initiative should look to be reciprocated, allowing partners to access JPUH held information for equal patient benefits.
Further, that these portals could aid in the development of remote and mobile based solutions, and ‘mini-apps’. These must be flexible and help staff to make decisions based upon ‘real-time’ information, helping to identify issues such as with current activity pressures and issues (i.e. bed occupancy and falls). This should be
supplemented by a capability to supply trends so that the results of decisions can be monitored and reviewed.
Integral with a Clinical Portal would be a ‘reporting services’ module that could be developed to improve upon all statistical, research, and clinical analysis of the main clinical systems.
Mobility At present, bar a very limited deployment, all Trust applications are presented on fixed position devices.
The Trust and IT department will look for ways to increase the adoption of
applications that can be used in a mobile capability. Mobility, by it’s very nature is an amorphous subject. The IT department, in recognising this, is writing a separate strategy that is focussed on mobility, and adopts many of the concepts and developments within the main IT strategy.
It is acknowledged that this is not a ‘one size fits all’ approach, and each department and section will have their own mobility needs. The strategy must recognise certain user constraints, such as nurses tending to stay on one ward and needing a rapid data entry method to carry out repetitive tasks.
System alignment The Department will work with partner organisations, and adopt same systems and services where possible. Primarily with NNUH to improve the service to patients. Cloud based services In improving access, both inside and out of the Trust facility, improving flexibility and
reliability, the IT Department will look to move towards systems being supplied over remote or internal ‘cloud’ technologies.
NHSmail is expected to be a major shift, resulting in improved external access, and to reduce local cost.
Microsoft Office products will also be explored, to determine if these services can be made available ‘on-line’ external to the Trust.
Specialist or ‘mini-apps’ Develop a facility whereby ‘apps store’ and ‘apps store’ type technologies can be adopted. These could be purchased by the individual, corporate, and they could include ‘apps’ developed in-house.
The department would look to introduce a quick-app development tool or forms designer tool, whereby small applications, benefitting specialist teams, could be quickly developed and implemented.
It is expected that a major beneficiary of these would be those carrying out
standard/regular checks, such as on ward rounds, where direct entry and access to information would be very beneficial.
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Voice Voice as a distinct technology has to the most part disappeared. Voice is nowsubsumed into a greater media whole. Voice is now integrated into voicemail, email, texting, video, ‘Skype’, social-media, and more.
The existing telephony system is approaching the end of its serviceable life, and as such there needs to be a phased migration to a new service. This new service will need to be a fully integrated system that is designed to fit with advancements in mobility, remote working, information access and exchange.
Any voice development will look to replace all current communication devices into its plans; these must include examination of the current pager, mobile phone, and radio services in use across the Trust. The department would look to enable staff to carry a single device that could incorporate all of the operational needs.
It must be recognised that this is a rapidly changing environment, and even more recent voice communications, such as the ‘Vocera’ intercom system, are quickly becoming outmoded. Alternatives such as using the ‘Vocera’ technology using personal devices will be investigated.
The hosting and presentation of information
It is recognised that the current folder and file structure is in need of significant improvement. The requirement and options regarding a document management service, that enables the sharing, dissemination, annotation, retention/deletion of documents, will be explored.
The options around adoption of Microsoft Sharepoint could be of significant benefit, especially as this product is included within the Microsoft Enterprise Agreement. The Trust Internet and
Intranet sites
The Trust has already committed to developing a new Internet site. The Trust should also look to subsequently redevelop it’s Intranet site.
Options to move aspects of the Intranet outside of the Trust infrastructure should be explored. The development of an external public/private extranet, which can merge with IT clinical and corporate services, will be explored. This could provide a much more flexible, accessible, and controllable environment for the public, our patients, and our staff.
Business Continuity With the increased reliance upon IT and IT services, it is recognised that their reliability and the effects of any failure, will become increasingly and more immediately felt by the Trust.
The IT department must continue to work with the Trust, in order to maintain a very high level of reliability, and develop effective business continuity for all areas. Core Corporate and Departmental systems
Microsoft suite With the end of the National Microsoft Enterprise Agreement, the IT Department will present the case for the commencing of a Trust Enterprise Agreement, so that services such as Excel, Office, Exchange, and Infrastructure services can continue to be developed and supported.
An Microsoft Enterprise agreement is a core component of both the mobility and clinical portal developments, without which, neither would be possible.
