Frameworks, lyrics and non-adoption of technology

Frameworks, lyrics and non-adoption of technology

You know that feeling when a piece of music (or a book or film) resonates so strongly that it helps you understand something about your life? In my late teens it was The Smiths who did just that. I suspect that teenage hormones may have been a factor, but every lyric from Morrissey’s pen seemed to speak to me directly. Fast forward to 2018, and minus the heady mix of adolescent intensity and the tunes, I had a not altogether dissimilar sensation reading Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies by Trisha Greenhalgh et al (2017). This paper felt like reliving the first four years of my journey into the digital health technology sphere – every challenge, mistake, obstacle we have encountered is captured in this compelling paper on why technology doesn’t get adopted in the NHS. It felt a bit like the life story of mHabitat but minus the highs… NASSS is an evidence based and theory informed framework that endeavours to set out the interrelated factors that influence the non-adoption abandonment, scale-up, spread or sustainability of technology. It aims to be a tool that can easily be used in practice. The rich blend of research methods comprising case studies with qualitative interviews and ethnography, along with a review of the literature, elicited the seven framework themes (see the diagram above). Our tacit experience of non-adoption could have easily have been one of these case studies – everything from poor clarity of the problem the technology is meant to solve; poor...
Convenient access to your GP – what’s not to like?

Convenient access to your GP – what’s not to like?

General Practice is in crisis. A record number of GP practices closed last year as a result of growing patient demand without the requisite funding and workforce to respond. So a new app-based service for Londoners, which offers information services and video based consultations must be a good thing – right? The launch of GP at hand, which promises that you can see a GP in minutes for free, has been widely covered in the press. Whilst it has its fair share of promoters, they are some notable detractors. The purpose of this post is to curate those concerns and to consider implications for the future of digital in the NHS. What is GP at hand? GP at hand is a new NHS service offered by a GP Practice in partnership with the commercial company Babylon. The practice offers registered patients the ability to book an appointment via the app, have a video consultation via the app 24/7 and within two hours, pick up a prescription from their chosen pharmacist, visit one of six clinics in London Monday to Saturday. The app, which is powered by Babylon, also offers a symptom checker, health monitoring, and the option to replay your appointment so you can remind yourself of what was discussed. The app offers convenience, quick access and the ability to speak to a GP anytime and anywhere. A quick reminder about how General Practice works General Practices offer primary care services to a local community. On their website, NHS England say they are ‘at the heart of our communities, the foundation of the NHS.’ Most GPs are independent contractors...
How can digital innovators give their ideas the best chance of adoption in the NHS?

How can digital innovators give their ideas the best chance of adoption in the NHS?

So you’ve got a fantastic idea for a digital technology or maybe you’ve developed something which you think could add value to the NHS. How do you give your idea the very best chance of adoption in a health service which is still only just beginning to understand the potential value of digital technology as an enabler to better health and care? I recently ran a workshop on this theme at the Yorkshire and Humber Academic Health Science Network Digital Health and Wellbeing Ecosystem meet-up.  With a room full of people who have thought about this tricky question from many different angles I think we made some way towards finding a few answers. So here are 15 tips for starters: 1.Build adoption in from the get-go It may sound obvious but our adoption map made it clear that adoption must be built into the very beginning of your idea development. Considering at the end may only lead to having to go back to the beginning again. 2. Develop your core idea (or understanding of the problem you are trying to solve) before you think about technology Sounds obvious too? But it’s worth noting the technology isn’t always the answer and if it is the answer then you can only know that once you’ve defined the problem well. 3. Identify your *user* *chooser* and *buyer* The person who uses your technology (perhaps a patient) may not be the person who chooses the technology (a health practitioner) who may not be the person who can buy your technology (provider or commissioner). Take them all into account early on and identify benefit...
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...
The gap between hyperbole and reality in digital health

The gap between hyperbole and reality in digital health

Looking back at what the mHabitat team have been up to in 2016, I am convinced more than ever that the gap between the hyperbole of digital health and reality in practice remains a yawning chasm. There have been moments in the year when I’ve been quite taken aback by the distance we have yet to travel in utilising even the most basic and ubiquitous of technologies to improve healthcare. Here are three  stories that have stuck in my mind from our co-design work during 2016 to give a sense of what I mean. They aren’t heroic stories of great leadership and transformative change, but rather everyday stories of things not working quite right, and that’s sort of the point. Doing the simple things well (or not) It was during a co-design workshop with a health service that young people described how they value the text messaging reminder service. A good example whereby a ubiquitous technology is used to keep in touch and a solid foundation to build on. However participants were dismayed when a member of staff brought down the box with the office non-smartphone that is brought out daily to send each message individually with each number punched in for every single message that is sent. The staff explained how, to save time, they type the message in one of their (personal) smartphones and then text it to the device and then forward it onto their recipients. They went on to demonstrate how the phone will only hold 50 messages so they have to wipe them each time they want to send out a new set of...