Adoption and implementation of virtual wards in Integrated Care Systems in England: A qualitative exploration of the views and experiences of Integrated Care System commissioners
Laura McGowan, Fiona Graham, Jan Lecouturier, Louis Goffe, Falko Sniehotta, Mike Kelly,
Avoidable hospital admissions and prolonged in-patient stays cause patients distress, limit hospital bed capacity and are costly to the NHS. Older people and those from socio-disadvantaged areas are at greater risk of avoidable emergency admissions. The emergence of COVID-19 has brought new urgency to the adoption of strategies that increase hospital bed capacity and reduce risk of hospital infections. Virtual wards are being introduced in England as a way new of delivering care to patients that would otherwise be in hospital. Using digital technologies, patients are able to receive acute care, remote monitoring and treatment in their own home or care homes. Virtual wards have been adopted and introduced in different ways in both primary and secondary care settings. Virtual wards have most commonly been introduced for people with acute respiratory infections, including COVID-19, and people living with frailty. These virtual wards are commonly known as hospital at home (NHS England, 2022). Newly formed integrated care systems (ICSs) in England have been tasked with developing detailed plans on how they intend to move from current practice to using tech-enabled virtual wards. These plans are to be based on partnerships between secondary, community, primary and mental health services. ICS commissioners have an important role in the development and implementation and effective adoption of this new model of care in clinical settings.
The overall aim of this research is to develop an understanding of the acceptability and feasibility of adoption and implementation of virtual wards in England from commissioners’ perspectives. Objectives
Specific objectives are:
- To identify and characterise the adoptions and implementation processes of tech-enabled virtual wards.
- To identify barriers and facilitators to the adoption of tech enabled virtual wards.
- To identify what support is needed to aid the adoption of tech-enabled virtual wards by ICSs.
- To explore what implications virtual wards have for health inequalities and how potential negative impacts have been identified and adverse risks mitigated.
- To identify research priorities and next step.
This study will have a longitudinal qualitative design, using elements of rapid qualitative inquiry (RQI) (Beebe, 2014). One-to-one, semi-structured interviews will be conducted with ICS commissioners via an online platform (e.g. Teams) or over the phone. Data analysis will involve two main stages. In the initial stage, interviewers will document key findings during the interviews using rapid appraisal procedure sheets as per the RQI method, which will be discussed as a team to identify key themes emerging from the data. These key findings will be shared with stakeholders (e.g. contacts at NHS England). In the second stage, interview transcripts will be analysed thematically using the Framework approach (Gale et al., 2013; Ritchie & Spencer, 1994). The analysis will involve both inductive (i.e. data-driven) and deductive (i.e. theory-driven) processes, using the CFIR (Damschroder et al., 2009) to guide coding and analysis.
Data will be collected at two time points, six months apart. This will enable the exploration of how the adoption and implementation processes evolve over time – what is working well and not so well and whether additional support is needed.