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Focus on: Peer Facilitator - Nellie

posted 5 Aug 2020, 02:56 by Hollie O'Connell

Carol Wildey 
Peer Facilitator, Simple Telehealth - Nellie 

05 August 2020 

Carol has been working in the South Eastern Melbourne Primary Health Network (SEMPHN) for nearly 3 years.  She uses her previous knowledge and experience in healthcare, alongside drawing on the learning and evidence-based psychology behind Flo, to help support successful implementation of ‘Nellie’ (Flo’s Australian cousin) to primary care teams.   Carol has kindly shared her experience of being a Peer Facilitator for Nellie.

What is your background and role within your organisation?

My role with SEMPHN is Peer Facilitator, Simple Telehealth – Nellie.  I started working at SEMPHN at the end of 2017 when Nellie was just starting to be rolled out in our Primary Health Networks catchment in South Eastern Melbourne.  Prior to moving to Melbourne from the UK in 2011, I had worked for the NHS as a dietitian for over 20 years in various positions.  I mainly worked in the area of diabetes education with a focus on supporting patient self-management, patient-centred care, and care and support planning for long-term conditions (chronic disease).  When I moved to Australia I worked as a research project manager across a diverse range of research projects including diabetes prevention for women post-Gestational Diabetes, cancer and health literacy.

My role at SEMPHN involves working with primary care teams to identify where Nellie can be used to supplement existing models of care (by fitting in easily with them) in new and innovative ways to benefit the team and patients.  E.g. this, from the published paper: “… can be implemented into routine primary care at scale with little impact on clinician workload…”.

What did you set out to achieve with Nellie and how did you go about it?

We set out to establish whether Nellie was a valid, useful and effective tool to use within the Australian primary health care context.  It’s always challenging to introduce new interventions and tools to busy general practices and evidence suggests that it takes up to 17 years to embed new evidence-based interventions in health care.  Okay, so we didn’t have 17 years up our sleeves, but the SSHC Community of Practice has been a valuable factor by being able to draw on others' experiences and pathways with Flo and Annie.

We used our PHN communications channels to talk about Nellie and asked for teams to contact us if they were interested.  We visited interested practices and gave them a live demo of Nellie.  Most of these teams were excited about the prospect of using Nellie and immediately thought about specific patients and cohorts who they thought Nellie’s friendly messages and interactions could help.  Many of them also identified how they thought that Nellie could make their work lives easier, especially with Nellie’s intuitive interface – this provided crucial motivation for them to embed Nellie in their workflow.

The key message was always, start small.  We worked with clinicians to identify how they thought they would like to use Nellie and collaboratively designed suitable pathways.  Some teams were more interested in using Nellie to monitor their patients remotely, such as using a Blood Pressure monitoring protocol.  Others were much more interested in how Nellie could help their patients establish healthier habits through sustained behaviour change, such as by increasing their physical activity.  As Nellie uses basic SMS messaging, she is easily accessible and familiar to most people, however we always emphasised the importance of making sure they screened their patients for their capacity to use and interact with Nellie, but also the importance of assessing an agreed health-related goal which was important to the patient.  A key element to creating sustained change is that the clinician must work together with the patient to help them identify an action plan to achieve their goal, and one that the patient felt confident they could achieve and were ready to commit to.  The Nellie protocol to support this action plan is then highly likely to be both helpful and effective.

We now have around 50 teams actively using Nellie with good feedback from both patients and clinicians.  As part of evaluation for pathways and patient experience, we build Net Promoter Scores into most pathways where we are able to measure patient feedback.  The results remain good!  We are also using Nellie to measure Patient Reported Outcomes Measures, or PROMs, using a tool called howru from R-Outcomes to track patient status measures over time.

Were there any surprises?

Patients often think of Nellie as “she” or “her” - as if she is a friend looking out for them.  During a time where there are many different health apps available, I have been amazed that something as simple as a persona-based SMS service can have such a profound impact on patient outcomes.  I spent many years as a clinician, struggling to help my patients to change certain behaviours such as their diet, activity levels, smoking status, alcohol intake, engagement with medication regimens etc etc etc.  Change is hard.  Change is especially hard for people with complex health needs, but Nellie is something unique!  I now hear stories about how Nellie has helped people who may have been struggling for many years.  Small changes can lead to huge improvements in people’s quality of life, and that’s what’s really important.

How does Nellie fit with your organisational vision/current strategies?

I work in the digital health team.  Our organisation’s strategy has digital health as one of its core pillars, and Nellie is a perfect fit.  It underpins the work across the entire organisation.  One strategic aim is to reduce the number of potentially preventable hospitalisations.  Nellie has already helped many primary care patients to better self-manage their health at home, with better outcomes through her persona-based messages.

What do you consider your biggest success with Nellie?

Having so many primary care teams use Nellie without any financial incentives!  We have great feedback from patients across a broad range of different protocols used.  They have really appreciated the extension of clinician-led care that Nellie provides in their day-to-day lives in a friendly and non-judgemental way.

How do you engage your clinicians and wider organisation with Nellie?

We have a Nellie page on our website and use ‘Basecamp’ for our local community of practice, as well as regular communications with practices via our regular SEMPHN newsletters.  One of the key drivers for implementing Nellie is understanding how using Nellie can make clinicians’ lives easier.  Talking to clinicians, with a focus on the quadruple aim of better outcomes, improved patient experience, lower cost and importantly, improved clinician experience, helps us to frame Nellie in a way that engages clinicians in thinking about how they might use Nellie – and it’s different for every team.

