Ease of technical use

One of the most common subdomains associated to the platform’s technical performance was that of ‘ease of use’. It was often stated that the VC platform used in NHS Wales (Attend Anywhere) was ‘easy to use’ for both patients and clinicians.

Easy to use, lots of good information. (Parent of patient under 12 years, ABUHB, Physiotherapist, paediatrics and child health, Advice)

It was easy to use, and appropriate to use during the pandemic. (Patient, Female, HDUHB, 25–44, Midwife, Obstetrics and gynaecology, First appointment)

In addition, this ease of use was expressed as a ‘surprise’ to some, in that both patients and clinicians found the VC platform much easier to use than they initially anticipated, and in some instances, this exceeded expectation.

More effective than I expected a non-face to face appointment to be. (Patient, Male, 45–64, HDUHB)

This is my first experience of a video call, so I was pleasantly surprised. (Patient, Female, 64–80, BCUHB, Doctor, Follow-up)

First time to use video call I was very impressed, better than expected. (Patient, ABUHB, Podiatrist, Follow-up)

Ease of experience

For some clinicians, it was felt that having access to a VC platform was ‘easier’ for some of their patients than a face-to-face appointment would be. This was especially apparent in terms of patient experience and their personal circumstances, and those with access difficulties, anxiety issues or complex home situations that were made more convenient with VC.

Easier to access with social anxiety. (Doctor, CVUHB)

Very helpful for autistic patient. (Dentist/dental nurse, SBUHB)

This was also expressed in more depth by the patients themselves, whom in addition felt VC was better than attending a face-to-face appointment, such as making the patient feel safer, less stressed and more empowered, as opposed to their prior experience of face-to-face appointments.

Easier and safer than going to the hospital. I didn’t have to take much time off work. (Patient, SBUHB, Female, 25–44, Dietician, First appointment)

Just as good as a face-to-face meeting and to be honest I felt like I was being listened to far more than when I have been in face-to-face meetings on the same subject. (Parent of patient, ABUHB, Female, under 12 years, Nurse, Mental health, Advice)

Ease and unique for collaborations

Clinicians comment that the ‘ease’ of the VC platform and its positive associations to patient experience provides an additional unique opportunity. This opportunity is the ability to link up others to the video call, thus enabling multidisciplinary appointments to take place. This is felt to be unique in the sense that this collaborative approach would not have been possible if conducted face to face, thus in turn produces additional advantages and improved outcomes for patients, families and clinicians.

It was easy to join both my patients and other colleagues in. (Doctor, HDUHB)

Also, his Wife was able to join session—significant information shared by Wife today. (SLT, BCUHB)

It also means that in some instances, there is an increase in patient or parental onus which is perceived as an additional advantage to patient care.

Parents have to take a more proactive role than they might in clinical session. (SLT, ABUHB)

Definitely helped with family involvement today. (Nurse, HDUHB)

Mum appears happy to support and possible not very involved until now. (SLT, ABUHB)

Communication, personalisation and rapport

Patients commonly expressed how VC helps them to communicate effectively, to receive a more personalised and patient-centred approach and build rapport with their clinicians.

Having a video call made it more personal for me the support given to me was excellent. (Parent of patient, CAVUHB, under 12 years, Paediatrics and child health, Advice)

We have built up a relationship with our clinician via VC. (Patient, Male, 45–64, CAVUHB, Counsellor, Mental health)

Patient positivity and appreciation

A strong consensus of patient ‘positivity’ and ‘appreciation’ towards their clinicians is expressed widely in the narrative. This positive clinical presence led to many patients feeling safe, comfortable and supported during and after their VC. This was particularly evident across specialties such as mental health and therapies.

