20 tips for a successful digital project in health and social care #PDDigital16

20 tips for a successful digital project in health and social care #PDDigital16

What is the absolute best way for a domain expert (health or care practitioner) to collaborate with a digital team (software designers and developers) to realise your goals and create a digital tool that has a chance of seeing the light of day? This is a question we set ourselves at #PDDigital16 after hearing a salutary tale of a practitioner’s nightmare experience whereby a brilliant idea descended into a heap of trouble and a resulted in a failed project. Everything that could go wrong did go wrong and it was a tricky experience for everyone involved. But it doesn’t have to be like that! A group of health and care practitioners and digital experts put our heads together to work out how to collaborate well to get the best results. The 20 tips we came up with are as important for software developers as they are for domain experts. They might make the difference between a wildly successful project and one that maybe isn’t so great. So here goes… 1. Involve end users from the outset (always and always and always) remembering that end users are not just patients (citizens) but often other health and care practitioners and administrators 2. Invest in lots of discovery (early stage research) so you can really understand the problem you are trying to address, the outcomes you want to achieve, and the experience you want to create 3. Check if your idea already exists (review the market) and avoid reinventing the wheel 4. Commission a process rather than a product – this means a collaborative relationship rather than an exhaustive specification – that...
China cups and therapy dogs with a dash of teal

China cups and therapy dogs with a dash of teal

What do china cups, therapy dogs and self-managing teams have in common? Well, quite a bit it turns out… It all began at an Improvement Academy Fellows event some months back where consultant physician Dr Rod Kersh and I had a serendipitous conversation about self-managing teams in healthcare based on a model known as Teal. In his presentation humanity above bureaucracy you can watch Jos de Blok describe how in 2007 he set up a new model of nursing in the Netherlands led by practitioners and co-produced with patients: Back in Doncaster, Rod and his team run a ward for older people with acute medical needs and dementia type illnesses. Their practice is informed by the principles of Teal and grounded in compassion and empathy.  On his ward it’s the small thing that count – such as the this is me information sheets that are part of the medical record, and the photos of staff on the wall accompanied by a this is what people like about me mini-biography. But sometimes it’s the apparently small stuff that can be the toughest to resolve. Rod has been engaged in a valiant battle to replace standard hospital issue plastic cups with china tea cups on his ward. You can read his blog about it here in which he describes the importance of the everyday in engendering humanity: “Person-centred care, where we remember that the patient is a person and, that person is the reason for the existence of the hospital, and our work, where we need to sometimes check ourselves when we slip into modes of process and performance; here the cups...
The next Uber for healthcare

The next Uber for healthcare

‘This app is basically the next Uber for healthcare’ A web search for the phrase uber for healthcare yields around 11,100,000 hits along with a plethora of suggested related searches. Uber has become shorthand for customer convenience and the disruption of established markets. It seems many people are looking for the lucrative uber for healthcare model and it’s a phrase with currency at many digital health events and in numerous articles. This recent Kevin.MD blog post argues that an uber for healthcare will be ‘super convenient, quick and easy, and inexpensive’. A recent commissioned article in the weighty British Medical Journal, entitled Uber for Healthcare asks:   Is it time to reinvent the home visit? … app happy entrepreneurs backed by venture capitalists believe that they can turn back the clock (Hawkes, N. 12 February, 2016).   The idea of a quick and convenient healthcare system that we can access with a swipe of our app while we go about our busy lives is seductive. But should we be questioning more deeply whether we want app happy entrepreneurs backed by venture capitalists disrupting the NHS with uber-style models of healthcare? Relationships or transactions An uberised model of healthcare prioritises transactions over relationships – it elevates convenience, efficiency and accessibility. But arguably healthcare is much more complex than an A to B taxi journey for all but the most simple of ailments. What happens to an uberised model when referrals along a multi-provider care pathway are required or ongoing support to help someone manage multiple long term health conditions? An uber style healthcare model may benefit the generally fit and...
Is digital technology a technical or adaptive problem in health?

