Fiona Fraser Project Lead - RRHEAL Remote Participation Rethinking efficient, engaging and accessible education; The utility of video conferencing (VC) increasing reach and inclusion Fiona Fraser Project Lead - RRHEAL

Context Scotland - 20% population live across 94% of remote and rural landscape Challenging – service delivery + staff support Drive for service re-design, new roles & ways of working Cultural shift with change Innovation required –improve quality and reduce cost Policy directive Delivering for Remote and Rural Healthcare (2008) “access, rural specific content and support for remote and rural learners .....key issues to be addressed” RRHEAL “Working with partners to design and deliver NES remote and rural inclusive learning events and programmes that make effective use of digital technology to improve access for the rural nursing and healthcare workforce.” develops and delivers practical, structured educational resources and networks. 

Global health workforce crisis Skill mix imbalance Uneven distribution 2011 WHO Publications Global health workforce crisis Skill mix imbalance Uneven distribution (health professionals) The WHO report 2010 (4) compounds understanding of the link between accessible education and ability to recruit, maintain and retain remote health workers. Networking and peer support alongside CPD opportunities are attributed to having a positive impact. RRHEAL strategic engagement prioritised accessible education as a key need. Need more, but not more of same!

WHO 2010 Factors related to decisions to relocate to, stay in or leave rural and remote areas NES EQUALITY AND DIVERSITY PoLiCY INCLUDES geographical inclusion

Connectedness – impact on recruitment and retention Background An island Board sought help; Isolated, generalist mixed discipline health teams Dispersed island chain Need Increased access to “live” content Reduce cost and service impact of staff engagement Increase networking and peer to peer critical debate CPD opportunities Connectedness – impact on recruitment and retention   Educational engagement Some such isles are 320 miles+ from the nearest large town.

* Scotland Europe *

Intervention Initiate a RRHEAL Video Conferencing (VC) educational network specific to remote & rural/ islands teams: Pilot as proof of concept Standardised format enhancing remote participation and inclusion (Apply existing RRHEAL VC guidance) Monthly meetings/ audience self selecting Existing S L A for VC in NSH Scotland Focus on networked discussion & application to local best practice   Intervention Initiation of a VC educational network specifically for remote and islands teams   Following a successful pilot of a Northern Islands VC education programme for health and social care teams, RRHEAL progressed this network approach to include all remote and island Scottish NHS Boards and Partnerships. RRHEAL develop innovative approaches to inclusive and accessible networked education using VC, facilitating monthly meetings sharing contextually appropriate presentation/ discussion. Role modelled best practice regarding VC etiquette (RRHEAL VC guide (5) ) with provision of presented materials prior to engagement. The audience are self selecting. RRHEAL facilitate sessions, a subject expert presents Evidence Based Content, followed by networked discussion as a vehicle for both critical debate and local interrogation, broadening awareness across this networked audience. Utilisation of existing national Service Level Agreement for VC bridging service. Cost neutral and familiar engagement route to this end audience. Opportunity to share potential for applications of the (presented) content to local best practice is maximised. The National Video Conferencing Service has been established to provide a service desk and multisite conferencing facilities for all NHS Boards in Scotland. Services available include: telephone service desk available Monday to Friday, during office hours multisite bridge booking services, including links to internet based callers VC from desktop and mobile devices guidance on specific codes and etiquette remote support of endpoints and infrastructure In addition, RRHEAL has produced a VC education guide which provides a practical and straight forward guide to using VC for communication, training, teaching and learning. The guide is aimed at both new and existing users of VC and provides guidance on standardised procedures, etiquette and the wider potential of this medium. The guide includes; a comprehensive learning pack on VC a quick start guide easy to use checklists for booking, setting up and chairing a VC session. VC education full and ‘quick start’ guides

