What have we learned so far?

As of Feb 2020, i.e. pre-Covid, we were in planning and stakeholder engagement stages. There were three distinct issues we were trying to understand:

1.       Making digital health an alternative to, as opposed to addition with, hospital visits

2.       Making the practicalities of working across organisational boundaries easier

3.       How to facilitate ICT integration/two way flow or information

Covid19 response accelerated movement and volume of patients into community services (#1). The willingness to test in adversity and provide support in goodwill has been instrumental in getting the virtual phlebotomy model in place (#2). While not all community sites were in the 1st wave accepting patients, all are now in conversations as part of the Covid19 recovery, and therefore engaging with the project (#2)

Covid disrupted [drastically] patient pathways and expectations that were helpful to our iniative. The original test area was slower to adapt, but the most significant area [outpatients’ haematology clinics] is now the main focus.  Everyone realises the value of avoiding unnecessary hospital appointments, and asking “what is necessary” (#1) without pre-conceived answers.

ICT integration (#3) is still a live issue. While we had buy-in at the initiation of the project, the pandemic has meant less progress than planned, and the current solution is very low-fi. While the app is in development; the company is still working out how to facilitate two-way communication. We need to bring together patients, clinicians and informatics experts in order to help solve this aspect

This (#3) has also meant obtaining regular data on number of blood tests has been challenging, due to internal IT infrastructure and variance in booking systems across the 3 CCGs. Measures have been much, much harder to source than expected, and remains in early stages of the provision of ongoing real-time measures

The pandemic has meant our plans (of a tight, neat, methodologically- robust QI project) is in disarray. We didn’t test small, there was minimal planning/briefing to relevant parts of the system about real-time data capture, or revealing the learning as we went along. The approach of the project is to now look at how we keep and maximise usage of the virtual phlebotomy model

What could others learn from our experience of working across boundaries, with a range of stakeholders?

The pandemic has taught the project team to push harder, and the wider health landscape has experienced significant change rapidly. Common purpose focused on patient safety has enabled this, and articulating the vision regularly.

We are about to embark on events with patients and multiple care providers as we seek to create a vision of what ‘remote care’ will actually mean, and making that happen will require changes by all parts of the service. There is still poor uptake of virtual consultations – clinicians have been providing telephone consultation – and we know this is less sustainable. The importance of this on-going co-design with patients will continue to persuade stakeholders to keep working together.

The project team use of technology has been an important awareness/parallel process. Virtual meetings are good enough to be able to plan, deliver and execute. No face to face meetings were needed, which was previous gold standard for project engagement and success. What has been created instead, is weekly 30 min updates with senior players, and this has been vital to build rapport and explore emerging issues across different partner organisations rapidly

What is working well and any challenges you have faced?

1.       Community and hospital services are in agreement that hospital patients will be seen locally for blood tests, and this is happening

2.       Clinical teams and patients are more creative in what they can envisage/accept as suitable care packages

3.       Understanding/accounting for individual clinicians choices about care provision. If clinicians have been delaying care, there is a risk that they will want to re-establish traditional care.

4.       The variance in how local phlebotomy is provided is a challenge as local level adaptations are needed: This is the antitheses of the Carter report and will need consideration in scale up and sustainability.  It is also created the challenge to project measures.