Connections, Collaborations and Co-production

Paula Wheeler, Hilary Garret and Bethany Gill from Equitable Place-Based Health and Care Theme (EPHC) have written a brief introduction to their collaborative work with the Innovation Agency on Virtual Wards. They discuss what a virtual ward is, who they are work with and how they are applying their EPHC approach.

What is a virtual ward?
A virtual ward supports patients, who would otherwise be in hospital to receive care in the place they call home. This is a relatively new model of care, which can include acute care, remote monitoring, telehealth and hospital at home models of care. We are working with different member organisations to keep understanding the language and differences in models of care.

We recently created this animation to explain our current understanding of virtual wards https://youtu.be/THcwHLvclGI

What are we doing?
Well…. It all started with a catch up coffee and cake in M&S with Paula and Jenni West (Associate Director of Digital Change at the Innovation Agency) and now we are working as part of a multi-organisational collaboration, which includes several ARC member organisations to look at pathways for how this model of care can be integrated and implemented across the Cheshire and Merseyside Integrated Care Board (ICB) footprint.

What is different about what we are doing?
Although virtual wards have had quite a lot of attention over the last couple of years (as they were mobilised during the COVID-19 pandemic), a lot of the work that has been done has mainly involved quantitative metrics, and there has been very little about the experience of delivering and receiving care on virtual wards.

We are taking a qualitative approach to understand more about people’s experiences and feelings towards virtual wards. We are speaking to staff to find out more about their experience of this different way of delivering care and where it works, and where some of the challenges lie. We also are going to speak to patients and their friends, family and carers to find out their views, what they have liked and what they haven’t, so local partners can start to think about the best way to deliver care and support people on virtual wards.

We have applied our EPHC approach to this programme of work. Essentially this ensures , connection, co-production, collaboration, and health equity are integral elements in all our projects.

Another key component of ARC is ensuring public and patient engagement and involvement at every stages of projects production, EPHC public adviser co-led Hilary has established an instrumental role, advising the steering group at design stage as well as initiating and leading on a piece of work with ICB communication teams to design a glossary of terms to be included with patient communications. IN addition, Hilary and other Public Advisors have fed into project planning and contributed to s programme documents. They also led the co-writing of the script for the animation.

Collaboration has been key, since Paula sat down for that first coffee and cake! Since then we have worked with Jenni to pull together a team of the public, clinicians, strategic leaders and researchers to work together on this project, both regional and nationally. We have also drawn on the skills of the EPHC team to create collaborations for the transfer of skills and knowledge, including our Theme Leader Professor Heather Brown providing expertise on quantitative data analysis and management.

Health Equity is central to all ARC work, and as a team EPHC are always looking to how we can do this better. For this project we have used the latest version of the HIAT (forequity.uk) to shape the research. We have used the HIAT to consider potential inequalities and the intersectionality of these, and to then consider our approach to participant recruitment and the context for our results. We have also used this to support the wider team in considering the potential inequalities that may need to be addressed when considering the business case for the virtual ward.

What difference does this make?
We think that by bringing the EPHC approach to this project we are creating the space for collaboration, co-production and the consideration of health equity. We are also flexible and responsive and we have continued to change the plans for the project with the iterative nature of the virtual ward landscape itself.
There are many different organisations collaborating on this project and by supporting this we are gaining important insights beyond what any one organisation could bring.
We use the phrase ‘critical friend’ to describe our input into the project. We are often the ones saying ‘yes, but’ or ‘have you considered this’ as we want to ensure that what we are doing is appropriate for the population and does not risk increasing inequalities.

We have also started working with several communications teams early in the project to ensure we are sharing the learning and any impacts as soon as possible.

How they feel?
We don’t really know how staff, patients and their families, friends and carers feel yet, but we are hoping our research will make a start in understanding this a bit better.

We have had some really great feedback from some strategic leaders. Paula was recently on a panel of leaders from the North West for a podcast (which you can access here https://evolutionjobs.com/exchange/evo-nhs-84-benefits-realisation-for-digital-enabled-care-at-home/ ) and as part of this shared the importance of the work EPHC are undertaking.‘That qualitative side of things, is really missing in the evidence base, and that is where the ARC is going to focus their attention around a lot of this because we need this we need to know, why patients accept this technology, why they don’t, and what do staff really think about this, what’s the impact on carer’s – we don’t know’ Jenni West

What are we hoping to learn?
We want to learn as much as we can about people’s experience so we can help shape the design and delivery of virtual wards.
We are also wanting to learn and reflect how we as an EPHC team work in collaborations, and our role as part of ARC in learning and working in a local context.

What next?
Further research
Our qualitative research is underway and we are hoping to be able to share the results by late summer/early autumn 2023. The momentum for virtual wards research is growing and we are hoping after this project to get involved in more work on this!

Business case and national strategy
The qualitative research is part of the larger collaboration which will form a business case for virtual wards and will contribute to shaping the national strategy.

Sharing
As part of our communications strategy, we are working closely with the ARC Communication Team to try and keep ARC members up to date with all things Virtual Wards. If you would like to know more though please do get in touch with us!