BackgroundThe COVID-19 outbreak has placed the National Health Service under significant strain. Social distancing measures were introduced in the UK in March 2020 and virtual consultations (via telephone or video call) were identified as a potential alternative to face-to-face consultations at this time.Local problemThe Royal National Orthopaedic Hospital (RNOH) sees on average 11 200 face-to-face consultations a month. On average 7% of these are delivered virtually via telephone. In response to the COVID-19 crisis, the RNOH set a target of reducing face-to-face consultations to 20% of all outpatient attendances. This report outlines a quality improvement initiative to rapidly implement virtual consultations at the RNOH.MethodsThe COVID-19 Action Team, a multidisciplinary group of healthcare professionals, was assembled to support the implementation of virtual clinics. The Institute for Healthcare Improvement approach to quality improvement was followed using the Plan-Do-Study-Act (PDSA) cycle. A process of enablement, process redesign, delivery support and evaluation were carried out, underpinned by Improvement principles.ResultsFollowing the target of 80% virtual consultations being set, 87% of consultations were delivered virtually during the first 6 weeks. Satisfaction scores were high for virtual consultations (90/100 for patients and 78/100 for clinicians); however, outside of the COVID-19 pandemic, video consultations would be preferred less than 50% of the time. Information to support the future redesign of outpatient services was collected.ConclusionsThis report demonstrates that virtual consultations can be rapidly implemented in response to COVID-19 and that they are largely acceptable. Further initiatives are required to support clinically appropriate and acceptable virtual consultations beyond COVID-19.RegistrationThis project was submitted to the RNOH’s Project Evaluation Panel and was classified as a service evaluation on 12 March 2020 (ref: SE20.09).

Background Normalisation Process Theory (NPT) is frequently used to inform qualitative research that aims to explain and evaluate processes that shape late-stage translation of innovations in the organisation and delivery of healthcare. A coding manual for qualitative researchers using NPT will facilitate transparent data analysis processes and will also reduce the cognitive and practical burden on researchers. Objectives (a) To simplify the theory for the user. (b) To describe the purposes, methods of development, and potential application of a coding manual that translates normalisation process theory (NPT) into an easily usable framework for qualitative analysis. (c) To present an NPT coding manual that is ready for use. Method Qualitative content analysis of papers and chapters that developed normalisation process theory, selection and structuring of theory constructs, and testing constructs against interview data and published empirical studies using NPT. Results A coding manual for NPT was developed. It consists of 12 primary NPT constructs and conforms to the Context-Mechanism-Outcome configuration of realist evaluation studies. Contexts are defined as settings in which implementation work is done, in which strategic intentions, adaptive execution, negotiating capability, and reframing organisational logics are enacted. Mechanisms are defined as the work that people do when they participate in implementation processes and include coherence-building, cognitive participation, collective action, and reflexive monitoring. Outcomes are defined as effects that make visible how things change as implementation processes proceed and include intervention mobilisation, normative restructuring, relational restructuring, and sustainment. Conclusion The coding manual is ready to use and performs three important tasks. It consolidates several iterations of theory development, makes the application of NPT simpler for the user, and links NPT constructs to realist evaluation methods. The coding manual forms the core of a translational framework for implementation research and evaluation.

BackgroundPainful shoulders pose a substantial socioeconomic burden accounting for 2.4% of all primary care consultations in the UK. There is a strong evidence to indicate that the majority of this shoulder pain can be managed successfully with exercise based treatments and that common surgical procedures provide no extra benefit. Patient adherence and engagement is cited as an important factor in gaining positive outcomes.The MUJO System has been designed to help target the rehabilitation of the rotator cuff muscles which are commonly recommended for the management of shoulder pain. The purpose of this qualitative study was to evaluate the acceptability of the MUJO System amongst clinicians and patients.MethodsA qualitative study was undertaken to look at the usability of the MUJO System both from clinicians’ and patients’ perspectives. Patients with shoulder problems were identified by an experienced physiotherapist using the study eligibility criteria. and invited to participate. Semi-structured interviews were performed with patients and clinicians to explore factors surrounding its acceptability and feasibility of use. The study was designed using Normalisation Process Theory as a theoretical basis for the inquiry.ResultsSeven physiotherapists and ten patients were interviewed in the study. The Internal and External Devices were seen as having the potential to rehabilitate the rotator cuff however it posed limitations towards more functional based exercises. Patients and clinicians found the visual feedback from the Patient App enhanced the rehabilitation experience. The Internal and External Devices were acceptable to all for rehabilitation providing the devices were available for use by the patients in the community.ConclusionPatients and clinicians found the MUJO System acceptable as a modality to perform shoulder exercises. For the MUJO System to be taken up as a routine part of clinical practice patients need to be able to access the devices in the community. For the MUJO System to be taken up in clinical practice it needs to be workable within the context of the treatment pathway and not interfere with standard processes.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2042-6) contains supplementary material, which is available to authorized users.

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