Attending hospital appointments is essential for patients to access the medical care they need to maintain and improve their health. Across North West London, individuals living in the most deprived areas and from ethnic minority groups face a variety of barriers to attending outpatient appointments at Imperial College Healthcare NHS Trust. The focus of this collaborative project between IGHI’s Helix Centre and the Trust was to understand why people miss their appointments and to co-design solutions with community members that help them to attend.
Going to the first outpatient appointment can help prevent a chain reaction of health inequity. By attending diagnostic appointments (such as scans), individuals help to ensure timely diagnoses and interventions, which can lead to better health outcomes and more effective treatment and management of their conditions. Trust data showed that people living in the most deprived areas of North West London or people part of a Black, Mixed or Other ethnic groups are more likely to miss their outpatient appointment. In this project, we worked with local community members throughout the project, who were linked to these groups, to ensure the project and any intervention were designed appropriately.
Meet one of the Public Steering Group members
“My name is Phayza and I am a community member involved with Imperial College and as part of the Strategic Lay Forum at Imperial College Healthcare NHS Trust. I was one of the eight people recruited to the Public Steering Group, bringing together diverse voices to shape the project.
“As someone deeply involved in community development and public health promotion, I was eager to contribute my insights to this initiative. My background gave me a unique perspective on the systemic issues faced by minority and disadvantaged populations in accessing healthcare. This opportunity was not just a professional duty but a personal mission to amplify the voices of those often unheard.” – Phayza, Public Steering Group member
Phayza (left-hand side) and other community members at one of the co-design workshops
Gathering insights from people who had missed appointments
The Helix Centre team interviewed over 25 patients who had missed appointments in several clinical specialtiesand staff to understand why people could not attend. Through these interviews, we learned thatvarious factors contribute to why someone might miss an appointment, including caring responsibilities, work responsibilities, travel difficulties, distrust with the NHS and communication issues (such as not receiving appointment details via text or letter). We are sharing these findings as widely as possible with relevant groups. The Helix team shared the barriers back to Trust staff to ensure that they were aware of the issues faced by their patients. We recently published an academic paper outlining the barriers, co-author by a Public Steering Group member, Chris. We also worked with the Public Steering Group to design a poster (below) that visually communicates the attendance barriers, which we are sharing with public members involved in the project and a wider audience.
Moving from barriers to solutions
Poster titled ”What makes it harder for patients to attend hospital appointments?”. It visually depicts the seven barriers that public members highlighted and describes what Imperial College London has done with these learnings. Credits: Pip Batey
We ran three co-design workshops with local community members from groups facing inequity, to come up with ideas that address the barriers people face attending hospital appointments. We worked with the Public Steering Group to decide which barriers should be prioritised and brought to the workshops, along with reviewing the workshop materials to ensure they were engaging. The workshops were held in local community spaces that people were familiar with, for example the White City Community Centre. The Public Steering Group helped with recruitment for the workshops, by promoting it in local networks, such as the Black and Minority Ethnic Forum newsletter (which Phayza is linked to). A diverse range of people with different knowledge and experience participated alongside NHS staff, with everyone learning from each other. Of the 23 workshop attendees, 16 were from ethnic minority groups and 9 lived in the most deprived areas of North West London.
“What I liked most about the workshops was working together and being very listened to. I appreciated all the effort which had been put into them” – Workshop attendee
The workshops were a melting pot of ideas and experiences. Building on the barriers we heard from initial interviews, people shared and discussed the issues they and their family members had faced attending hospital appointments and proposed solutions. At the next workshop, we developed the ideas further and had to think about whether the idea was feasible. For the prioritised ideas, we further developed what they could look like and shared this back to the workshop attendees for their feedback.
Testing the final ideas in a research study
The ideas taken forward from the workshops address barriers around paying for transport, travelling to appointments and fear of attending appointments. The solutions we developed include extra message reminders sent to patients before their appointments, which connect them to clearly designed web pages with information about how to get to their appointment, whether they’re eligible for travel cost reimbursement or what to expect at their appointment. We are testing these additional tailored reminders in a research study to see if they help people to attend their appointments and plan to roll out any successful changes across Imperial College Healthcare NHS Trust.
Highlighting the impact of public involvement
The Public Steering Group influenced the project throughout, from reviewing interview questions to co-designing the language used in the texts and websites sent to patients in the study. When we were planning the interviews, Mohamed (a member of the Public Steering Group) reviewed the interview guide and suggested that we might have more success with recruitment if we talk about the impact the study could have at the start of the conversation with the patient instead of at the end.
“By beginning with the wonderful impact the study could have that you have given in the end it may in my opinion give the researcher a soft landing and a willing-to-participate interviewee/patient.” – Mohamed, Public Steering Group member
When we were prioritising themes to take the workshop, the Public Steering Group raised transport as a critical barrier to attending hospital appointments, initially not prioritised by the team. This suggestion significantly shaped the project’s direction, resulting in several final interventions aimed at improving support around transport.
