Staff safety is fundamental to running an effective health service and delivering quality care. This year has highlighted how important risk assessments are in protecting the NHS workforce, as it continues to respond to the COVID-19 pandemic.
We know that frontline healthcare staff are more at risk of becoming infected with COVID-19. We also know the virus has a disproportionate impact on staff from minority ethnic communities, and that many NHS workers are considered “clinically vulnerable” to COVID-19. There are also risk factors that relate to gender, age, weight and many more. This can understandably leave staff feeling confused about what they should and shouldn’t be doing to look after themselves and their colleagues.
On 24 June, it became mandatory for all trusts to complete occupational risk assessments of vulnerable NHS workers. In this interview, Patient Safety Learning speaks to James Duez, CEO of Rainbird. James tells us how his company developed an automated decision-making tool, able to produce individualised risk assessments so that appropriate measures can be put in place quickly.
Questions & Answers
Hi James, can you tell us a bit about Rainbird?
Rainbird has existed since 2013 and we have a team of about 45. Our platform provides decision-making support for a variety of industries including finance and professional services. We take the human knowledge needed to make complex decisions and automate it. This enables us to improve efficiency, raise the quality of decision-making and reduce risk – all at scale.
Our focus hasn’t historically been on the healthcare sector but when the pandemic hit, we wanted to throw our weight and expertise behind projects that would support the NHS. We offered free access to our technology to anyone who could use it to support the COVID-19 response. But we wanted to do more.
How did the idea for the COVID risk assessment tool come about?
The idea for the tool came from a conversation with Dr Robert Hardman, a senior Consultant in Occupational Medicine at Workplace Health and Wellbeing (the Norfolk and Norwich University Hospital Trust’s Occupational Health Service) and a Director of the Faculty of Occupational Medicine.
We knew that NHS managers had been tasked with risk assessing all vulnerable staff at a time when they were already under huge workload pressures and many were experiencing burnout. Many staff were increasingly becoming concerned about their own safety and the risk to their families. One Trust was getting 600-700 calls a day from colleagues seeking assurance.
Dr Hardman was also focussed on the ethical implications of manager-led assessments. There was a risk that, during such pressured times, managers would be asking staff intrusive questions about their personal medical history, which is something that should instead be discussed with trained occupational health colleagues. Together, we decided to create a tool that could quickly identify those who were most vulnerable – one that could be used at scale, whilst maintaining staff privacy and adhering to ethical standards.
We worked with Dr Hardman to gather all the relevant data, research and guidance to create a digital knowledge-map of COVID-19 risk factors, including appropriate weighting of all the various elements. This model was the basis for an online, culturally sensitive risk assessment tool that could be used by individual staff members to measure risk, at tremendous scale.
How does the risk assessment tool work?
An individual completing the online consultation form will be taken through various questions, and at the end two reports are generated. One report goes to their manager and provides an analysis of that person’s risk level and advice for next steps. It tells them how best to manage that individual’s risk without unnecessarily disclosing their personal medical details.
A more detailed version of the report is automatically generated and sent to the occupational health team, providing them with a base document for a follow-up consultation, if needed. This also helps them to fulfil their legal obligations. This more comprehensive report is also sent to the individual and includes advice about how they can reduce their risk factors, where relevant.
What happens when wider guidance changes?
As we know, guidance around COVID-19 has continuously changed throughout this year. When new rules come into place, for example around asthma risk, those on immunosuppressants or those who were shielding, we can quickly adapt and test our risk assessment tool so that the reports generated from that point on are reflective of the latest advice.
How long did it take to build?
It took just 8 days to create and launch the risk assessment tool. That’s because such tools are built using the Rainbird Studio which is incredibly rapid at enabling experts to be at the centre of building such tools.
What’s next for Rainbird in health?
We are continuing to work with Trusts who have chosen to use the risk assessment tool, and the feedback has been excellent. Remember the Trust that had those 600-700 calls a day from worried staff? That went down to just 10 a day after they introduced our tool and most of those remaining calls were from people who hadn’t yet heard about it.
We have also started many new projects supporting COVID anxiety and track and trace. One new project is designed to support how staff decide whether to administer a Post Exposure Prophylaxis (PEP) injection to colleagues following an incident where they have been wounded with a dirty needle. The drugs used to reduce the risk of a serious infection from the needle, can have lasting side effects so it is a critical and sometimes complex decision to make. Sometimes it is administered when it shouldn't be and vice versa.
Like many of our projects, we are using human knowledge to build a tool that will support clinicians in making the right decisions at a crucial moment.