Had a really tough week, but [name removed] was amazing and she listened to me. She gave me great support and was really kind to me. (Patient, CAVUHB, 25–44, Psychologist, Mental health, Therapy/treatment)

She was engaging, courteous and professional in explaining what she felt the issues were with my hand. I found the whole experience thoroughly satisfactory. (Patient, CAVUHB, 45–64, Male, Occupational therapist, Trauma and orthopaedics, First appointment)

It was great to feel that someone was there to chat to, who could see a difference in [patient name removed], while at the same time supporting us as a family. (Guardian/carer of patient, SBUHB, 25–44, Male, Mental health, Follow-up)

Convenience, safety and home comforts

Many of the patients demonstrate the benefit of convenience when using VC as opposed to a traditional face-to-face appointment, with additional advantages such as improved safety and home comforts.

As we live quite far away, the virtual meetings are a lot more convenient and it’s nice to feel more comfortable at home. Thank you. (Patient, CAVUHB, Female, 25–44, Obstetrics and gynaecology, Follow-up)

I felt really comfortable talking to [name removed]. I was able to get things off my chest, and talk about the assault more deeply than I have ever done. (Patient, ABUHB, 45–64, Female, Counsellor, Mental health, Therapy/treatment)

Client is pregnant and so is vulnerable to the COVID virus. AA means she can continue with therapy without the additional risks. (Mental health, HDUHB)

Flexibility of VC

For many patients, a benefit of using VC was the flexibility it allowed. For example, patients reported to be able to continue ‘getting on with other things’ while waiting in the ‘virtual waiting room’, which would not have been possible in a physical location.

I felt it was good as I could start the call and then get on with things around the house while I waited. (Parent of patient, BCUHB, Female, under 12 years, Physiotherapist, Paediatrics and child health, Therapy/treatment)

I think that it is excellent to have a consultation this way. It was easy to log on and saves so much time for both of us. (Patient, ABUHB, 45–64, Female, Physiotherapist)

In addition, having three modes of appointment (VC, telephone or face to face) provided the patient with a stronger sense of patient choice and flexibility. However, it was felt that VC, as opposed to a telephone consultation, allowed comparable aims and goals to be achieved similar to a face to face.

VC let us achieve patient’s 1st choice, which could not have been achieved over the phone. (Occupational therapist, SBUHB)

AA is a way of bridging direct face-to-face and a visual interaction can be helpful as part of the clinical assessment. (Nurse, HDUHB)

Having a video consultation is so much better than just a telephone call—it allows you to chat as if it was in person. (Patient, PTHB, 64–80, Female, Nurse, Respiratory medicine, Advice)

The ability to be able to visually ‘see’ the patient is considered imperative to clinicians, as for many healthcare conditions VC is needed to enable visual cues.

Better than just telephone call as could get non-verbal clues about emotions. (Doctor, ABUHB)

Really useful being able to see patient via system—really added to consultation, infinitely superior to telephone consultation. (Doctor, SBUHB)

Time savings

When using VC as opposed to face-to-face appointments many clinicians and patients expressed that they had saved time in several ways, and this was a considerable benefit to patients, families, clinicians and the NHS service as a whole.

For example, clinicians felt that the ‘time’ used to conduct a VC was reduced in comparison to the usual components of a face to face, for example, logistics. The time saved from travelling to and from appointments was able to be combined into the overall virtual consultation in some cases, ultimately benefiting clinicians’ availability to attend to other patient needs and clinical tasks.

Video consultation reduces time required the next day. (Midwife, CVUHB)

Video consultation prior, ensures that less time on home visits. (Health visitor, SBUHB)

In addition, the use of VC lowered the ‘wait times’ in some instances for patients, in comparison to waiting for a face-to-face appointment.

Fantastic way to be able to have an appointment without having to wait months. (Parent of patient, CTMUHB, under 12 years, Male, Doctor, Otolaryngology (ENT), First appointment)

Reduces time required for next appointment. (Audiovestibular medicine, BCUHB)

From the data, ‘travel time’ or ‘time off’ work or school was perceived as the biggest saving of time in comparison to attending a face-to-face appointment for patients.

