Caroline Poole, Clinical Improvement Lead at Pennine Care NHS Trust recently attended the Simple Telehealth National Conference in Stoke-on-Trent to give a presentation about the trust's success in implementing Flo Telehealth.

1. Sustainability and spread across
multiple pathways in Community
and Mental health services
Caroline Poole
Clinical Improvement Lead, Service Development and
Sustainability
Date

2. A bit about us…
• Community and mental health provider organisation
• Commissioned to deliver into 6 of the 10 boroughs across
Greater Manchester
• Covering a population of 1.3 million
• Approximately 5,500 staff
• Delivering 263 different services
• Almost 2.5 million patient contacts last year

3. About our strategy
‘To embed self-care and self-
management into every service
we deliver’

4. Challenges we needed to address:
• Understand the elements
• Get a baseline measure – where are we now?
• How big is the gap and what do we need to change?
• How do we make this an authentic change in culture, not a tick box
exercise?
How do we bring people to the table when generally they think they are doing
it well anyway?

5. Our experience shows that:
• Flo is one of the SYSTEMS we’ve adopted to enable the
culture change
• Flo supports CLINICIANS to think differently about patient
capability and opportunities for service redesign
• Flo supports PATIENTS to feel confident and capable

6. Why text messaging and why Flo?
• Uses familiar technology;
• No significant requirement for up-front cost whilst
building local evidence base for ROI
• Evidenced to supporting self-management and
improve outcomes
• Flexibility of product to meet locally identified need
• Tried and tested in NHS provider organisations –
credibility and safety

7. Our initial approach to service redesign
• Clinically-led by front-line teams
• Opportunistic, working with the willing
• Simple evaluation of impact

8. Gave us these outcomes:
• Huge initial enthusiasm from teams who could easily see
pathways that could be enhanced
• High drop-off rate
• “popcorn” go-lives
• Challenges with sustainability
• No spread of adoption despite positive outcomes
Frustration….missed opportunities…..ongoing challenges with
sub-optimal outcomes and demand/capacity challenges

9. Why was this happening?

10. The COM-B model (Michie et al 2011)

11. Capability
• Who are the
innovators?
• Service improvement
methods
• Technical capability
• Cultural barriers –
shifting from parent to
coach

12. Opportunity
• Whose priority is this?
• Time and head space to
innovate and improve
• What is the “day job”?
• ‘finding the good people
and filling them with
work’

13. Motivation
• Getting it on the ‘important’ list
through strategy, CQUIN etc
• Intrinsic reward from success
• Managing the barriers in
adopting others’ work
• Using clinical networking
• Award nominations, publications,
and research funding bids

14. Building behaviour change through
local leadership resource
• Local programme managers have adopted Flo into their
porfolio

15. Challenges
Changing staff mind-set:
• “We only keep patients that are unable to self manage”
• “How can I fit Flo in to an already busy consultation”
• Embedding in to the team – some times only 1 or 2 clinicians
using it
But…..do these challenges relate to:
• Use of Flo itself?
• Delivering the supporting self-management agenda?
• Instigating change and improvement?

16. Local learning
• Need to have a champion in the team
• Local lead needs to maintain the momentum, regular
contact with the team with details of activity by team
member
• Patient feedback on the content and volume of the texts
and adapt and change as required; co-production reaps
rewards

17. Where are we now?
• Technology programme managers providing local support
for development, implementation and delivery (in 3/6
divisions)
• Mechanism for working across geographical boundaries
• Central directory of Flo improvement projects
• Peer assist being actively developed and encouraged
• Results are coming in!
Moreover…..lessons learned feeding into strategic review of
our improvement infrastructure

18. Showcasing some of our pathways

19. Psychological therapies: reducing stress and improving mood
Reduction in DNA (50%), improving clinical outcomes (22%)
OT/Physiotherapy: upper limb rehabilitation post-stroke
80% increase in achieving goals through group intervention
Community Nursing: supporting self-management of wounds
Positive staff/patient experience and outcomes; 50% reduction
in appointments for eligible patients/wounds

20. Speech & Language Therapy: supporting dysfluency group
impact
Positive parent feedback; ongoing evaluation of outcomes
Learning Disabilities
Early identification of mental health deterioration for people on
Care Programme Approach
Child and Adolescent Mental Health: eating disorders pathway
Improving outcomes for young people on intensive treatment
programme

21. Podiatry: supporting self-care in high risk foot pathway
Patient story: empowerment to act at early signs of
deterioration
The patient stories are so powerful…. This letter….
- Previously had toes amputated
- Chronic ulceration of feet
- Now: no ulceration due to supported self-management

23. My key messages:
• The technology isn’t the change; the pathway redesign is the
change
• Without a strategic approach, it is difficult to get anything
other than popcorn delivery from self-selecting enthusiasts
• Local ownership and leadership is invaluable – clinical,
managerial, project and technical

24. My key messages (2)
• Spread doesn’t happen without effort – using “peer assist”
and professional networks for recent adoption
• The power of patient stories….collect and use them!
• Apply robust service improvement methodology to
demonstrate impacts (patient experience, patient
outcomes, staff experience and service utilisation)

26. caroline.poole@nhs.net