change challenge innovation: improving telecommunication
TRANSCRIPT
Change Challenge Innovation: Improving telecommunication channels for rheumatology
patients to improve access to information and people during a pandemic
Click here to head over to the discussion board for this innovation
Improving telecommunication
channels for rheumatology
patients to improve access to
information and people during a
pandemic
What happened? Describe the change
When did you change?
Who was involved?How did you change?• What challenges did you face?• What successes occurred?
Why did you change? What compelled it
What was the impact?To patient outcomes; patient experience; staff; stakeholders; productivity and efficiency; health inequalities, greener NHS
Embedding beneficial change
How will you carry forward the change?• What are your recommended actions?
Will the change benefit others? • What are your recommendations to them?
What happened? Describe the change
1. Telephone advice appointment service - During Covid-19 ensuring the accessibility of our service was critical forpatients to feel cared for at home. The response was to increasethe number of available online telephone advice appointments byrecruiting professors, consultants and registrars to engage inonline telephone appointments, a role usually held by nurses.
1. Webpage content redesign - Clinicians were supported bythe Digital Lead to provide content for a new Coronavirus andMedication Frequently Asked Questions (FAQ) page on therheumatology service webpage which patients co-designed andreviewed. The FAQs were based upon audit findings from thenurse-led telephone helpline, emails and telephone adviceservices with ‘live updates’ from the rheumatology MDT dailyCovid-19 ‘huddle’ meetings.
1. Rheumatology Access Telephone-Tree ServiceClinicians, administrators, service managers and the trustdigital/website team were involved in supporting the rapidredesign of the telephone tree based upon an audit of the natureof calls received and who typically dealt with these #firsttime.
What challenges did you face?Due to the first wave of the pandemic,there was a rapid reduction inrheumatology outpatient services with amajority of routine outpatientconsultations rapidly switching totelephone appointments. Nursing staffwho typically manage the telephoneadvice appointment service and nurse-led helpline were redeployed, rapidlyreducing the capacity to offer un-planned non-F2F consultations.What successes occurredThere was a rapid ‘coming together’ ofmembers of the multidisciplinary teamto support the threetelecommunication initiatives. As aresult, there was a greaterunderstanding and appreciation ofeach others roles. Also a relationshipwas swiftly made with the digital teamwhich allowed for rapid iteration ofcontent as the national guidance onshielding was updating at pace.
Who was involved?The rheumatology multidisciplinary team, administrators, service managers, patients and the trust digital/comms team. How did you change?
The Guy’s & St Thomas’ Rheumatology Service implemented three changes to improve telecommunication channels for rheumatology patients during the first wave of the pandemic.
When did you change?March 2020 during the first wave of the Covid -19 pandemic.
Patient contact card
Why did you change?What compelled it?
The reason for #1 #2 #3 changes
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I
Top 5 Themes for calls into our service
Through observation and audit data, it was also evident that multiple members of the wider rheumatology team managed similar calls with limited understanding of each others roles and ‘non-value’ adding time spent passing queries between members of the team, meaning patients did not always have their issue resolved first time.
Change #1 Telephone advice appointment service - The challenge was three-fold. 1.60% (3/5) nursing team were redeployed to work on Covid-19 wards during March-May 2020 inthe first wave of the pandemic. 2. A high number of patients using rheumatology services wereeligible for shielding in the extremely clinically vulnerable category due to immunosuppressantmedication used to treat chronic rheumatology conditions. 3. Demand from patients to book atelephone advice appointment rose significantly during the first wave of the Covid-19 pandemic.
Change #2 Webpage content redesign Prior to Covid, our website was definitely under-utilised and there was an unmet need to address a high volume of frequent emails, telephone callsand voicemails left on the nurse helpline through the use of better channels of telecommunications.The most frequent reasons to contact the rheumatology service were themed:
Change #3 Rheumatology Access Telephone-Tree Service - A high volume of calls and delayed access to the right help #firsttime had led to reported low patient confidence in accessing the service and a rising number of complaints relating to access, prior to Covid-19. The current telephone-tree often meant multiple hand-offs between medical secretary, clinician and patients.
ANY changes aimed to INCREASE ACCESS to
information and people through GREATER CHOICE and
encouraging those with digital skills to visit our website or
those already using our remote monitoring SMS service to use SMS, email or website first to
ensure more EQUITABLE ACCESS to our service. We tried
to encourage patients to think about their fellow service-users when accessing the service and whether an email would resolve
their query without taking an unnecessary telephone booking.
What was the impact?
There was a significant reduction in calls to the nurse’s telephone helpline (March 2020) (answer-machine service)
Change 1. Impact to Telephone Advice Appointment Service
There was a multidisciplinary team response to enquiries due to staffing redeployment and complexity of enquiries
There was a ‘peak’ in medication enquiries which reduced significantly with the introduction of the FAQ page in March
2020
There was an increase in contributions by the multidisciplinary team due to staff redeployment during the wave 1 peak
Change 2. Impact to Nurse-led Telephone Helpline
Launch of the Coronavirus FAQ page 24th March 2020
Coronavirus FAQ #Change2
Change 3. Impact to Access to Rheumatology Service (patient survey captured at F2F appointment)
Medication FAQ #Change2 - added 24/8/20
Webpage visit peaks on 26/3 & 30/3
“Having emailed to speak to the consultant not only did I get a response to the email immediately I also had the
consultant call me straight away. Very impressed this time”
Patient feedback
Improving feedback on access
added 24/3/20 and SMS sent to patients to advertise the FAQ page
Webpage visit peak
Mostly non-F2F care delivered
Embedding beneficial change?
How will you carry forward the change?
The webpage content will require ongoing review and updating to ensure it continues to meet the needs of patients. For example, as the nature of the calls and emails changed to relate to the consequences of #lockdown1 e.g flares, blood tests, physical inactivity, mental health, the FAQ pages were updated with relevant links to psychological support and physiotherapy resources to promote exercise at home, and signpost to advice regarding priority blood testing etc. The FAQ pages then went through 3-4 iterations to reflect emerging guidance around going back to work, school, and appointment models including what to expect from a telephone and video consultation. The priority is to continue to offer choice to patients by encouraging multiple channel access to personalised advice via a ‘digital-first’ and #makingeverycontactcount approach whilst ensuring the telephone service remains accessible to those for whom this is their preferred communication route to ensure access is not further reduced through digital exclusion.
What are your recommended actions?
The Rheumatology service Digital Lead ran a series of ‘’A Day in the life of…..’ MS teams workshopswhere members of the nursing, medical secretary, reception and access team led a brief presentationand Q & A about their roles in the service. This was to raise awareness across the wider rheumatologydepartment of responsibilities and shared skills to address the most common problems. It has helped thewider team gain insight and respect the role each other plays within our service. This is arecommended action for other services to help improve team working and to involve staff incontinuous improvement of their service.What tools or guidance will you develop to help embed the change?
Evaluating the impact of the website and telephone service redesign through the collection of patient experience, complaints and audit data will help support the service to adapt and adjust to meeting the changing needs of patients during service recovery.
Will the change benefit others?
Yes. By focussing on what the problems patients currently face in accessing your service, only then can you begin to work with your patients to improve access in
a way that matters to patients.
A culture of continuous improvement using a
Plan/Do/Study/Act (PDSA) cycle
Further Details:
• Which team or organisation implemented the beneficial change?
Rheumatology DepartmentGuy’s HospitalLondonSE1 9RT
• Who is the lead or key contact?• Melanie Martin, Rheumatology Digital Lead: Topol Digital Fellow
• Can we follow up with them to delve further into the detail?• Yes