Frailty Virtual Wards from an Acute & Community care perspective
Welcome to the latest update on Sheffield Teaching Hospitals (STH), Frailty Virtual Ward Big Room. We are 5 months on from our last article in which we explored the Big Room Coaches’ perspective, roadblocks and key learnings.
In this article we speak to the Clinical Lead for developing the Frailty Virtual Ward project, Helen Wear and Head of Integrated Community Care, Helen Chapman who are Big Room participants as well as leaders of the project to establish the Virtual Ward at STH.
The interview explores the role the Big Room has played in the wider project, including designing the new service, cementing relationships, and underpinning the communications across the project team, participants and patients involved.
Q. When were you first introduced to the concept of the Big Room and what were your initial thoughts?
A few years ago I attended the original Frailty Big Room specifically during winter pressures and so I was familiar with the concept. I became a regular attendee when the Big Room relaunched as the Frailty Virtual Ward Big Room last year. This Big Room was set up to run alongside the Frailty Virtual Ward Project structure, providing the opportunity for everyone involved from community and acute services to come together and contribute to the design of the ward.
Helen Chapman
The Big Room was a new concept to me when I joined the Frailty Team at Sheffield, last year. At first, I was a little intimidated, there were 30-40 people virtually in the room some of whom understood the process whereas the situation was new to me. It was a steep learning curve, but I recognised quickly how vital the Big Room was in getting all the different people from across the acute and community settings together to have conversations about the new service.
Helen Wear
Q. What role has the Big Room played in the Virtual Ward service introduction at Sheffield?
At the beginning of the project, for me it was vital in understanding more about the community services we already had. I understood from my experience of virtual wards in London that our approach to the service set up would be very influenced by this, it would be important to avoid a silo approach. So, what I liked about the Big Room is that it so nicely brought everyone together, gathering their perspectives, which led to deciding together on how we wanted the service to work.
Our aim was to ensure that the project results in a fully integrated service that is sustainable, not just an acute service that could easily stall when funding ends. By working closely with the community and acute teams in the Big Room space to understand what services we had and what we needed, meant the project could focus on the missing requirements early on.
Helen Wear
For me the Big Room is a collaborative space, bringing people together in a safe way. The fact that we did this virtually has been brilliant as the team are from such a broad geographical area. The Big Room has effectively brought the acute and community worlds and the people in those services together. Anyone can just pop their hand up and ask or pose questions in the chat or raise any concerns. This has led to more collaboration and stronger relationships. This is not a space to design the detail of processes (occurs in another meeting) but can be used to review and agree tests of change.
Helen Chapman
Q. How does the Big Room create ‘psychological safety’?
I think it’s the shared facilitation, there is not one leader, and all the roles are taken on by different people each week. This ensures that everyone has a voice, no one dominates the meetings, and everyone can share their thoughts and ideas.
Helen Chapman
I think the clear structure contributes (Effective Meeting Skills), we collectively agree the agenda in advance too and we alternate the roles, this gives people permission to move outside of their usual role. By taking on a role that they don’t normally do builds their confidence and helps to make the space feel safe.
Helen Wear
Q. What evidence do you have that demonstrates how the Big Room has increased collaboration and positively impacted the project or the work at the Trust?
The administrative co-ordinators recruited to support the Frailty VW now actively participate in the Big Room. The Frailty ACPs have learnt more about the level of care that can be provided in the community from the conversations. The Frailty ACPs have spent time shadowing the community matron’s and equally the community matrons have spent time in the acute space.
Helen Chapman
If I think back to the first SOP writing which started in the Big Room and then moved into a focused group. The speed with which the more recent SOPs came together reflects the relationships built in the Big Rooms.
Helen Wear
Q. What challenges do you think the big room has enabled the project to overcome?
The Big Room has supported a PDSA approach to this service development facilitating small tests of change and sharing feedback to make improvements. I would like to think that the space is enabling a greater understanding of risk management in the community setting hopefully increasing the confidence of acute colleagues in the complex care that can be provided at home and therefore supporting this development. Observing the room really highlights the differences between the two worlds and the journey we need to go on together. I also believe that having a project team working alongside the Big Room has been vital for providing rigour, governance, and support in designing this service in a timely way.
Helen Chapman
It’s been a space for feedback where all teams can come together to overcome challenges together, evaluate what has been going well and why things didn’t work. Having everyone together to talk about the whole patient pathway has been effective, it’s also brought to life the patient’s perspective. Hearing from the matrons that the patients were doing so much better when at home, is really nice.
Helen Wear
Q. Tell us about the achievements of the project to date and the aspects you are most proud of?
Six months ago we didn’t have a virtual ward service, we now have a service that is regularly admitting patients and for many of them it is working out brilliantly. Having an alternative pathway that avoids them being admitted to hospital is what they want.
We’ve expanded the ‘step down’ service from frailty to other base wards and into weekends. We’ve also begun a ‘step up’ service and a solution for community IV’s is ready to be trialled.
We’ve recognised that setting up this service to be sustainable is hard, but our collaborative approach and processes are working, and although we’ve had teething issues, by and large it’s been pretty smooth. There are plans to expand and grow, and for that I am proud of everyone involved.
Helen Wear
I agree with Helen and would add that it’s the teamwork that I’ve seen that is brilliant. I have observed a growing understanding of each other’s roles, and a collective enthusiasm from everyone to make it work as they all understand it’s the right thing for the patients.
Q. Are there any Top Tips or words of wisdom you would share with others involved in Virtual Ward development?
Open and effective communication between the acute and community teams is vital. If you don’t create the space to talk to one another then the project is destined to fail. I would suggest making this a priority from the earliest point in the project, we worked really hard on this in the Big Room and benefitted from this investment in time.
Helen Wear
I would agree, if you don’t get communication right, you would forever have two camps: acute and community and a lack of understanding between them.
Helen Chapman
I would just add, learn from others. I have borrowed or taken so many ideas and documents from others developing their services, this has been very helpful. I have observed a real willingness to share, so ask for help from other trusts if you need it and don’t reinvent the wheel.
Helen Wear
The FCA would like to thank both Helen Wear and Helen Chapman for their time in creating this article. We hope you agree it’s been a fascinating look inside the Frailty Virtual Big Room. We will be sharing more updates on the progress of this project over the coming months so to make sure you don’t miss out on the next instalment sign up to our newsletter below.
Catch up on previous Frailty Virtual Ward stories.
Related resources
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Frailty Virtual Wards from an Acute & Community care perspective
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