For our latest interview we spoke to Sam Jackson, Clinical Services Manager for the Virtual Health Hub, and Kezia Marshall, Improvement Project Manager at Hampshire Hospitals NHS Foundation Trust.
Topics of conversation included digital champions, their individual work, challenges, successes, and more.
Here’s what they both had to say…
Projects past and present
Kezia explained her work on virtual appointments: “I’ve been working for a couple of years on non-face-to-face appointments, which includes telephone and video, but focusing mostly on the video because that’s where more support has been needed. I’m also involved in our Patient Hub project which replaces paper letters with digital appointment notifications and cancellations, and a few other pieces as well.”
Over the past two and a half years, Sam has been part of the Virtual Health Hub which combines three independent services: telemedicine for care homes, clinical communication centres, and virtual wards. On telemedicine for care homes, he said: “It’s a remote access triage and clinical assessment and treatment service for care homes across Hampshire. So if a resident in a care home deteriorates , the staff would call into the telemedicine service and we would clinically triage the best place for them to receive their treatment.
“The second arm is called the clinical communication centre, which is a clinical switchboard for GPs looking to get advice or admissions into hospitals. The idea is that our team speak to the GP, and together we facilitate that admission into hospital where appropriate.”
The virtual ward service, meanwhile, “is aiming to expedite discharges from hospital with telephone and remote monitoring support for patients.”
Challenges and successes
Kezia has been working on projects around digitising outpatients at Hampshire Hospitals, and offering patients virtual options for their appointments. This has many benefits, she said: “We encourage video so that you can still maintain that emotional relationship and communication – it’s about encouraging staff and patients who might not feel like they are very digital. I’ve had some amazing training opportunities with staff and patients who have been really surprised at what they can do.
“In terms of challenges, I’d say that getting people to embrace something new can be a challenge. So it’s about supporting them through that and helping them to feel that they can achieve it, they can feel proud of themselves. For example, I’ve had support workers set up virtual groups for patients. They’ve said that they can’t do this task or they’re no good at that one, but actually, they’re fantastic.”
She added: “I think the other challenge is sustaining that progress. Obviously we became very digital during COVID because we didn’t really have much choice and we had to decrease the amount of footfall through the hospital. But we’ve managed to maintain over 30 percent non face-to-face appointments, we’ve been really happy to see that numbers have stayed that way and people are continuing to embrace virtual appointments.”
Touching upon a similar challenge, Sam explained that digital burnout can have a significant impact, especially with services moving to digital so suddenly due to the pandemic. “A year ago things rightly had to be done at speed, and that meant that people often worked siloed. Your area would take on a project to solve a problem, then move onto another one, and people can end up stuck in the middle of that. Patients could end up interacting with six different services using six different digital platforms. People got frustrated and understandably so. So I think one of the biggest challenges we’re facing – and overcoming really well, locally – is making sure that we all stick together. There’s great agreement across our patch that everyone uses the same platform for their remote monitoring so that patients aren’t overwhelmed with lots of different platforms.”
Tackling digital inequalities
Kezia explained: “Digital inequality always comes up when you’re working in digital, especially in healthcare. You always get the argument that older people are not able to access digital, and evidence shows that they absolutely can. Many older people use digital in all aspects of life – to get their shopping, book their flights, go on holiday. Booking your hospital appointment is not that different. In fact, it can enable people a lot more than it disables them.
“When we send letters out about our digital offering, we really stress patient choice. In all of our comms around the different appointment options, we emphasise that it is an option. We’re not saying this is the only way to access the hospital.”
For Sam, this is one of the reasons that telephone services have been especially important to continue working with. “In many ways, I think it’s really important to maintain that phone work. Our primary care colleagues run a COVID oximetry service, so people with COVID text in their oxygen saturation levels, heart rate and various other parameters that have been set for them. That was a national programme that has worked fabulously well. There’s clearly a cohort of patients who haven’t got the capability to do that, but they have a telephone or a relative that can go in to check on them on a daily basis. We can have a conversation with them about what could work.
“As you said, it’s a challenge. For the majority of people, it does work, but you also have to bear in socioeconomics – especially with the cost of living crisis. Mobile phones are expensive, getting credit on your phone is becoming increasingly expensive. There’s a cost for a landline too. So we really need to think more broadly about how we support these people, especially as they are they are often the highest service users.”
Kezia shared another side to the discussion: “My counter argument for the digital inequality is the fact that we are potentially at risk of increasing inequality by requiring everybody to attend the hospital in person. There’s the cost of transport, childcare, taking time off work. There could also be a social anxiety aspect too. Offering alternatives is increasing the equality, because you’re taking note that one option works for some people, and the other option works for others. We want to be accessible for everybody.”