What are the future plans with Nellie?

We will continue to work with our primary care teams to make improvements where we can to deliver an even better program.  We’re also thinking about engaging with local partners to use Nellie to improve the integration of health services and reduce organisational barriers in areas such as shared care, hospital discharge, mental health and addiction services.  Watch this space!

Focus On: Advanced Diabetes Nurse

posted 28 Nov 2019, 02:45 by Hollie O'Connell

Seonaid Morrison  
Advanced Diabetes Nurse 

29 November 2019 

Diabetes - Self-management support 

Seonaid Morrison is an Advanced Diabetes Nurse for Argyll & Bute Health & Social Care Partnership.   Seonaid has kindly taken some time to share with us her experiences of working with Flo as part of our “Focus on Evaluation Project”.

What is your background and role within your organisation? 
I’ve been in the NHS since 1984; my background is nursing and my roles have changed over the years I have been practicing.  I have worked within the ward situation as well as being a diabetes specialist nurse and doing some management posts. 

What did you set out to achieve with Flo and how did you go about it?
We set out to use Flo as an addition to our diabetes education programmes.  We have been extremely lucky in Argyll & Bute to have a great team who informed us of how Flo’s methodology of subtle psychology can help with the ongoing care of our patients.  The reason we decided to use Flo was to enhance our structured education programmes and support people to be more motivated to continue to make lifestyle changes and self-manage their diabetes.

Were there any surprises?
No, we haven’t had any surprises, but we are very happy that a number of our patients have used the service and had a positive experience based on the feedback that we have received.  All of the feedback from Flo has been positive and people like to receive Flo’s prompts as they remind them of the goals they have set and encourage them to take forward their goals.

Change can be difficult; if you experienced any resistance within your team, how did you overcome this?
As we are part of a very small team we are all very motivated and believe that change can be a positive rather than a negative, so we have not had any difficulties with this.

What do your clinicians like about Flo?
As a clinician, Flo is very easy to use. Flo is used in addition to our structured education programmes; we would not routinely follow up those patients who had taken part, and they are later invited to yearly review sessions.  We have therefore implemented Flo as an additional tool to support and act as a prompt to assist people to think about their self-management between the initial education we provide, and the yearly follow-up.  Flo has been a positive tool for us, and all our educators believe this is beneficial for both patients and themselves in their practice. 

An additional benefit is that where there were previously no structured education programmes available in Argyll & Bute, we are now offering them to patients and Flo supports us with this.

What do you consider your biggest success with Flo?
I think that our biggest success is having patients report back to us that Flo has been helpful as a reminder to self-manage their condition.  Patients who have used Flo tell us that she has kept them on track with changes in their diet and/or exercise, which can really improve their long-term health outcomes

What are the future plans with Flo?
We plan to keep using Flo for diabetes education; at the moment, whenever we change any of our patient education we update the information on Flo to maintain continuity.  If we develop any further education for patients we would look to incorporating Flo in addition to our practice.

How do your patients feel about Flo?
Any patients that have utilised the service have provided positive feedback about the addition of Flo.  We have seen examples of various positive outcomes including weight loss, reduced blood pressure and blood glucose levels, which is fantastic.

What can you do more/less/differently with Flo?
I don’t think we can do anything differently at the moment, as Flo is successfully enhancing the education available for patients in Argyll & Bute.

Mental Health Member’s Network; Beating the Blues with NHS Highland

posted 2 Oct 2019, 02:30 by Hollie O'Connell   [ updated 2 Oct 2019, 03:10 ]

Hannah Mountford 
Support Officer - Technology Enabled Care SSHC 

02 October 2019 

Our Mental Health Member’s Network has recently been launched to support learning and sharing amongst community of practice members, with the first network call taking place on 17th August.  Kylie Dentith, Senior Support Officer for Technology Enabled Care SSHC, began the call by giving an overview of the aims of the Member’s Network, and some of the current applications of Flo for mental health.  If you would like to read an overview of these, please take a look at our blog.

Following this, Kylie introduced the call’s featured clinician, Iona McMurdo, who is a CBT Project Support Officer with the TEC team at NHS Highland.  Iona joined us to share her experiences of supporting the implementation of Flo with Beating the Blues (BtB). 

BtB is an online cognitive behavioural therapy course, used for the treatment of low to moderate anxiety and depression.  The course aims to help people to challenge and change their thinking patterns, understand their feelings and learn how to overcome negative thoughts by the use of interactive tools.  Case studies have shown that CBT is just as effective in treating anxiety and depression as antidepressants, with the added benefit of helping to prevent symptoms returning.

Previously, BtB had to be accessed using a PC, but updates have now allowed service users to access modules via mobile devices such as phones and tablets, making the course more accessible.  BtB comprises of 8 sessions, each with 3-4 modules, and on average it takes 10-14 weeks to complete.  Flo provides additional support to those completing the BtB course between sessions to encourage people to continue with and complete the course.