2014
PAS (iPM) The Trust has been advised that the existing CSC PAS service is guaranteed up to 2016. The strategy is to confirm the on-going
provision of iPM for a number of years beyond this, accepting revenue implications. The Trust is currently corresponding with CSC and HSCIC in order to understand the financial and support implications. CSC have previously advised that with 105 customers (80 NPfIT & 25 direct), iPM will not be withdrawn from the market for some
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considerable time after 2016.At the end of the NPfIT contract, it is expected that the Trust will have to absorb the support costs for iPM.
2016+ Pharmacy The existing Ascribe service is due to be replaced by a joint service
with the NNUH. This will utilise a new Pharmacy and e-Prescribing solution from JAC.
2014/15
Radiology The existing GE supplied Picture Archiving and Communications System (PACS) is being replaced in 2014 by a Sectra supplied product.
The existing HSS supplied Computerised Radiology Information System (CRIS) is expected to receive upgraded hardware and software in 2014.
The Trust must look to explore opportunities to integrate these into a potential future Clinical Viewer / EPR.
2014/15
2014
Pathology Part of the 2012-14 Eastern Pathology Alliance. Currently procuring a Sunquest ICE solution.
The existing APEX/iLabs ‘hot’ labs system will be reviewed; examining options around a 3-Trust solution or a hardware replacement initiative
2014 2014 e-HR The e-HR system will be further developed, with the aims to include
making the system quicker, providing a new user interface, developing e-form and workflow capabilities.
It would be expected that e-HR would be a major component of any Clinical Portal facility.
2014+
Maternity The IT Department, Transformation, and Maternity Departments will work towards the development of a new Maternity capability.
2014 A&E – CSC EDIS
system
The Supplier has advised that an upgrade roadmap is scheduled through into 2014, and that support is expected to continue beyond 2016.
Having adopted a ‘best of breed’ strategy, it would be expected to replace the A&E system as the current system approaches end-of-life.
2017/18
Theatres – CSC ORMIS
The Supplier has advised that an upgrade roadmap is scheduled through into 2014, and that support is expected to continue beyond 2016.
Having adopted a ‘best of breed’ strategy, it would be expected to replace the Theatres system as the current system approaches end-of-life
2017/18
Intensive Care System The current ‘GE’ system is currently being replaced with a new solution from Fukada.
2014 Bed Management and
whiteboard
The existing Bed Management system will be further reviewed, with the intention to develop, integrate or replace.
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6.4 KNOWLEDGEKnowledge
In the context of this strategy, knowledge is the utilisation or exercising of information that has been collected. It is the application and decision making capabilities that can be improved or created as a result. With more information, and through being able to ask the right questions of it, then knowledge is made increasingly available and increasingly useful.
Information being collected will be precise, accurate, and more detailed than ever before. This will enable real-time management decisions to be made, and more efficient planning of routes, routines, and pathways can be made. Information Services will be able to improve upon their reporting and analysis capabilities. Finance, Payroll, and HR would also look to maximise their use of the knowledge in order to better manage staff and funds.
Knowledge will help the Trust to identify key patients that could benefit from personalised treatment, to identify positive and negative trends in the results from treatment.
Knowledge will help Clinicians and all care and management staff to improve their decision making processes.
Knowledge must become more easily accessible and to a wider audience. The IT department must work with Information Services and across the Trust to provide a more complete picture to wherever it is needed.
Initiative Benefits
Provide a more complete clinical view of patient health and treatment
Improved data mining and analysis tools e-Learning development
Improving patient care through information analysis
Improve performance monitoring and reporting
More efficient use of limited resources Better decision making
Improved research and development opportunities Patient safety and treatment
Action Points Electronic Document Records Management - Clinical Portal
A Clinical Portal would be the most visible development of knowledge presentation. Information from individual applications for a specific patient could be presented into one clinical view; a complete knowledge picture to aid in patient care.
Data Warehouse - Reporting services
Integral with a Clinical Portal will be the under-pinning data warehouse. The IT Department would work with Information Services,
Transformation and other teams across and outside of the Trust, to develop a warehouse that will hold current and historical clinical information from as broad a range of Trust and external systems. IT and IS would work together to develop a series of standard report structures, which could be utilised across the whole Trust, in order to produce new and informative reports. Standard reports, and variants, could then be made available externally to the CCG, Monitor, patients, and others.
This will result in improved and more dynamic reporting capabilities, which should be able to greatly enhance the current services.
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GP care records The IT Department is working across the CCG and CSU, in order toincorporate GP information such as from EMIS, System One, and the Summary Care Record (via Medical Interoperability Gateway - MIG), in order to further enhance the level of knowledge ‘completeness’.