Digital champions
Sam noted that all his team are digital champions. “I guess digital is a loose word,” he commented. “In some of our projects, for example, the telephone is digital. I think it’s important to recognise that – sometimes you need to focus on the basics to make sure people can access a service. We have a mix – some of my team are super techy, super keen and really want to push forward with that. Others are particularly focused on basic digital services for monitoring patients, like the telephone. Across the spectrum they’re all really enthusiastic about digital, and about change.”
He continued: “Other clinicians are working to reassure patients that digital doesn’t have to be scary. Actually, if you look at a lot of the population – many people don’t think they are digitally capable, but if you look at how they use their mobile phone, they actually are quite capable. Our team is really keen to debunk the myth that digital has to be hard. It can be, but if you go in on a low level to start that bit of change, it doesn’t have to be a particularly difficult challenge. It’s about breaking down myths really.
“So I would say that my team are all digital champions. They’re all absolutely fantastic and are very keen to support change and recognise the challenges around digital, and the different levels that you can enter to be a digital champion.”
What makes a great digital champion?
For Sam, it’s someone who is enthusiastic. “Somebody who is enthusiastic for change, who is willing to give something a go. Somebody who the team wants to have a conversation with, who recognises change and sees change happen. I think much of being a champion is within personality, digital or otherwise. If you’ve got an enthusiast, then you are a champion.”
He added: “They don’t necessarily need to be working in the area that you are working in. It’s just somebody who is passionate and supportive of change in a non-confrontational way. They need to have the personality traits to lead people, and hold people’s hands through change.”
For Kezia, it’s about enthusiasm, friendliness and cheerfulness. She said: “It’s how you bring people along with you. But I would say the digital champions are the ones that give it a go because they have patient care at the heart of what they do. So they personally might not be enthusiastic about digital change but they understand the benefits it’s going to bring to the patients. That’s why I love being a digital champion at HHFT, because you’re working with people who want to make things better for their patients.”
What do they value in their digital champions?
Kezia reiterated that it’s about having the motivation to make things better for patients, and having them at the heart of what you do. “We regularly monitor the feedback from both clinicians and patients and we have achieved over 93 percent positive feedback for non face-to-face appointments..”
Sam said: “I think there’s something around how they are good at reflecting. They have good reflective practice or good ability to analyse what’s going on. So with the virtual wards, for example, we have a 2 percent mortality rate at 30 days for over 65s. The trust mortality rate for those patients without virtual care is somewhere between 2.8 and 3 percent. Our champions have reflected on that and can see this is something that we need to continue to push forward with.
“Equally, there are elements of the service where we haven’t seen the success that we’ve wanted and we’ve been able to reflect upon that. We’ve brought in a quality improvement mindset in those cases and not just pushed forward with digital change. As we’ve said, it’s important to recognise the different levels of entry for different patients and keep a broad mindset about what works for which patients. I would say that my team certainly have those skills.”
How important is digital to healthcare?
Sam said that it is imperative in his view. “We’ve clearly got a growing and ageing population, digital is a really effective way of managing large cohorts of patients. When we use technology for people to text in their results, for example, one member of staff can easily monitor 200 patients a day.
“It’s about considering what can affect different areas within the department, and what can affect things in the future. That helps you to recognise where it is appropriate to implement digital change, and where it isn’t. I think it’s really important to recognise that digital isn’t the be all and end all – it’s still vitally important to put a stethoscope onto somebody’s chest, or do an X-ray, or take blood.”
Kezia added that it is about prioritising patients and communication: “With the amount of patients ever-increasing, there needs to be a way that they can communicate with clinicians, and digital enables that.
“I think there’s also a massive safety aspect in going from paper to digital. You have this safety net. You know that pieces of paper aren’t going to go missing – we have records of everything. We can keep an eye on things, we can keep track of appointments that are cancelled and rebook them. There is better ease of access to information.”
Finally, Sam brought up an example of digital improving healthcare through virtual wards. “Often when I’m doing virtual wards, I’m looking back at digital notes that doctors have made at their clinic appointment, and I can then use that to scope what care I’m providing.
“Moving forward, I can see what interventions this patient has had in the past and it helps me recognise trends in their healthcare, like the regularity of their conditions and what is ongoing. I know who the doctor is and then it’s really easy for me to have a chat with them if I need to, to provide the best level of care that I can.”
We would like to thank Sam and Kezia for sharing their time and thoughts with HTN.
