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Blog posted by: Caroline Kenyon, 12 August 2020.

Personal stories about switching to digital ways of working in the eye of the COVID-19 storm reveal ingenuity, flexibility – and pride.

The reflections are from individuals in a range of roles – in businesses, hospitals, a local authority, at system level and in primary and community care.

Each person has been on a roller coaster journey with experiences to share about how they got there; the positives which resulted from the changes; and some warnings about potential negatives.

They were interviewed during the months from April to July 2020, during and shortly after the pandemic peak. I’ve chosen these seven ‘lessons’ or themes from their stories as they were the factors which resonated most strongly in all the interviews.

1. Strong leadership

Paul Fleming of Blackburn with Darwen Council describes the importance of a clear head and keeping stability in the team around you: “It has required laser-like focus and command and control ways of working. We are working fast and innovating fast and we have learned fast. The biggest difference is pace; what we were planning to do over six months we have done in three weeks; it has been innovation and implementation at breakneck speed.”

Dr Elliot Street of Inovus Medical realised he had to take time out to plan: “Even though it can seem like there are a million different fires to put out, the most important thing for an organisation’s leadership team is to have the discipline to hit the pause button. Otherwise we would have zero direction during a time of huge uncertainty without sight of things returning to normal.”

2. Importance of communications

East Lancashire Hospitals’ Director of Communications Christine Hughes found a big change in attitude towards the corporate messages – and the staff delivering them: “A massive change for me has been the receptiveness of the audience, internally and externally - people are keen for information, and have generally acted on it. I haven’t heard the expression ‘nobody told me’ for ages!

“Also, COVID has increased recognition of comms as a key strategic function of our organisation and the incident response.”

For Dr Richard Cooke at Alder Hey Children’s Hospital the use of MS Teams for all meetings had its drawbacks: “It’s working very well so far but I think there’s a lot to be said for being able to view people’s body language in a meeting. The whole business of building relationships with people just can’t happen unless you’re physically together.”

Blackburn with Darwen Council redesigned their website to signpost to COVID resources.  “There has been a massive increase in our use of social media both as a tool for direct communication and for two-way dialogue, for instance dealing with questions about business grants and the Help Hub. There has been a lot of constructive feedback – and a lot of gratitude,” said Paul Fleming.

Dr Elliot Street said that one of the most important things as part of their ‘war room’ planning was communication: “The level of communication in the first six to eight weeks of COVID was way beyond normal. We were communicating with total transparency and sharing information that would often be kept at management level, throughout the organisation.”

3. Ability to rapidly pivot

Managing change, particularly at speed, requires co-operation at all levels of an organisation and our story tellers were proud of how their teams had responded.

Laura Atherton helped the musculoskeletal team at Southport and Ormskirk Hospital to change to online consultations and exercise classes – and made an important adjustment when something wasn’t working well: “A few patients advised they didn’t want to do video and there was an assumption made that it was because patients weren’t very techy.

“I decided to look into the evidence of this and when patients were asked, I was really shocked to find that a proportion was because they didn’t like seeing themselves on the video. Attend Anywhere has the functionality to solve this and so we did and we show patients how to turn off their own video.”

4. Astonishing speed as barriers disappeared

For Dr Chris Dewhurst at Liverpool Women’s Hospital the most impressive aspect of their new telemedicine service was the speed at which it happened, from zero to up and running in just two weeks.

He described previous experiences of ‘ten committees where ten people in every committee agree but one person in the tenth committee disagrees and it goes back to square one’.

“I was saying we need this in 48 hours and we had the support of key people who were brave enough to say yes and press that final button.”

At Alder Hey Children’s Hospital, Simon Minford found that ‘every blocker evaporated overnight’, working at speed to implement telemedicine: “We have been pushing forward and every time we find we can’t do something, all of a sudden it gets fixed or some critical assistance appears from elsewhere in the organisation!”

GP Dr Ian Pawson wondered what had stopped clinicians from making some of the digital changes earlier: “On reflection, I’m not sure that it really was ‘red tape’ or contractual restrictions, although these definitely can be factors, I think that the biggest issue is that there just wasn’t the collective urgency for it.”

GP Dr Sian Stokes was impressed by the speed at which the company providing the AccuRx secure text messaging service worked over a weekend to develop an extension to the app to enable video calls: “It is very simple to use and it happened so quickly! If it wasn’t for COVID-19 there would have been 20 hoops to jump through and a lot of paperwork. It is safe to use, it can’t be hacked and it is perfect.”

IT trainer at The Walton Centre, Vicky Clarke was excited by the enthusiasm of clinicians to use Attend Anywhere – and by the reaction of patients: “Patient feedback has been extremely positive; in these difficult times they don’t want to be leaving their homes and they are really complimentary and appreciative of the new way of working.”

5. Don’t forget the non-digital patients

Kidney patient network co-ordinator Tara Bashford found that online community forum meetings were a vital contact and information point for people shielded at home. But she cautioned: “I feel sorry for those who don’t have the technology or struggle to use it on their own as it can be difficult and I’m sure they can’t wait to get back into clinic and see someone face to face.

“During COVID it is very important for the most vulnerable people in society to have access to the support they need and that can be quite difficult. They need somewhere to turn to and that’s what our group gives people; even the ones we don’t hear from know they can come to us when they need help.”

Consultant dermatologist at Vernova Healthcare, Dr Faisal Ali also identified reliance on digital tools as a major drawback for some patients: “I have noticed that older people miss the social interaction and when we phone them they are happy to chat for long periods.”

6. Consider the impact on staff

There are positive and negative impacts on staff wellbeing. Psychosexual therapy service lead with Lancashire and South Cumbria NHS FT, Zoe Hargreaves said that working online from home meant that her productivity had increased by at least 15 to 20 per cent: “COVID has taught us it is actually fine to work from home with some adjustments and there are many benefits for staff and patients.”

Associate Director for Psychological Professions, Dr Gita Bhutani saw the pandemic as an opportunity to think more deeply about how we help people to manage their mental wellbeing: “We know that the psychological impact starts to be felt six weeks to three months in, and lasts much longer. We know that suicide attempts have gone up, in our area and nationally, which is why mental health is so high on the agenda.

“What I wish for, is proper infrastructure for our profession with national leadership; we should have a chief psychology officer – just like we have a chief medical officer and a chief pharmacy officer. Then, our psychology professionals will be better placed to support our NHS workforce.”

Keren Jamieson at specialist support service provider AFG sees digital as a big part of their new five-year strategic plan: “It will change the way we recruit people as they will have to be digitally savvy – or at least willing to be trained.”

7. Increased potential for collaboration

As GP practices worked together within Primary Care Networks to reorganise their services, Dr Ian Pawson asked what more could be done by working in collaboration: “As we have successfully begun to send our patients to a hot hub to be reviewed by network colleagues, we are asking what other work we could effectively share. The COVID experience has probably accelerated these conversations by more than 12 months.

“The changes have to be in the best interests of patients but there is likely to be a way we can improve working practice for everyone - patients, staff and practices. Can we make sure that the regular working day for our general practice teams is satisfying, because it continues to provide exceptional care for our patients, whilst also safeguarding a healthy work-life balance for our staff and making general practice an attractive place to work for years to come?”

As the debate continues about how to sustain and build on the best of the changes that have happened in the last five months, it’s clear that in many circumstances there is no going back. Now, attention has to focus on who has fallen through the gaps in switching to online ways of working – and how we avoid the risk of increasing inequalities in healthcare for our population.

Read more stories about digital transformation during COVID-19 >