A single pandemic-era messaging platform has enabled thousands of staff at Austin Health in Melbourne to focus directly on patient care by raising clinical communication efficiency and reducing time-consuming communication tasks. 

THE PROBLEM

In 2019, a detailed assessment of the state of clinical communications at Austin Health was done in pursuit of hospital accreditation standards. It found two major issues: difficulty in identifying who is performing a specific clinical role at a specific time and having multiple communication channels at play with high variation in clinical communication practice. 

"These factors made it challenging for staff to know how to communicate, time-consuming to perform clinical communication activities, and took frontline staff away from direct patient care. The variation in clinical communication practice, with there being as many as nine different clinical communication methods available, was also a patient safety concern."

Nicole Hosking, Operations Director, Radiology/Molecular Imaging & Therapy, Austin Health

PROPOSAL

With the onset of the pandemic, Austin Health quickly sprang to action to resolve its internal communication challenges. The organisation immediately introduced an ad-hoc, role-based communication solution that allowed doctors in the COVID-19 wards to communicate with doctors outside using Microsoft Teams accounts on dedicated phones which staff would pass on at shift handover. However, staff found this solution difficult to use; it also could not be scaled. 

Around the same time, FiveP had been closely working with Austin Health during its migration to Office365. They were also in talks about the initial implementation of a role-based communication solution in the COVID-19 wards. Subsequently, the health IT company offered to develop a scalable, enterprise solution based on Microsoft Teams for the health system – and thus Baret was born. 

"By leveraging the Microsoft 365 platform, we could meet security and governance requirements and explore new solutions that would allow us to address the two key identified issues within our clinical communication framework and improve our communication practice."

Alan Pritchard, Director EMR and ICT Services, Austin Health

MEETING THE CHALLENGE

It took almost two years to roll out the new role-based messaging solution across the organisation from planning to implementation. The project, along with its team, was officially kicked off in April 2021. After six months of development, a three-month pilot involving seven clinical teams followed. The pilot was successful, and the project was granted approval by Austin Health's executives in March 2022 for an organisation-wide rollout, which went on between June and December.

According to Pritchard, two major factors were considered during Baret's implementation. The first was which clinical roles to start with and in what sequence. Identifying the key groups, roles, and message types was important to driving interest and adoption. Based on experience from the pilot phase, uptake would be limited unless frequent interaction via Baret was required during shifts. It was due to this reason that clinical role groups were first engaged through the platform before it was introduced to medical staff. Given the frequency of its usage among the clinical role groups, there was rapid and positive engagement among junior medical staff when it was rolled out to them later.

"Successfully driving clinical communication through one medium such as Baret relies on the power of the network effect. No matter how good the technical solution, there must be a significant amount of people in the system sending valuable messages to drive ongoing use," Pritchard explained. 

The second area of consideration was which communication methods would be the first to be removed from the clinical communication framework and replaced with Baret messaging. Austin Health started replacing routine paging, urgent paging, and simple, non-urgent internal phone calls first as these three communication methods occurred at high volume daily across all clinical disciplines and services. 

Considering these two key factors, the initiative led to "significant positive outcomes" for staff, including the progressive adoption of Baret during the staged rollout marked by an increased volume of messages on a daily basis – rapid growth was more pronounced when junior medical staff were brought into the system. 

Meanwhile, Austin Health saw no major pain points during Baret's rollout. "The technology is easy to use, so familiarisation of staff with the application was straightforward," Pritchard noted.

However, as with all other large organisations, getting the word out about Baret to thousands of staff working 24/7 across different shifts proved to be a challenge. Austin Health sorted this out by reaching out to them using multiple communication methods, including an intranet communication campaign, emails, team meetings, education sessions, pop-up alerts on the paging system, presentations at staff orientation events, desk tents, posters, and their HMO Facebook page. 

RESULTS

As of end-April this year, Baret is being used by approximately 5,948 registered users and 165 clinical teams across the 24/7 care environment at Austin Health. Over 200,000 messaging communications that involve around 800,000 interactions (such as clarifications, acknowledgements, and replies) have been completed. 

The initial implementation produced the following results: 

• Making it easier to identify who is working in an on-site clinical role, which facilitates faster communication

• Enabling the systematic removal of paging systems

• Making clinical communication more efficient, with staff not constantly interrupted by telephone calls often for somebody else. Staff can instead refer to a dashboard of messages for the clinical role that they are performing, which they can then prioritise, and action based on clinical need

• Improving operational oversight and clinical governance of clinical communication, as managers can now see which roles are available 24/7 and can see if key roles are not covered

The Baret implementation at pharmacy and radiology teams, for example, has streamlined inter-team communication, decreased the time taken to perform communication, reduced interruptions to performing clinical tasks, and enabled staff to better focus on clinical care delivery. Radiology has even saved one full-time-equivalent radiographer who is redistributed to direct patient care. 

There is also the ability to collect and analyse more data that informs clinical changes. Austin Health now has data showing the busiest roles; the level and type of interactions among roles; the length of time for each role to reply; and the number and frequency of requests for urgent clinical review of an inpatient. 

It also has access to urgent clinical review (UCR) data, which is now being used to identify trends and patterns that were previously difficult to assess or unknown. It is now receiving insights into the number of UCRs per hour, day, and medical unit to improve clinical care delivery.

"The introduction of Baret has enabled Austin Health to improve clinical communication efficiency, reduce the communication workload of healthcare professionals, collect and analyse relevant communication data, and improve patient safety. These positive outcomes demonstrate the significant benefits that can be achieved by implementing a standardised role-based clinical communication platform in a healthcare setting," Hosking emphasised.