New guidance1 for Integrated Care Systems (ICSs) aims for each ICS to deliver up to 24,000 virtual ward beds by December 2023. The targets set out by NHS England and NHS Improvement are ambitious with a recent article2 suggesting that only 80 virtual wards exist across 51 NHS trusts at the moment. The question for many ICSs will be where to start.
Our experience delivering tech-enabled virtual wards across NHS primary and secondary care has left us with valuable insights into what it takes to succeed. Watch our webinar on designing virtual wards on demand to find out discuss how to set up your virtual wards service for success, and read some of our top tips below.
1. Create the right team
Virtual wards can present a significant change to long-established ways of working. This is particularly challenging in large, complex organisations such as hospitals where change can be slow and incremental. Therefore, to build efficient, successful and sustainable virtual ward services, you must ensure buy-in from all relevant stakeholders early on.
Identifying the key individuals and departments that need to be involved in setting up a virtual ward can be difficult. Delivering virtual ward projects depends on creating the right teams and identifying and involving relevant individuals early in the process to avoid hold-ups further down the line.
Senior personnel, from both the clinical and operational sides, that need to be involved when planning to launch a virtual ward include:
- Chief Executive Officer
- Transformation Leads
- Chief Clinical Information Officers (CCIOs)
- Chief Nursing Information Officers (CNIOs)
- Clinical Directors
- Lead consultants and clinical nurse specialists (CNSs) for the services implementing the virtual wards
2. Define your goal
You need to know what you’re trying to achieve from the start if you want to know whether your virtual ward is a success. Each project should have a clear goal, whether it’s to avoid acute admissions, improve specific clinical outcomes, or support early discharge.
Normally the project goal will be determined by the project owner, who is often a senior manager or clinician, but its value should be clear to all stakeholders and address a genuine pain point. Without this, clinicians responsible for managing the virtual wards may become disengaged, seeing the project as an additional burden being forced upon them. Whilst senior management and clinicians might decide to prioritise different metrics or outcomes based on their own needs, everyone must support the overarching objective of the project.
3. Scope time and resource requirements
Once you have your goal you need to understand and be realistic about what is necessary to deliver the project. Developing a robust plan with relevant stakeholders, and setting up an appropriate governance structure and project management team takes time, but is essential for your service to be a success. These steps also require input from people inside the organisation who understand it best.
Project teams can include existing clinical, transformation and project management teams, but additional resources may be required. Our experience working with over 20 NHS sites allows us to provide realistic expectations on time and resource requirements for each project. Internal staff may have competing demands or a lack of experience in remote patient monitoring, meaning that external resources are sometimes required to staff virtual wards. By partnering with leading external nursing agencies we can advise clients and take action if capacity or skills gaps are anticipated.
4. Design a virtual ward that draws on existing services
Virtual wards should be designed to meet the needs of the hospitals, trusts and clinical teams involved and, most of all, the patients under their care. A successful virtual ward project requires a discovery and planning phase before jumping into the rollout. A large part of that discovery phase should be spent understanding what services already exist and figuring out how best to leverage and enhance them, not necessarily re-design them.
Including someone familiar with existing services in the design process is critical to ensuring that virtual wards fit within, and harness, what is already being done well. Experienced specialist nurses are typically best suited to help with this part of the design process as they are the people most familiar with both inpatient and outpatient services for their speciality.
5. Before going live make a plan to evaluate success
To know whether the virtual ward is delivering what was intended you must put a clear evaluation and evidence generation strategy in place before going live. It’s essential to understand what metrics you will need to capture, how you will measure them, and how often. These metrics should be built into the service design with feedback loops so you’re able to learn and improve throughout the project, not just at the end. The domains of evidence generation that we focus on include clinical capacity and productivity, clinical outcomes, patient experience, and impact on resources and workflows.
For example, assessing whether virtual wards had an impact on clinical capacity might rely on knowing the average length of stay, or readmission rates and waiting times, whereas qualitative interviews and surveys would give a better understanding of the impact on patient engagement and satisfaction. If you don’t plan for evaluation, and ensure you have the relevant historical or baseline data to make comparisons, it will be hard to evidence and evaluate whether the virtual ward service has been a success.
- NHS England 2022, Supporting information for ICS leads: Enablers for success: virtual wards including hospital at home [Online] Available at: https://www.england.nhs.uk/publication/enablers-for-success-virtual-wards/ [Accessed 3 May 2022]
- Illman J 2022, NHS will not hit virtual wards target, internal data suggests, Health Service Journal [Online] Available at: https://www.hsj.co.uk/quality-and-performance/nhs-will-not-hit-virtual-wards-target-internal-data-suggests/7032539.article [Accessed 12 July 2022]