For a recent webinar on patient communication and engagement, we were joined by a panel including Joanna Dundon (national digital lead for public engagement at Digital Health and Care Wales); Laura Adams (patient and public involvement and engagement facilitator for research and innovation at Medway NHS Foundation Trust); John Kosobucki (CEO and founder of OX.DH); and Bex Cottey (business manager at Conisbrough GPs).
The panel explored considerations for successful patient engagement, approaches and experiences, technical considerations, integration, change management and more.
Introductions and work on patient engagement and communication to date
To begin, our panellists shared some insight into their work and experiences to date.
Laura discussed her background at Medway, including her work as a research nurse within a research team, where she noticed “a lot of barriers to people taking part in research” which inspired projects to try to improve that. She highlighted the example of a project looking at data on recruitment that identified that post people taking part in the trust’s research studies were from white ethnicities. “As a result, we started a project to look at why other ethnicities aren’t taking part in research as much,” she said. “We’re doing that in collaboration with our community colleagues. Main findings so far have been around trust and safety, so it’s useful information to then take away. A big part of our engagement is making sure we continue to work with the public and the community to come up with ideas together on solutions to these issues.”
Joanna spoke about her work at Digital Health and Care Wales around digital inclusion and patient engagement, particularly around ensuring that inclusion is considered when launching new projects, and that support is available for people who may struggle to use things like digital apps. On her current work, she shared: “I’m trying to build up digital champions throughout Wales to help people as they get onto the app, which has now gone out to all 370 GP practices in Wales. We’re adding extra features like a health timeline and a journal, and there’s a new project around waiting lists as well. We want to increase access to more services, and we are doing work on the Welsh identity verification service. Proxy access is the next big piece of work, so there’s a lot going on at the moment.”
Bex noted that although she has only been in the NHS for around five years, she has already seen “massive change” take place. These changes include the integration of total online triage, which “involved a lot of patient communication and onboarding to make sure that they understood why we were making the change and how it would improve services within the practice”, and a recently-launched podcast. The podcast came about as Bex felt that she was having the same conversations with different people not understanding the changes that were being made within the NHS and why they were being made, with “no one place I could signpost people to for information.” The idea of a podcast came up in conversation with one of the practice’s partners, with the aim to explain the NHS landscape to people “in a way that they understood, so that they could help themselves to get the care that they need, and to give them something that could help them to navigate the system.”
John then shared his insights and perspectives as a “lifelong technologist”, launching OX.DH “with the intention to bring some of the experiences from other industries into digital experience for healthcare”. He added: “I’m sure everyone has a very high expectation in retail, finance and travel aspects of their life about what is possible with digital experiences, and there’s been great progress over the years in health. To continue that progress with focus on standardisation and security, we work exclusively in the Microsoft Azure environment and leverage the investment the NHS has made with Microsoft to add on new capabilities and functionality.”
The role of digital in patient engagement and activation
What role does – or can – digital play, when it comes to patient engagement and activation?
Bex looked at the examples of the total triage solution and EPR. “One of the key elements to patient engagement is patients; not only in the information dissemination, but also in the guidance on expectations and how to use the technology or process,” she said.
She explained that the practice embraced technology after experiencing the telephone lines going down for a long period of time, and said: “It was the best thing we ever did, both for ourselves and our patients. Guiding patients through it meant they had the confidence to do it themselves at a later date, so even when people could get through on the telephone, we were taking the pressure off our care coordinator reception staff.”
When it comes to communications strategy and acknowledging the complexities that are often inherently present in healthcare messaging, Bex highlighted that her team tend to aid communications at a reading age of ten years old. Constant focus is placed on how things could be phrased in a simpler way or made more clear for patients, along with avoiding terminology those outside of the NHS might not be familiar with.
On her experience in Wales, Joanna said that she had been working on similar projects, working with a supplier on the NHS app to look at user-centred design, and bringing in people through patient involvement surveys and user research panels.
“We had about 4,500 people registered to do that, which was a great way of capturing people with different abilities, disabilities, sensory loss, and so on. I agree wholeheartedly with Bex’s comment about terminology – that is a big thing I think that we have realised. It isn’t always easy to explain what is happening or why.”
Joanna also shared that she has a patient and public assurance group, which brings in a range of different stakeholders including digital inclusion leads and patient experience leads. “There’s a lot of work going on behind the scenes to make sure that it is fit for purpose. We use the feedback that we get within the app as well, to make sure that it is still fit for purpose and building that into continuous improvement.”
Bringing in OX.DH’s experiences John raised a case study with Barnsley: a pilot exercise launching virtual consultations and online engagement. “A big part of that was getting feedback directly from the people that were participating,” he reflected. “People like being heard, and they appreciate it when they see you taking things on board. The good news is that with the type of tools and technologies that are available today, you can make front-end changes in a controlled, secure way, that allows you to have a tight feedback loop.”
Laura added that whilst her team try and do a lot of work going out into the community and speaking to people face-to-face, it can be “quite time-consuming” and can only reach the people who are physically there, whereas digital expands this reach considerably. “We can reach people in their homes, at times that are convenient for them, so that definitely helps. Having that almost-instant feedback also gives us something to work on.”
Virtual consultations
We highlighted stats from NHS England on the prevalence of video consultations, which now make up roughly two percent of practice appointments, and asked our panellists how their clinicians and patients were finding the experience of carrying out consultations via video. Do they think that this percentage should increase?
Bex noted that from her team’s experience, “there is more comfort in a telephone consultation than a video consultation”, which she considered may be related to privacy and security. “I think people feel that a telephone consultation can be quite enclosed; it’s a bit like having something behind a closed door, whereas a video consultation still feels quite exposed with being on camera.”
