Health Service Focus

Why trusts are getting WIRED

A digital training record system developed at West Middlesex University Hospital NHS Trust has proven extremely popular and is now being taken up by other trusts across the country, with help from Skills for Health. NHE talks to the creator of the WIRED application, Harjinder Mann.

A new system called WIRED (the Workforce Information Reporting Engine Database) is popping up at more and more NHS trusts as they realise what a simple and effective way it is of letting staff manage their own training records.

Information analyst Harjinder Mann of West Middlesex University Hospital NHS Trust (WMUHT) was commissioned to develop the system, and he has now been seconded to sector skills council Skills for Health to promote its wider use around the NHS.

The system is updated by a nominated person in each training area (for example fire, infection control, or information governance) and everyone at the trust can access it via their intranet. It helps staff and managers keep track of their training, assisting with scheduling and compliance.

One size does not fit all

Mann told us about the genesis of the project, after it was commissioned by the hospital trust’s director of workforce & development, Nina Singh. He said it was basically a reaction to over-centralisation of IT systems previously, adding: “Unfortunately one size doesn’t fi t all and as a result a lot of trusts were struggling with the national workforce system. It served the nation well for when it was designed several years ago; it achieved its objectives and was one of the more successful public sector IT stories.

“However, it is fundamentally flawed in quite a few ways, one of them being the management of training and compliance.

“It took me about a year or so to develop the product in conjunction with doctors and nurses and consultants. I tried to make it very specific to their needs, but based on a standard central data – the ESR (NHS Electronic Staff Record). It pays around 7% of the nation’s workers, so it is a very good HR and payroll system – just not good for everything else.”

‘Revolutionary’

WMUHT’s transfusion practitioner Monique Chituku (pictured, top) has to deliver essential blood transfusion training to nearly 1,000 staff across the hospital trust and was one of the fi rst clinicians to use WIRED. She said: “It has revolutionised the way I organise training, allowing me to focus on training the right clinical staff and thereby ensuring that patients receive high quality care.

“WIRED enables me, the clinician and managers to clearly see which staff need training and levels of compliance across clinical areas. This management information is required by the trust board and external regulators such as Care Quality Commission and NHS Litigation Authority.”

WIRED is based on Microsoft’s SQL Server, already widely used for NHS patient and clinical databases. Mann said that without much in the way of central support, many local hospitals and NHS organisations have already used this standard technology to develop interoperable applications able to talk to each other, answering local needs.

Unlike massive national IT implementations, WIRED can be implemented at a typical hospital trust with 12,000 staff in less than a day, making it available on every PC via Windows log-in authentication.

“When you log onto your PC, it automatically recognises who you are and it can show you your record automatically with no need for you to manage it via another user ID or password, it’s just automatic.”

This ease-of-use and access is a big change to the previous national system, Mann said. “We were endlessly submitting bugs and fixes for the national supplier, and it’s a really bureaucratic process. You’re getting local, regional, national support and before you know it a year or two’s gone by before any changes have been made.

“It’s about trying to convince the powers that be that there are better ways of doing this.”

He gave the example of the fi nancial services industry and banks – into which he sold a software product he developed earlier in his career – where there is fi erce competition, but standard technology platforms allowing interoperability.

(Above: Linda Orrú, mandatory training and induction manager for learning and development at The Royal Marsden NHS Foundation Trust, using WIRED.)

Saving clinicians’ time

More and more NHS trusts are choosing to use WIRED, Mann said. “The demand is just immense and I’ve got great support from Skills for Health. We are growing, we have hired some good people and my focus is always existing customers.

“We’re really fortunate: in the first year we’ve had IT and HR directors going on record and saying they’ve achieved, in a few months, 25- 30% compliance at a fraction of the cost of the national system.

“If you can enable clinicians to work faster and better, everyone wins.”

It is a system that’s proven secure enough for every information governance officer so far sign it off. Also, the licensing agreements with Microsoft make it a very affordable technology: indeed, some trusts haven’t even had to pay for the technology behind WIRED at all.

Patient safety

Trusts have been attracted to WIRED because of the cost savings and ease-of-use, but there are important clinical factors to consider too – such as how better monitoring and compliance with training can safeguard patient safety.

Mann explained: “In many trusts, there is a blame game going on; certain data not being presented in a timely fashion. ‘It’s wrong’, ‘it’s out of date’, ‘the admin department has put this in the system’. But with WIRED, the ownership is put back at the operational managers’ level and there’s no blame game, people saying ‘we did our blood transfusion training on Monday and it’s not on the system’.

“This whole concept of manager self-service is just ridiculous in the NHS. You can’t have managers to manage hundreds of clinicians; each clinician has their own professional responsibility to do their own medicine management training and so on. So if you offer technology that shows how you get access to your record in one second, there is no excuse not to book yourself on with the relevant training.”

Trusts so far have been choosing to adapt WIRED to allow the publication of ‘score cards’, promoting competition between departments and wards to get their compliance up. Such ‘naming and shaming’ can be contentious, but often proves effective.

Mann said: “It’s not rocket science, but the user interface is very easy to use and has a lot of information on it very neatly presented, based around traffi c lights. Nobody wants to be ‘red’. People know that you can look at the chief executive’s record, even.

“Why not make it open and transparent? Why hide the data and give people excuses not to do the training?”

Information in seconds

Mann, who has been in the NHS for five years, says in a way he is ‘doing himself out of his job’, since WIRED replaces a lot of what his role was about previously.

“A problem with the centralised system is those guys haven’t worked in a hospital, in an acute or primary care setting, so they’ll never understand the nuances of why people are moving away from the national system.”

He said that during an inspection after a death, for example, if regulators need training information, in many NHS hospitals it’s “pretty embarrassing” how long it can take.

“With WIRED it takes seconds; you don’t have to go through weeks of finding that information, contacting people. It’s just there.

“It’s about the culture too: you can have great technology, but if the organisation doesn’t change its culture…”

WIRED has been ‘future-proofed’ as much as possible. “I’ve not really had to customise it; I physically make any code changes so it’s basically a really confi gurable system.

“At Chase Farm for example, they went live with WIRED back in April 2012. I spent a half day with the IT department; I spent almost two days with the administrator and had a half a day training session with the rest of the team.

“I support them via WebEx for probably about an hour a month and they’ve gone on record to say they’ve increased compliance from 65-70% to 85% within three months.”

More trusts are signing up all the time: during January 2013, for example, Guy’s and St Thomas’ NHS FT signed up to a WIRED licence, and the executive directors of Barking, Havering and Redbridge University Hospitals NHS Trust approved funding for a WIRED licence.

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