Easy online access to shared information and peer discussion is proving a prime mover in engaging clinicians with quality assessment and transforming services

While the country begins its struggle out of recession and the public sector endures a climate of extreme budgetary pressures, changes are inevitable.

49,867 - Doctors who engaged with the high volume care awareness programme over 17 months

9,000 - Clinicians, on average, who accessed the material each month

224,771 - Page views in the 17 months of the campaign

Encouraging doctors to scrutinise their clinical practice and assess whether quality and efficiency improvements can be made is a crucial way in which fundamental change will be achieved, says Simon Grime, head of public sector at the online network Doctors.net.uk.

“It’s frontline clinicians who will play a key role in the future of the NHS, but they need to be engaged, involved and empowered, not dictated to,” he says.

“In an era of information and initiative overload we need to give clinicians the power to drive change alongside service managers and arm them with realistic and practical tools that are proven to make a difference.”

That focus on engagement was at the heart of the NHS Institute for Innovation and Improvement’s high volume care programme, which ran an educational campaign on best practice in the most common conditions and treatments managed by the NHS.

Studies from the NHS Institute into the effectiveness of hip and knee replacements, for example - which account for 160,000 procedures in the UK every year - found that getting people mobilised within 12-18 hours of surgery speeded up recovery time, benefiting patients and supporting productivity.

“We have a wealth of practical information available. However, there’s a big difference between having the knowledge and getting that information to the people that can really make a difference. And it’s an even bigger chasm to cross when you want people to change their practice,” says Mr Grime.

There is evidence that the network’s support to the high volume care programme has sown the seeds of change. After one year, the programme prompted 55 per cent of the 40,000 doctors reached to assess their clinical practice, with 21 per cent changing working methods as a result.

In 17 months, nearly 50,000 doctors across a range of specialties engaged with the programme.

Advice online

Accessing advice online proves a good match with busy doctors and their high levels of internet use can put them at the heart of an integrated campaign.

“It enables us to target doctors specifically with high volume care programme messages, and deliver a measurable change in clinical behaviour,” says former NHS Institute programme director Mark Jennings. “The real value came from driving awareness and encouraging peer to peer discussion and I doubt there’s another way we could have delivered such results.”

Members were targeted with content relevant to their specialty and tailored clinical bulletins were then sent to those most likely to have an interest in the subject to drive them to a specially designed microsite.

There, doctors could view podcasts, download PDFs on a specific disease or injury and access guides on working efficiently and effectively in fields which absorb the most health service resources, such as diabetes, short stay emergency care, cataract operations and coronary heart disease.

  • Doctors registered with Doctors.net.uk - 90%
  • Doctors who use the internet to research professional information - 88%
  • Doctors who use the internet at work - 50%
  • Doctors who have completed online ‘e-learning’ modules - 83%
  • Doctors who use the internet at home - 93%

Source: Doctors.net.uk, June 09

Based on a survey of 4,000 members

Redesigning diabetes inpatient care

Having followed the high volume care programme module on Inpatient Care for People with Diabetes an endocrinologist consultant says: “We are implementing these changes as service redesign across the area - including community, outpatients and inpatient. Inpatient care is a key strand. At present there is daily review of all diabetic patients admitted on a day by a doctor and diabetes specialist nurse from the team.”

He says the e-referral system is linked to each patient and with the monitoring of vitapaks, improving staff awareness.

He says the department has improved education of ward staff to ensure early referral to the specialist nurse; enabled e-referral to nurses; streamlined follow-up and identified areas of improvement and lack of resources. He says the importance of these changes lies in “delivering continued care and improving the patient care path through hospital stay”.

Top five tips

Priorities for driving clinical engagement

  • Set clear objectives at the outset - is it awareness or education that is most important?
  • Make information relevant and targeted - avoid a scattergun approach
  • Provide messages in a variety of formats - different people engage in different ways
  • Refresh information regularly and keep it up to date
  • Measure, adapt, and measure again - an ability to react to feedback is vital