Another example of a key recommendation from the group, was to ensure that appointment reminders that are being sent as part of the research study include a phone number for patients to call if they have questions or need to reschedule their appointment. This simple addition ensures that people without access to digital tools can still manage their appointments effectively. Another suggestion was to soften the language in the study’s appointment reminders to adopt a more supportive tone that encourages patients to attend.
“We suggested to change the text message language to ‘Let’s make it easy for you to plan your journey’ to make it warm and supportive” – Phayza, Public Steering Group member
Unfortunately not all of the ideas generated from the workshops could be taken forward, such as having ‘community health navigators’ supporting people with rescheduling or attending their appointments. However, we shared all the ideas back to Imperial NHS Trust to see if they could be adopted in other projects, and the Trust are continuing to use the insights from the project as part of their work to improve outpatient experience for patients.
Learning from this approach
We came up with several ideas about how the approach could have been improved, and have applied these changes in more recent projects with Imperial College Healthcare NHS Trust. The team had organised paid childcare for one of the workshops which was during the half term school break, to allow parents to bring their children to the workshop. However, we could have also made this even clearer when advertising the workshops along with other supports that would help people to attend, such as carers or interpreters.
The Public Steering Group suggested that we recruit patients to interview by ringing them beforehand to schedule a call in advance, as opposed to asking to speak with them then and there. This new approach would have led to more in-depth conversations, as people could speak to us at a time that was convenient for them. We have used this method in another Trust project called Waiting Well, as well as offering the interviewee a choice of whether the interview is in-person (in a location chosen by the patient) or on the phone or on a video call.
“For the interviews and workshops, the team also could have utilised the Trust’s interpreting services so that we could hear from people who would prefer to speak other languages. I am pleased to hear that the team has taken forward all these ideas in other projects.” – Phayza,Public Steering Group member
Empowering community members to shape future initiatives
By involving community members from under-represented and under-served groups throughout the project, we helped to ensure the messages we are testing in our research study were appropriate and accessible.
We are still waiting on the results of the trial, which will be out later this year. We hope to see improvements in hospital appointment attendance, and if so, these interventions can be rolled out more widely at Imperial College Healthcare NHS Trust and beyond.
In February we hosted the Julia Anderson Training Programme (JATP) Careers Event 2024 at Institute of Global Health Innovation (IGHI), a fantastic evening for sixth form students to learn more about our Julia Anderson programme and the IGHI, and get inspired for their future careers.
Credit: Rolando Charles
Sixth formers from different London state-funded schools travelled to The Invention Rooms, at Imperial College London’s White City Campus, to participate in the event. They got the chance to learn more about the opportunities at IGHI, hear some of our staff members’ career journeys, as well as interact with some of the fantastic workstreams we work on to improve people’s health.
About the Julia Anderson Programme and next cohort recruitment
The evening started with Sophie Pieters, IGHI Operations Officer and JATP Programme Lead, welcoming the attendees and introducing the JATP programme, including the eligibility criteria and the new trainee roles available in the summer.
The Julia Anderson Training Programme gives people with limited or no work experience the opportunity to join an impactful stream of work at IGHI, Imperial College London’s. The paid programme gives trainees the opportunity to grow their network, boost their CV and develop applicable workplace skills and knowledge.
Sophie announced the three upcoming roles for the next cohort in July, specifically Analytics and Events Trainee, Public Involvement Trainee and Educational Research Trainee (the first two are open to those with no university). On 14 March, a webinarwill be held to provide people with more information on the programme, the training positions on offer and useful advice for the application. Students were highly encouraged to sign up for the webinar.
Career talks from IGHI staff and trainees
Next, some of the IGHI staff and current trainees delivered individual presentations highlighting their career journey, challenges, and other valuable insights from their experience.
“I found the job I loved although didn’t know it existed. It’s okay if you don’t know what you want to do.’’, said Eleni Daniels, Patient Safety Research Centre (PSTRC) Manager at IGHI, who has a background in biomedical sciences and worked in advertising before finding her dream job in a patient safety field.
Image: Eleni Daniels giving a presentation about her career journey. Credits: Rolando Charles
Amish Acharya, Scientific Advisor to Professor Ara Darzi at IGHI, talked about his ‘unconventional’ career path from medicine, followed by PhD in Behavioural Science, to his current role, where he is contributing to creating research projects and supporting the progress of scientific work. Amish advised:
“Exams don’t represent who you are and what you can do. It’s never too late to change your path, don’t be afraid to try different things – this can often make you more adaptable and rounded as a person.’’
One of our current Julia Anderson Trainees, Tania Domun, a graduate of Population Health and Medical Sciences with a Master’s degree in Public Health, shared her experience so far as a JATP trainee in Behavioural Science and the benefits of joining the programme:
Tania Domun sharing her experience as a current JATP trainee. Credits: Rolando Charles
“JATP allows you to develop your skills and support you with the next steps in your career. It’s challenging when you don’t have a mentor or people to help you navigate your professional path. The programme does exactly that, by focusing on you as an individual. It’s a lot about your passionsand not your previous work experience. This makes it a unique programme.’’
