This summary shares learning from the second fortnightly learning logs in our video consultations insight project. Expanding on the first logs we explore what the cohort of 35 participants are doing to build the foundations for video consultations to be used in the long term and identifies some key challenges for sustainability.
Key themes from the second learning logs (week ending Sunday 3 May)
- Rapid roll out of video consultations continues to be focused on the immediate response to COVID-19 but participants are working on the basis that video consultations will be an integral part of a ‘new normal.’
- Key enablers perceived to support sustainability include: integrated infrastructure; a culture of ‘giving it a go’; clinical leadership; feedback and regular communication.
- Yet, many challenges around sustainability remain, including longer-term strategic leadership, evidence around clinical outcomes, fears around inequalities, and greater patient engagement to drive demand.
Making video consultations the “norm rather than the exception”
Whilst rapid roll-out of video consultations is focused on the immediate response to coronavirus (COVID-19), many participants are aiming to make them part of a ‘new normal’, sensing a moment for potentially radical transformation. Participants and their colleagues are seeing first-hand the possibilities and benefits and increasing their confidence. Through the learning logs, we identified five key factors that are perceived to support this sustainability:
There is a golden opportunity and perhaps once in a lifetime chance to change the way we deliver healthcare.
1. Making it easy
The importance of making it easy through the availability of hardware, easy access to the right software and integrated records and other admin processes have been key to embedding video consultations in daily practice. Where participants have experienced barriers around integrating infrastructure and processes, continuing to develop positive new working relationships (e.g. with IT teams), recognising dependencies and working collaboratively to problem-solve across teams have been seen as effective ways to overcome them. Participants feel making different systems compatible should be a key national and organisational priority.
2. Giving it a go
Many participants are building staff and patient engagement, capability and acceptance based on a culture of giving it a go. We heard that they are finding that once people try video consultations, it increases acceptability and confidence. Clinical leadership and greater autonomy within individual services are key factors driving acceptance.
3. Recognising the realities of context
It’s important to recognise that people are taking on “physically and emotionally exhausting” workloads and showing great flexibility to capitalise on the current context. Participants recognise that the ‘give it a go’ culture may not persist but they are working now with people to champion the process and support others in their teams to drive “organic growth, rather than forced growth”.
4. Permission to adapt
Some organisations appear more flexible than others, but the lifting of other targets and expectations has given people the space and permission to experiment and adapt at their own pace. As one participant described, their message is for different teams to “adapt not wholescale adopt”.
5. Proactive communications
Proactive internal and external communications to share learning and success stories seem to be an important component of many people’s approach. This has helped to increase patient understanding and expectations, and drive leadership support. Often communication has been through formal feedback such as clinician or patient feedback surveys.
Key challenges ahead and actions needed
We know that planning for the long-term while in a time of crisis and uncertainty is challenging. The learning log responses highlighted five areas that participants felt need attention to support sustainability:
1. Clear leadership and vision
Clear leadership and a vision for the future at both a national and organisational level is vital. This should be accompanied by long term resources and guidance to support teams with hardware and integrated infrastructure. Redesigned contracting processes and tariff regimes will also be important.
I am facing a bit of resistance because [the service manager] wants to set up a future “permanent” way of working and I don’t think we can guarantee that
2. Widening uptake
Extending uptake including through greater use of video relative to phone and reaching more resistant staff will be critical. On the patient side, much more work is needed to understand and address inequalities of access and how this interacts with wider health and social inequalities that have been laid bare during the pandemic. People are beginning to involve local partners and patient groups and more meaningful public participation will be needed to increase access and acceptability long term.
3. Understanding the impact and risks
Evidence is needed to understand the ultimate health impact of wide-ranging expansion; to identify ‘hidden risks’ of such rapid roll out; and to more precisely understand the appropriateness of video for different groups or services. Some of this evidence is needed at the individual service level but building a collective evidence base at national level to support decision makers is also seen as vital.
4. Building capacity and infrastructure
We heard that embedding training and building digital capability longer term will be needed. This may include reviewing the skill mix of different teams, changing the scope of some roles and even rethinking team structures – as well as considering what changes will be needed to the physical infrastructure and estates of healthcare organisations.
5. Sustainable modes of working
In the last blog, we highlighted the benefit of the whole system response, discretionary effort and new collaborations but it is uncertain how these enabling factors will persist. Not least the extremely high workload in some teams is unsustainable and for one participant “the degree of stretch has, at times, extended into panic.”
Join the conversation
Each fortnight we will post some key questions to consider and resources to share. Please do join in the conversation or share links below if you can help to answer the following questions:
- How can services meaningfully engage patients and the public in the current context?
- How can we build the necessary evidence base at both service level and collectively to inform sustainability?
- How will the conditions that have enabled rapid progress change as we move through subsequent phases of the pandemic response?