Changing the paradigm: my Malinko story
By Rob McGovern, Co-Founder and Director, Malinko
As Malinko moves into its fifth year of supplying the NHS with clinical e-scheduling software for community healthcare, Rob McGovern reflects on his personal journey with Malinko:
When NHS England and NHS Improvement assessed e-rostering software coverage and usage in 2018, their conclusion was to ask why so few have realised the benefits of e-rostering software, and why have the benefits of e-job planning, not been realised?
Back in 2014, whilst working at a major e-rostering software supplier to the NHS, I was asking myself the same question, “Why has the NHS not realised the benefits of capacity planning systems such as e-rostering and e-job planning systems… and how do we fix this?”. Undoubtedly, the adoption of these services would dramatically improve workforce planning, whilst enabling the NHS to deliver better, safer care to their patients at a lower cost for the taxpayer.
It puzzled me why NHS community services workforce planning had such low uptake compared to other sectors. Perhaps one of the key reasons was that there is no reliable empirical data available to provide an accurate picture of demand (caseload and patient needs)?
This led me to an even bigger question: Despite all the rhetoric and initiatives – such as the NHS Transforming Community Services programme (2011) – why is the focus in the media and the investment within health economies still on hospital-based care?
With the rising demand that comes with an ageing population, system leaders know that we need to move more care closer to home if we are to have a sustainable NHS. Most patients prefer to be treated in their own home and community services can often deliver safer clinical care in the home at a lower cost.
For years system leaders have known the paradigm has to change, yet it hasn’t. Why?
I wondered what would happen if the NHS had a system that enabled community services to become a data-driven service. A system that can give their community health and social care teams the same real-time visibility and transparency of capacity and demand as an ambulance service and an inpatient area in a hospital. A system that enabled them to capture and report on the reliable data they need to assure them that their community services have a handle on – and real-time visibility of – both distributed clinical workforce (capacity) and caseload (demand).
If the NHS had a system like this, would it give system leaders the assurance and confidence to invest more in their community services? And in doing so accelerate the shift away from hospital-based care and finally start to change the paradigm?
Rob and Roisin talk about how Malinko’s clinical e-scheduling software is helping NHS organisations build back better, driving efficiencies in community services that have a knock-on effect across all healthcare services.
1. Matching clinicians (capacity) to patient need (demand)
From my time at that e-rostering provider, I knew capacity planning systems had no way of enabling the NHS to capture reliable patient demand data. It needed to allow community services to assign shifts to clinical and non-clinical staff intelligently.
The lack of ‘demand’ data was impacting operational performance and patient care and meant community services were unable to accurately identify the skills and staffing levels needed to meet their caseload and patient needs (demand).
This was the first problem I wanted to help the NHS community services solve.
2. Coordinating patient-centred care across organisational boundaries
In 2014, community services were beginning to adopt GP Electronic Patient Record (EPR) systems. However, patient demand data held by EPR systems was often inaccurate and unreliable, making intelligent rostering and effective workforce planning near impossible.
Additionally, EPR systems had no way of dynamically scheduling patient care or managing their distributed workforce on shift to meet their patients’ and caseload needs, either within or across organisational boundaries.
This was the second problem I wanted to help the NHS solve.
The Eureka moment
In 2015, I concluded that NHS community services needed a new type of clinical system to solve these two problems: a clinically safe Field Service Management system, referred to by our NHS partners as a clinically safe e-scheduling system.
Myth busting – Clinical systems and workforce management systems
Let us first bust a myth out there. E-scheduling is not a simple ‘add-on’ to an e-rostering system. Yes, they are complementary, but they are completely different systems. E-scheduling is a clinical system for caseload management and e-rostering is a workforce management system and is categorised as such.
E-scheduling and e-rostering systems are also regulated differently. NHS e-scheduling falls under clinical system regulatory framework DCB0129, and more recently, as the Malinko feature set has become further enriched and clinical decision support has been increased, it has crossed the threshold to the requirement for Class 1 Medical Device registration.
In contrast, e-rostering is classified as workforce management systems. As e-scheduling is subject to clinical regulations which do not apply to workforce management systems, e-scheduling systems like Malinko must be governed, designed and engineered in a very different way.
Integrated with and complementing the EPR to improve caseload management: bringing together capacity planning and capacity scheduling
Firstly, let’s look at how other sectors have addressed these issues. ERP Focus defines both systems and outlines how they are used in different sectors:
“Discussions on capacity planning and capacity scheduling are difficult because some people confuse the two and some believe the terms to be interchangeable. However, they are two different things that solve two different problems. Capacity planning exists to help ensure that capacity is available when it is required, and capacity scheduling exists to help optimise whatever capacity actually is available. The former is primarily a medium to long term tool whilst the latter frequently only looks a few days ahead; perhaps a couple of weeks at most. A look at both to see what they can and cannot do will be useful in helping to decide if individual companies need planning, scheduling or, indeed, both.”
It seemed evident to me that, just like in other sectors, NHS community services needed both systems: a clinical capacity scheduling system to complement their existing workforce capacity planning systems. If they had a capacity scheduling system, it would enable them to solve these two problems – giving NHS leaders the opportunity to move more clinical services out of the hospital and into the community and finally change the paradigm.
