Why DX in healthcare fails, and what can be done about it
The onslaught of the Covid-19 pandemic played a huge part in accelerating the digital transformation for many industries – not least of all in healthcare.
Even prior to the pandemic, a study conducted by US giant Deloitte suggested that healthcare professionals were already beginning to see the benefits of marrying technology to industry, with around 92% achieving better performance following their digital transformation programmes.
The UK’s NHS is no exception, as Dr Avi Mehra, associate partner and clinical safety lead, Healthcare and Life Sciences at IBM pointed out in his keynote speech at this year’s Digital Healthcare Show in London.
“Technologies such as telehealth, remote monitoring in virtual wards, digital triage, data platforms, digital tracing, clinical trial acceleration, the NHS app and digital vaccine records, to name a few, all came to the forefront of the NHS’ weaponries,” he said.
With this, Mehra added, also came the understanding that having the right data and digital foundations in place would be key to the long-term sustainability of the health and social care system.
However, despite this watershed moment Mehra noted that the pandemic also brutally exposed a healthcare system that has been under severe pressure for many years and this included mental health.
Symptoms of failure
At this year’s healthcare event, at the London’s Excel centre – a venue which itself became an impromptu NHS ‘Nightingale’ hospital during the pandemic years – two NHS digital mental health specialists, Ayesha Rahim and James Woolard, gave insight into lessons they’ve learned from digital transformation within mental health services.
One key area that Rahim kept coming back to was user confidence: technologies were being deployed but people were often not given the support to integrate it into their workflows.
“We are in an era where that evidence-base for technologies is still emerging, so if you don’t have people on the ground that are confident about the technologies, they’re not going to implement them in their workflows,” she said.
Rahim noted that leaders can often assume a level of technical knowledge that NHS staff working at the coal face don’t have and more user support and change management practices were often needed to expediate tech adoption.
“The hard yards of actual transformation on the ground – and changing how people work. Because you can have the best technology in the word and if you dump it and run you are not likely to get good adoption.”
Below are two case studies that demonstrate how an inclusive approach to DX can result in platforms that are actually used by both patients and healthcare professionals.
DMH’s user-centric platform
According to NHS Digital Mental Health (DMH) technology advisor James Woolard the organisation is embedding a patient health record system across its Oxleas NHS Foundation Trust, which employs around 5,000 clinicians working with 70,000 patients across South East London.
Owned by the patient, the platform allows people to input their own healthcare data to track their sleep and medication and enable them to communicate and share information with a clinical team.
The DMH team took the time to engage with both patients and staff during the procurement process to help design the platform.
One of the systems’ key features was the sign-up process. Patients wanted to be able to create an account and decide who they shared their information with. They could also set up permissions, like Facebook, and request the clinical team to join their community.
“We thought we had a really good product but actually, what we found is when you’re trying to implement a standard piece of technology across 250 teams, it’s really tricky as every team has a slightly different way of working, whether it’s engaging with patients, how they manage information, or who does what job,” Woolard explained.
Woolard said that clinicians had complained that they were too busy to talk about this technology with patients and were unsure how to guarantee patient buy in. Patients meanwhile, found the signing in process more tricky than it it needed to be.
As a result Oxleas was only getting one or two people signing up to the clinical teams so it couldn’t get to the point where it was able to leverage the digital transformation of the patient records.
“We looked at what we could do to make it easier. Were there elements we could automate so that when you’re referred to Oxleas we can create an account for you and when you finalise that account you can opt in or opt out.”
The organisation employed several embedding leads across the trust to build capacity so that the clinicians had that time to engage with the system.
“Asking clinicians to take on an extra task they aren’t familiar with is an uphill struggle. My view is you almost must take two away from them and give them one back,” says Woolard.
Woolard added that it is sometimes the services that need to be re-designed, not the product.
“Don’t just bolt the products onto services, work with organisations to think about how we redesign the socio-technical digital mental health system.”
Case study: The patient portal
DMH’s clinical lead Ayesha Rahim planned to roll out a patient portal similar to Oxleas’, “but one that would also understand citizens’ needs as a patient-facing product.”
Initially the portal was to be built for the Mental Health Trusts but following challenges from the CDIO (chief digital information officer) it became clear that patients didn’t want to have to download an app for every single organisation. What was required was an entirely new patient portal that could run across all systems.
Having also decided on a user-centred design approach, the organisation not only needed to collaborate with patients but also find out more about how user-centred design works.
“I drew on the support of colleagues from NHS England, the head of User Centred Design in the regions, Pete Nuckley, and he came down with a team of colleagues and set up workshops for staff across its Integrated Care Systems [ICS’] which are involved in digital transformation,” said Rahim.
The organisation also carried out user research with digitally excluded communities. These communities typically include older people, people with disabilities, people who are homeless, sex workers, people living in rural areas, those from low socio-economic backgrounds and people with low digital or literacy skills.
According to Rahim if you get it right with these communities “you’re likely going to get it right for everybody”.
The team reached out to Blackpool charity The Well which cares for people with addictions. After rounding up a band of digital transformation colleagues, the group in-actioned some mapping exercises.
“One suggestion was that QR codes could be added onto their appointment letters that would entitle them to free bus journey to get to their appointments.
“The person who suggested this said it took them three busses to get to their nearest hospital to receive additions care and “if I’ve got £11 that I need to spend I’d rather spend that on vodka!”
“I’d have never imagined that something like this would be so key to someone just even accessing the services in the first place,” Rahim said.
“I’d gone in with assumptions as healthcare professional, ‘people want to see their appointment times and they might want to cancel or book their appointments’, but what came up was basic access to care,” she added.
Rahim says workshops like this are vital when planning to digitise customer products and services for patients.
“You might do a bit of a tokenistic consultation,” she says, “but we would have never got the insights we did, had we not had that workshop exercise to really get into the detail of what matters to people.”
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