RRHEAL VC Education Network – topics Falls update Technology enabled care Early recognition of the sick child: A skills maintenance tool & paediatric early warning system The Children and Young Peoples Act 2014: key issues and implications The Technology Enabled Learning Analysis ScotSTAR Update_ Introduction to the service Stabilisation and management of the Critically Ill child prior to Transfer Apps for AHPs Seasonal / Winter illness focusing on Bronchiolitis and Croup Debriefing: The Essentials

Evaluation High audience appeal VC -greater potential for educational delivery inter-disciplinary support & networking knowledge exchange and cultural shift Demand for **MORE**/ higher specificity Challenges broadband and connectivity Presenter preparation Pitch/ level of content delivery VC Education networks with enhanced knowledge support showing favourable feedback+++ Presenters with VC skill & remote and rural awareness Further VC educational networks; RRHEAL Rural paediatric specific content Rural GP “Test for change” Rural General Hospital + + + “Off shoot” developments . Evaluation  Note –increasing numbers of presenters previously unfamiliar with use of VC for presenting and leading educational debate, now with support, developing skills with this format and uptake/ spread across their “home” organisations. This has resulted in at least 3 “off shoot” VC educational programmes, fostering greater opportunity for inclusive educational engagement. One such VC network with enhanced knowledge support is showing very favourable feedback and audience satisfaction Summary Positive feedback and evaluation supports growing interest in this accessible format. The audience generally familiar with VC with many presenters becoming so as a result of engagement, increasing skill for delivery via this medium in future. Note Impact on presenters VC -increasing demand, to access previously hard to reach R&R teams Transferability – to other hard to reach audiences developing incrementally at scale

NHS Highland Diabetes Foot Education Network “The idea was to involve as many healthcare professionals as possible and deliver education relating to the diabetic foot. To show them what the guidelines are, where the guidelines are, and how to use them, using a case study approach; using patients known to us” “We can reach people in the ‘far reaches’ of NHS Highland who would struggle to engage otherwise.” Cumulative success and increasing audience engagement the model now better known - our recent survey of priority needs for the RGH network enjoyed v good returns- informing content delivery for some smaller boards this presented material and supported discussion now becoming a key component of mandatory/ required educational delivery and STAFF CDP

Take home messages: Prepare – consider workplace access to VC hardware and computers Include “work- arounds” for areas of reduced connectivity VC skill development and support Good organisation, technical support and VC facilitation is vital , with role modelled VC etiquette Speaker preparation crucial R&R audiences familiar with remote participation = supports presenters who may be less so Content - Application to remote and rural setting Target the audience, session by session Host site/ Repository Ability to record presented materials Consider alternate modes for delivery **High transferability to non remote, hard to reach audiences** Limited workplace access to computers/ VC is restricting engagement for some. Robust facilitation crucial and support enhances confidence and familiarity/ engagement Reduced connectivity/ bandwidth can be very testing for those in most remote locations, whom often stand to gain considerably by such at distance participation Challenging to deliver broad based content to a mixed discipline, self selecting audience. Taxing to anticipate engagement, varying from theme to theme with this self selecting audience. However, with facilitation and support - rich debate developing with mixed discipline staff Audience very familiar with remote engagement, whereas the subject expert speakers sometimes less so. Preparation of presenters for at distance engagement crucial alongside appreciation of remote and islands contexts in relation to their subject speciality. Evaluation supports greater use of this mode of delivery for educational enrichment This model highly transferable to other non remote, hard to reach audiences Limited workplace access to computers/ VC restricting engagement so prepare and anticipate audience need/ staff clusters Reduced connectivity/ bandwidth challenging – work arounds necessary Challenging to deliver broad based content to a mixed discipline, self selecting audience. Taxing to anticipate engagement, varying from theme to theme with this self selecting audience. Robust facilitation and support enhances confidence and familiarity/ engagement R&R audiences very familiar with remote participation, which support presenters who may be less so Speaker preparation crucial with separate facilitator support High transferability to non remote, hard to reach audiences

Thank you www.rrheal.scot.nhs.uk

The professions of the 122 participants whose profession was known, is shown in Figure 2