Engaging with patients virtually during COVID-19: Insights and recommendations
Talking to patients can provide invaluable insight into the care journey, highlighting both what adds value to a patient’s experience, and those processes requiring improvement. This data is often gathered by discussing issues with patients face-to-face. Techniques for this can range from hosting interviews and focus groups, to passing out short surveys and having conversations in clinic waiting rooms. COVID-19 has resulted in many changes to how services are able to meet with patients and deliver care, several of which seek to reduce face-to-face interaction and minimise hospital footfall to prevent risk of infection. For many services, the roll out of NHS Near Me provided a way to ensure services could continue seeing patients whilst keeping both staff and patients safe.
NHS Grampian Dermatology and Plastics services innovatively applied the technology to support their quality improvement work. By taking the technology out of the clinic, they were able to engage with their service users safely and continue their pathway redesign work at pace. The team were able to overcome restrictions and conduct in-depth interviews with patients who had received care as part of the Urgent Suspected Care (USC) pathway.
In this guide we present 10 key recommendations from Acute Transformation Programme Manager Laura Kluzniak, and Clinical Nurse Specialist Ashleigh Davidson, about their interview experience, along with top tips from the Access QI programme for other teams looking to engage with patients virtually.
1. Keep your questions simple
In order to capture the patients’ full care journey, the team decided to split the interview questions into multiple sections covering:
- patients' pre-hospital and hospital care experiences
- how patients received news of their diagnosis, their treatment, and their results
their care experience, and - reflections on what went well, and aspects of treatment that could be improved.
After talking to patients, both felt that many questions had received the same answers and may have been repetitive for the patients. Be adaptive and flexible, and skip questions that you feel have already been covered.
2. Types of questions
Using yes/no questions and statements with response scales/categories can be useful. However, as the Dermatology and Plastics services discovered, they can take time to explain. Also, they could be open to interpretation bias, as participants will respond differently based on the information and description provided. By agreeing how each interviewer will describe categories beforehand you can ensure consistency and minimise bias.
Also, you may wish to consider whether these types of questions could be part of a pre-interview questionnaire shared with participants and then discussed in the session. This would allow you to capture further information on what may have influenced their choices.
3. Introduce yourself and get consent beforehand
Make initial contact with attendees explaining the purpose of the interviews. This allows them to make an informed decision about being involved. The Dermatology and Plastics services sent introduction emails so attendees knew who they would be speaking to. Also, send a consent form for attendees. This should be signed and received prior to the interview.
4. Choosing your mode of communication
Deciding how you will conduct the interview is a critical first decision. Here are some key questions we recommend you consider during planning:
- What technology do your participants have access to, and feel comfortable using?
- What technology do your interviewers feel comfortable using? Do they need any help or training?
- Do you need to see your participants? Maybe a telephone call would suffice.
- Have you planned any activities or tasks within the interview that require you to share resources, links, or your screen? If so, could these be distributed to participants beforehand, possibly in an information pack?
For the team in NHS Grampian, their experience of using NHS Near Me meant it was easy for them to set up and guide participants through its use. Use what is comfortable for you and your participant!
5. Could you get the data elsewhere?
Upon reflection, the team realised that some of the questions they asked were unnecessary as the information was available on TrakCare. They would suggest teams consider what data and information they can collect prior to speaking to participants. This can free up time for other questions.
6. If possible, practice
From their own experiences, the Access QI team would recommend doing a quick practice where possible, even if only with other team members. This can help build interviewer confidence and also highlight duplication amongst questions. If this is not possible, why not debrief following the first interview and make changes based on that experience? These immediate reflections can help you make amendments and improve at pace.
7. Test your technology
As with all new technology and tools, scheduling time for a quick test can be invaluable. This is especially useful if interviewers are in different locations from one another as well as the participant.
8. Who should conduct the interview?
Having someone highly familiar with the service or pathway conduct the interview alongside the QI advisor can provide different perspectives on patient responses. For NHS Grampian this format was key to making sure the patient felt they were being listened to by someone who knew what they had gone through, whilst also ensuring the interview would provide the key information needed to inform the planned QI work.
9. After the interview
Following the interview, the Dermatology and Plastics services emailed the patients to thank them for sharing their experiences. They also plan to keep the patients updated about changes they make following the interview.
10. Collected your data, now what?
For NHS Grampian, collating interview notes and then dividing them according to the questions asked allowed them to identify common themes quickly. They also assigned a colour to each respondent so it was clear when discussing the experience at the de-brief meeting whose response they were referring to.
Using these techniques also made the notes user-friendly for reviewers who had not been in the interviews. Following discussions, it was agreed that the notes would be themed and fed back to the specific teams involved in each aspect of the patient care experience, to inform the development of test of change ideas.
Another quick and simple approach to theming this type of data is to revisit your project aims and remind yourself what insights you were hoping to gain. Then, as a team, review the notes from each interview in turn and categorise responses according to which aim they inform. This then starts the team discussions as to which issues need prioritising (as they were mentioned by more than one participant), and the identification of possible tests of change.
This guide provides some useful starting points for conducting your own patient engagement work. We would like to thank NHS Grampian Dermatology and Plastics services for sharing their experience and key learning.
Do you have more examples you'd like us to share?
Please email us your suggestions at: his.accessqi@nhs.scot