Barnsley Hospital improves patient and clinician experience with Microsoft Teams

In a healthcare system under pressure with funding, grappling with strike action, adapting to the pressures of demographic change and still recovering from the pandemic, digitalisation offers opportunities to use constrained resources ever-more efficiently. 

At Barnsley Hospital NHS Foundation Trust, Microsoft technologies have been intelligently deployed to build a digital platform which will help the trust to meet the challenges of twenty-first century healthcare.

A better solution for the long term

During the COVID-19 pandemic lockdowns, the Trust rolled out Microsoft Teams very quickly to staff to aid remote working and collaboration. Over this period, the IT team relied on Teams to successfully rollout a new electronic patient records (EPR) system, completed entirely remotely over Teams.

Alongside this, however, a different solution was being used to enable virtual patient consultations and appointments. While it helped the Trust to meet the urgent need during the pandemic, the system was clunky, required a lot of manual rekeying and wasn’t very patient-friendly. 

Richard Billam, Deputy Director of ICT at Barnsley Hospital NHS Foundation Trust, saw the need for a better solution that would enable an improved patient and clinician experience.

Learning from local partners

Barnsley Hospital NHS Foundation Trust is closely linked with three local NHS teaching hospitals. As the Trust began exploring what was possible, Richard Billam was introduced to a virtual consultation system being used at the local partner teaching hospital in Rotherham. 

The digital health platform was created by a Microsoft Partner and is developed and hosted on Microsoft Azure and utilises standard Microsoft services and technologies wherever possible to ensure best-in-class capabilities, simplified support, assured ongoing development and a seamless user experience. This includes leveraging Microsoft Teams for virtual consultations and appointments.

Richard Billam was cognizant that the Trust’s clinicians were already dealing with a very difficult environment. Clinicians had accepted a great deal of change through the pandemic, including the rollout of the new EPR system. Choosing a familiar, intuitive, integrated and easy-to-use solution would be absolutely crucial to assure user acceptance. 

Intuitive and familiar 

As well as offering seamless integration with the new EPR system, importantly, the new platform would give clinicians a familiar Teams environment, boosting user acceptance and reducing onboarding time and effort. This was important to the IT team, who wanted to minimise change and disruption for clinical staff.

“Our clinicians were very clear that they didn’t want to spend time rekeying things. They didn’t want to have to log in to different systems. And they didn’t want to use a different platform,” explains Richard Billam. “Everybody in the Trust uses Microsoft Teams every day. They’re always logged into it and it’s not a new platform to them. They like it.”

Microsoft Teams also offers improved audio and visual quality. Richard Billam adds, “The video quality is far superior using Teams and that’s very important in a clinical context.”

In addition, using Microsoft Teams has simplified the patient experience. Richard Billam says, “I love that patients can access their consultations on any device with just a web browser. There is zero cost of entry there. That is so powerful.” 

Trialled by the speech and language therapy team

The Speech And Language Therapy (SLT) team was chosen as the first service to adopt the new platform.

Richard Billam explains, “The SLT team had expressed an interest in becoming a digital service – not just in terms of video consultations but in terms of becoming paperless and driving improvement and efficiencies by using integrated digital solutions.”

Since implementing new systems requires commitment from service users, the IT team at Barnsley worked with two service champions – a physiotherapy practitioner, Elizabeth Cook, who was less tech-confident and a service lead, Dawn Walton, Physiotherapy Service Manager. They both found it very easy get started and to use the Teams-based solution. 

Together, they provided a great deal of useful feedback about the clinician and patient experience. Their input into the service was taken with the view from the patient and the clinicians on a day-to-day basis which enabled Barnsley to make further enhancements and improve the experience in a more agile way.

Small tweaks can have a big impact

“The engagement has been really good,” says Richard Billam. “Clinician feedback has been fundamental to us understanding where the patients get stuck, so we can simplify the patient experience.”

Perhaps counterintuitively, one such improvement driven by patient feedback was based on removing choice. Barnsley Hospital initially offered the choice to patients to connect via the Teams app or via a web browser. After realising that this choice was adding unnecessary complexity, Barnsley Hospital moved to a browser-only experience to simplify the user experience.

Richard Billam explains, “It helps the clinicians because they know exactly what the patient is seeing. We don’t have to worry about install messages or redirections to corporate accounts. The patients have a really simplified experience and there aren’t any complications. Through user feedback we’ve seen how small decisions like this can have a big impact.” 

The advantages of video consultations

“Lost slots are a huge problem for the hospital,” says Richard Billam. “Any ‘did not attend’ causes issues. Video has a big advantage here. If someone is already set up as video-ready, we can offer them a slot at short notice. I have received real-world feedback from clinicians who had patients on the line crying because they were going to miss their appointment. That’s a situation where video really helps and it’s really common. To be able to offer to do it on video on the fly – it’s a great thing.” 

What’s more, if a patient is struggling to attend a remote consultation via Teams, the clinician can make a telephone call in one click directly from the system via Azure Communication Services. Richard Billam states, “That’s really seamless and another improvement that has been driven by direct clinician feedback.”

