Co-designing the use of NHS Near Me at home
- Winning idea
Meet the team: NHS Near Me
- Michelle Roxburgh, Assistant Head of Nursing, University of the Highlands and Islands
- Laura MacDonald, Project Support Officer, NHS Near Me, NHS Highland
- Gill McVicar, Director of Transformation and Quality Improvement, NHS Highland
Our idea in a nutshell
Every year, thousands of patients travel from distant locations across NHS Highland to attend out-patient appointments in a central hospital. To be honest, this isn’t good enough: asking patients to travel for several hours to attend a 10-minute appointment is not patient-centred. To improve this, NHS Highland has developed a new service called NHS Near Me. It uses video technology to enable patients to have consultations at a remote site. So far, we have provided NHS Near Me from local NHS facilities (rural hospitals or clinics). The next step is to enable patients to use the service from home. This bid aims to develop the at-home service by co-designing the service with patients in one remote and rural location, namely the Isle of Skye. Specifically, we would use the funding to work intensively with patients before, during and after the introduction of NHS Near Me at home to ensure the service meets their needs.
The aim of this project is to adopt the use of NHS Near Me at home in the Isle of Skye with the local community using co-design principles by June 2019. It is well recognised that you cannot just ‘lift and shift’ an intervention from one setting to another (Horton 2016). Despite having NHS Near Me in place in NHS facilities, we don’t know yet how to provide the service for patients at home. The role of context has been well rehearsed in the improvement science literature (Øvretveit 2014; Dixon-Woods 2014; Newbronner et al 2013) therefore further work needs to be undertaken to understand the next part of our service development. Changing the way out-patient appointments are delivered so that patients are supported to utilise video consultations from home is challenging – it involves redefining roles, assumptions, as well as putting in place processes and infrastructure that support the use of NHS Near Me.
How we would do it
Stage 1: Exploring the idea – public information session and focus group to present the use of NHS Near Me to patients/public. Provide rationale for the intervention and evidence of its use from previous Near Me clinic experience. Record a facilitated discussion on assumptions, fears, understanding, opportunities and threats. Identify patients/public members interested in assisting. Conduct focus group interviews with public members to gather initial ideas, thoughts and concerns. (0-3 months)
Stage 2: Ideation workshop – present the intervention and describe which components are fixed (i.e. the technology) and flexible (how the local community can best use it). Hold a facilitative workshop to co-design a process flow map for Near Me. Generate ideas for adapting and testing. Test various steps in the process. Use PDSA cycles for testing and learning. Arrange a focus group interview with public members to gather patient experience and inform further testing and spread within Skye. (3-6 months)
Stage 3: Implementation – the final process will be agreed at an open forum with public members before implementation. Conduct a focus group to gather experience of implementation and the use of Near Me. (6 – 9 months)
Stage 4: Dissemination – Prepare report with the public for dissemination. Write a 3 monthly blog to both inform and learn from the Q community. (9-12 months)
To see if the new service works, we would measure the number of patients using the Near Me service at home. But more importantly, data from patient experience focus groups will aid understanding of the intervention and implementation process.
What’s the benefit?
The ultimate benefit is to give patients easy access to specialist care. By engaging patients in developing the NHS Near Me at-home service, we think the service will better deliver what patients need. Although we will initially focus on a rural community, offering telehealth services helps patients in urban locations too, for example by reducing the need to take time off work to attend appointments.
We anticipate cost saving to NHS Highland for reduced travel for both patients and clinicians, and reduced waiting times. Reducing travel will also reduce NHS Highland’s carbon dioxide emissions which will contribute to the Scottish Government aim of a 42% reduction in greenhouse gas emissions by 2020 (Scottish Government 2018).
Learning from our experience could aid other Q members to implement use of telehealth within their communities. We plan to write a 3-monthly blog to both inform and learn from the Q community. We believe the learning can be applied not just to hospital outpatient appointments in other NHS organisations, but also to other clinical situations, for example, primary care and out of hours care. A clearer understanding of patients’ views on the use of video consulting in NHS appointments could be useful for many services. Our materials, such as standard processes and patient resources, would be useful for others implementing something similar.
How you can contribute
- We need advice and tips on successful use of co-design of services
- We need some critical friends to challenge the idea to help improve it
This is a great project because…
The challenge the team are working on has wide applicability for others. There is a strong emphasis on co-production with a focus on implementing technology sensitively rather than on building the technology itself.
By the time of the event we encourage the project team to think more about…
The team should connect to other teams working on this challenge to ensure they are benefiting from their experience. Some things to consider would be the practicalities of implementation and how they can share their learning more broadly beyond the scope.