Factors Influencing the Implementation of a Multispecialty Virtual Ward Program in the United Kingdom: Qualitative Exploration of Staff Experiences and Perspectives

Abstract

Background: The National Health Service (NHS) in England is facing unprecedented demand for hospital services, with virtual wards (VW) being a central tenet of the strategy to manage these ongoing pressures on capacity. VWs combine digital and analog tools, monitoring systems, and teams of multidisciplinary care providers to support patients in their place of residence who might otherwise be cared for in a hospital. Despite virtual ward programs continuing to proliferate in the United Kingdom and across the globe, the models of care that support them are still evolving, and best practices in their design and implementation are yet to be fully established. It is therefore necessary to continue to gather evidence about the influences that shape their design and support their successful and sustained introduction.

Objective: This study aims to explore the experience of staff involved in designing, developing, and delivering VWs as part of the national program, in order to understand the factors that influence their implementation and sustainability.

Methods: Qualitative data were collected through semistructured interviews with staff and senior stakeholders involved in developing, leading, and delivering the virtual ward program within one of the largest integrated care systems in England. Data were analyzed using directed content analysis, informed by the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework.

Results: We interviewed 20 participants from clinical and nonclinical roles, including service transformation leads, program leads, physiotherapists, nurses, and consultants. Using the NASSS framework, we identified several key findings: patient context was as important as clinical criteria in determining referral suitability (Condition). Stand-alone digital monitoring solutions with offline capability improved accessibility (Technology). While benefits to patient rehabilitation and hospital capacity were widely understood, concerns over the lack of evidence remained (Value proposition). Clearer messaging about the nature and benefits of VWs was needed for patients and carers, and staff described challenges with remote care and shared responsibility across settings (Adopters). Pre-existing collaborative arrangements helped but varied by specialty (Organizations). NHS targets and metrics of success were considered unrealistic (Wider system). Finally, participants recommended more coherent regional planning that involved consultation with patients (Embedding over time).

Conclusions: If the United Kingdom's VWs program is expected to move forward, it requires patients, their families, carers, and staff to receive coherent messaging of their responsibilities and benefits. Targeted training and ring-fenced time for staff would help, as would the provision of purposely designed patient-facing technologies. Finally, extended planning and funding cycles are needed to gather robust evidence and refine VWs, ensuring better integration with existing services that incorporate the needs and preferences of patients from various sociocultural backgrounds.

Keywords: digital health; health services research; qualitative research; remote monitoring; virtual wards.

Figure 1

Summary of the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework.