Table 1

Quality improvement test cycles in the development of the Near Me video consultation service for outpatients

AreaIssueTest cycles
Patient access
  • Patients confused by different URLs for different clinical services, and data protection issues with emailing patients

  • Poor internet connectivity at patients’ home (see also Pharmacy Anywhere section below)

  • Confusion over patient appointment letters

  • Created single website entry point, tested design and content

  • Introduced Near Me clinics in NHS premises (phase 1)

  • Multiple letters tested to try to reach clarity on location of clinic and information about Near Me service, within constraints of TrakCare electronic medical record system options

Virtual receptionist
  • Who should undertake the virtual receptionist role

  • Patient transferred to incorrect waiting area

  • Unscheduled calls

  • Tested role in patient booking service then outpatient reception team

  • Introduced patient identification via TrakCare

  • System for unscheduled calls introduced

  • Need to identify patient appointment type, location of patients and location of clinic

  • Confusion over how to build clinics

  • Services wanted to be able to provide mixed clinics (some face to face, some Near Me)

  • Tested various options for patient appointment and location types, and reporting in TrakCare (one of most complex parts of service)

  • Created training materials, multiple versions tested involving many people

  • Tested mixed clinics (first time used in Highland)

Clinic room
Booking and scheduling
  • Need for single system for anyone to book rooms

  • Need for multiple clinical services to run Near Me clinics at remote sites at any one time

  • Tested system in Computer Aided Booking System

  • Multiple versions of schedule produced. Most complex part of system

Clinic rooms for consultants
  • Need for rooms to be appropriately equipped

  • Image clarity was poorer with tablets than with computers

  • Device settings kept being changed

  • Tested various types of equipment

  • Use computer and webcam instead of tablet in clinic rooms

  • Introduced system for checking settings before clinics

Clinic rooms at remote site
  • Need to create Near Me clinic rooms from disused office space

  • Screen size, webcam selection, angling of cameras, speakers etc identified issues

  • Identification of correct clinical equipment

  • Tested single room before defining estates specification. This included testing different lighting, flooring, sound reduction, paint colours.

  • Tested various types of equipment—larger screens installed, tested various webcams, tested clip tripod and various speakers

  • Ran multiple clinics with multiple services to identify all clinical equipment needed, trolley with list defined, plus large equipment (examination couch, bins, privacy screen, etc)

Clinical support
  • Clinical services identified need for appropriate clinical support in calls

  • Defining role, creation of job description

  • Training of healthcare support worker

  • Systems needed to enable remote authorisation by clinicians

  • Role developed over multiple clinics, as full extent of role became clear (different for each service)

  • Role and job description drafted and refined with each clinical service. Role linked into existing outpatient department

  • Core training defined with further training on a service by service basis

  • Testing systems for remote requesting of blood tests and images

Standard service manual
  • Need to create a single service manual for NHS Near Me to deliver consistent service and reduce variation

  • Need to make manual widely available

  • Single process manual created involving 21 key contributors and many more other contributors. Went through multiple tests of change, from 6-page starting point in Jan 2018 to final 39-page document in May 2018.

  • Intranet site for manual tested and simplified following feedback

  • Need for guides for patients, clinicians, virtual receptionists plus troubleshooting guide

  • Need for public relations

  • Guides created and tested, refined and then added to intranet site

  • Presentation given at 20+ events, refined each time.

  • Film created and then shorter version created on feedback.

  • Twitter account created

  • NHS, National Health Service.