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?
I am an Obstetrician and Gynaecologist, and like everybody else we have had to be really adaptable to the ever-changing situation. Initially, I mainly supported the maternity service, whilst all elective gynaecology work was put on pause.
Almost overnight, we were asked to introduce remote consultation in our antenatal clinics for suitable women. This had been something we had discussed for a long time in my role as an Improvement Coach, but we had never managed to get it off the ground. COVID-19 gave us the perfect ‘burning platform’ to change, but I really wanted to use a systematic approach with Improvement Science methodology to carry out this change so it could form a sustainable long term improvement.
I moved my multidisciplinary improvement meeting, the “Antenatal Big Room”, onto Microsoft Teams, to engage midwives, administrative staff, and doctors in the work. We collected data on waiting times and women’s experience, and also had some mums and dads come to the Big Room to contribute to the work.
Through a series of PDSA cycles, we managed to see about a third of patients remotely, initially using telephone consultation but quickly moving to video consultation. This resulted in fewer women in the waiting room, enabling social distancing, and also a more efficient clinic and shorter waiting time for those who did have to come in for face to face visits.
What positive change or adaption would you most like to keep after COVID-19, in the ‘new normal’?
It has been a huge paradigm shift – challenging the assumption that you need to see and touch a patient in order to give clinical care
COVID-19 has really shifted the way we think about waiting time. Pre-COVID, we often just accepted that as an NHS patient we would have to wait to be seen, and I have really struggled to get any traction with managers and other team members to prioritise this aspect of patient experience. We had a lot of patient feedback from the clinic that long waiting times were an issue, and I know this contributed to pressure and stress faced by clinicians. With COVID-19, having lots of people squeeze in a crowded waiting room is no longer acceptable. Unnecessary time spent in hospital is no longer acceptable. All of a sudden, I have seen and experienced the will to undergo huge transformational change in myself and in my team members.
I would like this focus on efficiency, and valuing patients’ time to continue post-COVID. It has been a huge paradigm shift – challenging the assumption that you need to see and touch a patient in order to give clinical care – but now that we are here, it is clear that remote consultation, when used in selective patient groups and where clinically appropriate, offers huge convenience, flexibility and other benefits to both patients and clinicians.
What have you learned about delivering change at pace?
One of the things that kept me going through COVID-19 has been my weekly Big Room. Though held remotely, it offered that weekly check-in with the team. The change of pace means that frequent communication between staff groups, clinicians and managers is absolutely paramount. Practically, obvious problems experienced by the frontline staff can be communicated to the people drawing up the new policies, thus giving staff the opportunity to co-design change. Having patient voices in the Big Room was an added bonus, and helped motivate staff as well as keep the patient in the centre of our improvement work.
How has your Improvement approach proved valuable?
One good thing about COVID-19 was that the aims of our improvements were clear – reduce the number of patients attending hospital physically, and decrease the time spent in hospital for those who have to attend. Nobody could argue with these very clear outcome measures. Using a systematic improvement approach has helped me feel confident that the changes we were introducing were working.
Qualitative feedback from patients via surveys and also by inviting them to join our Big Room has also been valuable. We always start the Big Room with a patient story, and this approach has helped inform our decisions. For example, we heard from women that telephone consultations didn’t feel like “real” consultations. Thus we tried video consultations which in most cases successfully replicated that interpersonal connection between clinician and patient.
“My video consultation was a maternity appointment and it felt exactly the same as a consultation.
I prefer remote consultations than face to face because it’s easier from home with young children.”
– Maryam (antenatal patient)
What has particularly inspired you?
COVID-19 and the changes it has forced us to make has really brought many of us together as a team. I have been inspired by the hard work and dedication shown by my colleagues, many of whom work in roles that are often overlooked. Because we had to enact changes before automated communications systems were in place, our admin team had to physically call every individual patient to tell who to stay at home and who to come into hospital for their appointments. This was a huge amount of work but vital to making the process work initially.
I equate this with the famous “start with why” story of John F Kennedy asking the NASA janitor what his role was, to which he replied (or so the story goes), “I’m helping put a man on the moon.”
COVID-19 has made me value the administrative team and the role they play in caring for patients more than ever. Their dedication to the “why” of keeping patients and colleague safe has been an inspiration to me.
Is there anything you can share that you’d like to collaborate with other improvers on?
I don’t think my improvement journey in the area of remote consultations is done. As I have been given the novel opportunity to introduce remote consultations as a sensible tool, rather than being forced to adopt it as a target, I can see its limitations. It works really well in a patient population, of whom most have access to internet, a smart device, and are used to using technology to communicate. I would love to collaborate with other improvers on how to bring the benefits of remote consultation to patients who might have challenges.
For example, I had one woman who was reliant on lip reading to communicate and the video calling platform just didn’t have the sufficient definition she needed to lip read. The slight lag in time between sound and visual was a challenge for her as well. Part of me thinks there has to be a tech solution to this particular problem. Bringing lip-reading patients into hospital for face-to-face appointments all the time when they are unable to protect themselves by wearing masks or getting their clinicians to wear masks doesn’t sit well with me either.
I have also had issues with getting telephone translators to join me in video calls with patients, even though the tech is clearly capable. All I would need to do is text or email the link to the translator, but I am not allowed to contact them directly for bureaucratic reasons. Surely, this is something we can work together to improve, through engaging with telephone interpreting services.
All in all, I would love to try harder to find solutions to these challenges that mean I am currently unable to offer the same level of service to my patients with slightly more complex needs.
Does this sound like something you could collaborate on? Get in touch with Sabrina.