The digital revolution can support waiting lists!

Izzie Wilson

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ADI Health hosted a webinar, where we discussed how the digital and technological revolution is helping to improve hospital waiting lists. Mike Farrar, Independent Management Consultant (former Chief Executive of NHS Confederation, and Northwest and West Yorkshire Strategic Health Authorities) led the conversation with a general background of the NHS backlog. Jill Lomas, MSK Programme Manager at Sheffield Teaching Hospitals, provided a real-life insight of using MyPathway Waiting List Management within her service.

Elective recovery is a major government priority, the opportunity to reduce the backlog using digital and technology is huge, however what this webinar explored was how we can use digital and technology to help organisations almost achieve the impossible, to reduce the backlog and improve elective recovery within the patient population.

“I would argue MyPathway is one of the most obvious and revolutionary ways in which we can think about technology helping us.” Mike Farrar.

Mike highlighted that managing the waiting list is probably the most difficult situation the NHS has ever faced. The NHS is managing the waiting list backlog, whilst also dealing with the ongoing COVID situation that is still prevalent in hospitals, as well as managing COVID recovery, whereby the NHS have committed to get 30% additional activity beyond pre-covid levels. The NHS are also in the middle of a system reform with ICS development, there is a workforce shortage, staff fatigue and wellbeing including limited bandwidth for change management and new priorities to address inequalities. It is clear that demand exceeds supply, therefore we have to work smarter not harder, and this is where digital can help.

Technology – theoretical possibilities

The possibilities of what technology can achieve is vast. Technology can create the opportunity for mobilising the patient and the population, empowering shared responsibilities. The opportunity to improve patient outcomes and experiences through digital is prevalent, which MyPathway can support with. Using digital can cut out administrative and logistical burdens of patient management. Patient flow has massively improved by using digital communication within an organisation, from assessment to treatment and through to rehabilitation, all can be managed extremely well if we have flow of data and digital communication.

Crucially, technology it is not just about managing the here and now, its about creating digital means that generates data, that we can analyse to target future resources and those with greater needs to reduce inequality, which is a key aim throughout the NHS.

Technology – current practice

There a more and more ways in which theoretical possibilities are being put into practice. Population and lifestyle management apps, such as Sleepio, an evidence based digital sleep improvement program are becoming more mainstream. We know that remote monitoring of conditions and understanding whether people are deteriorating or improving can really help to schedule their care.  MyPathway offers remote monitoring of patients and enables clinicians to monitor patients, allowing them to indeed remove them from care or bring them in for care which can accelerate their outcomes. MyPathway can also support validation of care pathways and options in real time. PCR testing for COVID has evidently highlighted how digital communication can be done in a way that takes out labour costs and allows people to work smarter. Technology is also prevalent all the way through the treatment journey, from smart ambulances, virtual outpatients, booking systems, theatre management and flow systems. Technology is also helping NHS staff with workforce deployment and rostering systems. There is a huge amount of digital technology being used in practice throughout the NHS. The key thing is to differentiate and understand how all the technology can work together, creating a virtual health and care system. Currently these technologies are not being used to underpin the main challenge of elective recovery, however we can do so much more to achieve that.

Key Challenges

Developing the technological opportunities is not straightforward, there are key challenges that we need to examine. Clinical Engagement is critical, as it only works if clinicians use the technology to redesign care. There are issues with building confidence in patients and therefore patient engagement is crucial, we must empower patients and encourage them to take responsibility in their own care. The question is how you then put these systems in place and create a whole system which is coherent and that delivers the benefits and therefore management and resourcing, the technology is vital. And finally, how do we help suppliers engage, as they need to understand how to make their product commercially attractive. It is clear when deploying digital within the healthcare system, there is a lot to consider and there will be challenges.

MyPathway means various things to different people

Following on from what Mike outlined as the challenges healthcare and digital are facing, ADI Health Commercial Director, Judith Clarkson, introduced how MyPathway can support clinical management by connecting patients to clinicians and empowering and engaging patient in their own healthcare journey. MyPathway means various things to different people, primarily because what people are trying to get out of the journey through the system, depends on their role, whether they are a patient, service manager, clinician, or administrator. Finance managers are looking for cost savings, MyPathway seeks to be cash neutral, therefore you get the benefits of using the platform and it pays itself back. From the commissioner’s perspective, MyPathway can provide population level health data and an insight into what types of treatments are being successful. Clinicians can use MyPathway in different ways, whether that be using MyPathway to horizon scan their patient cohort, looking for deterioration/improvements so they can pinpoint intervention or they can deep dive into the individual, look at each patient and decide what the next action should be. However, MyPathway’s main purpose is focussed on the patient, we focus on their experience, so that they are the most activated they can be, and they do the things you want them to do, such as complete their PROMs, show up to appointments or complete goals. From a patient point of view, we understand that digital is not the answer for everyone, but for those who want to work in this way, it’s much more efficient and immediate and can save time to help the system support those patients for whom a digital pathway is not suitable.

Using MyPathway within Sheffield Teaching Hospitals

Five years ago, Sheffield Teaching Hospitals (STH) embarked on moving towards an outcomes-based contract framework within the MSK service. Jill Lomas, MSK Programme Manager at Sheffield Teaching Hospitals, explained that they wanted a digital system to communicate with patients to collect data, for an automated system. The key aspect of MyPathway is that it links to IT systems, you can track where a patient is in the system. Throughout the last five years, Sheffield Teaching Hospitals have used MyPathway in numerous ways. They collect PROMs from patients, using specific questionnaires such as EQ5D, Oxford Hip and GAD-7. They also communicate with patients using mass messages, especially useful during COVID for guidance regarding shielding. There is self-referral functionality, patients can self-refer without needing to see their GP if appropriate and agreed by the service. They are also running virtual clinics, where patients can be asked to attend for an x-ray and answer questionnaires remotely so the clinicians can review both results to see if the patient needs to have a face-to-face appointment.  