NHS Highland first implemented BtB with Florence in 2017, and data gathered indicates that service users are 30% more likely to complete the course if they opt into Flo also.  Initial engagement is also improved, as they are able to receive the link to BtB from Flo, and then start the first module directly thanks to the update allowing mobile devices to access the course.  Flo’s messages can also be reassuring for those living alone with anxiety or depression, as they make people feel as if someone cares about them.  NHS Highland aims to focus on inactive and pending users to encourage them to activate the course, and this is something Flo is able to support in her gentle & friendly manner. 

As with any implementation, Iona and the team did experience some challenges initially, including poor mobile signal in rural areas, service users on multiple protocols having a few too many messages from Flo, and some unfounded concerns around a charge for opting into Flo.  

Iona’s key advice here is to educate and inform patients from the start, so that they have a better understanding of how the system works, including that it is free to use and their confidence around it is improved.  Part of this includes a phone call from Iona after referral, allowing service users to be as informed as possible around the benefits of engaging with both BtB & Flo. 

Iona was also able to share some fantastic patient feedback:

“This is an amazing course that has really helped me. I feel it should be part of the education curriculum! It is so helpful and so beneficial and I can see how my thinking errors started quite young. I have told everyone and anyone who was prepared to listen of the benefits of Beating the Blues/CBT”

“Beating the Blues was a brilliant course, and my GP has been a fantastic support… Really I couldn’t be more grateful to you all. Feel Saved!”

Iona finished by discussing some of the next steps for Flo & BtB in NHS Highland:

  • Ensure better communication with service users as they begin their journey with BtB, and provide more information around Flo to help them make an informed decision.
  • Improve how the team measures outcomes to assess the impact of the programme.
  • Focus on activation, drop-out and completion rates to explore contributing factors; for example, patients who opt into Flo compared to those who don’t.
  • To meet with and communicate with the wider BtB team to discuss challenges and share learning, with the aim of continually improving service delivery moving forward.

Following Iona’s presentation, community members who had joined the call had the chance to discuss and ask Iona some questions.   The group discussed improved use of technology in older populations.  It is often thought that technology such as Flo may not be suitable for older users, but increasingly this is found to be inaccurate as tech literacy improves.  

Other discussion topics included: the addition of evaluation questions in Flo protocols, how to evaluate cost-effectiveness of programmes such as BtB, choosing the best language for your patient cohort and how clinician confidence when discussing Flo can improve patient engagement. 

Flo: improving Patient Safety through technology

posted 18 Sep 2019, 05:22 by Hollie O'Connell   [ updated 18 Sep 2019, 05:34 ]

Hannah Mountford 
Support Officer - Technology Enabled Care SSHC 

18 September 2019 

In July 2019, NHS Improvement published the first-ever NHS Patient Safety Strategy.  The strategy outlines three main aims:
  • Insight: improving understanding of safety by drawing intelligence from multiple sources of patient safety information.
  • Involvement: equipping patients, staff and partners with the skills and opportunities to improve patient safety throughout the whole system.
  • Improvement: designing and supporting programmes that deliver effective and sustainable change in the most important areas.
Investing in new technology to support improved patient safety features throughout the strategy, and Flo with her solid track record of improving patient engagement and adherence to best practice clinical care is in a fantastic position to further support the Patient Safety initiative moving forwards.  We have many examples of where she has already helped clinicians to ensure patient safety and improve the outcomes of best practice care.

Hypertension Diagnosis:

One of the most widely used applications of Flo is in the diagnosis of hypertension.  Patients who demonstrate a high blood pressure during an appointment at their GP surgery can be added to Flo’s hypertension diagnosis pathway, which asks for several readings over the course of the week to help clinicians to diagnose or rule out hypertension.  Patient safety is improved by reaching a quicker decision about diagnosis, without waiting for ambulatory monitoring, or making multiple trips to the surgery.  Those who have hypertension can begin treatment in a timely manner, whilst those who may have exhibited white-coat symptoms, or who are not hypertensive are quickly identified.  Flo’s application across hypertension, including diagnosis and monitoring, has been so successful that the Scottish Government have made a £1.2m investment to scale up their hypertension services with Flo nationally; you can find out more about this here.

Medication Concordance:

Flo has supported many patients to adhere to their medication regime, including taking insulin and inhalers, as prescribed.  Ensuring medication regimes are followed is key to patient safety, as it helps to both treat and stabilise health conditions, avoiding exacerbations and flare-ups.  Find out more about how Flo has helped patients stay on track with their medication:

Medication Titration:

As well as ensuring patients take medications on time, Flo can also support medication titration to make sure dosage is appropriate and correct, improving patient safety.
  • Hypertension: Properly tracking blood pressure after diagnosis provides regular data which clinicians are able to use to safely and accurately titrate blood pressure medications to ensure condition control.
  • Tacrolimus for renal transplant patients: Flo interacts with the patients about their dose adjustment following their most recent appointment.  Flo asks patients to reply to ensure that they had read and understood the changes to their medication, thus improving patient safety.

