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Igniting Clinical Curiosity – Go with the Flo

NHS Arden and GEM 

Commissioning Support Unit

Joan Pons Laplana – Flo Clinical Lead 

The NHS is going through a tough moment. With increasing financial pressures and soaring demand, the NHS is changing. Questions over quality, services, technology and funding make it hard to imagine what the NHS might look like in 10 years’ time.

For me there is one solution to make sure that the NHS continues to be the best health system in the world.  We need to turn the NHS upside down and empower frontline staff and patients.  If we really want to deliver patient centred care we need to give more control to our patients. 
Critical to the future of the NHS, is that the general public takes greater responsibility for their own health and wellbeing.  We as health professionals must support them to be able to do this.  Patients need to feel enabled and involved to prevent them being passive consumers of care and become active and leading partners in their own health. Individual responsibility and lifestyle choices are as important to the success of our health system as is the quality, or quantity of care we provide; enabling and equipping our patients to take responsibility and to make educated choices about lifestyle

In a healthy and happy future, patients are actively involved in decisions about their treatment, co-designing solutions with increased choice over the type of care that they receive.

Supporting Informed Decisions

Patient choice is a key component of the healthcare they receive.  Our role as health professionals needs to change from a provider of healthcare to a facilitator, and support the individual with their own choices.  Our role in providing our patients with sufficient and detailed information (on treatments and providers) helps them make informed decisions about the care they receive.  We should be their ‘Advocates’ within the system to help them navigate their options and make ‘good’ decision.

Preventions vs. Cure

For this to happen, large cultural change needs to happen within and between health care professionals. Most of our focus is on returning patients to a healthy state.  Most of us become doctors, nurses1 or physiotherapists to help to make people better.  This mentality needs to change and encompass prevention alongside treatment.  Our role needs to move from saviors, to preventing illness in the first place.  A lot of us are not ready.   We don’t need more health professionals trying to be heroes.  This is a battle that we will never win because as humans we are all designed to die.  Our mentality needs to shift into thinking how to maintain people healthy on their community for as long as possible.  A useful comparison is telling a fireman that suddenly his main role now is not to extinguish fires but to prevent fires happening in the first place.  The benefits are obvious however resistance is unavoidable and peppered with questions and perceived barriers.   As my grandmother used to say: “prevention is cheaper than the cure” however the key is in actually enabling this prevention.

Technology as an Enabler

A key component for a happy future is that we maximise the benefits made available to us via technology. Acceptance and capability of technology in our everyday lives is commonplace and we need now to extend the benefits that technology brings into the delivery of our healthcare.

Technology plays a key role in a ‘healthy state’ NHS, both for patients and the public, and for the system.   We are living on a 21st century society where communication is fast and accessible but our NHS still using technology from 25 years ago.

As John Lennon said “Call me a dreamer but I am not the only one”.  NHS England clearly commits to this in its 5 Year Forward View.   The Five Year Forward View sets out a clear direction for the NHS, showing why change is needed with an emphasis on patients needing to gain far greater control of their own health.  The NHS makes the commitment to do more to support people to manage their own health, staying healthy, making informed choices of treatment, managing conditions and avoiding complications

I am a firm believer in this vision.  Person-centred care is my passion.  Making a difference is what motivates me to get up every morning and go to work with a smile.  I am on a mission to turn the healthcare system upside down and empower frontline staff and patients to lead together in achieving better health outcomes.

The past decade has seen rapid development and adoption of technologies that change the way we live.  The NHS needs to start using these new technologies and embrace the new opportunities that they bring for our health and care system: improving the accuracy and usefulness of information we can gather on our health; changing how and where care is delivered; and offering new ways to prevent, predict, detect and treat illness.

Going with the Flo – Buxton Breathe Easy group

Why Consider Telehealth in how we Deliver Care?

Telehealth is the way forward and is emerging as a critical component of the healthcare crisis solution. Telehealth can change the current paradigm of care and allow both improved access and improved health outcomes in cost effective ways whilst increasing access to healthcare, reducing healthcare costs and improving support for patients and families.  What’s not to like it?   It’s a win win!!

My Journey with Florence3 (Flo)

For these reasons my local CCG funded a Telehealth Clinical Lead role focusing on expanding the use of Florence and it didn’t take me more than two minutes to realise that that is what I wanted to be;  I was over the moon when I was appointed.  The CCG had been running the project since February of 2014 and I was looking forward to joining the team.

But soon I realised that the challenge was a lot bigger than I originally thought. What I was trying to change is the way that people worked.  The organisation’s culture is deeply embedded and therefore by nature extremely difficult to change

I came face to face with some big challenges from the beginning.  Florence was not the only project competing for the attention for Front Line colleagues. Most of the other projects like POLAR, EPS R2, SCR AI, were compulsory and for obvious reasons Flo was the latest in a long line of initiatives.

