Trisha Greenhalgh|Sara Shaw|Joseph Wherton|Shanti Vijayaraghavan|Joanne Morris|Satya Bhattacharya|Philippa Hanson|Desirée Campbell-Richards|Seendy Ramoutar|Anna Collard|Isabel Hodkinson
Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study
University of Oxford|University of Oxford|University of Oxford|Barts Health NHS Trust|Barts Health NHS Trust|Barts Health NHS Trust|Barts Health NHS Trust|Barts Health NHS Trust|Barts Health NHS Trust|Barts Health NHS Trust|London Borough of Tower Hamlets
background much interest virtual consultations using video technology randomized controlled trials shown video consultations acceptable safe effective selected conditions circumstances however model rarely mainstreamed sustained realworld settings objective study sought 1 define good practice inform implementation video outpatient consultations 2 generate transferable knowledge challenges scaling routinizing service model methods multilevel mixedmethod study skype video consultations micro level embedded organizational case study meso level taking account national context wider influences macro level study followed introduction video outpatient consultations three clinical services diabetes diabetes antenatal cancer surgery national health service trust covering three hospitals london united kingdom data sources included 36 nationallevel stakeholders exploratory semistructured interviews longitudinal organizational ethnography 300 hours observations 24 staff interviews 30 videotaped remote consultations 17 audiotaped facetoface consultations national local documents qualitative data analyzed using sociotechnical change theories addressed staff patient experience organizational system drivers quantitative data analyzed via descriptive statistics included uptake video consultations staff patients microcategorization different kinds talk using roter interaction analysis system results clinical technical practical preconditions met video consultations appeared safe popular patients staff compared facetoface consultations similar conditions video consultations slightly shorter patients slightly talking parties sometimes needed make explicit things typically remained implicit traditional encounter video consultations appeared work better clinician patient already knew trusted clinicians used skype adaptively respond patient requests ad hoc encounters way appeared strengthen supported selfmanagement reality establishing video outpatient services busy financially stretched acute hospital setting proved complex timeconsuming originally anticipated end study 2 22 consultations undertaken remotely participating clinicians remainder clinicians chose participate video consultations considered impractical technically unachievable clinically inadvisable technical challenges typically minor potentially prohibitive conclusions video outpatient consultations appear safe effective convenient patients situations participating clinicians judge clinically appropriate situations fraction overall clinic workload technological innovations clinicians adopt readily whereas others need incentives support complex challenges embedding video consultation services within routine practice organizations hesitant change especially times austerity