Timely response to changes in condition:

Many patients who are introduced to Flo can send readings in to support them with self-management of their condition.  Flo helps patients to improve their understanding of and ability to recognise changes in their condition, allowing them to take action or seek clinical help as appropriate.  Pathways with Flo draw on pre-existing local best practice support with additional clinician input; any responses Flo sends to patients following receiving their reading contain the clinician’s advice in conjunction with the patient’s shared management plan.  Implementing shared management plans with Flo can also have the added benefit of helping to standardise care as they can be used with all patients, regardless of whether they have been enrolled with Flo or not.  Here are some examples where Flo’s support is helping to improve patient safety:
  • Maternity: Flo has been used to support ladies with pregnancy-induced hypertension and gestational diabetes.  If blood pressure or blood glucose readings are not within range, ladies are advised to contact their midwife, ensuring that any required intervention is timely.
  • Diabetes: Similar to gestational diabetes pathways, patients with both type 1 and type 2 diabetes are provided with advice or asked to contact their specialist nurse.  This potentially avoids hypo or hyperglycemic episodes, improving long-term outcomes and patient safety.
  • Oncology: Patients at the University Hospital North Midlands who were receiving chemotherapy sent temperature readings to Flo.  Raised temperature can be a sign of infection; patients recording high temperature readings would be asked to attend the Emergency Assessment Bay, ensuring a prompt action to counteract any potential infection was taken.
  • COPD: Patients with COPD may be asked to send readings in about a variety of symptoms, including breathlessness score, sputum colour or cough.  For example; If the symptoms suggest a worsening in condition, Flo can prompt patients to follow their shared clinical management plan and start to take their rescue medication and contact their respiratory nurse.  By starting medications in a timely fashion, patient safety is improved by potentially avoiding more severe exacerbations.

As you can see, innovations with Flo have already helped many clinicians ensure that their patients take an active role in improving the safety of best-practice care through better engagement and adherence to shared clinical management plans.  If you would like to read more about the NHS Patient Safety Strategy, please follow this link (Membership required).  For more information about how Flo can help support you in ensuring high levels of patient safety, please get in touch with a member of the team:
Karen.Moore@simple.uk.net   Lisa.Taylor@simple.uk.net   Kylie.Dentith@simple.uk.net   Hannah.Mountford@simple.uk.net

New to Flo or need to refresh your skills? Access our on-line training for Clinicians

posted 16 Sep 2019, 02:05 by Hollie O'Connell   [ updated 16 Sep 2019, 03:33 ]

Kylie Dentith 
Senior Support Officer SSHC 

16 September 2019 

Florence on-line Training 

The Florence Clinician Training sessions have been created to help and support clinicians to become more capable and knowledgeable when implementing Flo into practice with their patients.

Delivered by one of the team here at Simple Shared Healthcare Ltd the sessions are scheduled to take place monthly.  Additional sessions can also be arranged by request either on a one to one basis, for teams or for those clinicians who are unable to join on the scheduled dates and times.

Delivered remotely via a web conference platform the session consists of a short presentation, a live demonstration of Flo via screen sharing and covers the following clinician activities in Flo:
  • How to add a patient
  • Adding protocols
  • Personalising protocols for patients
  • Reviewing readings and notifications
  • Patient discharge/transfers
  • Managing your clinician account preferences

Feedback from delegates so far has been that the sessions are easy to book with a good choice of dates, and they have recommended to colleagues who are new to Flo or wish to refresh their existing skills.

To sign up or find out about our upcoming dates please click here.  If you would like more information or would like to request a session for your local team then please email Kylie.Dentith@Simple.uk.net

Sharing Experiences and Knowledge: Supporting Asthma Care with Flo in a Rural setting

posted 19 Aug 2019, 02:35 by Hollie O'Connell

Hannah Mountford 
Assistant to Director of Services and Community SSHC 

19 August 2019 

Our Member’s “Network Calls” enable peer to peer sharing across a single area of clinical interest, providing clinicians working within specialist fields the opportunity to hear from their peers to discuss their own experiences and learning with Flo.  The third “Respiratory” Member’s Network Call took place in July featuring Corinne Clark, Respiratory Specialist Nurse from NHS Highland.

What attracted you to integrating Flo into your service?

Corinne gave us an inspirational overview of how she has firmly integrated Flo into her service, helping her to care for patients on the team’s caseload who have been diagnosed with asthma.  Corrine specifically supports patients with Flo whose asthma is poorly controlled which can lead to acute exacerbations, and for some potentially near-fatal asthma attacks.  Corinne explained that there was also a specific group of patients who were not engaged with their healthcare, which puts them at further risk of exacerbation.  Corrine identified that Flo would be able to increase the engagement of these patients to self manage their asthma better, and ultimately lead to an improvement in their asthma outcomes.  Corinne has the additional challenge of rurality, as she is the only specialist covering acute asthma for a large geographical area, where patients may have to take a 5 hour round trip to attend a clinic appointment. 

How does Flo support your patients?

The inclusion criteria for patients accessing Flo as part of NHS Highlands asthma pathway included:
  • The patient has a confirmed diagnosis of asthma;
  • The patient has had a previous hospital admission for acute exacerbation of asthma;
  • Or, the patient had been referred to the Respiratory Community Nurse for specialist input.
  • Patients also need access to a mobile phone to interact with Flo.

Patients are provided with a peak flow meter and a 7 day supply of their prescribed rescue medication.  The protocol that the patient is enrolled onto is assessed by Corrine according to their current best peak flow reading.  Flo then acts as an electronic asthma action plan for the patient, prompting them to take and reply with their peak flow readings.  The patient’s peak flow reading will fall into one of four zones; Flo replies to the patient motivating them to follow the appropriate advice according to each zone. 

