Implementing integrated sexual and reproductive healthcare in a large sexual health clinic in England: challenges and opportunities for the provider.
ESC Congress Library. Boog K. 05/10/18; 208166; ESC250
Dr. Katie Boog
Dr. Katie Boog
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Introduction This quality improvement project reports service-level challenges of implementing an integrated sexual and reproductive healthcare service from a provider's perspective. In January 2014, the contract for our service was won by a new Trust, with a new co-commissioning strategy by 3 local authorities. This resulted in the merging of hospital Genitourinary Medicine services with community contraceptive services, and amalgamation of staff from both departments. The challenges to delivering 'one-stop' integrated care at a service level included high client load, lack of dual trained staff, resistance to change and inadequate 'patient flow' systems related to providing integrated care.   Design and methods These changes led to a complete overhaul of the pathways into and within the service, which were implemented in 3 phases over a 2-year period. These phases saw appointments moving from walk-in only to a general walk-in clinic with specialist booked appointments. Patient work-streams were adapted, changing from one single work-stream for all clinicians, to individual work-streams whereby patients were allocated to clinicians, based on their expertise. A patient-completed triage form was implemented and modified across the phases, reflecting the patients' needs to allow allocation to the appropriate work-streams as they evolved. Feedback from staff was sought at each intervention. Staff training was prioritised with reception staff being trained in allocating patients to different work-streams and healthcare assistants in asymptomatic screening. Additionally, a new buddy system and daily protected staff teaching were introduced to support dual training.  Results Despite the changes to patient appointments and clinic flow, there has been no reduction in clinic activity, with a modest increase seen. Patients are now being allocated to an appropriate clinician, reducing the need to return to clinic at a later date or see multiple clinicians in one appointment. Patient surveys this year have consistently shown high levels of satisfaction, with >90% of service users reporting recommendation to a friend and >95% being satisfied with their care.  Remarkably, staff satisfaction scores have rocketed from only 2.5/10 in phase 1 to 8.1/10 in phase 3 with significant improvements in staff morale. Conclusions Despite the difficulties associated with such dramatic changes, the service has managed to overcome obstacles in training, patient pathways and workloads and has implemented a successful, fully integrated service.  Our approach has encompassed three key elements - communication, flexibility and prioritisation of staff development - and we recommend other services undergoing these changes to consider a similar approach.
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