Sheffield Teaching Hospitals NHS Foundation Trust Patient Information Leaflets

The Problem


Dealing with over a million patients each year, Sheffield Teaching Hospitals NHS Foundation Trust provides a full range of local hospital and community services for residents of Sheffield, as well as specialist care for patients from further afield. The Trust has a history of high quality care, clinical excellence and innovation in medical research.

The provision of patient information is a key part of this care. Some 1500 patient information leaflets are currently produced by the Trust, and are used every day by staff and patients. Including details about hospital procedures, services, medications and conditions, most of these leaflets are given out as part of routine clinic appointments or as part of a patient’s preparation or recovery.

The availability, timeliness and accuracy of these materials have to meet standards set by the NHS Constitution, those of the Care Quality Commission and the NHS Litigation Authority. The information must include risks, benefits and, if appropriate, alternatives to any proposed course of treatment or surgical procedure.

Sheffield Teaching Hospitals’ patient information leaflets are managed locally by a network of 160 Patient information Leads, supported by a small Patient Information Team who oversee the development and review of information, and by the Medical Illustration department, who support the illustration and design of the leaflets.

The majority of leaflets are produced as A5 booklets, which may range from a simple 4-page instruction leaflet to a 40-page guide. There are also A4 factsheets and DL leaflets. These were being produced by the Medical Illustration team using professional design software, and then digitally printed externally as well as being published as low-resolution PDFs on the Trust’s intranet. This system worked well for a number of years and had brought a certain amount of standardisation to the visual style, but could only be updated by Medical Illustration staff which meant that even simple date changes could have to wait several weeks to be processed.

With a continuous improvement in standards, there was a need to update leaflets on a more regular basis, which increased workload for the staff responsible for producing and maintaining the documents and caused growing delays in leaflets being updated. In addition to this, the Trust took on responsibility for a range of Community Services, which added hundreds of leaflets to the portfolio, many of which had been created using Microsoft Word or Publisher and lacked consistent formatting.

To address these growing workload issues they decided to hold a stakeholder event to discuss ideas for future development. They considered subscribing to an external service but its range was not broad enough and it would have required sign-off from all the departments involved as it couldn’t be funded centrally. They wound up asking that provider what they used and that’s where we learned of PIPS from Interlagos.

The Solution

The word-of-mouth recommendation wasn’t sufficient in itself to make the decision to proceed with PIPS. Within the NHS they have strict tendering protocols and need to consider other solutions. They have a range of criteria to judge each system against, including impact on their own IT department, the quality of document templates and typographical control to meet NHS identity guidelines and accessibility standards.

Other system selection criteria included ease of use and intuitiveness of the interface, the ability to provide different levels of access and workflow reporting tools. A Microsoft Word-based alternative was considered but was ultimately rejected in favour of PIPS, largely on the grounds of its typographic and layout capabilities. The finished look was important to Sheffield; it had to be professional.

To make the creation of leaflets easier a link to NHS and NICE content is provided by the system. This allows users to browse the content of these databases and extract information on a subject. This can then be downloaded into the leaflet and local branding added. Interlagos plans to add further content in the future.

Official publishing of leaflets with PIPS began in May 2013 and has dramatically streamlined the process, bringing it under full control of the Patient Information team, and significantly reducing the demands on the medical Illustration group who are now able to focus on their core design work without being constantly distracted with requests for minor text changes and other updates.

Simple changes can now be made at the click of a few buttons and leaflets republished in minutes and changes to static text such as their copyright and alternative format statement can be made across all documents in one go. It saves Sheffield a great deal of time.

Consistency across A4 factsheets, A5 booklets and folded DL leaflets is now ensured and templates have been set up to meet best practice guidelines for accessibility, in which font choice, size, emphasis and other typographic and layout parameters are defined and automatically implemented. PIPS can also optimise the PDF documents it produces for cost-effective printing by allowing the inside pages of documents to be set to black and white where appropriate, which reduces external printing charges.

The workflow reporting requirement is addressed by PIPS too. The system shows where a document is in the development process, if it’s with the author for editing or review, ready for further work by the Patient Information team, complete or published.

Sheffield Teaching Hospitals NHS Foundation Trust are very pleased with the development, implementation and maintenance support they received from Interlagos. Interlagos have been incredibly supportive throughout. Sheffield are really pleased with the results and can’t believe the transformation compared to a year ago and how easy it is to produce these documents now.

Further developments centred on the PIPS implementation include support for Easy Read, a document standard developed for readers with learning disabilities, for which Interlagos has already developed a template, plus wider access to the system so that individual Patient Information Leads – clinical staff and other healthcare professionals who contribute to and review leaflet content can update the material themselves, saving the time it currently takes to re-enter and check any changes.

Plans are also well-advanced to make the content of the various leaflets available to the public via the Trust’s website. PIPS supports direct output to HMTL as well as PDF, so this will allow material to reformat for display on devices such as smartphones and tablets where the screen size makes viewing print based PDFs impractical. This will also help to avoid the potential information overload when patients are given everything at once in printed form when they visit the hospital.

They will point people to the website for information and expect this to become the normal route in years to come. Previously, they couldn’t even get at the text in their leaflets but now they are much more in control.

As a result of the new system on average Sheffield are reviewing/publishing 72 leaflets per month compared to just 30 per month using their previous manual system. At the peak they have managed to publish as many as 130 leaflets in one month, a staggering increase on previous production rates.

As well as the speed of production the system has hugely improved the standard of information produced. They have more leaflets ‘in-date’ than ever before moving from a point of only 41% in 2010 to their current position of 88%.

ther improved standards include:
– Consistent formatting and Trust branding
– Automatically set to the highest accessibility standards (for patients with a visual impairment, learning disability etc.)
– Clear review dates and referencing
– Compulsory recording of evidence base and user testing
– Reduced duplication through use of existing ‘approved’ content and no double-entry of text

Feedback from staff has been sought at various points during the project. In October 2014 Sheffield recorded the following results using

– 100% said the system was user friendly; 11% found it extremely user friendly, 42% very friendly.
– 100% reported the system was successful for publishing leaflets to some degree; 15% extremely successful, 66 % very
– 94% reported satisfaction with the system; 35% replied extremely satisfied, 42% quite satisfied. None reported dissatisfaction.
– 75% said the system had reduced the time spent on a leaflet; 56% said much quicker, 19% said somewhat quicker.

When asked what they particularly liked comments included:

– Simplicity
– Independence to do them [leaflets] yourself rather than going back and forth to the very busy patient info team.
– Keeps all patient information in one place, allows me to easily check what needs updating. The preview function is really
 helpful too.
– Quick and easy to make simple changes to review and you don’t have to phone around to check stuff is done.
– Being able to write and amend leaflets in one go as you can see problems with formatting etc. and make appropriate changes – removing a step of the process when using the previous system. Seeing at a glance on a page all the leaflets I am responsible
 for and their review dates.

There has been large scale acceptance of the system and virtually all users have said that it is easy to use, saves them a lot of time and it is much quicker.