The impact of virtual and face to face patient consultations in MSK clinics on clinician perception of clinician consistency

Abstract

Keywords: Clinician consistency; Clinician perception; Therapeutic alliance Purpose: Best practice guidance acknowledges that clinician consistency has a positive impact on therapeutic alliance (TA) and patient clinical outcome. With the rapid implementation of virtual consultations throughout the Covid-19 pandemic, developing and maintaining TA through clinician consistency has been a new challenge for clinicians. Purpose: While face to face assessment and treatment of MSK patients was limited due to Covid-19 social restrictions, this provided the opportunity to complete a Quality Improvement (QI) project with the purpose of exploring the impact of virtual consultations on clinician consistency and hence TA, develop clinical and operational pathways to support clinician consistency and engrain some lessons learnt when returning to a “Back to Better” model of MSK working post Covid-19. Methods: To establish a baseline perception of clinician consistency with the use of virtual patient consultations, a survey was sent to all clinical and administrative staff. The Model of Improvement methodology was utilised and two cycles completed whereby the survey was repeated six-weekly to inform iteration of the next cycle. The key interventions within these two cycles to enhance clinician consistency, were to devise and implement clinical and operational pathways. This included a standardised process of clinician documentation for the administrative staff to identify a specific timeframe for patient follow up, stipulating the appropriate clinician to ensure “Making Every Contact Count” (MECC) principles and enhancing patient choice on the consultation type i.e. virtual or face to face. Results: After 2 cycles (12 weeks) of using enhanced clinical and operational pathways to support clinician consistency, the clinician surveys demonstrated that 23% of clinical staff perceived an improvement in clinician consistency. Additionally, there was a 29% reduction in negative impact of cross reviews on personal workload, with a 33% increase in appropriate use of cross reviews as clinically indicated. This resulted in a 20% reduction in negative impact on quality of patient care. Conclusion(s): This Quality Improvement project has highlighted that utilising virtual consultations can negatively impact clinicians perception of clinician consistency. However, through installing clinical and operational pathways to enhance clinician consistency, while maintaining MECC principles, positive impact on clinician perception can be demonstrated within 12 weeks. Impact: This Quality Improvement project on clinician consistency has impacted clinical and operational pathways to ensure appropriate use of clinician consistency. This has a positive impact not only on clinician perception but also on creating a therapeutic alliance between therapist and patient. With these clinical and operational pathways now embedded in our clinical practice, the Croydon MSK department is moving towards “blended” clinics where all patients have the choice of consultation type whether that is telephone, video or face to face. This encourages patient choice and engagement throughout their MSK pathway. Funding acknowledgements: No funding required.