Table 4

Lessons learnt regarding rapid implementation of virtual clinics

It is important to have a multidisciplinary team when rapidly implementing VC.The COVID-19 Action Team possessed a range of skills and abilities. The operational management and leadership provided the group with oversight of the workings of the RNOH and the strategic direction in response to COVID-19. Higher level support (from the Chief Operating Officer) facilitated engagement across RNOH. An assigned project manager directed the changes in response to the changing strategy of the Trust. QI personnel provided expertise on the change methodology required to facilitate a rapidly changing service. The use of QI provided a framework to identify and overcome unexpected issues. Insight from a clinical researcher helped identify potentially unexpected clinical issues. Access to data management support was essential to the success of the rapid implementation by providing real-time evaluation data. Flexibility across the group was essential to cross cover roles and responsibilities, particularly during the complex environment of COVID-19 when the system was undergoing rapid changes.
The presence of QI experts and the use of QI methodology facilitate rapid change.The COVID-19 Action Team was strongly outcome-focused and action-focused, and the improvement expert was able to influence the approaches to ensure learning was captured and built on. A skilled improvement advisor added structure and form to the project while facilitating improvement at the pace required. The PDSA approach offered a pragmatic framework to build sustainable change.
It is important to have daily briefings across the team when rapidly implementing VC.Daily virtual briefings with all members of the COVID-19 Action Team ensured optimal communication. Assigning a meeting chair and logging issues and actions ensured focus. Having all members of the multidisciplinary team present allowed for real-time troubleshooting and action planning.
It is important to have effective leadership when rapidly implementing VC.The strategy of the RNOH was clearly communicated to members of the Trust community. Setting a timed and distinct goal provided staff with clear direction. The allocation of resources to facilitate the goal provided the community with the support to enact the goal.
The success of VC is reliant on engaged staff.RNOH staff were flexible, proactive and supportive of the requirement to rapidly implement VC due to COVID-19. This supported a sense of common purpose, which was built on by project leads through continuously listening and reacting to issues raised by colleagues, leading to greater engagement and commitment to the shared goal.
The success of VC is reliant on adequate IT support.The IT team rapidly rolled out a programme of software upgrades and installed hardware for VC across the RNOH within a short space of time. The IT team prioritised COVID-19-related tasks during this period.
The success of VC is reliant on adequate IG support.The IG team were responsive to COVID-19 and provided clear and distinct guidance and troubleshooting for staff who were expected to work differently during this time.
The success of VC is reliant on adequate administrative support.The admin teams responded quickly and effectively to the rapid implementation of VC due to COVID-19. The admin staff were required to call patients to inform them of changes to their care. The teams conducted a huge number of challenging conversations over a short space of time.
It is important to undergo regular evaluation when rapidly implementing VC.After each consultation and at the end of each clinic, the feedback was studied, issues logged and communicated across the COVID-19 Action Team, and actions either taken immediately (eg, technical considerations) or agreed at the daily review meetings. These were conceived and presented as PDSA cycles.
Creating narrative through effective communications.Effective staff and patient communications were central to the success of the project. Staff were supported to share their stories early on, alongside creating easily accessible technical advice and training materials. Examples include clinician blogs, a patient video, training webinars, highlights via existing executive updates, podcast, and use of intranet and internet to access up-to-date tools.
  • IG, information governance; IT, information technology; PDSA, Plan-Do-Study-Act; QI, quality improvement; RNOH, Royal National Orthopaedic Hospital; VC, virtual consultation.