Approaches for increasing health professionals’ capacity to support patients with digital health skills.
Research? Service Design? Training Needs Analysis? Who cares what you call it; it’s about understanding people and relationships as best you can.
Test Beds are a way of trialling new technologies and devices with patients . In Sheffield, our role has been to understand the training needs of NHS staff. For patients to adopt new technology, staff need to be advocates. Staff can only be good advocates if they understand the technology themselves. And how to overcome the barriers faced by patients.
Health is complicated and the way that people relate to their own health is complicated. When we ran the NHS Widening Digital Participation, we found that there are lots of things which prevent people from engaging with information about their health. You cannot simply provide health information on the internet. In many cases you also have to create the conditions in which someone will use that information. To do this, you need to be mindful of the complex lives of your service users.
With this in mind, it’s hard to create good models of support that suit all types of NHS staff. For the Sheffield City Region Test Bed, we approached the problem through our Design Principles, and this is how we applied (and continue to apply) them.
What was the question again?
To have an answer, you first need a question. A question helps to define the reach of the research. It develops understanding between stakeholders, which helps everyone to work together. It is tangible and specific, so you know when you have answered it. This is the one that we came up with:
How can we develop health professionals’ capacity to improve digital health skills for people living with long-term conditions?
The first step towards answering this question was speaking with people. Health professionals to be exact. In partnership with the Sheffield Test Bed team, we arranged interviews with 10 different members of staff. Their roles included Receptionists, Nurses (community and hospital-based), Consultants, GPs and Practice Managers.
These were semi-structured, one-to-one interviews based on three areas:
- Their perceptions of digital for themselves (work and personal use);
- What they thought their patients felt about digital technology;
- How they respond to different ways of learning or training.
Patient Focus Group
We spoke with patients and reflected back our findings from the interviews with health professionals. This enabled us to understand the common ground between patients and health professionals when it comes to engaging with and using digital technology. For health professionals to support patients in this way, they must focus on the common ground where the mutual benefits are clear.
We then brought health professionals, patients and our learning team together for a co-creation session to build on the insight from the interviews. This helped us to identify, once again, the fertile common ground on which we should focus our efforts when it comes to training health professionals.
Themes that emerged
Through all of this, a number of core themes emerged:
- Language: NHS staff and patients have said that the way digital is described can be confusing and off-putting.
- Peer support: NHS staff can help each other and create a culture of shared knowledge, rather than be ‘taught at’, and a number of examples of this were raised through the insight activities.
- Show don’t tell: During the consultation stage a number of individuals highlighted that specific examples and hands-on support help show both clinicians and patients the benefits of understanding and using digital.
- Personal touch: Every NHS staff member and patient is different. Though many share the same values, it is important to find a way to connect on a personal, one-to-one basis.
- Myth busting: Providing correct, positive information can help clinicians and patients change their perception of and willingness to try digital.
- Barriers: A number of barriers were highlighted throughout the insight activities for both NHS staff and patients. These included:
- The time available to patient-facing staff
- Staff’s experience of digital technology
- Patient access e.g. cost
- NHS culture barriers e.g. changes to ways of working, training, hierarchies
So, what do we do now?
Taking everything we had learned, we set about designing, delivering and iterating a training package for health professionals based on the themes from phase 1. This is where we are now (December 2017) and we have delivered the first workshop. We are running the pilot training for three cohorts of ten NHS staff in total where each cohort is mixed in terms of level of digital confidence and type of NHS role.
We are adopting an iterative approach to delivering, testing and improving the training. The first two training cohorts will be asked to provide feedback after each activity so that we can iterate the training delivery and reflect changes in the subsequent cohort. The third and final cohort will provide an opportunity to test a training model that has been informed by the maximum amount of feedback. This final model will then be treated as the baseline for the project’s evaluation phase.
Our aim overall is to work closely and collaboratively with NHS staff and patients to learn as much as possible about ‘what works’ in building this type of training offer for the NHS. Through this we hope to create the potential for wider use of the training, helping health professionals and their patients across Sheffield and South Yorkshire to engage with digital technology.
So, was the training any good and was it the answer to the question?
In March 2018, once all of the workshops have taken place, we will set about understanding how well (if at all!) we’ve answered our initial question.
Our main evaluation question is:
How do we design and deliver training for patient-facing NHS staff that enables them to support patients in using digital technology for the management of long term conditions?
To answer this question, we will:
- Use the insight activities we have already undertaken to date as a baseline and to inform the first iteration of training materials and resources;
- Enable feedback to be given after each activity during the face to face training for the first two cohorts;
- Interview and/or survey training attendees one month after the face to face training to ascertain any behaviour change as a result of the training and to collect anecdotal evidence for impact on patients;
- Identify at least one case study (from NHS staff) that attended the training and, where possible, a patient case study of receiving support post-training;
- Detail and critique the methods employed to design the training;
- Make recommendations for what could/should happen next.
Watch this space!
Thanks to the Sheffield City Region Test Bed team for supporting the way we have worked as part of this programme so far. Their understanding of what we’re trying to achieve and the flexibility they have allowed to take this approach has been both refreshing and crucial in getting us to this point.