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Many Q members have found their work radically changed by the coronavirus (COVID-19) pandemic. As part of our work to support health and care services to learn from the rapid learning and improvement taking place during this time of unprecedented change, we are sharing brief interviews with members reflecting on their experiences.

If you’d like to share your story, please get in touch.

What have you been working on in recent months to support COVID-19?
Over the last few months, my focus has been sharply around targeting the evidence-based best practice gained over many years with the NHS’s ‘Florence’ to COVID-19-specific pathways nationally. ‘Florence’, or colloquially, Flo is the NHS-owned ‘telehealth with a human touch’. Flo interacts with patients, using their mobile phone, to help them to manage their own health and wellbeing better between clinical contact.

I am lucky enough to work with the many stakeholders that bring innovation to life locally.

This targeting has ranged from existing Community of Practice members, such as East London Foundation Trust who have recruited Florence to help design specific COVID-19 care pathways between home and acute care, to new organisations who have recognised the role that Florence has in a rapid public health response during the pandemic. My role spans the change lifecycle and I am lucky enough to work with the many stakeholders that bring innovation to life locally.

What positive change or adaption would you most like to keep after COVID-19, in the ‘new normal’?
The onset of COVID-19 has provided many challenges to maintaining safe health care delivery. Managing unprecedented new demands on health care specific to the pandemic whilst maintaining high quality existing patient care and managing risk has brought pressure to the system. However many opportunities quickly emerged through this challenge and were brought into sharp focus.

Understandably, much of this change has been practically driven to reduce, or limit, non-essential face-to-face contact and the spread of the virus. Yet beyond this essential practical need, the mandated shift to more remote health care provision is also highlighting the value of remote patient interactions. By interacting remotely, more focus is inevitably placed on enabling patients to become more confident and capable of understanding their health needs independently. Whether specific to COVID-19 management, or other existing health needs, interactions become more focused around health literacy and helping patients to recognise signs and symptoms; understanding the right action to take is becoming a priority.

I hope that we are all living through a cultural shift, that the ‘new normal’ recognises a growth in what we all consider to be non-essential face-to-face contact, activating patients as true partners in their health care

I hope that we are all living through a cultural shift, that the ‘new normal’ recognises a growth in what we all consider to be non-essential face-to-face contact, activating patients as true partners in their health care. As clinicians become more confident in supporting patient cohorts remotely, and as patients come to accept technology as a health care tool, the wide ranging benefits of targeted remote health care delivery can be sustained beyond COVID-19.

What have you learned about delivering change at pace?
Optimising the way that we deliver health care is consistently on the horizon, requiring clinical leadership, a driver for purposeful change and, importantly, clinical confidence that the new way of working is going to deliver improvements for our patients. Indeed we are witnessing transformational change across the NHS during COVID-19, requiring a rapid shift in structures and cultures firmly underpinned by perceptions of what is actually possible. In igniting transformational change, tensions commonly exist between early innovative practice and ensuring clinical safety, between the pace required for change and the value of true stakeholder engagement.

Acquiring knowledge from across a Community of Practice provides a wealth of experiences to help mitigate some of the tensions that exist and help speed up the pace of change.

Delivering change at pace can also mean that some of these key implementation milestones need to be achieved much faster. Membership of a Community of Practice means that no individual, team or organisation is ever facing this alone. A Community of Practice provides immediate access to peers who may have already been in your position. They may be existing experts in what you are trying to achieve and, in my experience, be gladly willing to share their learning, both good and bad to provide flavour and colour to your challenges. Acquiring knowledge from across the community provides a wealth of experiences to help mitigate some of the tensions that exist and help speed up the pace of change.

We quickly introduced a rapid innovation forum focused on COVID-19 redesign across our Community of Practice to quickly connect members

In recognition of this, we introduced a rapid innovation forum focused on COVID-19 redesign across our Community of Practice to quickly connect members. Members were invited to dial in and either just listen, bring an idea to discuss or share their COVID-19 related learning around implemented pathways with Florence. Early calls were mainly ideas based, with several effective conversations enabled to short-cut thinking and add value to decision making. Themes soon moved onto more recent calls centred on sharing patient stories, and clinician feedback focusing on the impact, positive unintended consequences and learning through pathways supported by Florence. These calls really help the listening participants begin their journey and provide recognition to teams who are already delivering optimised remote care; new relationships are building and conversations continuing outside of the calls.

For this reason, a Community of Practice is built on trust; trust to feel safe to reach out for help, trust in the value of the expertise, and trust to take this forward to underpin local rapid change. I have been humbled to witness how members of our community, regardless of geography or organisation, have recognised the support that they can offer each other in freely sharing their learning and experience with Florence to really and truly expedite the rapid, and most importantly safe, adoption of innovation across the NHS.

How has your Improvement approach proved valuable?
Before COVID-19, much of my focus was typically coaching and mentoring organisations to develop and, importantly, sustain their newly adopted ways of working. My role was ensuring that the shift from a ‘project’ or ‘test for change’ morphed seamlessly into the ‘new normal’ continuing to deliver the improvements that had been anticipated.

In the current climate my approach has also had to change. Between the early phases of clinical engagement and adoption, many of the techniques and strategies that I previously championed had to wait; the focus is on the here and now. Teams want trusted and accessible support to help them to continue to deliver high quality care within new guidelines.

I have seen a real shift towards empowerment when working with teams

Collective leadership has become more apparent, conversations are more targeted and decisions are being made more quickly. I have seen a real shift towards empowerment when working with teams, and I have had to be adaptable and create connections across teams or within an organisation to allow clinical focus to be where it absolutely needed to whilst I navigated other conversations. This approach is based on relationships: relationships and trust; I became a member of the team for a short while. It is these relationships that I hope, once the intensity of delivering change at such pace has settled, will endure allowing me to revisit key areas and work towards sustaining these service delivery changes.

What has particularly inspired you (e.g. tool, person etc)?
Evaluation and outcome sharing is a foundation for sustaining and spreading improvement but typically takes time and attention from a wide range of stakeholders. I am immensely proud of how Community of Practice members still recognise the value of capturing the impact of change even throughout times of unprecedented change and increasing demand on their time.

The commitment to consistently evaluate safety, service quality and patient experience across newly designed remote pathways highlights the commitment to high quality care provision across the NHS. It also recognises the willingness to support the system as a whole by sharing knowledge and learning.

Our Community of Practice proudly includes colleagues from the Veterans Health Administration in the USA who have published their outcomes from recruiting Flo’s cousin ‘Annie’. As part of their COVID-19 response, Annie helps Veterans to monitor their symptoms safely and advises them when it is necessary to contact their care team or a nurse triage line. I am confident that this has helped to expedite similar applications in the NHS with Florence.

Is there anything you can share that you’d like to collaborate with other improvers on?
I am an advocate for innovative health care models that activate patients to take a more active role in their health care. My personal interest is how we sustain behaviour change, particularly improving adherence for patients who are less compliant with their health care. I would be interested in collaborating with improvers on how this challenge can be addressed.

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