During my research, I met Mark Richardson who is Ocado’s Chief Operations Officer. I learned that capacity e-scheduling systems were used in other sectors, either as part of an Enterprise Resource Planning (ERP) system or alongside specialist capacity planning/rostering systems. The use of both these system capabilities enables organisations like Ocado, Sky, the AA and many others to manage and optimise operational and financial performance.
The reliable demand data captured, held and reported on in capacity scheduling systems enables these organisations to optimise productivity whilst managing and continually improving operating performance. Through the use of both systems, these organisations can intelligently and accurately forecast and plan future service and workforce requirements and better roster staff.
I concluded that NHS community services needed a capacity e-scheduling system which met the regulations was clinically safe and which complemented – and integrated with – existing EPR systems. Although not critical, integration with business intelligence systems (data warehouse), capacity planning systems (such as e-rostering and e-expenses systems) would further enhance the user experience.
They also required these three components:
- Mobile app – enabling healthcare professionals to easily capture valuable patient care contact time and acuity data contemporaneously
- Web application – providing visibility and transparency to safely assess capacity and demand, ensuring patients are seen by the right clinician, with the right skills, at the right time
- A clinically safe, intelligent scheduling engine – safely assigning caseloads to clinicians, optimally scheduling patient care and appointments, minimising travel time and optimising care contact time.
In 2015, Malinko was already in use for capacity scheduling in other sectors, such as social care. The core of Malinko was there, but it needed more. And in 2016, I pitched the idea of developing Malinko for use in the NHS to the founder of Malinko, Andrew Threlfall, and we agreed to work together.
Building the world’s first clinically safe e-scheduling system
Malinko was already being successfully used in social care and in other sectors, and we knew that in order to create a new clinical system for the NHS, we would need clinicians to help us design and build it.
We had to find NHS co-design partners to adapt and develop Malinko’s basic capacity e-scheduling system. I had strong relationships with NHS leaders, and Andrew had recently met and impressed Rachel Dunscombe (CIO of Salford Royal NHS FT). Andrew pitched the idea to Rachel, who agreed to trial Malinko at Salford Royal NHS Foundation Trust. At the same time, I persuaded Anglian Community Enterprise CIC to also give us a chance.
In early 2017, after many meetings and several system demos of the prototype Andrew and his team built, we were able to secure partnerships with Anglian Community Enterprise CIC and Salford Royal NHS Foundation Trust, to co-design the world’s first clinically safe e-scheduling system for community services.
Salford, like ACE CIC, generously supplied clinicians to help design a new system that would meet the clinical needs of the service. They made it very clear to Malinko that the system must:
- Support several competency-based nursing and therapy models, both within their own organisation and across organisational boundaries to better enable collaboration with social care.
- Enable its community services to intelligently deploy their clinical workforce according to patient need and acuity
- Allow them to capture and report on reliable data to help with service and workforce planning
Making the 2020s the decade of community services
The clinical system we built – both for and with community healthcare services – has now been adopted by 20 NHS organisations and two local authorities. Although we continue to improve Malinko, it is enabling our NHS partners in England make a dramatic difference to their community services.
Following a successful early adoption programme for District Nursing in Wales, Malinko was selected and awarded an ‘Once for Wales’ contract by NHS Wales for all seven of their University Health Boards. The goal? to enable the Welsh District Nursing service to become a data driven service by April 2022.
Although the NHS is not the most adaptable market for new innovations, everyone at Malinko feels privileged to serve the NHS and we are extremely proud of what we have achieved so far. However, we also accept that there is much work still to do if we are to repay the trust and faith our NHS partners have given us and live up to the expectations of Rachel Dunscombe who gave Malinko a chance a Salford Royal NHS FT
“My view is this. Malinko is about enabling us to safely manage capacity and demand as we move services from bricks and mortar to the community. The paradigm I envisage is that we have always had flow and state systems along with rota systems for the acute space. (Using Malinko) Community can now operate with the same transparency and safety and as we make these big changes to models of care, we will do so with a knowledge that we have a handle on capacity, demand and skills needed. Social care should of course be included.”
Rachel Dunscombe, Former Non-Executive Director at Malinko (2020-2021), CEO of the NHS Digital Academy, Visiting Professor Imperial College
So, thank you NHS, and thanks to all these great NHS innovators and risk-takers (the NHS is full of them) who co-invented the system and gave Malinko a chance.
It’s a privilege to serve the NHS and we are forever in your debt.
Amanda Hobson– Former Lead Nurse Adult Community Services, Salford Royal NHS Foundation Trust
Clara Gilfillan – Operational Lead for Community Nursing, East Suffolk and North Essex NHS Foundation Trust
Gwen Nash – Lead Nurse for District Nursing Services, Salford Royal NHS Foundation Trust
Simba Chandiwana– Director of Operations, East Suffolk and North Essex NHS Foundation Trust
Paul Crank – District Nurse Lead, Cwm Taf Morgannwg University Health Board
Rhys Roberts – Lead Nurse Merthyr & Cynon ILG, Cwm Taf Morgannwg University Health Board
David Gasiorowski – Clinical Change Lead, Salford Royal NHS FT
Raj Jain – former CEO, Northern Care Alliance NHS Group
John Llewelyn – Group Director of Digital, Northern Care Alliance NHS Group
James Sumner – CEO, Mid Cheshire NHS FT (ex-CEO Salford Royal NHS FT)
Jym Bates – Deputy CIO, Northern Care Alliance NHS Group
Ryan Calderbank – Deputy Divisional Director of Operations, Bolton NHS Foundation Trust