She also talked about the Imposter syndrome: ‘’I’ve realised many people, including me, deal with this syndrome – don’t let these feelings stop you from applying for the programme. This is the best time to explore possibilities and build new skills.’’
Lastly, Clarissa Gardner, Senior Design Researcher at TPXimpact and Honorary Research Fellow, spoke about her career journey as a ‘learning process’ and how she came about setting the JATP programme, after doing a MSc in Health and Design at IGHI:
‘‘Your job title doesn’t matter as much as your ability to help others and inspire positive change. I recognised the diversity of people at IGHI, so I proposed this programme to create work experiences for people.’’
Interactive activities showcasing IGHI Centres’ work
After these inspiring talks, we organised interactive activities led by each of the IGHI Centres. During these sessions, attendees had the opportunity to engage with the different workstreams at IGHI in small groups and interact with IGHI staff members.
The Hamlyn centre hosted a ‘create your own surgical robot’ activity. Sixth formers were challenged to conceptualise the design of a robot, then turn their drawings into 3D images using specialised software. Hamlyn centre representatives also explained the benefits of surgeons using surgical robots compared to traditional surgery methods, highlighting how they enhance precision during procedures. The participating team included Brandon Davies, Learning Technologist, Nazia Bharde, Project Officer, Robert Merrifield, Medical Design Associate and Salzitsa Anastasova-Ivanova, Facilities Manager.
Brandon Davies briefing students on how to design a surgical robot. Credits: Rolando Charles
At one of the Helix Centre stands led by Jodie Chan, Patient and Public Involvement and Engagement Officer, and Clare McCrudden, Policy Fellow from the Change Lab, students had the opportunity to discover how the public can influence research priorities, methodologies, and dissemination for healthcare improvement. They were encouraged tobrainstorm alternative names for ‘antimicrobial resistance’ and open the ‘can of worms’ around healthcare data through an interactive activity, sparking further discussions on its benefits and risks.
Image: Clare McCrudden talking about antimicrobial resistance with sixth formers. Credits: Rolando Charles
They also learned about one of the upcoming JATP roles –Public Involvement Trainee– who will help to involve local youth groups and schools in a project aimed at better understanding the mental health needs of children across the UK and identifying how services can better support them.
The second Helix Centre stand was led by Matthew Harrison, Senior Design Associate, Alex Dallman-Porter, Designer Healthcare Products, and current JATP trainee, Andrew Watt. People were invited to participate in a grip strength assessment activity, during which they were asked to squeeze a ball-shaped dynamometer (‘squegg’) in their hand to measure their frailty levels and compare with their peers. Additionally, the stand showcased a sleeping mat used for measuring heart rate and respiratory rate, along with other environmental sensors designed for individuals with dementia.
Jessica Newberry Le Vay, Climate Change and Health Policy Fellow at the Climate Cares Centre, hosted an interactive session about exploring climate emotions and imagining what future they want to see. The students were challenged to think about the following questions: ‘’How does climate change make you feel?, What stories do you hear about the future?, What would you want the future to look like?’’
People were able to discuss their responses to these questions and see what other people have put. They explored actions that can improve both mental health and the climate, building hopeful and constructive narratives around climate change.
Eleni Daniels from PSRC also had a stand on patient journey. She encouraged students to reflect on healthcare experiences of themselves, their family members, or friends, and to consider how these experiences could be further improved. People shared their thoughts and experiences, engaging in a dialogue that allowed them to open up and explore patient journeys from the GP to hospital settings.
Feedback from sixth formers
We were impressed by the amount of positive feedback we received from the sixth formers. Some examples below:
“I’ve discovered that you don’t need to know exactly what you want to do at this age. It’s more important to be open to learning and taking on new opportunities and experiences.”
“Many internships and training programmes require individuals to meet specific minimum requirements. It’s fantastic to discover that the JATP program doesn’t have such requirements, giving people the chance to gain those skills and build experience.”
Sophie Pieters, JATP Lead, and Holly Merton, JATP trainee, chatting with the sixth formers. Credits: Rolando Charles
“I found the event very engaging and fun. It made me think about my future career, the steps I want to take next and the sort of support I should be seeking. I am keen to apply for this programme!’’
On the day feedback indicated that, among our participants, 90%were inspired for their career after attending the event. According to our post-event online survey, 92% of our participants expressed their willingness to recommend JATP to a friend, while 83% of respondents indicated their intention to apply for JATP in the future.
We are looking forward to seeing people applying for the JATP programme and taking advantage of the tremendous opportunities at IGHI to advance in their careers. The event was made possible by the EDI Seed Fund and we are very grateful for their support.
