Digital transformation within health and social care has the potential to improve services for individuals, as well as front line staff while lowering costs and capacity of running a service meaning that more people can benefit overall. Digitalisation can also facilitate service integration and reduce social isolation. But it also carries some risks: if not developed as part of an inclusive system, digital services could easily become impersonal and transactional. They could also pose challenges to data protection and confidentiality. Our main recommendation for maximising the benefits of digitalisation is to invest in a robust methodology, centred around an initial exploratory phase and a systematic formative evaluation practice throughout.
Traverse has been supporting organisations like Care Quality Commission (CQC), NHS Digital and the Local Government Association (LGA) to explore what ‘good’ looks like for digital services, designed to improve and integrate health and social care systems. These services span online GPs, medicine management systems, commissioning processes for data integration, Amazon Alexa features and wearable technology.
This blog post is the first of five on service digitalisation. Here we share what we have learned from our engagement with service-users and front-line staff and from evaluations of digital innovations.
The second blog post “Our Digital Innovation Framework” introduces a Traverse approach for developing, implementing and scaling service digitalisation projects. The approach was designed based on our experience and learning which we present below.
The blog series ends with guidance on best practice in project design, methods and evaluation approaches.
Why go digital?
Speaking to potential and existing service users of digital healthcare services, including front-line staff, we found general consensus on the potential benefits of digital technology. Accessing digital services could improve the convenience and flexibility of engaging with health and social care services without the need to wait for an appointment, take time off work or travel.
Digital services could also offer clear and easy referrals routes, which the wider NHS system often fails to provide. To this end, better integration between digital and traditional primary care services should be encouraged, as well as clearer links between often private digital primary care services and wider NHS services. Access to previous medical records and patient information remains a priority for service integration.
Our evaluation of the Local Investment Programme, an LGA initiative to support innovation within local councils to improve services and create efficiencies within the challenging and increasingly financially pressed environment of health and social care, has taught us that digital services have an enormous potential to enhance digital literacy, boost independence and reduce social isolation. For staff, digital services encourage flexible working practices. For service users, they provide opportunities for prompt assistance and connection with clinicians and social care workers on short notice.
So what are the risks?
There are innumerable benefits that come with service digitalisation which is why the public is generally supportive of new technologies in the health and social care space. But service users are only willing to engage on one condition: digital services should not be the only available option. Face-to-face consultations are more suitable in certain cases and the system should have the flexibility to tailor care to individual needs. The number one priority for the public remains the ability to access the right service at the right time through targeted and holistic plans. It is essential that services don’t become transactional and impersonal.
These views are echoed by frontline staff and strategic leads in Greater Manchester. As part of the evaluation we are conducting of the Greater Manchester Health and Social Care Integration Plan, we are assessing the impact of digitalisation on service delivery. Practitioners in both Wigan and Bolton, the two localities we are working with, are telling us that service digitalisation shouldn’t come at the expense of tailored support plans and asset-based working, which have human empathy and connection at their core. So while service users and front-line staff recognise the potential of digital services, they also have fundamental concerns which anyone willing to develop and implement a service digitalisation project should take into account.
Privacy violation is another potential issue that could emerge with service digitalisation. Service-users feel strongly about the importance of introducing measures to preserve confidentiality and data protection. Users demand assurances around how patient information is used and how the service safeguards vulnerable individuals. Introducing verification processes, similar to those of online banking, is seen as a reliable system for data security. This could allow patients to verify whether doctors are accredited, and that the accreditation can be trusted. A secure system of identification would also ensure accountability in the system. Ownership remains a key priority: service-users need to know who is responsible, especially when something goes wrong.
How can we make digitalisation work?
We have identified some common challenges that are experienced by innovators in the digital space. These mainly revolve around buy-in from staff and service-users, the sharing of data across service boundaries, and interoperability. Here we share some ideas for how to overcome these challenges.
We found there are key behavioural barriers to adopting digital services, both on the part of service users and front-line staff. An understanding of these barriers is crucial in being able to maximise the success and impact of digitalisation projects. We believe that investing in an exploratory phase to understand public perceptions through engagement and user-research can help design purposeful interventions. Our “digital innovation framework”, outlines the core behavioural barriers we have identified through our evaluation of the Local Investment Programme (LIP).
A well thought-through exploratory phase should also be able to identify potential challenges around information sharing. While the sharing of data across council boundaries and between health and social care to better integrate services and commissioning was a key observable outcome of LIP-funded projects, the evaluation highlighted the importance of establishing robust information governance structures to comply with NHS Digital guidelines. Our research has raised awareness about the complexity of these types of projects, especially since the introduction of GDPR in May 2018. Ensuring the team has the right capabilities and knowledge before embarking on the project is paramount, especially if the tested solution involves management of DARS requests.
Our evaluation also made wider recommendations on methodology for developing, implementing, monitoring and scaling impactful interventions in this field. We believe that strong evaluation and monitoring processes are absolutely necessary for effective development and scaling of innovation. Formative evaluations in particular, introduce structures that help focus resources, align efforts and maximise efficiency. Through baseline assessments and the consistent capturing of data, formative evaluations can systematically, yet flexibly inform the project’s direction to make the most of emergent opportunities while encouraging a culture of peer-to-peer learning and development. We have found that formative evaluations are most effective when accompanied by a discovery phase that tests the usability of the selected approach and prototypes solutions through diagnostic tools.
Want to find out more?
Our next blog post presents our Digital Innovation Framework, a Traverse approach for developing, implementing and scaling service digitalisation projects.
And our final blog post in this series gives you some guidance on best practice in evaluation approaches and methods for digitalisation programmes.
If you would like to find out more, do contact us.