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All Change Challenge Innovations

Thank you all for your involvement so far. We have now published details of the most impactful ideas. You can filter on the left-hand side for each of the Challenge categories.

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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.

  • Telephone advice appointment service - During Covid-19 ensuring the accessibility of our service was critical for patients to feel cared for at home. The response was to increase the number of available online telephone advice appointments by recruiting professors, consultants and registrars to engage in online telephone appointments, a role usually held by nurses.
  •  Webpage content redesign - Clinicians were supported by the Digital Lead to provide content for a new Coronavirus and Medication Frequently Asked Questions (FAQ) page on the rheumatology service webpage which patients co-designed and reviewed.  The FAQs were based upon audit findings from the nurse-led telephone helpline, emails and telephone advice services with ‘live updates’ from the rheumatology MDT daily Covid-19  ‘huddle’ meetings.
  •  Rheumatology Access Telephone-Tree Service - Clinicians, administrators, service managers and the trust digital/website team were involved in supporting the rapid redesign of the telephone tree based upon an audit of the nature of calls received and who typically dealt with these #firsttime.

Who was involved?

The rheumatology multidisciplinary team, administrators, service managers, patients and the trust digital/comms team.

What challenges did you face?

Due to the first wave of the pandemic, there was a rapid reduction in rheumatology outpatient services with a majority of routine outpatient consultations rapidly switching to telephone appointments. Nursing staff who typically manage the telephone advice appointment service and nurse-led helpline were redeployed,  rapidly reducing the capacity to offer un-planned non-F2F consultations.

What successes occurred

There was a rapid ‘coming together’ of members of the multidisciplinary team to support the three telecommunication initiatives. As a result, there was a greater understanding and appreciation of each others roles. Also, a relationship was swiftly made with the digital team which allowed for rapid iteration of content as the national guidance on shielding was updating at pace.

Click on this link or the attachment below to read the full Change Challenge Innovation

What Happened?

When did you change?

In January 2019 a remote monitoring service went ‘live’ for patients with Rheumatoid Arthritis (RA).

Who was involved?

Multiple stakeholder groups- patients, clinicians, commissioners and a multifunctional team of designers, developers, user researchers. The change was led by a Topol Digital Fellow supported by the Health Education England Topol Digital Fellowship programme..

How did you change?

In 2017 clinicians involved in the change embarked on discovery work to explore better ways to help identify patients who could benefit from greater flexibility through remote care and continue to live well by avoiding the reminder of disease through attending unnecessary hospital appointments. Framing the significance of the regular remote capture of patient-reported outcome measures (PROMs) between appointments to support shared decision-making about when patients needed care the most was the cornerstone of the change.  An agile, multi functional team led the user centred design and delivery of a minimally viable rheumatology remote monitoring service in South East London for RA patients. ‘A service designed for patient with patients’. The solution has been to implement a two way SMS channel for patients with RA which captures monthly PROMs whilst allowing for two-way SMS contact from patients between clinic visits. 

What challenges did you face?

Whilst opening multi channels of remote dialogue with patients was seen as risky it was essential to sustainable transformation of care. Limited funding led to the need to prioritise service features and a growing product backlog. There were frequent requirements to engage with Information Governance to ensure the service met data handling regulations.

What successes occurred

Design features such as automated reminders, graphical feedback on scores, a red flag system to alert to changes and an SMS template library have supported personalised care for disease flare, emotional well being and appointment deferment, accelerated in uptake by COVID-19.  Learning and sharing insights from patients’ experience of the digital service has been invaluable in understanding the building blocks needed to form meaningful remote clinician-patient relationships and optimising user engagement at scale.

Click here or the attachment below to read in full

What Happened?

When did you change?

In March 2020, at the start of the first wave of the covid-19 pandemic

Who was involved?

The whole rheumatology multi-disciplinary team 

How did you change?

We have a well-established advice line & made several significant changes

  • recorded an updated answer phone message every week with general advice
  • drafted all the team (specialist nurses, consultants, physio, OTs) to assist in responding to calls
  • drew up a crib sheet covering commonly asked queries about covid-19, shielding advice and access to local support

 What challenges did you face?

  • supporting members of the team not used to answering queries
  • ensuring adequate documentation
  • ensuring consistent advice

What successes occurred?

  • demonstrated team working
  • drew on the different strengths and skillsets of the team
  • highlighted the importance of the advice line & ensuring the workload is recognised & job planned

Click here or on the attachment below to read and download the full Change Challenge Innovation

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