In April this year, we blogged about the NHS Book a virtual visit service that we rapidly developed with two NHS trusts in North West London at the height of the pandemic when patients could not be visited by their loved ones.
The service has proved a huge success ever since, with Trusts from around the country wanting to use it as part of their COVID-19 responses and more generally across wards.
One of these is Kettering General Hospital, which got in touch with us soon after the first alpha was developed so they could use it in their hospital. This has resulted not only in the widespread use of the service, with over 540 virtual visits having been completed, but also its further development to include new features designed around patient needs.
We spoke to Ian Roddis, Deputy Chief Digital and Information Officer, and Anna Awoliyi, Chief Allied Health Information Officer, about how we collaboratively worked with ward staff and patients to iteratively improve the service based on user research.
The Trust with digital ambitions
Kettering General Hospital is part of Kettering General Hospital NHS Foundation Trust and provides healthcare services in North Northamptonshire and South Leicestershire. It employs around 4,000 staff, deals with 255 A&E patients per day and has 310,000 outpatients each year.
Speaking to Ian, the Trust has big plans for making the most of digital and technology to serve patient needs and to help staff provide excellent care.
“We have the ambition to be the most digitally enabled hospital in the country. We want to deliver solutions for patient experiences that are based on their needs. That means taking the best of the digital landscape as it exists today and applying it to the hospital,” he said.
This strategy is being driven by Andy Callow, the Chief Digital and information Officer, looking to blend the best of national developments with local innovation, working with a range of ‘best in breed’ suppliers and developing the Trust’s own internal capability.
This approach was very much front of mind when the NHS Book a virtual visit service came onto Ian and Andy’s radar, as a result of the exposure it received on Twitter from senior NHS digital and technology leaders at the height of the pandemic.
A service for COVID and beyond
COVID meant people in the hospital wouldn’t be able to receive visitors, and as the Trust ‘resets’ this is still the case. The risk of hospital acquired infection is a real one, and in all areas of hospital life we need to maintain social distancing. This meant that the ‘virtual visiting’ service seemed to fit the bill!
“We knew we had to do virtual visits, we knew the solution we were using wasn’t ideal (it was a commercial freely available one, and had ‘information governance’ and privacy concerns). We also suspected that COVID wasn’t going to end soon and we would need something for when we reset too. This looked like a sweet little product that had been developed along the right lines, based on user needs and designed to be flexible”.
For Anna, the most important thing was that the service could benefit patients and ward staff during such a difficult time.
“It needed to be easy for our staff and the patients they were using it with. Imagine you are here, ill in a pandemic, with no phone, no loved ones and lots of fear around. At the same time, we had to think about how we could help staff, who are tired and overworked, to do even more.”
Initially, the Trust had planned to rollout the service over two months but, due to the enthusiasm with which ward managers and staff embraced it, the rollout was completed in just two weeks.
“What was phenomenal for me was how staff embraced the technology because they realised it could help them to work better in the difficult circumstances of the pandemic,” she said.
Evolving the service to meet patient needs
The original NHS ‘Book a virtual visit’ service had been delivered as an alpha in just 48 hours. It was released as open source code so that others could start to use it and evolve it for their own needs, which is exactly what occurred in Kettering.
“When we first saw the app, it was ready to go and ready to use but we still felt we had to do some more work to understand how we could involve and engage our people and our patients with it,” said Anna.
Therefore, we worked collaboratively to speak with patients and staff about their needs, and engaged with them as they used the service, in order to iteratively improve it. This led to the ‘rebook’ feature being delivered and then the ‘complete’ notification being added.
“Just from going on the ward and sitting with people, it was like a lightbulb moment to see that people didn’t know when the call was completed. You don’t find this sort of thing out unless you have these conversations with users.”
As the service was rolled out to different wards, comments from users would trigger new innovations, with agreed feature ideas rapidly delivered in one week sprints.
According to Anna, “the swiftness with which features were delivered was amazing”, while Ian said this ability to rapidly make changes to software based on the hospital’s needs is exactly how the Trust wants to continue in future.
“Our ability to influence big enterprise products is probably less than 1%, whereas with this service, our ability to change it is 100%. We’re using modern development tools and working off our own branch of the code, so we can develop different experiences for different wards and the different needs they have,” he said.
Open development in healthcare
As a result of the reception it has received from ward managers and the work they have put into the user centred design process, the NHS Book a virtual visit service is now used across 25 wards in the hospital and has facilitated over 540 virtual visits with an average duration of 50 minutes. This includes the Emergency Department, where it has been used for 8 virtual visits so far, even though it was originally never expected to be used there.
The service is expected to become even more important in the coming months as the restrictions on visitors continue at the same time as the Trust aims to return to 80% of normal services. Furthermore, there are plans to explore using the service at Northampton General Hospital – part of the KGH/NGH group model.
According to Ian, the technology and ways of working that have been introduced with the NHS Book a virtual visit service are exactly what he hopes the Trust can do more of as part of its ambitious future.
“The NHS is building its own digital capability now and this is how we want the Trust to work. Commercial suppliers obviously play a role but we want to build our own capability using the best technology and methods available. But more than anything else, this is about putting patients at the heart of what we do and the services we design.”
We’ve hosted a webinar about this service as a part of the Leeds Digital Festival 2020. The webinar recording can be viewed on our YouTube channel: Delivering a user-centred NHS virtual visit service during COVID.
A full case study about the NHS virtual visits project is also available on our website.
If you’d like to find out more about the service please contact us at firstname.lastname@example.org.