What were your outcomes with Flo?

The integration of Flo into the asthma pathway delivers benefits for both Corinne, her patients and the wider health care economy in NHS Highlands, and this is supported by external evaluation by Maria Wolters from the University of Edinburgh. 
  • 100% of patients would recommend Flo.
  • 94% agreed the protocol was easy to understand.
  • 88% agreed that Flo helped them to self manage.
  • Asthma inpatient hospital admission decreased from 129 to 29.
  • The average number of bed days decreased from 52 to 15.
  • GP contacts decreased from 6 to 1.6 per patient.
  • Primary care showed an improvement in the appropriateness of medication reordering.

In addition to the findings from the evaluation, Corinne also reports fewer DNAs to her clinic since implementing Flo.

 Further development & future plans

NHS Highlands have worked to integrate Flo’s Data with SCI Store (an information repository that provides clinicians with secure access to patient information at the point of care), whereby on a monthly basis the data is migrated across so that it is available for all clinicians with access to view the SCI Store.  Corinne has also presented the results of using Flo for Asthma across the country, as well as visiting Milan to talk about her success with Flo at the European Respiratory Society International Congress in 2017.

Looking to the future, Flo will be incorporated into “Near Me” clinics (whereby patients have an appointment with a clinician via a video), which will enable more effective conversations around the patient’s health.  Corinne is always looking to develop and refine the protocols that she has created with Flo, for example, Corrine identified that it would be useful for clinicians to understand the frequency of patients starting their rescue medication.  Flo now prompts the patient asking them to confirm this in order for clinicians to monitor how often this happens and plan any adjustments to treatment accordingly.  Additionally, Corinne and the telehealth team have developed a “Florence Lite” protocol to extend the reach of Flo’s support to the cohort of patients who require less frequent interactions.  The new protocol motivates the patient to take and send two peak flow readings per week over a 3 month period and is then reviewed.  It is hoped that this will be of interest to Primary Care services and will help the spread and adoption of Florence further across NHS Highlands.

Treating MS in a rural setting

posted 5 Jun 2019, 03:24 by Hollie O'Connell   [ updated 5 Jun 2019, 05:30 ]

Hannah Mountford 
Assistant to Director of Services and Community SSHC  

05 June 2019 

Flo supports both patients and clinicians in a challenging healthcare environment 

Scotland has the highest prevalence of Multiple Sclerosis (MS) within the United Kingdom, whilst NHS Western Isles is amongst 6 health boards with the highest prevalence nationally.  Clinicians working with the Western Isles face a number of challenges due to the rural island setting, including adverse weather conditions and long travel times.  Flo’s simple and proven methodology is now being used to support patients and clinicians managing MS in these challenging conditions.

In 2012, a specialist MS nurse was appointed to support patients in the Western Isles, covering all nine islands and an area of 3,071km².  Taking into consideration both the challenges of rurality and geographical area to be covered, the MS nurse felt that Flo could provide patients with additional support in between their clinical contacts to improve their confidence to self-manage their condition and adhere to their prescribed treatment.

NHS Western Isles’ MS pathway now includes Flo to specifically support patients who are taking DMDs (Disease Modifying Drugs).  Dependant on the specific drug prescribed for the patient, there is a requirement for regular blood testing fortnightly, monthly, 3 monthly or 6 monthly.  Flo gently prompts patients to book these appointments, which helps to ensure patient safety by improving adherence to clinical guidelines. Having up to date blood test results which are available for review also ensures patient contact is timely and effective, which is especially important given the amount of travelling required for both patients and clinicians in the Western Isles.

Kathleen Smith is a student doctor at the University of Aberdeen, and as part of her 5th year elective, completed an evaluation of patient’s experience of using Flo for MS.  Patients were asked to complete a questionnaire about their experience of using Flo using a rating scale of 1 -10, while also providing any further comments they wished.  Additionally, two healthcare professionals involved in the initial setup and current use of Flo (TEC Project Manager and specialist MS nurse) were involved in the evaluation and completed a separate staff questionnaire.
Patient’s responded very well to Flo, and their feedback reflected how Flo’s simple, supportive messages can make a difference in giving patients the confidence to self-manage their condition:
  • 100% of patients rated Flo as extremely easy to use.
  • 87% of patients rated Flo with the highest score of 10 when asked how useful Flo was in the management of their condition, while the remaining patients rated Flo’s usefulness as 8/10 or higher.
  • 100% felt that Flo was not at all intrusive in their daily lives.
“ Great reminder for management of my MS ”  

Good reminder for my bloods because I often forget until I get texts ”  

I am so happy with ‘Florence’, she is so helpful

Feedback from healthcare professionals was also positive; the MS Nurse responded that Flo was easy to use, was extremely useful in the management of MS, and felt that patients engaged very well with Flo.  They also commented:

[Flo] is such a valuable support for me as a lone working clinician covering a wide geographical area… [Flo is] extremely beneficial in reducing my workload

The TEC Project Manager responded that Flo was easy to initiate in clinical practice, and that protocols are relatively easy to set up, dependent on the type of pathway and its aims.

