TY - JOUR T1 - Testing and implementing video consulting for outpatient appointments: using quality improvement system thinking and codesign principles JF - BMJ Open Quality JO - BMJ Open Qual DO - 10.1136/bmjoq-2020-001259 VL - 10 IS - 1 SP - e001259 AU - Clare Morrison AU - Michelle Beattie AU - Joseph Wherton AU - Cameron Stark AU - Julie Anderson AU - Carolyn Hunter-Rowe AU - Nicola M Gray Y1 - 2021/03/01 UR - http://bmjopenquality.bmj.com/content/10/1/e001259.abstract N2 - Increasing demand for outpatient appointments (OPA) is a global challenge for healthcare providers. Non-attendance rates are high, not least because of the challenges of attending hospital OPAs due to transport difficulties, cost, poor health, caring and work responsibilities. Digital solutions may help ameliorate these challenges. This project aimed to implement codesigned outpatient video consultations across National Health Service (NHS) Highland using system-wide quality improvement approaches to implementation, involving patients, carers, clinical and non-clinical staff, national and local strategic leads. System mapping; an intensive codesign process involving extensive stakeholder engagement and real-time testing; Plan, Do, Study, Act cycles; and collection of clinician and patient feedback were used to optimise the service. Standardised processes were developed and implemented, which made video consulting easy to use for patients, embedded video into routine health service systems for clinicians and non-clinical staff, and automated much of the administrative burden. All clinicians and staff are using the system and both groups identified benefits in terms of travel time and costs saved. Transferable lessons for other services are identified, providing a practical blueprint for others to adapt and use in their own contexts to help implement and sustain video consultation services now and in the future. ER -