“We initially bought MyPathway for PROMs, but it is now an underpinning communication tool for our service.” Jill Lomas, Sheffield Teaching Hospitals

How we are using MyPathway for Waiting List Management

MyPathway has evolved within MSK at Sheffield Teaching Hospitals, and they now use MyPathway to help manage patients on their waiting lists. Over the last 9 months, in response to the pandemic, MSK at Sheffield Teaching Hospitals have been using MyPathway to support the waiting list management process, by communicating with patients and providing a way in which they can ask for support if they need it during their wait. Patients have been contacted to confirm they are still in the system and are provided with an update n the operational situation in the hospital. MyPathway was also used to provide self-help resources whilst waiting, educating patients on how they can help themselves. The platform also provides an easy way for patients to let us know if they need support, check if they still want to be seen, and therefore removing patients who no longer require an appointment. This helps reduce the overall waiting list and allows organisations to prioritise the list, moving away from the idea that if you’re at the top of the list you get seen first. It is important to note that this way of working needs to be simple and straightforward, it cannot be another admin burden in an already burdened system. MSK team at STH didn’t want to introduce another system for admin to learn, and the benefit of MyPathway is that once the pathway has been created, it’s easy to administer.

Sheffield Teaching Hospitals MSK service currently has four waiting list management pathways. When COVID-19 first hit, MSK did their first waiting list pathway with 1025 PhysioWorks patients. The patients had already been assessed but were waiting for treatment and MyPathway enabled the service to contact cohorts of patients quickly and easily. The service then looked at surgical hand patients, waiting for their first appointment that was suspended due to lockdown. For both pathways Sheffield’s priority was to ask the patients if they still wanted to be seen, and how are they now, so that they could be prioritised. Sheffield have just finished the third pathway trialling 150 Orthopaedic patients who are on the waiting list for surgery. The fourth pathway is the pain pathway, which is in test phase, for 20 patients waiting for pain procedures.

Sheffield are conscious of needing to offer an equivalent pathway for non-digitalised patients and there is evidence to suggest that these patients have experienced a greater health gap during the pandemic. MyPathway knows which patients have not opted-in to use the digital app so sends letter versions to those patients. Therefore, from an administrative perspective it still only requires one action.

When Sheffield first developed the app, they started an active MSK patient group, who have helped further develop the platform, which improves overall patient engagement. One of the most important aspects the patient group highlighted was that they want to be able to help themselves. MyPathway provides advice and self-help resources, so for those patients waiting for surgery, they can help themselves prepare so when it comes to their surgery, they reduce their chances of failing their pre-op assessment, so further delaying their surgery. Some examples of pre-op advice include seeing your dentist, reducing alcohol intake, stopping smoking, or having a healthy, balanced diet.

The results

During COVID-19, 1325 patients were contacted across PhysioWorks and Hand Centre. 66% of patients responded via MyPathway, highlighting that more than half of the patients do use digital. 7% of the surgical patients and 12% of the therapy patients confirmed that they no longer wanted an appointment, 37% of surgical patients and 16% therapy patients reported being worse, therefore the service could react with a clinical review and reprioritisation. The cost of this pathway was 43p per patient.

Mike highlighted that based on the numbers of patients who, by their own volition, no longer required an appointment equated to around 10%, if that was to be applied to the 5.5million people on the NHS waiting list, the value of that to the NHS in terms of elective recovery is enormous, around 550,000 patients. Additionally, those patients who alert the service that they require additional help if they didn’t have that option their health would quickly deteriorate. There is a huge amount of evidence within the PhysioWorks and Hand Centre pathway, that illustrates if technology is well applied, thoughtfully planned out, and there is patient/clinician engagement, there can be a profound impact on waiting times overall and reduction and speedy recovery for those people who continuously needs treatment.

The Orthopaedic waiting list is a massive problem for Sheffield now, they need a system to keep regularly communicating with over 2000 existing patients, plus new patients, until they can return to the pre-pandemic 18 week wait. From the 150 test patients, 20% requested support of which 30% required therapy support whether that be that they were worried they were going to fall or that they would benefit from some aids. These are things services can do whilst patients are waiting to try keep them safe. A month later the service went back to the 150 patients for feedback, to see if they found this tool useful. The results are still coming in but so far 9 patients have returned their feedback, all of which found that some subjects of information were useful, all had acted such as gone to the dentist. Following interviews with patients, the key messages highlighted was to keep in touch with patients and to regularly remind patients to keep mobile and take action with their own health.

What Next?

MyPathway easily allows a service to regularly ask patients for their feedback. MSK have assessed the patient feedback and as a result adapted some of the information within the pathway which they are going to apply to all orthopaedic backlog patients. At 43p a patient and how easy the platform is to operate; it is possible to tackle the 2000 patient backlog. As patients join the waiting list, they will be provided with information on what to expect, this will be repeated every 6 months, and at any point patients feel worried they have access to the feedback questionnaire to request further support. The next pathway Sheffield is rolling out is Stratification of patients waiting for hip surgery, how can they (re)prioritise their patients? Surgeons want to focus on those with poor outcomes and poor quality of life to ensure they are the priority.

Mike concluded the webinar stating that we cannot meet the needs of the health and care system going forward working as we have done previously, there simply isn’t the resource. We have got to think about how we apply technology but understand that technology cannot solve the problem alone. Technology is here to enable individuals to take responsibility, whether that be clinicians to be able to manage workload and prioritise patients but also the voice of the patient, in terms of supporting and managing their own care. Technology alone will get us so far, technology plus culture change and empowerment of patients and clinicians really is what makes the magic happen.