Dr John Lockley discusses how simplicity improves efficiency in the day-to-day running of a GP surgery
At a time when primary care is under immense pressure it seems sensible to ease the situation by revisiting that old management mantra: Keep It Simple, Stupid (K.I.S.S.)!
Here is the first of a series of articles on doing just that—practical tips to make things simpler and easier for yourself, your colleagues, and your staff. These principles will save time, reduce stress, and save money too.
Some ideas (but not all of them) will involve neat ways of using the practice computer. The computer isn’t the only way to make things happen more quickly or more reliably: there are many others—and sometimes paper is better.
So let's step back, and view practice life from a distance—a helicopter view.
You'll immediately notice that the computer, while being crucial to practice organisation, isn't the whole story. Lots of other things come into play: the patient, the practitioners, the people on your staff, the paperwork, and the protocols. Because these all begin with the letter 'P' and their effects are all mixed together, I call it 'P soup' (the more orthodox name is 'the IT eco-system').
The trick is to ensure that the IT eco-system, taken as a whole, works smoothly.
A place for everything
Let's start with one of the basic mantras of efficient system design: have just a single place to store a particular type of information. This means there's only one place to record it; only one place to look it up; only one place to amend it; and only one place to delete it.
Note that the storage site isn’t necessarily on the computer (though it could be). It may be more convenient to have a particular type of complex information—say, brochures from your local private hospitals—in paper or booklet form, on a particular shelf in the office. Everyone now knows where to find them, and where to go to replace them when a new brochure comes in the post—and now there won’t be 13 different versions of the same booklets scattered around the practice, 10 of which are out of date to varying degrees.
All for one and one for all
Although some types of information are best kept in paper form, centralised data such as protocols, contact details, and NHS missives are usually more accessible on the computer. You may need different locations to store different types of information, but there’s still only one place to look it up, store it, and change it—but now everyone in the office can access the data without having to move from their desk.
When starting to use each new computerised repository, refer to its contents on screen—don't print off the information, because that would fix its contents at one moment in time: it will eventually become out of date (and then you’ll have 14 versions flying round the office.)
Next encourage everyone to start using each repository, perhaps one repository at a time. Introduce the staff to the location you have decided upon, encourage them to start using it properly, and make sure that any unusual sources of the chosen type of information are copied across. Then, one dark night, without any warning and when everyone else has gone home, go round the practice, remove all the paper versions (e.g. address books), and lock them away in your desk.
OK, there will be grumbling the next morning, but once everyone starts using the new method it will save them all time, stress, and filing space—lots of it. It will also minimise errors because everyone will be using the latest information.
And if someone discovers that something wasn’t copied across to the appropriate repository, don't worry— one equally dark night you can return to your desk, extract the relevant document and return it to its owner with the injunction that it will soon do a second disappearing act—this time into the shredder—so they will obviously need to copy the information across ASAP.
Keep it safe
One important warning: because electronic storage is less robust than paper, ensure that you have up-to-date virus protection and a regular regime of backups—and keep your backups physically separate from the main computer in case of fire, or attack by ransomware.
Keep it up to date
Finally, keep your centrally-stored information bang up to date. Whatever else, don't have a backlog. It is often best to have a standing instruction that anyone who discovers new information has a duty to change the details there and then in the relevant repository. One of the most important features of any central reference resource is everyone's ability to depend upon it without having to waste time checking that it does indeed contain the latest version of the information.
And then sit back as the new, efficient, time-saving way of working quietly starts to reveal its benefits!
Next in the series: how to shave time off common tasks
- Remember the K.I.S.S. principle: 'Keep It Simple, Stupid!' In the time-poor world of primary care, focus on making things less complicated (and therefore easier) for yourself and your co-workers
- Don't think about 'the computer' and 'everything else'—consider them as being interconnected: 'the IT ecosystem'. Use the best bits of each modality (paper or IT)—whatever fits most effectively in a particular situation
- Wherever possible have just one place to store a certain type of information: this means only one place to record it, one place to look it up, and one place to amend it. Everyone will know where to find it; there's no question of ending up with several different repositories of the same information (which inevitably get out of sync); and the information you find will always be the latest version. There is only one proviso—keep it up to date.