Less travel and disruption of [patient] school day. (Dietician, ABUHB)

I just had just finished a night shift, and live a fair distance from work, so doing a video call made my life a lot easier. (Patient, SBUHB, 45–64)

Not having to travel to the hospital and waiting in the waiting room was much better, and there was no stress trying to get around everything all of the time. (Patient, CVUHB, 45–64)

Clinical value

Many clinicians suggested that VC has the ability to enhance a clinical session or determine clinical need. For example, some clinicians demonstrated opportunities to share visual resources immediately within the appointment. Others reported that VC allowed for an effective triaging tool to determine the ‘need’ for a face-to-face appointment as opposed to a remote consultation alternative.

It enhanced the clinical session because it added visual opportunity. (Speech and language therapy, CVUHB)

I could open investigations on screen easily, I shared internet resources links to patient, and she got them on screen straight away. (Doctor, BCUHB)

VC is not for everyone or everything

There are some clinical situations and personal circumstances which continue to necessitate the need for face-to-face consultations, where VC does not achieve the outcomes necessary, or suit the clinical condition or patient type.

Still needs face-to-face as cannot test hearing over VC. (Audiovestibular medicine, BCUHB)

Only thing missing was ability to weigh and get height. (Dietician, ABUHB)

Patient and clinician digital ability

Some issues with patient and clinician user abilities were also highlighted in the data, clinicians made note that on occasion patients struggled to undertake VC due to their lack of technological ability. This affected the potential quality of the VC and therefore impacted the patients’ opportunity to receive care via VC.

Client unable to get full screen. Client not familiar with using equipment at home. (Counsellor, Psychiatry and Mental Health, Mental health, Secondary, SBUHB)

Patient didn’t receive link so unable to do. I think it may be due to me being unfamiliar with new system in the end and it worked well. (Physiotherapist, Paediatrics and Child Health, Therapies (AHP), CVUHB)

Engagement over VC

Engagement was a further challenge that clinicians experienced when using VC. Within therapies for younger patients where parents were present, clinicians found it challenging to engage with children via video in the same way as face to face. Children were reported to be more distracted during these appointments as the concept of video was relatively new, therefore parents and clinicians had to attempt to engage with the child more than via face to face.

Poor picture quality does not encourage children who already have attention/listening difficulties to take part. (Speech and language therapist, ABUHB)

Child had short attention span and parents had to work hard to keep him in front of camera. (Speech and language therapist, ABUHB)

Sound quality not adequate at times to determine success of target so reliant on adult feedback. Child however responding better than expected although once attention levels drop it is quite difficult to return to tasks. (Speech and language therapist, Paediatrics and child health, ABUHB)

Waiting room issues

A problem that was reported by a small number of patients was associated to the virtual waiting time being exceedingly long, or that their appointment was missed by a clinician, or in some instances, where no clinician attended at all.

Waited for over 40 minutes in the waiting room. (Parent of patient, SBUHB, and parent of child under 12 years, Paediatrics and child health, Follow-up)

We waited in the virtual waiting room for an hour and 30 minutes without anyone answering. We couldn’t wait any longer and due to our poor internet connection in our area, I had to use all my monthly data. (Parent of patient, ABUHB, Parent of child under 12 years, Male, Paediatrics and child health, Follow-up)

Good versus bad quality

For high-quality ratings, these were paired with praise for VC in the free text narrative box, suggesting that the audio and visual elements of the VC were of high quality.

Great connection. No glitches very smooth call. (Parent of patient, ABUHB, under 12 years, Female, Physiotherapist, First appointment)

The video and picture was perfect, was able to hear the doctor clearly. (Patient, CAVUHB, 45–64, Female, Doctor, Follow-up)

However, there were technological challenges reported within the narrative such as poor connectivity, thus impacting on visuals and audio.

Lag in audio/video sometimes causes miscommunication or difficulty with younger patients. (SLT, CVUHB)

The video was very choppy and when my therapist was talking it was delayed video with speech. (Patient, CAVUHB, Female, 25–44, Counsellor, Mental health, Therapy/treatment)

In some instances, technical issues were associated with specific device types and their perceived incompatibilities with the VC platform.

