Kylie Dentith Technology Enabled Care Support Assistant SSHC
The Shropshire & Wales Regional Network Event was held of 20th March 2019, hosted by Telford & Wrekin CCG and as usual was an inspiring day for sharing and making new relationships.
Regional events take place across the UK to provide community members with the opportunity to meet and discuss their current and proposed pathways, share best practice and offer the potential for future collaboration and system wide pathway development with member organisations also using Flo nearby.
Regional events are a great opportunity to share and celebrate the clinically driven innovation taking place across the region. The day was kicked off by Lisa and Karen, who warmly welcomed attendees to the event and gave an update of recent news and events from around the Simple Telehealth Community.
Lisa and Kylie gave a brief overview of Flo’s role within the NHS England Test Bed at University Hospitals of North Midlands NHS Trust (UHNM) “Smart with Your Heart”, which is based on a successful pilot at UHNM where the cohort demonstrated reduced admissions for patients after discharge when supported by Flo. With Flo as one of the three digital partners, previous learning is being scaled up and the team at UHNM have developed a pathway that will ask the patients for daily responses about how they are feeling, or about their symptoms in conjunction with their symptom checker to increase awareness and confidence of any actions they need to take. Patients will be prompted at the end of the pathway to answer four evaluation questions which will support the team in their final evaluation for NHS England, and to inform a sustainable approach to continuing the service. More information is available here.
Hollie O’Connell, Assistant to Chief Innovation Officer and Chairman – Nellie Overview
We then made the most of using technology by joining into a web conferencing platform with Hollie O’Connell. Hollie gave an introduction to Nellie (our next generation system) and shared the way in which the features and interface have been designed and created to reflect the learning from Flo.
Kath Lloyd, Service Development Manager for Therapies and Health Sciences , Powys Teaching Health Board
Kath kindly gave an overview of Powys’s journey so far with Flo. Powys first introduced Flo with a workshop in 2016 with positive clinical feedback securing Flo from October that year. The first patient was recruited to Flo on the 31st October 2016, and throughout 2017/2018 interest spread across other clinical teams throughout Powys.
Pathways supported by Flo include:
- Falls
- Respiratory
- Pulmonary Rehab
- COPD Maintain and Monitor
- Diabetes Education
- Diabetes Non-Metformin
- Pain Management
- Blood Glucose in the South of Powys
- Parkinson’s Disease
Patient feedback from a variety of the above protocols:
“ Flo encourages me, I like the little tips and reminders ”
“ I find it very helpful and it has benefited me ”
“ Flo has improved my diabetes and general wellbeing ”
“ Flo has motivated me and shocked me into making changes. ”
Feedback from clinicians:
“ I feel the small aspect of Flo has created a large impact ”
“ The patient, who is on 7 doses of meds per day, is feeling the benefit of Flo after a few days. ”
The team are now looking to introduce Flo within GP Practices to use with their hypertensive patients and also with their local CAMHS team. The team are also looking to recruit a Telehealth Coordinator for 3 days a week to support the rest of the team to spread the use of Flo across the health board. For more information please see here
Kath Fackrell, Voluntary Services Link, Shropshire Community Health NHS Trust
Kath, along with Wrekin Housing Trust and the Carers Centre have collaborated on working on a pathway for patients that are discharged from the hospital, to go back home and recover with the support of a carer.
Kath shared a few of Flo’s interactions that are included in the pathway such as messages with contact numbers for further support, information on discounts they can get at venues like the Theatre for example, and general information on keeping well. To ensure the patients and carers are fully informed with all relevant information, the team created a patient information leaflet, which includes information on free-to-use texts, what Flo is and what the patients will receive once enrolled onto Flo. Some of the patients that will be introduced to Flo may not have their mobile phone with them at the time of enrolment, so the team has also added what to do if this is the case to the leaflet.
The team also created a consent form which all patients will be required to complete before being able to be enrolled onto Flo. The information that is on the patient information leaflet is also covered on the consent form.
Maximising the Impact of the Initial Introduction to Flo
Karen and Lisa delivered a lively session on maximising the impact that the initial conversation between patient and clinician has on patient engagement when introducing Flo, a session suggested at the previous meeting.
The importance of the patient’s initial introduction to Flo by their clinician cannot be underestimated. While still relatively new within healthcare, supported self management with technology as an enabler can be a relatively new concept to both patient and clinician, and one that certainly becomes more natural with experience, particularly as clinicians begin to see and feel the impact that Flo’s interactions have on the behaviour of their patients.
Learning from across the Simple Telehealth Community of Practice demonstrates that for some clinicians, discussions with their first few patients when introducing them to Flo can be the most difficult as they begin to familiarise themselves with not only the concept of technology as part of healthcare management, but the cultural shift in motivating the patient to take more responsibility for their self care outside of the routine face to face clinical environment.
Similarly for the patient, the same cultural shift needs to take place. The most powerful positive influence around this is derived from the confidence demonstrated by the patient’s own trusted clinician in this initial conversation. Where a clinician understands and articulates to the patient the benefits that additional support to their self management can bring, the rate of acceptance and subsequent engagement substantially increases.
Confidence in the clinician can be assured by focussing on a few factors. Often where a clinician has been involved in the design of the new pathway from the start, this confidence is apparent much sooner as a result of their depth of understanding both of the rationale and process. However as the number of clinicians integrating Flo into their clinical management spreads for example across a team, it’s vital to dedicate time up front with new clinicians to assure the depth of understanding also spreads.
Once a clinician begins to experience the anticipated benefits within their own patients, a unique opportunity develops, and new initial conversations organically start to feature context from the clinicians previous experiences when their patients have been supported by Flo, which is then very easy for the patient to understand.
To bring this to life, Karen and Kath Fackrell used role-play to demonstrate a scenario with Karen being a clinician and Kath a patient. The scenario demonstrated clearly the correlation between the patient’s acceptance of Flo and their clinicians confidence both in the rationale for use and explaining what the patient should expect, and what they may need to do.
The role play ignited a discussion on how to enhance the way clinicians approach to this initial conversation.
- The value of training was highlighted as an area that can be reinforced locally to provide assurance and confidence around the rationale for introducing Flo, and also to reduce any personal fear of technology that the clinician may bring.
- Specifically highlighting the importance of this initial patient to clinician conversation was also suggested as a dedicated topic to cover within routine training. This was also raised as an effective method to be able to unpick any additional gaps in knowledge or skills that can be supported early on.
- The group discussed how insufficient understanding can often be enough to deter clinicians from introducing Flo to their patients, or can result in a poor quality discussion. Offering the clinician a prompt or guide on what to remember can motivate them to embark with those first few patient discussions. This can often reassure clinicians enough to make a start with recruiting patients.
- The conversation between the clinician and the patient needs to be informative for the patient but simple enough for them to understand what they need to do and when, and what Flo means for supporting their condition.
- It is optimal to be able to add the patient to Flo during this initial discussion as it assures the patient’s competency around their use of Flo demonstrated by them replying to her to opt in, that they have provided the correct mobile phone number and reassure the clinician that the patient will start to receive Flo’s support. A shared management plan and patient information leaflet reinforces this conversation and allows the patient to reflect and compound their understanding in the first few days of Flo’s support. For patients who wish to reflect on whether they want to join in, patient leaflets can provide a good overview of Flo, who she is, how she works and explain what to do if they do decide to join.
We would like to say thank you to all those who were involved and contributed to such a depth of discussion. We look forward to seeing you at the next Shropshire & Wales Regional Network Event.
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