The use of ‘Florence’ in MS management has overall impacted patient care and healthcare professionals positively.  Patients feel the service is useful and healthcare professionals feel ‘Florence’ has decreased workload.  The service is simple and also provides valuable feedback for patients.   Expansion of ‘Florence’ into other areas of healthcare, and the ability of pathways to be tailored to individual patient needs, will create new uses for the service.

It is fantastic to be able to share this evaluation, and to know that Flo is really making a difference to patient’s lives, as well as supporting clinicians who work in unique and challenging settings to provide high quality patient care.

Flo’s role in upskilling practice nurses - supporting the integration of TECS into everyday practice

posted 30 May 2019, 01:40 by Hollie O'Connell   [ updated 22 Jul 2019, 02:52 ]

Hannah Mountford 
Assistant to Director of Services and Community SSHC 

31 May 2019 

As the NHS works to meet increasing patient demand, Technology Enabled Care Services such as Flo offer a creative solution to help mitigate some of the ongoing pressures.  Flo has been featured in a number of publications that address the need for GP practices and other health care providers to embrace technology as an enabler to improving outcomes, while potentially reducing some pressure from the system. 

While the articles (available below) discuss a number of current healthcare delivery challenges, there is an overarching focus on aiming to improve the uptake and use of TECS, specifically by practice nurses, to help to mitigate some of the pressures on the system.  The articles point to a need for general up-skilling amongst practice nurses to enable the adoption of TECS; it is essential that nurses feel confident enough to integrate technology into how they provide care for their patients.  For example, from the patient’s perspective, being introduced to Flo as a tool to support self management by a nurse who is comfortable with Flo is reassuring and motivating, and could potentially lead to improved health outcomes due to better patient engagement in their health. 

Here are some examples of how Flo is making a difference for patients and nurses alike: 

Doing much of the hypertension monitoring using Florence Simple Telehealth has:
  • Improved compliance by sending twice-daily reminders.
  • Saved on appointments, as follow-up of patients can be done by phone.
  • Reduced time wasted on appointments when patients returned without their home readings.
  • Reduced time wasted chasing patients to return their sheets.
Primary Health Care, volume 28, issue 7

Flo telehealth can be a valuable tool to help patients with COPD self-manage at home and can reduce the need for as many surgery visits if the patient’s texted responses trigger advice to take standby medication without delay, improves their compliance with medication, reduces overall anxiety and ultimately avoids hospital attendances or admissions ” 

Practice Nurse, June 2018

Shropshire and Wales Regional Network Event

posted 28 May 2019, 02:29 by Hollie O'Connell   [ updated 29 May 2019, 03:46 ]

Kylie Dentith 
Technology Enabled Care Support Assistant SSHC

29 May 2019 

The Shropshire & Wales Regional Network Event was held of 20th March 2019, hosted by Telford & Wrekin CCG and as usual was an inspiring day for sharing and making new relationships.

Regional events take place across the UK to provide community members with the opportunity to meet and discuss their current and proposed pathways, share best practice and offer the potential for future collaboration and system wide pathway development with member organisations also using Flo nearby.

Regional events are a great opportunity to share and celebrate the clinically driven innovation taking place across the region.  The day was kicked off by Lisa and Karen, who warmly welcomed attendees to the event and gave an update of recent news and events from around the Simple Telehealth Community. 

Lisa and Kylie gave a brief overview of Flo’s role within the NHS England Test Bed at University Hospitals of North Midlands NHS Trust (UHNM) “Smart with Your Heart”, which is based on a successful pilot at UHNM where the cohort demonstrated reduced admissions for patients after discharge when supported by Flo.   With Flo as one of the three digital partners, previous learning is being scaled up and the team at UHNM have developed a pathway that will ask the patients for daily responses about how they are feeling, or about their symptoms in conjunction with their symptom checker to increase awareness and confidence of any actions they need to take.  Patients will be prompted at the end of the pathway to answer four evaluation questions which will support the team in their final evaluation for NHS England, and to inform a sustainable approach to continuing the service.  More information is available here

Hollie O’Connell, Assistant to Chief Innovation Officer and Chairman - Nellie Overview

We then made the most of using technology by joining into a web conferencing platform with Hollie O’Connell.  Hollie gave an introduction to Nellie (our next generation system) and shared the way in which the features and interface have been designed and created to reflect the learning from Flo.

Kath Lloyd, Service Development Manager for Therapies and Health Sciences , Powys Teaching Health Board

Kath kindly gave an overview of Powys’s journey so far with Flo. Powys first introduced Flo with a workshop in 2016 with positive clinical feedback securing Flo from October that year.  The first patient was recruited to Flo on the 31st October 2016, and throughout 2017/2018 interest spread across other clinical teams throughout Powys.
Pathways supported by Flo include: 
  • Falls
  • Respiratory
  • Pulmonary Rehab
  • COPD Maintain and Monitor
  • Diabetes Education
  • Diabetes Non-Metformin
  • Pain Management
  • Blood Glucose in the South of Powys
  • Parkinson’s Disease
Patient feedback from a variety of the above protocols:  

“ Flo encourages me, I like the little tips and reminders ”   

“ I find it very helpful and it has benefited me  

 Flo has improved my diabetes and general wellbeing ” 

 Flo has motivated me and shocked me into making changes. ” 

Feedback from clinicians:  

 I feel the small aspect of Flo has created a large impact   

 The patient, who is on 7 doses of meds per day, is feeling the benefit of Flo after a few days. 