She added: “From our digital consultation side, we do use video for complete total triage; but we find that most requests are for face-to-face or telephone. So I would say that that low percentage mark is probably reflective of what we experience.”
“The statistics tell the story,” John stated. “They reflect reality. I would say that it is beneficial to bring all of those channels of communication together in a single mechanism, so I can see my entire clinic list of everyone that I’m going to be speaking to that day, whether those appointments are face-to-face, phone, or video. It’s also good to have the flexibility to flip back and forth to any of those channels – for example, if you’re having a telephone consultation about something like a skin lesion, it can be useful if your solution allows you to flip onto video to show that lesion to the clinician, and then go back to audio only if they are more comfortable like that.”
Factors for successful patient engagement
Our panellists discussed what needs to be considered for successful patient engagement, sharing insights from some of their own work or initiatives in their areas.
Joanna shared details around her work on the NHS Wales app, collaborating with GP practices to get the app out there and working closely with Digital Communities Wales, who have been providing training for about 180 digital champions throughout Wales on safety and security of devices, use of the app, and its functions.
“We’re also now going directly to the sector organisations, local government and health boards, to find out whether they’ve got their own digital champions already set up,” she said. “That’s been a really good way of us actually providing a list of local communities that we can tap into. We’ve noticed that it is about trust in those local communities, so we’re making sure that we’re linking in locally, supporting people and getting that feedback, updating our help pages and our toolkits that we’re providing as well.”
Laura talked about her perspective from research, including main findings around the need for flexibility and considering who you are trying to engage with when designing interventions and services. Also, she said, it’s important to consider the best times and dates to reach your targeted community. “You’re not going to catch working parents at 1pm on a weekday,” she pointed out. “It’s about thinking who you’re trying to reach and then going to them, rather than expecting them to come to you. Also you need to think about the audience when you’re designing materials or events, like Bex said with ensuring that content is catered to a certain level to keep it widely accessible. We make sure that our research is translated into a lay format and do a lot of work to get it to a level that is actually readable. They’re scientific journals and it can be very difficult for us in the medical profession to understand, let alone the general public; so I do think tailoring communication is a key point.”
From a tech provider perspective, John talked about making sure solutions are accessible and easy to use. At OX.DH, John and his team look at how people actually use solutions, tracking how they interact, how much time they spend in certain areas and what they click onto.
“There’s just no substitute for group sessions, where you can get feedback,” he said. “When you observe people doing things from a distance, you pick up on things that you never would have thought of. Often they might be really obvious once they’ve been disclosed, but it’s not necessarily something that comes to mind. That’s where we found the greatest enhancements coming into our user interfaces.”
Bex added that her team had success in using the TV display in the waiting room to showcase how easy a digital tool was to use; how quickly they would get a response; and how the environment wasn’t something to be concerned about, such as if the kids were getting ready for school or if the house was noisy. “Showing to the patients made them realise that other people are using it, and that helped with building trust,” she said. “One thing we did find was that our ageing population were the ones who loved using it the most, which we didn’t expect; and even if they themselves couldn’t use it, they were encouraging their sons or daughters to do it for them.”
Joanna agreed with this perspective, sharing that recent statistics on app use in Wales show that over 45s are regularly registering to use it, with “more than 140,000 people downloading the app and starting using it since April last year”. Additionally, she said, the Royal Society for the Blind and Royal National Institute for Deaf People have been providing support around accessibility. “We’ve also got an easy read format through the Learning Disability Wales team. Those are the sort of areas that we want to tackle, and make sure that we are inclusive as much as we can be.”
Solving challenges
Bex relayed the initial “fearfulness” of her practice around introducing digital tools, referring to launching online as a “baptism of fire”. She added: “We were scared of the floodgates opening and not being able to cope with demand, but it’s not as scary as you think on the other side, and we’ve found it can help us manage patient need much better.”
She continued: “We were a total triage practice before, but it was all through the telephone. So our care navigators would take the call then put it on the doctor’s list, which meant that information on what the call was actually about would often be missing, necessitating an information-gathering exercise. Now, we find that patients are giving us the information upfront, so they can be directly booked in with the appropriate clinician. We get through so many more calls per day this way.”
In Medway, Laura shared that a part of her role involves finding ways to reach more people”without it taking a full day of event activity”. As part of this, she often looks at technology already in place “to see if there are ways we can use that to spread the word about our research”.
John noted the friction that can often be found in day-to-day activities, and highlighted the role that digital can play in removing this and supporting a “well-defined flow” to information coming in. “It can enable automation in retrieving additional information, and bring everything together in one place,” he said.
On these topics, what is the one challenge around patient engagement and communication that our panellists would most like to solve; and how might they be working towards achieving over the next year or so?
Joanna spoke of the challenge of equity in access and getting the NHS app out to as many people as possible across Wales, sharing that her team is currently looking at access for under-16s. They are placing focus on ensuring that it is available from secondary care as well as community services, and adding new products and services on the app.
Bex echoed the challenge of encouraging people to get on board and “overcome their fears”. She said: “It’s about urging patients to come on this journey with us and reassuring them that we can do this together, that it will be good for them and good for us.”
The challenge John would most like to tackle is around change management. “There are so many great things that can be done with technology, but sometimes people drive it just from a technology standpoint, or without looking at it holistically to see where it’s going to require a change in the behaviour of staff, clinicians and also patients.
From a techie perspective, he said, “For me the technology is the relatively easy part; it’s all the changes that take place around it that are the real challenge.”
Concluding the panel, Laura said that the challenge she would most like to tackle also be access, ands particularly raised the need to “demystify some of the barriers to access and encourage people to take part.” Looking to the future, she spoke of her desire to continue to try and get more people involved in research, “so we know it’s right for our community, and that we all working together”.
We’d like to thank our panellists for taking the time to share their insights and experiences with us.