“Video appointments are also great for giving rapid assurance. I spoke with a patient recently who was referred for something potentially life threatening. She would have found it difficult to carve out the time to attend. Having a video appointment gave her the reassurance she sought much faster,” Richard Billam continues. “And for the patients, there’s a cost-of-living advantage too: visiting the hospital is not cheap – you have to arrange time off, there are transport and parking costs.” 

Accessibility is especially important to SLT

The NHS target is to have 25 percent of consultations as virtual. While telephone is included within this number, the Barnsley Hospital team want to ensure virtual appointments are typically much more engaging than that. 

At the same time, they are conscious to address the issues around digital inclusivity and the health inequalities for those without access to technology.

Richard explains, “We make it very clear that virtual isn’t appropriate for every appointment, every clinician, or every patient. If you are going to book a video appointment, that must be an informed choice for the patient and the clinician. If you don’t do this, there’s a disconnect and some of those appointments will fail. It’s essential that the patient is well informed.”

The appropriateness of the solution also depends on the activity and the type of consultation. Dawn Walton explains, “Our SLT team use the video consultation to reduce the face-to-face time. In contrast, our physiotherapists can use the platform for a full consult instead of a face-to-face. This is particularly helpful because we have space constraints. It means our space utilisation can be more effective.” 

Improved clinician experience

“We’ve had great feedback from the clinical staff,” says Richard Billam. “We spent a lot of time to understand not only why people wanted to do this, but also their fear factors.”

Major improvements have resulted from the close integration between the new platform and the EPR system. This enables an appointment to be created in the EPR and for it to appear automatically and immediately in Microsoft Teams. The clinician simply clicks to join the call; there is no rekeying. This saves a lot of time and eliminates a great deal of frustration when compared to what was previously in place.

“Our clinicians like Teams because of the familiarity and clarity,” reports Dawn Walton. “Plus, it saves time and hassle for the patient. We expect around 15 to 20 percent of our consultations to be virtual once the system is fully rolled out – when that happens there will be significant gains and time savings. I would definitely recommend the system.”

Helpful automations boost success rates

Automatic notifications are generated when an appointment is booked, an hour before it is due to start and when the meeting has started. The invitations include a link so the patient can test that it is working in advance. 

By leveraging the low-code and no-code capabilities of Microsoft Power Platform, including Power Apps and Power Automate, in conjunction with Azure Service Bus these automations can be delivered very quickly using proven technology.

“One of the big draws of this is how we’ve been able to replicate the waiting room experience in Microsoft Teams,” says Richard Billam. “If the patient isn’t there, the clinician can move on to the next patient. Then they can keep going back to the patient when they do attend. The clinician can see and understand the waiting room and they don’t need to waste time keying emails.”

Dashboards and reporting based on Microsoft Power BI give the IT team visibility of what has happened, making it easy to diagnose and resolve problems. Richard Billam explains, “We can see where patients go on their journey. Did they click the link? What happened then? Eventually, we’ll publish these dashboards for service managers so they can see the results about how long calls are taking and other management information.” 

The foundation for continuing evolution

The Trust now plans to roll out the solution on a wider basis. Richard Billam explains, “Dietetics and the gastro team are already running some video appointments. We now want to roll it out fully. We think one area that will really benefit is our community paediatrics – if we can prevent sick children having to be wheeled around that will be beneficial.”

The platform offers opportunities to create further efficiencies. For example, in the IBD clinic, a gastro lead has identified the need to send surveys out to patients before the first appointment. 

Richard Billam explains, “Capturing necessary information beforehand would enable more of the consultation time to be dedicated to patient care and diagnosis, rather than information capturing and notetaking. We could see more patients without compromising the quality of care.”

On the platform, authorised users can use Microsoft Dynamics 365 Customer Voice as an easy, no-code way to create surveys. They can be associated with services and common workflows so, for example, they go out automatically before or after a certain type of consultation.

Because the platform leverages Microsoft technologies, it is easy to leverage the latest technologies, including Microsoft’s solutions for responsible AI. This includes dynamic translation during video calls and leveraging Azure Cognitive Services to summarise call transcriptions – solutions which will further enhance the patient experience and save a great deal of administrative time and effort.

Potential for re-use across the health service

The solution is running on the NHS national tenant and can be found on NHS App Source. This means it can be adopted by healthcare trusts which use the national tenant as easily and quickly as it can be adopted by those which don’t. Integrations with HL7 applications for seamless data sharing across systems can be delivered quickly. 

The team at Barnsley Hospital NHS Foundation Trust are happy to recommend the platform to other NHS Trusts. 

“The successful adoption of technology depends on overcoming any fears and we’ve been very focused on giving people the assurances they need. It doesn’t really matter what we say as IT people; it’s got to have clinical support,” recommends Richard Billam. “Our success has also depended on making sure the integration between our EPR and the video system is seamless. And on getting the basics right – making sure people have the right equipment and aren’t trying to make calls from shared spaces.”

“Nobody is suggesting that video is the right solution for every consultation,” Richard Billam concludes. “It’s just a great way to add volume and flexibility to your service.”