The team are now looking to introduce Flo within GP Practices to use with their hypertensive patients and also with their local CAMHS team.  The team are also looking to recruit a Telehealth Coordinator for 3 days a week to support the rest of the team to spread the use of Flo across the health board. For more information please see here

Kath Fackrell, Voluntary Services Link, Shropshire Community Health NHS Trust

Kath, along with Wrekin Housing Trust and the Carers Centre have collaborated on working on a pathway for patients that are discharged from the hospital, to go back home and recover with the support of a carer. 

Kath shared a few of Flo’s interactions that are included in the pathway such as messages with contact numbers for further support, information on discounts they can get at venues like the Theatre for example, and general information on keeping well.  To ensure the patients and carers are fully informed with all relevant information, the team created a patient information leaflet, which includes information on free-to-use texts, what Flo is and what the patients will receive once enrolled onto Flo.  Some of the patients that will be introduced to Flo may not have their mobile phone with them at the time of enrolment, so the team has also added what to do if this is the case to the leaflet.

The team also created a consent form which all patients will be required to complete before being able to be enrolled onto Flo.  The information that is on the patient information leaflet is also covered on the consent form. 

Maximising the Impact of the Initial Introduction to Flo

Karen and Lisa delivered a lively session on maximising the impact that the initial conversation between patient and clinician has on patient engagement when introducing Flo, a session suggested at the previous meeting.

The importance of the patient's initial introduction to Flo by their clinician cannot be underestimated.  While still relatively new within healthcare, supported self management with technology as an enabler can be a relatively new concept to both patient and clinician, and one that certainly becomes more natural with experience, particularly as clinicians begin to see and feel the impact that Flo’s interactions have on the behaviour of their patients. 

Learning from across the Simple Telehealth Community of Practice demonstrates that for some clinicians, discussions with their first few patients when introducing them to Flo can be the most difficult as they begin to familiarise themselves with not only the concept of technology as part of healthcare management, but the cultural shift in motivating the patient to take more responsibility for their self care outside of the routine face to face clinical environment. 

Similarly for the patient, the same cultural shift needs to take place.  The most powerful positive influence around this is derived from the confidence demonstrated by the patient’s own trusted clinician in this initial conversation.  Where a clinician understands and articulates to the patient the benefits that additional support to their self management can bring, the rate of acceptance and subsequent engagement substantially increases.

Confidence in the clinician can be assured by focussing on a few factors.  Often where a clinician has been involved in the design of the new pathway from the start, this confidence is apparent much sooner as a result of their depth of understanding both of the rationale and process.  However as the number of clinicians integrating Flo into their clinical management spreads for example across a team, it’s vital to dedicate time up front with new clinicians to assure the depth of understanding also spreads. 

Once a clinician begins to experience the anticipated benefits within their own patients, a unique opportunity develops, and new initial conversations organically start to feature context from the clinicians previous experiences when their patients have been supported by Flo, which is then very easy for the patient to understand. 

To bring this to life, Karen and Kath Fackrell used role-play to demonstrate a scenario with Karen being a clinician and Kath a patient.  The scenario demonstrated clearly the correlation between the patient’s acceptance of Flo and their clinicians confidence both in the rationale for use and explaining what the patient should expect, and what they may need to do. 

The role play ignited a discussion on how to enhance the way clinicians approach to this initial conversation.

  • The value of training was highlighted as an area that can be reinforced locally to provide assurance and confidence around the rationale for introducing Flo, and also to reduce any personal fear of technology that the clinician may bring.
  • Specifically highlighting the importance of this initial patient to clinician conversation was also suggested as a dedicated topic to cover within routine training. This was also raised as an effective method to be able to unpick any additional gaps in knowledge or skills that can be supported early on.
  • The group discussed how insufficient understanding can often be enough to deter clinicians from introducing Flo to their patients, or can result in a poor quality discussion. Offering the clinician a prompt or guide on what to remember can motivate them to embark with those first few patient discussions. This can often reassure clinicians enough to make a start with recruiting patients.
  • The conversation between the clinician and the patient needs to be informative for the patient but simple enough for them to understand what they need to do and when, and what Flo means for supporting their condition.
  • It is optimal to be able to add the patient to Flo during this initial discussion as it assures the patient’s competency around their use of Flo demonstrated by them replying to her to opt in, that they have provided the correct mobile phone number and reassure the clinician that the patient will start to receive Flo’s support. A shared management plan and patient information leaflet reinforces this conversation and allows the patient to reflect and compound their understanding in the first few days of Flo’s support. For patients who wish to reflect on whether they want to join in, patient leaflets can provide a good overview of Flo, who she is, how she works and explain what to do if they do decide to join.

Flo Focus On: Strategic Leads

posted 13 May 2019, 05:25 by Hollie O'Connell

Janet Davies 
NHS Test Bed Programme Manager 

13 May 2019 

Janet Davies was the Test Bed Programme Manager for the LCIA Test Bed during wave 1 in 2016-18, and wave 1.5 in 2018-19.  Janet has kindly taken some time to share with us her experiences of working with Flo for our new “Focus on Evaluation Project”.

What is your background and role within your organisation?

