Anthony, M

Keen, A

Locock, Louise

MacKenzie, Kevin

Melvin, M

Ramsay, Craig

Rzewuska, Magdalena

English

Melvin, Mike

Myhill, Anthony

MacKenzie, Kyle

Keen, Andrew

Aberdeen University Research

HSRU is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The author accepts full responsibility for this talk.Perspectives of staff adopting outpatient asynchronous consultations in NHS Grampian, ScotlandPresenter: Dr Magda Rzewuska (magdalena.rzewuska@abdn.ac.uk)On behalf of Prof Craig Ramsay (UoA), Prof Louise Locock (UoA), Mike Melvin (lay partner), Anthony Myhill (lay partner), Kyle MacKenzie (NHS), Dr Andy Keen (NHS) Asynchronous consultation bookingPatient referred Patient vetted for outpatient appointment Patient identified as suitable for asynchronous if appropriate or all cohort of patients offered.Patient contactedPatient reaches the top of the waiting list and is sent a patient-facing booking contact letter.Appointment bookedOn contact patient offered asynchronous, booked if accepted or if not then booked for an alternative mode of contact.New or returning. It’s optional and offered as a routine appointment only. There are differences in how patients are marked as suitable, wherein the pathway it’s offered, and synchronous alternatives are available. Asynchronous consultationIt means communication that doesn’t take place in real-time, instead, it takes place between clinician and patient at different timesPatient receives linkLink sent via SMS/email & a patient registers Patient has 5 days to provide informationWeb-based questionnaire Patient verifies & sends responsesPatient reviews their responses& send themClinician receives & reviews information Can ask more Qs via real-time messagingOutcomeInformation aids assessment of needs & copy stored and sharedOuter contextSystem antecedents for innovation System readiness for innovation e.g., COVID19 accelerated the uptake of teleconsultations but also created competing demands on the National Services Scotland’s integration hub.e.g., There was a strong internal need for a new secondary care model, but the innovation doesn’t fit the technical workflow.Outer context and systemStaff described the implementation effort taking place in the complex open systems of ‘real world’ contexts.e.g. NHS Grampian has a long history of telemedicine use but lacks a clear strategy.AdoptersStaff described what characterised the involved healthcare professionals as prone to innovate and thoughts they’ve given to increasing the uptake rate by users.Visionary, value flexibility, and risk-taking.Values & goalsLeads highly motivated, but concerned about other clinicians’ buy-in. MotivationSeen similar innovations elsewhere. Changes over time in attitude towards acceptance were observed. Social networksCondition type, demographics, psychological factors, and lifestyle. Targeting & selectingConvenient appointment booking, information giving, wording, online contact prior.Supporting  engagementHelpful, but unfortunately limited.Patient involvement The Innovation Practical demonstrations helpful Many advantagesWith a help of the developer, clinicians designed pathways and content, minding its value and adaptability to their needs.Clinicians couldn’t try it outPathway is bitty for patientsTasks issues for admin staff Evaluation plan in place…Assimilation & Implementation"What else has been unexpected? Just how complex the process is" – said a clinical leadSetbacks Reinvention/development Management Dedicated/human resourcesInternal communicationDelays right at the start: Contractual (4-months delay), technical integration (6-months delay) and IG/testing work (1-month delay). Mind when to integrate & sequence of tasks!.Transferability of the innovation across specialities was viewed as critical for routinisation, but currently, it is limited.Rotation of project managers negatively affected the continuation of communication, and thus staff engagement.Allocated time and resources needed (clinical, admin staff, coordinator, project management, evaluation lead, health intelligence).Adopters recommended: open and clear two-way communication, including relevant people from the start and keeping them informed throughout, records of communication, clearly outlined roles.…

Perspectives of staff adopting outpatient asynchronous consultations in NHS Grampian, Scotland

https://aura.abdn.ac.uk/bitstream/2164/19117/1/HSRUK_conference_ACORN_study_MRzewuska.pdf

Perspectives of staff adopting outpatient asynchronous consultations in NHS Grampian, Scotland

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