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6.5 INFORMATIONInformation
With step changes in how IT will be used, comes the opportunity to collect information much more accurately and extensively than before. We have seen how organisations such as Google, Twitter, Facebook and
LinkedIn, exist for the collection, analysis and use of information. This should also be developed for the Trust. The collection of real time information, where the precise times of treatment, consultation, attendance and from what location, will be able to provide the Trust with much more information than ever before.
A major strategic drive, both externally and internally, in the move away from paper forms and into much more direct digital data capture. This capability is a major consideration in the mobility strategy, so that information can be collected at the point of care.
Information must be moved around more than before; the whole philosophy of collect once and use many must be adopted. The more that can be collected automatically will again improve accuracy and
completeness, and it will also enable colleagues to carry out the more complex work, rather than filling in forms.
With real time information collection, the information will be more accurate, and opportunity for error will be greatly reduced.
Initiative Benefits
Improve collection of digital information Linking of information and directories Provide more complete, accurate, and timely information
Less error
More accurate, consistent, and reliable collection ‘Collect once, use many’
Improved billing accuracy and completeness Action Points
Data Warehouse In developing the concept of a Clinical Portal, a major aspect is the associated data warehouse. This would be where the information from the main clinical systems would be held for quick access and analysis.
Develop information recording capabilities
Detailed information must be developed to come from real time, location, and operation.
In recognising local (ward or specialist) needs, specific information should be made quickly available, such as providing recent comparative information where and when it’s needed. A considerable part of this would be from mobile applications and devices.
Develop the ability to process information better
The IT department would look to develop a more interactive and ‘tailorable’
capability in generating individual and standard reports. A reporting capability would be enabled, permitting Information Services and individuals to generate their own standard and specialist reports
The Trust should explore opportunities for patients, partners, and commercial organisations to access ‘their’ information in a safe and secure manner.
The Trust would explore opportunities for improved Research and Investigative information analysis.
Work with other departments to improve data quality
Work to reduce the amount of duplicate information entry and manual interactions. With any development of mobile technologies, comes the ability to input data at the point of collection. Real time information can be collected once and then shared
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and reduce data error across relevant systems. This will lead to improved audit and reduce the number of errors.
Error will be further reduced with the move away from hand written documents that can be prone to issues of legibility.
It should be recognised that if the initial data collected is wrong, then there could be the increased risk that the incorrect information is then disseminated across multiple systems, repeating the error multiple times.
Work with other
departments to provide better ‘real time’
information to our patients
Work with the Communications and Information Services Departments to provide patient information, potentially in A&E, waiting areas and on-line, through screens, the Internet and social media.
Specific examples could include A&E wait times being published internally and externally, for ward ‘dashboards’ to provide real-time performance information.
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6.6 INFRASTRUCTUREInfrastructure
The invisible engines that supply the information to where it is needed: The Trust needs to have efficient, effective and reliable core that will keep information safe, secure and available.
During 2013, the major components of the core IT infrastructure were replaced. This included the Virtual Environment, Storage, and Backup. This has resulted in a scalable long term central platform for existing systems and services, that can be built upon with new and replacement systems.
The core network infrastructure was replaced in 2012, and the edge components are replaced when needed. The Infrastructure strategy is to enable the step change from traditional ‘fixed’ IT to that of being ‘mobile’, and for information (voice, data, video, system) to follow the user. Key developments will have to include the adoption of the Microsoft Enterprise suite, mobile and Internet expansion, and the adoption of ‘IP’ based telephony.
A further fundamental change within the Infrastructure is intended to be the examination and potential development of external ‘cloud’ based technologies. The IT strategy is that, if financially appropriate, to commence a gradual shift towards external ‘cloud based’ storage or hybrid solution.
Initiative Benefits
Improve voice and data integration – unified communications
Provide comprehensive video capture and access capabilities – i.e. storing of videos (YouTube) of theatre procedures for training Management of data growth
Adoption of Microsoft Enterprise contract (Windows, Office, Server, Lync, etc.) Adoption of mobile capability
Review of storage model Partner integration
Improved access
Own devices – replacing broad range of current ageing devices Faster and easier access
Action Points
Storage / Backup Investigate and evaluate options around sharing storage/backup and moving storage outside of the organisation in order to improve access, reduce risk, and reduce costs.
Develop external ‘cloud’ based storage, and migrate steadily across in a phased manner, if appropriate to do so.
Security Utilise mobile device and Internet security devices in order to control, record, and manage a broader range of remote and mobile service users.