Frontline staff are stretched to the limits, they are working under an increased work pressure and they could not see the need for integrating Flo into the way they delivered their care.  The project had stalled but I noticed a few exceptions.  A handful of clinicians were using it with great success.  One in particular caught my eye.  Michelle Denyer, DCHS2 Community Diabetes Specialist Nurse was leading the way.

For my first two months I decided to network and make connections with other professionals and organisations that there were already using Flo.  I sent emails and established connections.  I also used social media and slowly but surely I gathered a picture of what was working in other regions and the best of all how they had overcome any problems.  
During my first two moths I visited Liverpool, Mansfield, Nottingham and Rochdale, to talk with Clinicians and patients.  I wanted to see with my eyes what the best use of Flo was.  But best of all, I was also establishing my network with other like-minded clinicians.  I even managed to raise a few eyebrows at the CCG with all my trips and very little progress.  A few emails went backwards and forward questioning my methodology, but I was determined to succeed.

The second thing I did was gather feedback from GP practices.  I wanted to know what the major obstacles I was facing were. During the previous 18 months the team had held launch meetings and had numerous contact with the practices but the opportunity had still failed to gain momentum.

Slowly but surely I was getting a full picture. In the meantime I decided to take another approach.  Flo’s aim is empower our patients so I decided to get the patients involved.  I contacted Louise Swain, Head of Patient Experience and together we designed a plan.  During the following months I was invited to attend the Patient Participation Group (PPG)  and as I expected it was a love at first sight. I had the patients on my side and the word of mouth was spreading fast.

At the same time that I was visiting the PPG groups, we decided to focus on the small group of clinicians that were using Flo successfully.  We visited them and celebrated their work and achievements.  We captured case studies and spread the word amongst clinical peers.  I used social media to shout out loud. We changed our focus from what was failing to what was working. It did not matter how small, we were determined to make some noise.

A lot of GP practices initially did not want to engage with me, they did not see Flo as a priority for them.  But I did not take “no” for an answer and on a regular basis I emailed the practice managers the latest stories and successes regarding Flo.  But the key that opened more doors to me was using the phone and having conversations with them.  I got their curiosity by showcasing what Flo was able to do and also by telling them what other surgeries were doing with Flo.  I ignited natural competitiveness that hides inside every human being. Nothing is more powerful that storytelling and I’m pretty good at it.   One by one after a few weeks I managed to get appointment to re-launch Flo in most of the GP practices across North Derbyshire.

Once I got inside the surgery I know that I only had one opportunity to engage with the staff so I changed my approach. I needed them to be able to view Flo through new eyes to assure success.  I needed to engage with them differently to shift their attitude from “they told me to” to “I want to”.

With some clinicians it was obvious that they did not want to be there and had only attended because of the prospect of gaining a few CPD points for attending my talk.  I love nothing more than to wake up the curiosity of people; to see their attitude shift from eating their lunch at the back of the room making minimal eye contact to at the end of the session seeing them raising hand telling me that they have a patient that they think Flo might work.  Only then did I know that Flo would succeed.  Curiosity is a driving force that we normally underestimate. For me curiosity is the beginning of any change.  Without it failure is more likely.

Change is personal and individual and for that reason my approach flexed to suit each occasion when I was talking with a clinician.  I let them lead the conversation, I gave them a space to express where their challenges were and then discussed how Flo could be a solution to their problems.  I established relationships with clinicians, I put them in the front seat and let them lead Flo were they wanted her to go.  I let them wonder and get excited about it.  I did not push Flo to them, I let them fall in love with and embrace her. To me this is the only way to make any change in clinical practice sustainable.

However this approach takes times and patience and very often our NHS doesn’t have this; relationships need space to flourish and produce results.  For the first few months I did not hit any of my targets and people got nervous, some even questioned my capability but now six months down the line the new approach is bearing fruit and at present over 80% of the GP practices are using the Flo.  My hope is that the other 20% will come on board soon.

#FloMania is spreading fast and other new organisations are beginning to be curious about Flo.  Ashgate Hospice are starting a pilot, using Flo to help patients to control their pain better and The Chesterfield Royal Hospital is at the later stages of planning to initiate a project to help patients living with Diabetes at their outpatients clinics.

But the best thing of all, is that I am establishing Flo Champions across all of North Derbyshire and they are the driving force from the front line.  I also became part of this fantastic network across England sharing learning, experiences and good practices.  Having recently been invited to present my experiences at a large regional event in the North of England, it’s now my time to share and inspire clinicians in other areas to help patients, to help themselves with Flo.

There is an African proverb that says: “If you want to go fast, go alone, but if you want to go far, go together. “

1Joan Pons Laplana’s inspirational journey in nursing has been published by NHS England; ‘My Story’.
2The work of the DCHS Community Diabetes team is recognised in the prestigious ‘Patient Experience Network Awards’ national finals.

3Florence, also known as ‘Flo’ is the friendly persona of the NHS ‘Simple Telehealth’ service used to help patients engage better with their own healthcare.  Described by the Health Foundation as “Telehealth with a Human Touch“, information about how it’s used can be found here

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