Dr Anna Fraser is a foundation doctor at Frimley Park hospital. She initiated the project, brought on support and has been the driving force behind its development.
How did this project start?
I think it was my first placement at Frimley Park. My first week, I was on nights. I was on surgery, so my reg and SHO were in theatre, and I was just dealing with patients on my own. In the past, at different hospitals, I’d had a booklet with guidelines in it. I just thought, “Where’s the Frimley Park booklet? Where’s my help here, when I’m on my own?” Genuinely, I didn’t know they were on the intranet, so I was using old hospital guidelines. Then it was a bit further down the line that someone said, “They’re here, on the intranet.”
There was a lot of really good information on the intranet, but there was so much information there that, actually, I sometimes couldn’t find what I wanted. So I kept using my old handbooks, and that’s when I felt that it was wrong to be using another hospital’s guidelines. I felt that we needed to do something for other junior doctors.
So I had a quick chat to the other people in my team. They were using different handbooks as well, and they were using Google searches and the Oxford Clinical Guidelines, those sorts of things. So that’s where it started up. I spoke to one of my seniors about it, and said, “What about doing a handbook?” They said, “Yes, that’s great. Good idea. Off you go. Sort it out.” So then I approached Dr Naidoo and said, “I’m going to do this as a project. What do you think, and will you help me?” He said, “Yes, great idea.” He was very supportive. It just kind of evolved and evolved and evolved from there.
What were some of your main concerns and obstacles about getting a clinical guidelines app made?
Well, it didn’t start off as an app. Actually, it started off as a booklet. My main concern was, I had spoken about an app, and I just felt like it was too much of a goal, too big a step to get to the app. I thought it was easier to do a booklet first. Because no-one had really done an app before, so I felt like we were treading new ground. It would be difficult for me to get the funding. It would be difficult to get the support. So it just felt like it was too far out of reach.
But actually, I was entirely wrong about that, because when we presented it to the board, they were the ones who said, “But why aren’t we doing it as an app? This is a much better way of doing it.” So actually, I think I was wrong in my initial assessment that it would be a step too far.
Frimley Park is quite – I’m not just saying this to make it sound like a good hospital – forward-thinking and it is quite innovative. I think they actually just thought, “Yes, we could do this.” So it was the board directors that said, “Let’s do it as an app.”
So I guess to answer your original question, what were the obstacles? It was breaking new ground, because no-one else had done it. It was getting funding for it, and it was getting buy-in for something that I think was quite innovative. So those were the things that I was most worried about.
What was the result, did the obstacles prove to be correct?
I think I didn’t appreciate how difficult this project was going to be in terms of having guidelines in different places in the hospital. So it was on the intranet, and having it on an app as well meant that we were having guidelines in two different places.
From a safety point of view, Information Governance were quite right in saying, “You need to manage the information so that there’s no chance of error.” So for example, one being updated, and the other one not being updated. Someone using an out of date guideline could potentially cause harm to a patient.
That was quite a big obstacle in the fact that I found that piece of information out much further down the line. So we had already started rewriting the guidelines so they’d be appropriate for an app. They were shorter; they were more concise, and more appropriate to our level. Then we understood that this was quite a big issue that we had to address. So we then had to take a few steps back again.
We lost quite a bit of time in sorting that out.
Also, the whole process of getting guidelines approved is quite a lengthy process, necessarily, to make sure they’re safe. I think as far as pushing these projects along, that was also something that took quite a lot of time to make sure that they were approved, not just by a consultant, but they had to go through Drugs and Therapeutics as well.
Then on top of that, we also had to speak to the IT Department to get their approval and put forward the business proposal for it. So actually, this whole project kind of started upside-down, and we had to do everything in a backward way.
If I was doing it again, knowing what I know now, the whole process would’ve been different.
So what would be the process, if you were doing it all again now?
That’s a good question. The process would be, I’d speak to IT and Information Governance first about what I was doing. Well, no, you get the buy-in from the top, as we did originally. We pitched it at the clinical governance meeting, in front of the CEO and the Medical Director, and we got buy-in for the project, so people were aware of what we were doing.
Information Governance to understand how to deal with the information we’re putting on the app. IT, because we need to liaise with them with where the information is. Then start looking at the guidelines. That’s the kind of process that I would go through. Then you look at the guidelines, and how they’re going to fit on; which ones you want, which ones need rewriting.
Now that the app is in people’s hands, what do you like the most about it?
It’s just really easy to get the guidelines. I’m often in a rush as a junior doctor, and trying to get someone off the computer and log-in yourself, and then get to the bit of information that you need actually takes quite a long time. Whereas if I have it on my phone, which is usually in my back pocket, I can very quickly access the information that I want. So it’s just really nice to have it there when you need it, and it’s just really easy to get to. So perfect, really, from that perspective.
Any other benefits?
It’s quick and it’s easy to access. Those are the two main things that help me. I also quite like the little functionality that you have where you can download the whole document. If you click on the top right-hand corner, you can get the PDF of the document and you can see the whole thing, as well as just seeing it in little chunks. I just quite like that, because I’m familiar with the old document, so that’s just quite a nice feature.
But mainly that I can just use it on the go. It’s quick and easy; fast to access the information on the go.