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Five steps to Florence

Shona Burge  Home Mobile Health Monitoring Development Manager 

What a service team’s journey with Flo looks like in Tayside “We are one big team” 

Thanks to funding from the Scottish Government Technology Enabled Care Fund, Angus, Dundee and Perth and Kinross Health and Social Care Partnerships (HSCP) together with NHS Tayside began their journey with Florence or ‘Flo’ in September 2016.  As the newly appointed Health and Mobile Health Monitoring Development Manager for the hosting organisation Angus HSCP, I began one of the steepest learning curves I’ve faced.  This has also turned out to be one of the most satisfying and enjoyable.  Aside from the unfaltering support of my manager Sally Wilson, one of the main reasons for this is the enthusiasm and commitment of the first wave of teams to trial Flo across Tayside.  Being new to Flo we decided to engage as many services as were interested in trying out this innovative way of working.   We loved the idea of using everyone’s best friend, the mobile phone to welcome Flo – ‘The clinician in your pocket’.  Sally had already been speaking about Flo and extolling her virtues to others before I came onboard so we had a group of interested parties ready and waiting for me to hit the ground!  Thankfully Sally had me on a kind of umbilical bungee cord and was always on hand to pull me in for that steadfast support and encouragement. 

We have started with five services those being: Weight Management, Smoke Free Pregnancy Services, Oral Nutritional Support, Heart Failure and Edzell Health Centre who wanted to use Flo to monitor hypertension.  We have a bit of a process we follow with services, some steps need more input from us, others require the teams to free up a bit of capacity to get ‘Flo ready’.  The process as always has evolved as we have moved through it.

Step 1: Clinical Engagement 

The role of promoting Flo has been undertaken by both Sally and myself.  Sally sends out the message to senior colleagues and I follow up with the practical stuff.  So either we send relevant case studies and/or links to or we gave short informal or more formal, invited presentations to services that have heard about Flo and were interested to hear more about how Flo works, what Flo can do and how Flo can help people self–manage their condition.  Basically we talk about Flo most of the time. 

Step 2: Planning 

If a service team is interested and thinks they would like to try Flo we arrange a visit.  In preparation for this the team is provided with relevant, example protocols where possible or protocols that could help thinking – i.e. hypertension protocols to demonstrate how readings can be taken by patients at home and fed-back to clinicians for decision-making. 
We found health behaviour change protocols, around weight management for example useful for other topics as well as the essence of the messages remain the same, only the topic changes.  The team also receives the ‘Scoping Document’ and are asked at this stage to just have a think about how Flo could integrate with their existing pathways; what their intended targets and cohorts would be; how Flo would assist self-management and patient support while freeing up clinician and patient time rather than building in extra work. 
At the visit we go over the scoping document as a tool to discuss ideas in more detail, what their specific protocol might look like and importantly discuss whether there is capacity and confidence in technology for the team to designate a member to become a System Administrator and be able to add protocols to Flo or if indeed this is required by me. 
In cases where the protocol is fairly simple I would have capacity to build it, however if the protocol is likely to be more complex, or specialised and have many iterations I do request a team member dedicates time to this as it generally needs specialist experience to complete this.  Team administrators who have a good understanding of the service and close contact with clinicians tend to be the key personnel here and this is something that can be identified fairly quickly in negotiations.

Sometimes there is no administration support available; however there is usually a key member of the team that identifies themselves as suitable for the System Administrator role.  At this stage we also consider evaluation and agree timetables for implementation.  I explain what information we can gather from Flo and what we will need from the services.   By this stage the team knows what will be required in terms of input upfront and this is usually balanced out by the team understanding the long-term advantages that Flo can bring.

Step 3: Developing Protocols 

The team will then identify which members will require training to use Flo; this is either provided on-line from the team at Simple Shared Healthcare or delivered locally with live support from them.  Some time is then required to develop protocols – this interim ‘work period’ is very important and can require careful monitoring so that Flo doesn’t fall off the radar due to other work pressures, but so far we have found teams are generally keen on making Flo work and excited to put her into practise so keep apace with agreed schedules. 
At this stage I will act as ‘super user’, set up the ‘TEST’ groups for teams and provide access for System Administrators to access protocols to work on if appropriate.  During this stage I work closely with team System Administrators to get test protocols ready for testing with staff members. 

Steps 4 & 5: Going Live and Evaluation

Once the team is happy with their protocols and have tested on colleagues we ‘go live’ in accordance with the integration to pathways agreed at Step 2.  Monitoring and data collection takes place on a monthly basis according to the reporting periods of the National Technology Enabled Care Team in Scotland and to meet any service requirements. 
During our journey I cannot stress how invaluable the support from the National Action Group and from Simple Shared Healthcare themselves has been, and continues.  Resources are shared; happily and easily, there are many questions – but none are ever ‘daft’; sometimes we excel ourselves and come up with a new question – but someone always finds the answer.  The sharing and learning is real and crucial on a practical level.  We are one big team.  

Service adoption of Flo – Process from stage of interest to using Flo

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