PDSA cycle outcome
| PDSA group 1: administrative processes | PDSA group 2: clinician training and skills development | PDSA group 3: install technical infrastructure to deliver virtual clinics at scale | PDSA group 4: design and implementation of clinical pathways | PDSA group 5: patient and clinician experience | |
| Number of cycles | 12 | 9 | 8 | 3 | 4 |
| Plan | To ensure standardised administrative processes are in place for effective booking and running of virtual clinics. | To understand clinical experience of virtual clinics across RNOH. To design ‘virtual clinic’ training tools available to all clinicians. | To equip all outpatient areas with the equipment required to run virtual clinics effectively at scale. | To ensure patients are able to access the required medication and diagnostics when attending clinics virtually. | To offer video and telephone appointments as an alternative consultation option. |
| Do | Map and redesign administrative booking process. Design new COF process to support virtual clinics from remote locations. Design and publication of standardised booking and patient communication tools. Admin leads allocated for each clinical pathway for refinement, approval and cascade of new processes. Manage the closure of Bolsover Street outpatient facility at RNOH. | Meet with teams experienced in telephone clinics and model processes. Clinical input into Attend Anywhere support tools. Trial with a clinician prior to going live and update support package. Allocation of daily ‘Floorwalkers’ to manage queries and opportunistically train within clinics. Daily clinic review feedback forms to inform troubleshooting tools and to refine coordination of outpatient clinics. | Licence approval for Attend Anywhere. Acquisition of headsets and webcams. Increase the number of external telephone lines from 60 to 200. Update all outpatient computers with the latest version of Chrome. Information leaflet regarding installing headsets and webcams. Infection control policy for sharing headsets. Create equipment log. Include technical support in floor-walker role. | Work with the pharmacy team to map the new medication pathway and SOP prior to ‘go live’. Design and implement new transport booking and cancellation process. Identify demand for essential diagnostics with clinical teams and design process to access as close to home as possible. | Call each patient to explain and offer alternatives. Design video appointment access details (specific to specialty) and patient guides. Created page on RNOH website with links to specialty waiting area as alternative access route. Establish process for monitoring patients waiting for video calls via admin screen. |
| Study | PDSAs coordinated by outpatient managers. Daily feedback enabled continuous improvement, with updates published to intranet folder and cascaded to front line. Recording of clinic type on appointment record to assist data collection. | Floor-walker roles important for troubleshooting. Face-to-face training more effective than training tools alone. Clinician blogs/stories shared via internal mail and social media. Training tools published to central intranet folder. | Floor-walker roles important to support staff members to set up. Process improved by gaining clinic list details 24 hours in advance. Excellent support from responsive information technology team enabled rapid acquisition of kit and updates required. | Pharmacy process in place with support from information governance lead. Transport booking process trialled on paper process, now electronic. Priority outpatient pathways being agreed and criteria for face-to-face/video/telephone clinics being reviewed with clinical leads to understand what demand will be for diagnostics moving forward. | Feedback collected via online survey at end of video appointments and paper ‘end of clinic reviews’, including patient feedback following telephone clinics. Data analysed daily to ensure real-time feedback so that any issues and suggestions are actioned quickly. |
| Act |
Implementation of new tools.
Clinic booking process SOP. COF process for remote working. Patient information leaflets. Development of an RNOH patient19 and generic NHS20 video. Patient telephone script and email confirmation templates. Support and executive ‘thank you’ to admin staff for achievement of this challenging role. |
Training tools in place.
Attend Anywhere patient video. Advice for conducting telephone consultations (based on ‘Human Factors’ principles). Attend Anywhere procedures and troubleshooting tools. Staff webinar. | All equipment and upgrades in place. |
New pathways in place.
Supply of medicines from RNOH virtual outpatient clinics SOP. Currently access to blood and diagnostics requiring face-to-face appointment. New pathways currently in negotiation with commissioning leads and NHS England. | Clinician and patient feedback mechanism in place. Ongoing data collection and more detailed analysis required to inform future practice and sustainability post-COVID-19. |
COF, Clinic Outcome Form; NHS, National Health Service; PDSA, Plan-Do-Study-Act; RNOH, Royal National Orthopaedic Hospital; SOP, standard operating procedure.