I have over 12 years’ experience in a senior management role, and 26 years of operational management.  During the past 16 years this experience has been within the NHS, however I have undertaken management roles in Private, Voluntary and Statutory sectors.  As Test Bed Programme Manager, I have responsibility for the delivery of the Testbed programme. I report to the Programme Board and the Programme SRO.

What did you set out to achieve with Flo and how did you go about it?

Flo was one of 7 technology partners chosen to work with the Test Bed to implement and evaluate a combination of technologies and practices aimed at supporting older people (aged 55 +) with long term conditions (LTC) to remain well in the community, avoiding unnecessary hospital admissions.  The combinatorial health technologies were designed to better enable older people with LTC to self-care at home and to improve patient activation.  The LTC included COPD, heart failure and dementia.

The LCIA Test Bed was delivered through two neighbouring Vanguard sites – the Fylde Coast Local Health Economy and Morecambe Bay Health Community (Better Care Together), located in Lancashire and South Cumbria.

Both our Vanguards were focused on population-based new models of care that were central to delivering the vision of the NHS Five Year Forward View: integrated primary and acute care systems (PACSs) and multi-specialty community providers (MCPs) whose focus was on integration.  The MCP model was designed to dissolve the historical divide between health and social care.  It involves redesigning care around the health of the population, irrespective of existing institutional arrangements. Blackpool Fylde and Wyre (Your care, Our priority) was a MCP Vanguard.  Better Care Together was a PACS Vanguard. PACS were based on GP registered lists with the aim of improving the physical, mental and social health and wellbeing of the local population and reducing inequalities.  PACS were designed to bring together health and care providers with shared goals and incentives, so they could focus on what is best for the local population.  Critically, the general practice was at its core.

Patients with LTCs were recruited to one of three cohorts depending on their level of risk of hospital admission (Cohort 1 being the highest risk category); individuals with mild to moderate dementia were recruited to an additional Cohort 4.  The combination of technologies each patient received was dependent on their level of risk and their primary LTC.  Flo was used within Cohort 2 in which patients had a risk score of 10% - 25%. Protocols were developed with clinicians for Falls, COPD, Heart Failure and carers.

Patients were recruited to the Test Bed through the clinical teams within the Vanguard, which for Better Care Together was GP led, and were taken from the patients lists using risk stratification through Aristotle.  In Fylde Coast, patients were identified by teams e.g. Pulmonary Rehab and Falls Team. 

Were there any surprises?

Engagement with staff was sometimes challenging and we experienced some resistance from teams to using technologies including Flo, with capacity being the most frequently cited barrier.  Due to the nature of testbeds being proof of concept rather than an introduction of new working practices, teams were required to continue with their traditional pathways alongside the new technologies we were asking them to try.  This sometimes meant that information was available in both existing pathways and new technologies, and so using new technologies for monitoring was often not a priority in an already busy workload.

Self-management as a concept is also relatively new and demands a real shift in thinking for teams in respect of delivery of care, which has historically been clinician led. As a team we were able to meet each concern as we went along, working closely with teams to break down barriers whether this be related to capacity or something more practical in nature such as the supply of handsets for patients who didn’t own a mobile phone. However as with any change in practice, there were of course some teams who were unable to overcome their local challenges to be able to fully engage with the testbed. 

How does Flo fit with your organisational vision/current strategies?

Flo was an integral Partner in the LCIA Test Bed.  While that programme has now concluded, the knowledge and understanding of Flo will however remain with the Test Bed leadership Team, who are now working with Healthier Lancashire and South Cumbria Integrated Care System to take forward the Technology Enabled Care agenda, starting with a Digital Discharge Bag.

What do you consider your biggest success with Flo?

Most patients interviewed in Cohort 2 experienced an increase in confidence in relation to their health as a result of taking part in the Test Bed.  This was linked to an increase in knowledge and skills, resulting in people being better able to self-manage their health.

  • 83% of Cohort 2 indicated an increased confidence about their health.
  • 94% with a risk score 10% - 25% indicated increased knowledge and skills enabling self-management of LTC.

The majority of Phase 2 patients in Cohort 2 had COPD.  Most found participation in the Test Bed programme helped them to learn about their condition and how to better manage it.  Participation in the Test Bed programme also had a positive influence on daily activities for some participants, with the biggest impact occurring in Cohort 2.

In addition, there was an overall total cost saving for Cohort 2 participants using Flo of approximately £133 per patient. 

How do you engage your clinicians and wider organisation with Flo?

To help us to engage with clinicians, we set up ‘Use of Clinical Operation Groups’ for each area (Better Care Together, Fylde Coast and Dementia), as well as providing a number of updates to encourage use of Flo and other TEC in the Test Bed, including: Innovator monthly updates, reporting as part of Board updates, as well as weekly updates for those using Flo and other TEC within the test bed. 

What are the future plans with Flo?

Despite the Test Bed ending, we have learnt a great deal and improved our understanding of Flo and how her unique persona can support patients with LTC improve their self-management and in turn their long-term outcomes.  The Test Bed leadership Team‘s experience and learning with Flo will support our work as we take forward the Technology Enabled Care agenda with Healthier Lancashire and South Cumbria Integrated Care System, beginning with the Digital Discharge Bag as I previously mentioned.

Information regarding the impact of FLO as part of a combinatorial approach to managing long term conditions has been reported as part of the Phase 1 and 1.5 evaluations, and you can find out more about the test bed here.

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