Thoughtpiece

Change Brings Pain and Suffering

The National Health Service and Innovation

First published: 17 Jun 2019 | 3 min read
Author: Ausrine Latvyte

The NHS is a beautiful yet complex system. For an innovator, it can feel like staring at a stone wall without a gate. We’ve experienced the pains of bringing innovation to the NHS (and getting it wrong) so that you don’t have to. Together with our partners, we wanted to share a few strategic tips to make technology transformation projects a little less painful.

It’s often tempting to follow old ways of doing things. After all, they seem to have worked for a lot of other people. Let’s imagine a current day in the life of Dr McCoy (for you StarTrek fans). He has an exceptional product that will make clinicians and patients very happy. But why does it take so long for the NHS to adopt it? The old ways of test-it-buy-it-use-it seem strangely irrelevant. At Huma, we understand what Dr McCoy is going through.

The Nuffield Trust looked at this problem from a clinician/change manager perspective and published a brilliant overview of what digital health adopters should know. The report offers great insights, packaged as seven lessons for success.

Three of the messages, in particular, made me start nodding and muttering in fierce approval:

Transformation first (and not technology first)

It’s a very simple truth yet it may take a while for it to sink in. Dr McCoy may struggle to detach himself from how amazing his Tricorder 1000 is and that’s all he wants to talk about. For it to be successful, technology innovation needs to support new ways of working.

“Where technological interventions have failed, technology has simply been layered on top of existing structures and work patterns.”

We found it particularly helpful speaking to system-level thinkers and disruptors-from-within.

Culture change is crucial

Ideally, NHS organisations should invest in programmes of organisational change that will go together with the new technology. Even in an organisation with a change-embracing culture, there will be resistance and dramatic mood changes, thus, it helps to have a growing network of senior supporters and clinical champions.

Design

The report used a diagram of clinician’s ‘workflow’ (tasks, processes and pathways) and ‘thoughtflow’ (clinical decision-making). It takes detailed user research and clinicians’ voices to understand each of these mechanisms. Sadly, too many great projects fall apart for this very reason — new technologies are thrown at clinicians with very little consideration for the upstream and downstream effects.

If you’re particularly interested in the design focus, take a look at our ‘Designing for Humans’ article.

It’s also worth reflecting on the power of analytics, continuous iterations and learning cycles, interoperability and the importance of information governance.

. . .

One of our partners — The Royal Brompton Hospital — shared some of their frontline experiences with technological change. Helen Parrott, the Associate Director of Rehabilitation and Therapies, and her team have been hard at work preparing the ground for a new remote health platform for people living with Cystic Fibrosis. She created a vision of what the future of Cystic Fibrosis care could look like and rolled up her sleeves to make it a reality. Huma was later awarded the tender to deliver on this vision.

She was part of the NHS Digital Pioneer Fellowship programme, run by Digital Health London. According to Helen, one of the great things about the programme was learning about navigating stakeholder maps. The NHS is a complex body and each trust has its own flavour of roles and responsibilities. It’s important to create a network of senior decision makers as sponsors but it may be even more important to have early clinical adopters and user champions involved from day one. It’s a good idea to put them all in the same room as innovation has no functional boundaries.

Resistance to change is to be expected. Your best tool is empathy and it’s a worthwhile exercise for both clinical champions and innovators like Dr McCoy. Helen suggests considering two concepts: the ‘gap’ and the feelings of guilt (yes, guilt!). The ‘gap’ refers to the fact that most of the NHS are still firefighting excruciatingly dated IT problems every day. Coming forward with a proposal for a shiny new tech will be compared against this mountain of pressing (and depressing) problems. The gap has to be acknowledged.

The feeling of guilt is an interesting new variable that is probably more commonplace in the NHS than we have thought. Could trying something new mean that precious resources are taken away from direct patient care? There are times and reasons for it to be the case but it’s a deep, unspoken feeling that needs to be tackled upfront.

Helen smiles when talking about how at some point things will start turning a bit dark. Leading innovation can be a very lonely experience. There will be a lot of critical thinking coming your way so having a strong network of coaches and sponsors will go a long way. Things will slow down or stop working altogether. Excitement will give way to fatigue and a sense of defeat. Teams will fracture, people will move on.

Is this the part where Helen reveals her secrets to success? Unfortunately not! This is what change is about. Sometimes it takes a lot of personal passion, resilience, persistence and time. It was never meant to be comfortable.

At this point, Dr McCoy must realise that his super-cool Tricorder is rather unimportant when considered in isolation. It’s about the interplay between transformation, culture change and clever design decisions.

I’d like to finish on a little tip that I got from another brilliant thought leader: “always follow the energy”. Helen and the Royal Brompton team are a stellar example of why this is a good idea.

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