Is digital technology a technical or adaptive problem in health?

Around three years ago I was invited to speak at a consultant psychiatrists committee meeting about social media and digital technology. I was mid way through my PhD and steeped in online ethnographic research about how people accessing mental health services and practitioners were making use of social networks. I had an inkling that I would have a mixed audience and I knew that not everyone would share my (then*) enthusiasm. As such I spent time preparing a range of compelling examples of digital technologies and social media practices, determined as I was to win over any detractors. I arrived a little early and so listened in to the tail end of an exasperated discussion about the various grinding limitations, obstacles and shortcomings of the in-house electronic patient record (EPR). If my audience’s primary experience of technology in health was such a bad one, then this did not bode well for my presentation – I quickly realised I was going to have to recalibrate. How could I be so naive as to think a conversation about the future potential of digital technologies would be welcomed, when the basics of reliable and effective electronic patient records seemed like a pipe dream? This experience came back to me whilst reading The Digital Doctor – Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age (Wachter, 2015) which is dominated by an expansive analysis of the shortcomings of contemporary electronic patient records. Wachter argues that EPRs have brought many a physician ‘to their knees’ with their clunky, confusing and complex systems (73). It is salutary to note that three years on...
What does new power mean for the NHS?

What does new power mean for the NHS?

What do shifting societal trends towards a sharing economy mean for the NHS? Understanding New Power (Heimans & Timms, December 2014) sets out a framework to conceptualise shifts in power which are enabled by digital technologies in contemporary society: Old power works like a currency. It is held by few. Once gained, it is jealously guarded, and the powerful have a substantial store of it to spend. It is closed, inaccessible, and leader-driven. It downloads, and it captures. New power operates differently, like a current. It is made by many. It is open, participatory, and peer-driven. It uploads, and it distributes. Like water or electricity, it’s most forceful when it surges. The goal with new power is not to hoard it but to channel it.   The authors conceptualise a participation scale from consumption to co-owning, from old power models exemplified by Britannica to new power models such as Wikipedia. You can find out more about their framework in a fascinating Ted Talk given by Heiman here: Despite this being a contemporary framework, informed and enabled by digital technologies, it resonates with Shirley Arnstein’s Ladder of Participation which was published all the way back in 1969 and remains common currency in the field of NHS patient participation. Arnstein conceptualised an eight rung ladder of participation in decision making from manipulation and tokenism at the bottom to citizen control at the top. Heiman and Timm’s framework is like Arstein’s ladder, with the rocket fuel of technology as an enabler of new power possibilities for those of us who have access to the digital tools and literacy to take advantage of them.  ...
Dignity in a digital world

Dignity in a digital world

It’s easy to love or hate technology, to blame it for social ills or to imagine that it will fix what people cannot. But technology is made by people. In a society. And it has a tendency to mirror and magnify the issues that affect everyday life. The good, bad, and ugly. Danah Boyd Digital innovation is routinely heralded as the panacea for modern health and social care – creating more efficient and effective services, enabling patients to take more control of their health, and citizens to manage their transactions with government online. Personalised Health and Care 2020  (November 2015) sets out a framework for digital technologies with a bold ambition: One of the greatest opportunities of the 21st century is the potential to safely harness the power of the technology revolution, which has transformed our society, to meet the challenges of improving health and providing better, safer, sustainable care for all. To date the health and care system has only begun to exploit the potential of using data and technology at a national or local level. Our ambition is for a health and care system that enables people to make healthier choices, to be more resilient, to deal more effectively with illness and disability when it arises, and to have happier, longer lives in old age; a health and care system where technology can help tackle inequalities and improve access to services for the vulnerable. But in our rush to embrace digital technologies, are we paying proper attention to the implications for all of us as patients and citizens? What does digitally transformed health and care mean for...