Working in patient-facing healthcare during the Covid-19 pandemic has come with its many challenges. One such challenge was the rapid implementation of video consultations to enable continued provision of care in the place of face-to-face appointments.
At Barnsley Assistive Technology Team, we implemented video consultations very quickly in response to Covid-19 and as a way to continue assessment and care provision with our clients. This came with a number of other significant changes to our day to day procedures of installing assistive technology equipment, responding to fault calls, and liaising with local professionals while minimizing patient contact.
Me and my colleague Emma Barrington, both Assistive Technology Clinical Specialists, had the opportunity to engage in a research project led by the Q Community looking into implementing video consultations in NHS services.
Project Aims and Methods:
The project aimed to support those implementing video consultations at speed and scale to reflect on this new way of working to improve practice and support learning from peers. A further aim was to uncover insights relating to video consultation implementation within the context of Covid-19 to share learning and inform future needs at a wider level.
As identified ‘improvers’ (someone who is implementing video consultations but seeking to improve and establish best practice) our engagement in the project involved completing fortnightly learning logs reflecting on a number of open questions relating to changes in our service, and the challenges and successes of video consultations. We also participated in webinars facilitated by the Q Project team, which involved reflecting on video consultation experiences and sharing these with other project participants.
The project took place over a 12 week period from April to June 2020.
Personal Reflections and Learning:
From engaging in this project and implementing video consultations over the past 6 months, I was able to reflect on the positives and the challenges that resulted from this way of working.
|Things that made me feel proud||Things that have been a challenge|
|How quickly my team was able to adapt to continue providing our service remotely to patients.||Working remotely has been challenging in terms of maintaining close working relationships with colleagues and it can feel like you are working in isolation despite attending video meetings.|
|How resilient and positive we have been as a team and how we have supported one another throughout this challenging time.||The video consultation platform we have used has not always worked effectively and this has caused issues when trying to provide remote support.|
|How as a specialist regional service we have been able to think innovatively and develop a huge amount of resources to remotely support local services and patients, carers, and families.||A lack of equal access to technology has meant that many people have not had opportunities to engage in video consultations. What is more, not everyone we have worked with has the confidence or skills to engage with the technology for video consultations.|
Overall, I feel that the following need further consideration and development both locally and organizationally:
- The development of robust procedures for implementing video consultations.
- How to measure outcomes of video consultations and ensure we capture patient feedback.
- Understanding the need to continue with some face-to-face consultations as video consultations are not appropriate for all patients or all situations.
- Ensuring there are back-up options in place for when things go wrong, such as having different video consultation platform options available.
- Development of quality measures around video consultations due to the potential to miss information that adds to the bigger clinical picture.
- Addressing digital poverty and inequalities for accessing technology for video consultations.
- Supporting team members’ health and well-being in relation to changes in clinical practice and potential isolation due to remote working.
Q Project Findings and Future Projects:
Findings from the Q Project revealed similar insights from approximately 50 participants. Please see the Q Project Blog for details regarding the insights from this project: https://q.health.org.uk/news-story/video-consultations/
One outcome was the need for further research around video consultations, more specifically relating to the following priorities:
- Can video consultations provide the same quality of communication as face-to-face consultations?
- Which patient group will benefit most – and least – from video consultations?
- What solutions are needed to support video consultations in the long-term?
It is clear that further research is required into the use and outcomes of video consultations in patient-facing healthcare settings.
For patients with communication needs who use assistive technology, specific questions and challenges will continue to surface. As a service, we are continuing to measure the impact of our input using Therapy Outcome Measures, whether this is provided remotely or face-to-face, and we are currently developing a means of collecting client feedback specifically around remote working. In the future, we hope to be able to analyse our collated data alongside other specialised assistive technology teams, which will offer further insight relating to the effectiveness of different ways of working.
Our focus now turns to creating sustainable change in the implementation of video consultations, and supporting patients and professionals with this ‘new normal’.
Danielle Diver and Emma Barrington, Assistive Technology Clinical Specialists
 Enderby, P. & Alexandra, J. (2015). Therapy Outcome Measures for Rehabilitation Professionals (3rd Edition). J & R Press Ltd.