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 messages. They finished by confessing that the phone contract had been taken out in the name of a previous member of staff and now they didn’t have the account details to end the contract.
What seemed like a simple use of technology to improve a service turned out to be laborious and time consuming when there are many simple web based solutions that would be so much easier to use. The offending phone (photo to the left) became an object of hilarity during the remainder of our workshop and a symbol of how technology doesn’t always make things better if its design does not match the intended use in practice.
Getting the right solution to the problem (or not)
The solution isn’t always the one you think it might be and the only way to find this out is to involve all the people affected by that problem. Sounds obvious right?
Another workshop we ran ended up with a group of practitioners and an absence of any young people (it was a cold and rainy evening and even a meal and a shopping voucher wasn’t enough to tempt people out). Our group of enthusiastic practitioners were convinced that video consultations were the way forward to making their service more accessible to young people. I was encouraged by their forward thinking and openness to change.
A week later on a less cold and less rainy evening we had a good mix of young people as well as practitioners. Young people confirmed practitioner assertions that getting to appointments was a problem. Some of them had up to an hour journey on the bus and they often didn’t have the fare. So video consultations are the solution then? “No way” said the young people – the thought of a video consultation from their bedroom with prying parents and siblings was a complete non-starter and they very much valued their face-to-face sessions. Their preferred solution was a digital means of getting a bus fare to them so they could make the journey even when they were skint.
This story goes to show that jumping to solutions based on assumptions can take us down avenues that may or may not be redundant, and how the answers that seem obvious can turn out to be plain wrong.
Without the Internet I’d be dead
My final story is one that always sends shivers down my spine. Last year we launched our digital practitioner programme which focuses on helping health and care practitioners work out how they can use digital technologies to improve experience and outcomes for the people they support. The programme came about because we started off talking about digital technologies with practitioners and quickly found that the basics were missing.
Discovery work undertaken by our friends from Stick People confirmed our hypothesis that digital confidence in one context does not automatically translate into another, so a confident user of social media and apps in everyday life may still need support to apply them specifically in health and care. We also unearthed a circle of silence in which digital tools are neither asked for by patients nor suggested by practitioners despite how important they are to many of us:
“I have OCD and wish more things, even accessing care, was available online or through an app as I find phone calls very difficult and sometimes cannot leave the house. Without Internet I would be dead.”
The non-smartphone theme continued with staff often not having the basics in place to enable them to even think about making good use of technology. This story reminded us of the life-changing/saving importance of digital technologies to some people and the opportunity to improve care that we often miss in everyday healthcare practice.
At mHabitat we hear variations of the three stories above on a frequent basis – stories of technologies not fit for purpose; stories of technologies which miss the point; and stories whereby we miss the transformative potential of technologies by not having the basics in place.
So what’s the answer to the gap between the transformative potential of digital technologies and the realities of day-to-day practice?
There isn’t one solution (of course) but part of it in my view is co-design – that is, bringing citizens, practitioners, designers, developers and academics (and others) together to collaborate in order to create a space whereby something worthwhile and transformative can begin to happen. The good news is that there are tried and tested approaches to draw on (such as service design thinking and appreciative inquiry) and lots of good people innovating in this field.
I was proud to team up with Anne Cooper and Roz Davies to run the second People Drive Digital event in 2016. Building a supportive community of people who understand the value of codesign and collaboration is so important and working out to do it well is crucial. And I’m looking forward to planning PDDigital17 (by hook or by crook) with Anne and Roz in the coming year, so watch this space.