The video call app did not give me the option of using my inner camera so I had to turn my phone around so the doctor could see me. (Patient, BCUHB, 25–44, Ophthalmology, Advice)

Problems with Safari on iPad. (Health visitor, SBUHB)

Session being done on Father’s phone so screen obviously small for child to watch. (SLT, ABUHB)

Clinical innovation and troubleshooting

Yet, despite these technological challenges, with the right amount of technical support and appropriate equipment available, clinicians report to be able to troubleshoot many issues and continue to use VC in most situations.

Tried to do call with mobile phone and there were issues for the patient not being able to grant access for use on mobile phone, but the consultation worked perfectly on their computer. (Dentist/dental nurse, BCUHB)

Issues at the start of the call with the audio but we disconnected and reconnected and it was then fine. (Nurse, SBUHB)

Some clinicians were able to troubleshoot the problems easily to make the consultation work best for them and their patients.

I was unable to connect through the desktop in clinic due to computer being extremely slow…. I was luckily able to connect through my Netbook which supports the platform. (SLT, CVUHB)

School initially struggling with internet connection but then able to move to a room with better signal and VC quality. (SLT, CVUHB)

Clinical recommendations

One of these suggestions was improved infrastructure and resources for clinical and administrative staff to have access to. It was felt that by having better equipment, they would deliver better patient care via VC. Not only this, but in some areas the number of devices and access to workspace was limited and needed significant improvement in the future.

It would be useful to have 2 microphones so I can share videos with my clients about EMDR therapy and PTSD. (Nurse, BCUHB)

Need appropriate screens and two monitors to view downloads and see patients, desk and chairs at right height. (Dietician, BCUHB)

Clinicians also suggested that there needed to be an improvement with the technical support that was on offer across health boards regarding VC.

Being taught how to split screen so we can write notes at the same time, rather than making paper notes and writing up after. (Occupational therapist, BCUHB)

This suggestion of technology support would ensure clinicians could use VC to the best of their ability, using all aspects of the platform. Some clinicians suggested new features that they felt would be useful in ensuring clinician/patient confidentiality and safety.

To be able to blur/add a background when working from home. (Dietician, SBUHB)

I would like to be able to leave the call screen but still be able to see patient in a little pop-out screen. (SLT, BCUHB)

Additional administrative support was also suggested for VC so that they could mirror the way standard face-to-face consultations were run.

For this to work administrative clinic support needed to mirror that provided for face-to-face appointments. (Nurse, CVUHB)

Patient wants and needs

Patients’ narrative also suggested that technical and digital skills support would be useful in the future use of VC. Some patients were slightly unsure of how to use the technology needed for VC and ran into some issues. By having support for this, it may lead to an increase in digital skills for future digital implementations and the move towards a new NHS digital strategy.

I couldn’t work out how to use the camera on the front of my and wasn't sure how to connect via my computer to the appointment. (Patient, ABUHB, 25–44, Female, Mental health, First appointment)

I was unable to switch my camera to front facing, so not able to see who I was talking to. (Patient, CAVUHB, Female, 45–64, Nurse, Otolaryngology (ENT), First appointment)

Patients provided narrative to suggest a blended approach of digital healthcare services was needed going forward. This was due to a large number of patients highlighting that VC provided numerous benefits, and help to supplement the quality of care received from clinicians, and believed a blended approach of VC and face to face was the way forward for the future of the NHS Wales support by clinicians.

Definitely the way forward for consultations, I live 100 miles away so for the purpose of consultation rather than treatment this is brilliant! (Patient, SBUHB, 45–64, Female, Doctor, Plastic surgery)

I think this will be the future. I felt more relaxed being able to do it from my home. (Patient, BCUHB, Female, 64–80, Doctor, Obstetrics and gynaecology, First appointment)

Video consultations act as a useful complement to face-to-face sessions and home visits. (Audiologist, BCUHB)