Tackling digital exclusion on the ground

Amrit Sehmi, Advanced Orthoptist at Moorfields Eye Hospital and Darzi Fellow, shares how she is focusing her Fellowship on understanding the extent of digital exclusion in the organisation and identifying potential solutions.

I have been working at Moorfields Eye Hospital as an Orthoptist for almost 12 years and I thoroughly enjoy being a clinician and helping patients. During my career as an Orthoptist, I have taken two routes; teaching and clinical leadership. Until recently, I never thought I would go into clinical leadership, however, a previous role leading paediatric services at satellite sites helped me realise that I was capable. One thing that I enjoy about clinical leadership is the ability to influence change that will directly benefit patients. As a sole clinician, you sometimes do not get this opportunity. As such, I was really excited when I was given the opportunity to take on the Darzi Fellowship last year.

The challenge

The Darzi fellowship involves being given a difficult challenge to solve as well as studying for a postgraduate certification in Leadership in Health. The challenge I have been given is to understand the true extent of digital exclusion in our patients and staff, so that we can build on digital inclusion.

The use of video consultations was scaled urgently due to the Covid-19 pandemic. This has been sustained at Moorfields and I was interested in looking into reasons why patients are unable to, or don’t want to, accept a video consultation, with the aim of learning how we could make this more inclusive for all. With regards to staff, I was interested in understanding the daily challenges they experienced in using digital technology and platforms, in order to identify potential solutions.

Gathering data

I started by conducting in-depth interviews with patients and staff to gather rich data. These interviews were effective in establishing the real concerns and struggles that patients experience when using video consultation services. As well as a lack of digital resources or skills, the majority of patients expressed a lack of trust in having a remote consultation: “I would be concerned how you would assess my eyes”; “I feel that I would not be given enough time to express myself”; “I feel that video consultations are a way for clinicians to do less work. I would need more information about the pathway if you want to offer me one”.

In addition to these interviews, I analysed data from the past year of patients who had cancelled their video consultation appointment. Over this one-year period, 12,763 video consultations were undertaken at Moorfields Eye Hospital. 5% (659) of appointments were cancelled by patients. Of these, 13% (86 patients) were digitally excluded. Digital exclusion was due to three main factors: lack of resources (52%), lack of skills (21%), lack of trust in the video consultation model (16%), or a combination of these factors (10%). This data analysis does not include video consults from the A&E service as this is an optional service and therefore those who are digitally excluded are likely to not opt in for a video consult and would attend face-to-face.

To understand digital exclusion in our staff at Moorfields, I also undertook in-depth interviews with colleagues. Not only did common themes quickly emerge but  colleagues also commented on how they felt pleased they were “being listened to” and confident that their comments would be heard.

From early in the fellowship, I found other people in the organisation who were keen to work with me on the project and offer their time to support. The patient engagement manager and his team have provided support and even helped conduct interviews. I have also been working with our communications team to work on creating a digitally inclusive environment for our staff.

The conclusions

From this, it was clear that we needed to tackle lack of resource and lack of trust. The need to improve education about video consultation was clear, to instil trust in our patients, ensure they understood the value and understood how it would fit into the pathway of their care. Currently, we are working on developing explanation videos and promoting video consultations around the hospital and on social media.

To tackle the lack of digital resources, we came to the concept of Virtual Pods, a place where patients could come and access the resources to be able to attend a video consultation. This would be supported by our own volunteers at Moorfields, who are digitally trained and could support patients log on. This is currently in the pilot phase, so we can test if the concept works and will be used by patients. If the pilot is successful, the aim will be to roll this out to our satellite sites and possibly into the community.

Looking to the future

My journey on the Darzi fellowship so far has been a new experience; I’ve learnt new skills and developed my clinical leadership capabilities. As someone who has been part of Moorfields Eye Hospital for a long time, it has been a great opportunity to understand how the organisation works on a much larger scale and also develop relationships with others within the organisation. I am lucky that my sponsor, Rashmi Mathew, has been an amazing mentor throughout the process so far and is helping navigate me not only through the fellowship, but also in the next steps of my professional development. I am hoping to continue working in a similar context in a hybrid role while also running some clinical sessions.

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