A Reflection: Visiting Norfolk and Norwich University Hospitals To Look At Virtual Wards
As Storm Eunice swept through the country, our planned in-person visit alongside Chief Nursing Officer for England, Ruth May, turned fittingly into a virtual visit.
We were nonetheless ably hosted by Emily Wells, Digital Health’s CNIO of the year for 2021, and CCIO Ed Prosser-Snelling. A powerful clinical leadership duo with a clear vision for the digital transformation of their Trust.
New technology but old fashioned nursing
The Norfolk and Norwich University Hospital (NNUH) team demonstrated their virtual ward and talked us through their experiences of how the approach was changing the way they deliver care.
We particularly remember Michael, an experienced senior nurse, describing how this model of care not only reduced length of stay but was:
"...taking us back to old fashioned nursing where you really have time to get to know the patient".
The joy he felt at this was evident and it was another demonstration that good technology, implemented with attention to the people and processes, can go beyond efficiency and clinical effectiveness to improving how we connect and care for our patients as people.
Interestingly both Emily and Michael discounted some of the challenges to virtual wards we sometimes hear regarding problems delivering care or their potential to further stretch an overburdened workforce.
Michael described how this model of care goes beyond monitoring and responding to vital signs by building relationships with patients who feel more at ease to express themselves on screen in a way that sometimes they don’t on a hospital ward:
"...digital curtains are soundproof, unlike those on the ward".
He gave the example of one lady who felt able to describe her difficulty opening her bowels, enabling the team to take action with laxatives promptly prescribed and despatched by courier.
And the nursing team at NNUH feels virtual wards offer them some helpful flexibility, with the chance to continue to nurse for patients at home when their situation makes hospital wards untenable. The option of having virtual ward shifts has become an attractive aspect of their employment, helping with recruitment and retention. All nurses who have joined this team have been retained.
Safety and outcomes
Whilst nationally NHS England and Improvement has established a workforce group to address the question of staffing ratios in virtual wards, early adopters like NNUH have been setting their own levels based on experience. Emily described a robust approach to establishing a dedicated team with the right expertise to staff the virtual ward that included a good skill mix and senior nurse leadership.
NNUH is also ensuring they are supporting the nurses and wider teams staffing the virtual wards with high-quality training and development. The work of Emily and her team in this space has already informed a national e-learning module that will support other teams across the country to help implement virtual wards.
Virtual Wards page: NHS England and Improvement
Arguably this is just the start and there is much more to do to ensure we offer the necessary training and support as this model expands but building on the learning from these early adopters will be key.
It is encouraging to see the positive impact the virtual ward has on hospital length of stay, we know broader measures will be helpful to fully examine their effectiveness. The national team is working with local teams to determine the best set of metrics to help ensure we are getting the best possible outcomes, including measures of staffing, outcomes, and staff and patient experience.
Wider transformation plans
Like many trusts, the digital journey at NNUH has not been straightforward with a mix of different digital systems and paper still in use. Emily described the familiar challenge of needing multiple different logins, multiple screens plus paper to get a full view of the patient. Fortunately for the staff and patients, leadership at Norfolk and Norwich are working across their entire ICS on a plan to have a single EPR.
The clinical support for this plan was made very clear through numerous spontaneous statements of support and enthusiasm. A single comprehensive record accessed by all clinicians, regardless of profession or setting, will ensure clinicians have access to all the relevant information, giving patients the best chance for high quality and efficient care.
National challenge
We heard the challenge to support the professionalisation of digital nursing. We are hopeful our Guidance for Nursing on What Good Looks Like, will provide some much needed support for executive nurses to make their case locally.
We left our virtual visit inspired by the vision, expertise and determination of those who are driving change every day across that system – whilst being reminded we have much to do nationally to support the local delivery of the digital capability needed to enable the change we all want to see in a person-centred health and social care system.
Originally posted on LinkedIn by Professor Natasha Phillips, as part of her former role as England’s CNIO – follow Natasha to hear the latest from Future Nurse.
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