Transforming Respiratory Services
The aim of this project is to transform the Highland Respiratory Care pathway towards a pathway that is truly patient centred, by co-designing it with patients and all those who either use or provide respiratory services from the outset.
Our project team comprises:
- NHS Highland’s Technology Enabled Care (TEC) team
- University of Highlands & Islands (UHI), Division of Rural Health and Wellbeing
- A medical research doctor embedded in the Respiratory Service
Our stakeholder group includes:
- Patient & carer representatives
- Chest Heart and Stroke Scotland
- LGOWIT (Let’s Get On With It Together)
- Respiratory specialists including consultants, specialist nurses and physiotherapists
- Primary Care representatives, including GPs
- Public Health and IT specialists from NHS Highland
- Scottish Ambulance Service
- Housing organisations
- Scottish Government
The Journey
Project Set Up: May 2019 – October 2019
Recruitment of researchers and a project manager, research ethics approval, building relationships between partners, project planning and a first pathway mapping exercise.
Discover Phase: November 2019 – April 2020
During our Discover phase, we wanted to explore the end-to-end life circumstances and journey for people who experience respiratory symptoms. We designed and carried out a range of research activities with stakeholders, in total engaging with over 120 people. These included:
- Workshops across the Highlands run by researchers from UHI
- Informal interviews, questionnaires and discussion groups run by TEC researchers
Map of Discover Phase Research
In addition, we:
- Undertook a literature review, collating findings from secondary sources
- Heard about findings from research undertaken by third sector organisations & housing
As a result of this work we understood far more about the respiratory pathway as experienced by both patients and healthcare staff, and developed a far more complex diagram of our system than we had originally envisaged:Â
Define Phase: May 2020 – October 2020
After analysing our research findings, during the Define phase we brought together findings from all our different sources, triangulated the findings, identified key patient needs and problem statements, prioritised issues, and looked at the feasibility of addressing them. Additional research with patients to verify findings was also undertaken.
Develop Phase (a): November 2020 – May 2021
We started our work to Develop solutions to the problems we had identified by sending out questionnaires, holding individual stakeholder workshops and holding a well-attended joint stakeholder workshop (November 2020). We continued our work in a set up of three short-life working groups, which each met monthly during January to June 2021. Â These working groups were extremely well attended and included ideation sessions, guided discussions, and the use of blueprints, prototypes and storyboards.
An extensive range of fact finding meetings were also required, with a range of NHS Highland staff, the ambulance service, third sector organisations and commercial suppliers.
One result of this first part of the develop phase was a report prepared for NHS Highland’s Board, setting out our findings and recommendations for change.
Develop Phase (b): June 2021 – December 2021
This second part of the develop phase has involved detailed work on developing, prototyping and testing our ideas, working in collaboration with a variety of stakeholders, liaising with others, exploring options, writing papers, negotiating, seeking approvals, and much more. Our focus has been on three main areas of change, comprising 12 individual workstreams, some of which have multiple strands:
- Improving patients’ access to information – through development of a respiratory resource hub, a programme of open learning sessions and digital access to health records
- Improving patients’ access to support – especially through supporting, developing and standardising the specialist respiratory nurse and pulmonary rehab services, while also working with CHSS and LGOWIT
- Improving clinicians’ ability to meet patients’ needs – through improvements to respiratory guidelines, a range of activities to improve clinicians’ knowledge and understanding of respiratory conditions, improvement and standardisation of secondary care processes, and also of data and IT issues, and data sharing with the Scottish Ambulance Service.
Although we are encountering a number of bumps in the road, we are making progress towards implementation of all of these solutions. Notable amongst these is our Respiratory Resource Hub, which can be accessed at: www.bit.ly/respiratory-resource-hub
Deliver Phase: 2022
The final phase of the project will be to Deliver the solutions which we are currently developing. We plan to continue developing and testing prototypes and then delivering the final version of our new and improved services during 2022.