Investigate options around migrating the management of security to specialist parties. As the device utilisation changes, the complexity of management will also increase.
Develop methods whereby the need for the sharing of passwords is removed. Work with partners to remove barriers to access where safe and appropriate to do so. This would permit consultants working across multiple organisations to access information from any location.
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availability increases. The IT department, in the design of systems, must look to ensure that the designs and solutions are developed to reflect on the increasing reliance that the hospital will have with regard to it’s IT.
Virtual Environment The ‘VM’ solution was replaced in 2013 with a ‘HyperV’ alternative. This has
provided the Trust with a much increased capacity through to 2018 and beyond. This capability should be extended wherever possible in order to improve resilience and reduce costs.
Client devices IT will continue to explore alternatives to the standard desktop and laptop solutions. In particular opening up to personal devices, mobile devices, and alternative client software.
Secure services will look to use ‘thin client’ technologies where it is appropriate to do so. This will reduce the amount of Trust owned physical hardware, and reduce the frequency of renewal even further.
Telephony – unified comms
Replacement of the existing and aged telephone exchange, and move towards ‘unified communications’ – no distinction from data, voice or video – all is information to exchange .
Hardware replacement programme
The IT Department manages and maintains a broad range of hardware devices, that include servers, switches, access control devices, desktop PCs, laptops, mobile devices, and more.
In order to reduce costs, the IT Department will continue to explore alternative technologies, suppliers, and devices.
Where it is appropriate and safe to do so, the IT Department will look to purchase refurbished equipment and extend the lifespan of existing devices where possible. Trust Interface Engine
(TIE)
A new TIE, ‘Ensemble’ from Intersystems, was introduced during 2013, with existing and new interfaces being migrated across onto it in 2014.
TIE development will continue as systems change and new requirements are created.
It would also be a fundamental segment of the development of any clinical portal and data warehouse.
Wireless The IT department will need to significantly improve and expand the current wireless (Wi-Fi) capability across the Trust, to enable the expected increases in demand to be accommodated.
The Trust should also look to capitalise on improved mobile communications across the region, in using the expanding mobile networks and ‘hot-spots’.
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7.0 SERVICE DELIVERY MANAGEMENTThe department must continue to develop it’s service capability. It must continue to work with all parties both inside and outside of the Trust, and to assist the Trust to transform, increase efficiency, and contribute to continual improvement in patient care. The values
Accompanying our vision are our set of values that define who we are and our contribution to the Trust. They make up the ethos that the department must adopt in order for it to deliver the products and services that its customers need.
They are that the IT department will strive to:-
Recognise and commit to playing our part in patient care
Continually work to improve the quality of our services
Focus on outcomes that matter most to our customers
Be pro-active and work in partnership with our stakeholders
Improve our performance whilst driving down costs
Develop a professional and skilled team Departmental aims
The department also looks to continue to:
Continue to develop it’s customer focus
Meet with and develop IT with its customers
Benchmark IT performance and efficiency
Produce regular performance reporting information
Improve it’s communication with the Trust
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8.0 IMPLEMENTATION AND MONITORING OF THE STRATEGYIt can be argued that five years within an IT environment is too long a period for a strategy to last. As such, it has already been stated that this strategy will evolve and develop over time.
Due to the rapid changes within IT, this strategy will be complemented by:
A Technical and Applications strategy, which is re-compiled on an annual basis, with more detail and costs identified as each year approaches.
An Annual Plan that details what is intended for each year.
The implementation of this strategy is also influenced by the priorities of the Trust, the affordability of the components of the strategy, and by our National and local partners. Current influences include NHS England technology funds, which if the James Paget University Hospital is successful in its bids, could change the order and dates of the proposed developments.
The timeline below is intended to give an indication of the order of potential
developments and when they would look to be implemented. These will be subject to successful development of their respective business cases.
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Appendix A - Equality Impact AssessmentPolicy or function being assessed: IT DEPARTMENT STRATEGY Department/Service: IT
Assessment completed by: JOHN GASH Date of assessment: May 2014
1. Describe the aim, objective and purpose of this policy or function.
The purpose of the IT strategy is to provide the technical systems and services that will assist the Trust to deliver its strategic objectives 2i. Who is intended to benefit from the policy or function?
Staff
Patients
Public
Organisation
2ii How are they likely to benefit? Improved technology to assist in better healthcare and healthcare decisions 2iii What outcomes are wanted from this policy orfunction?
Improved clinical and corporate access to information, which will enable the whole Trust to better care for its patients and staff; and more effective and efficient use of its resources.
