What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

The evidence demonstrates that the health care system is facing unprecedented levels of demand and pressure. Creating additional capacity in a very cost effective and sustainable way would not only be welcomed by the organisation but would also reduce the time for patients waiting for consultations. However, this is not the only benefit of this improvement as patient satisfaction will also be improved as the consultation will be more person centred and meaningful. By sharing two-way information in advance of the consultation both the clinicians and the patients are more informed and prepared which maximises the available time whist increasing the quality of the conversation. Patients would be sent an assessment questionnaire with relevant information about their condition with options available in advance via an app. The Consultant would review the responses before meeting the patient. This prepares the ground for good shared decision making.

What does your project aim to achieve?

The project will allow clinicians and patients to exchange customised patient information, forms and questionnaires in multiple formats including audio-visual before and after appointments. This will make the discussions during the consultation more meaningful and efficient with care more personalised and the shared decision making process more supported. A pilot paper trial demonstrated:

• Reduction in the consultation time 22%
• Reduction in rate of return appointments from 24% to 4%
• Ability to create 15% additional capacity
• Increase in patient satisfaction from 76% to 96%
• Remarkable increase in patient’s realistic decisions and self-management of chronic conditions, reducing demands on other parts of the system.

Moving to a digital platform will enhance these results as communication can be facilitated in multiple formats such as audio-visual.

The project will also facilitate a feedback process for further improvements. It will improve appointment management, reduce waste, increase efficiency and improve utilisation of available capacity and reduce costs of paper and post.

How will the project be delivered?

The application will be developed by a software house with full involvement from the project team. The app will be hosted on the Right Decision platform (Scotland wide for patient & public information). Technical aspects, information governance and copyright issues will be managed within the NHS Lanarkshire Evidence Team which can be shared when spreading the project to other Health Boards.

Baseline, process and outcome data will be collected when implementing and testing the intervention. Assessment cycles will initially be short to gain learning and improvement with plans for an annual review once the app is established for continuous quality assurance and improvement.

The team has experience in quality improvement methodology and has tested the theory on paper. There is also experience of app development following the successful launch of the NHS Lanarkshire Guidelines App and a governance process for app development.

How is your project going to share learning?

The value of this project will be maximised with wider implementation. This project will be applicable with the same desirable outcomes to any outpatient service in the UK. If only 10% of consultant outpatient clinics in Scotland implement this app, it is expected to add around 86,455 appointments per year saving £15,819,435 (using data from ISD Scotland 2019). Additional saving could also be made in other AHP or nurse-led clinics with the benefit of also being paperless.

We would be delighted to share our learning with other health organisations to replicate or develop similar projects. This could be through the Q community and other networks as well as professional, national and international organisations such as royal colleges and associations. We would also like to publish the project to provide a wide reach.