SLaM: project recovery
Putting a stalled NHS electronic observations programme back on track, scaling it to 800 staff across 50 mental health wards.
The South London and Maudsley NHS Foundation Trust (SLaM) provides the widest range of specialist NHS mental health services in the UK - more than 230 services including 52 inpatient wards. A pioneer of electronic patient observations in mental health care, the Trust piloted an open source observation tool on two wards in 2015 and set out to roll it out across the Trust.
The transition from pilot to live had stalled. Open Digital led the recovery: establishing a clear roadmap of what was required and when, resolving the issues the Trust was experiencing, and directing the delivery team and stakeholder relationships through to a successful trust-wide rollout. This engagement is a working example of our project recovery service.
The work
Recovery began with a stakeholder workshop bringing together clinical, technical, cultural and project management perspectives to rebuild a shared understanding of the goals. Mental health observation differs from the acute setting - patients are not necessarily allocated to a bed - so the work included updating the escalation algorithm to clinical needs, reducing the key presses required for common tasks, designing workflows to allocate patients to nurses and escalate to doctors, and interoperability with the Trust's patient journey system over HL7.
Performance and capacity analysis established measurable operational characteristics before rollout. A software release pipeline enabled repeatable delivery, kept sensitive data on the Trust's site, and allowed testing and training environments to be stood up easily so every change could be validated before going live. The first production release went live across three wards in 2018, with continuous collaborative development thereafter.
The outcome
When the pandemic doubled observation volumes beyond the original design load, the teams worked through the technical, clinical and user experience together - delivering a ten-fold capacity increase with faster submission times for every user. Being open source, the growth in users carried no additional licence cost.
The platform now supports over 800 staff across 50 wards. Deteriorating patients are identified sooner, escalation is automated, and a live acuity board gives nurses and clinicians real-time patient information - raising standards of care quality and safety, and moving wards towards paperless working. The application has since become part of a wider open source health programme, so every adopter benefits from each other's investment.