For Questions 3-11 below, please specify whether the policy/function does or could have an impact in relation to each of the nine equality strand headings:
3. Are there concerns that the policy/function does or could have a detrimental impact on people due to their race/ethnicity?
N If yes, what evidence do you have of this? E.g. Complaints/Feedback/Research/Data
4. Are there concerns that the policy/function does or could have a detrimental impact on people due to their gender?
N If yes, what evidence do you have of this? E.g. Complaints/Feedback/Research/Data
5. Are there concerns that the policy/function does or could have a detrimental impact on people due to their disability? Consider Physical, Mental and Social disabilities (e.g. Learning Disability or Autism).
N If yes, what evidence do you have of this? E.g. Complaints/Feedback/Research/Data
6. Are there concerns that the policy/function does or could have a detrimental impact on people due to their sexual orientation?
N If yes, what evidence do you have of this? E.g. Complaints/Feedback/Research/Data
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7. Are there concerns that the policy/function doesor could have a detrimental impact on people due to their pregnancy or maternity?
N If yes, what evidence do you have of this? E.g. Complaints/Feedback/Research/Data
8. Are there concerns that the policy/function does or could have a detrimental impact on people due to their religion/belief?
N If yes, what evidence do you have of this? E.g. Complaints/Feedback/Research/Data
9. Are there concerns that the policy/function does or could have a detrimental impact on people due to their transgender?
N If yes, what evidence do you have of this? E.g. Complaints/Feedback/Research/Data
10. Are there concerns that the policy/function does or could have a detrimental impact on people due to their age?
N If yes, what evidence do you have of this? E.g. Complaints/Feedback/Research/Data
11. Are there concerns that the policy/function does or could have a detrimental impact on people due to their marriage or civil partnership?
N If yes, what evidence do you have of this? E.g. Complaints/Feedback/Research/Data
12. Could the impact identified in Q.3-11 above, amount to there being the potential for a disadvantage and/or detrimental impact in this policy/function?
N Where the detrimental impact is unlawful, the policy/function or the element of it that is unlawful must be changed or abandoned. If a detrimental impact is unavoidable, then it must be justified, as outlined in the question above.
13. Can this detrimental impact on one or more of the above groups be justified on the grounds of promoting equality of opportunity for another group? Or for any other reason? E.g. providing specific training to a particular group.
N Where the detrimental impact is unlawful, the policy/function or the element of it that is unlawful must be changed or abandoned. If a detrimental impact is unavoidable, then it must be justified, as outlined in the question above.
14. Specific Issues Identified
Please list the specific issues that have been identified as being discriminatory/promoting detrimental treatment
Page/paragraph/section of policy/function that the issue relates to
1. INSERT HERE 1.
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3. INSERT HERE 3
15. Proposals
How could the identified detrimental impact be minimised or eradicated?
INSERT HERE If such changes were made, would this have
repercussions/negative effects on other groups as detailed in Q. 3-11?
Y N
16. Given this Equality Impact Assessment, does the policy/function need to be
reconsidered/redrafted?
Y N
17. Policy/Function Implementation
Upon consideration of the information gathered within the equality impact assessment, the Director/Head of Service agrees that the policy/function should be adopted by the Trust.
Please print:
Name of Director/Head of Service: Mark Flynn Title: Director of Finance Date: 15th September 2015
Name of Policy/function Author: John Gash Title: Head of IT Date: 15th September 2015
(A paper copy of the EIA which has been signed is available on request). 18. Proposed Date for Policy/Function Review
May 2017
Please detail the date for policy/function review (3 yearly): 1 May 2017
19. Explain how you plan to publish the result of the assessment? (Completed E.I.A’s must be published on the Equality pages of the Trust’s website). Trust Intranet
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20. The Trust ValuesIn addition to the Equality and Diversity considerations detailed above, I can confirm that the four core Trust Values are embedded in all policies and procedures.
They are that all staff intend to do their best by:
Putting patients first, and they will:
Provide the best possible care in a safe clean and friendly environment, Treat everybody with courtesy and respect,
Act appropriately with everyone.
Aiming to get it right, and they will:
Commit to their own personal development,
Understand theirs and others roles and responsibilities, Contribute to the development of services
Recognising that everyone counts, and they will: Value the contribution and skills of others, Treat everyone fairly,
Support the development of colleagues.
Doing everything openly and honestly, and they will: Be clear about what they are trying to achieve, Share information appropriately and effectively, Admit to and learn from mistakes.
