The webinar discussion on ‘what it really means to take a patient-centric approach to healthcare in the NHS’ was facilitated by Livework. The reason for having this discussion now is because the NHS has recently signalled its intention to put “digital tools in place so patients can be supported with high quality information that equips them to take greater control over their health and care”, with the funding now being provided to realise this ambition.
We invited three expert panellists (Liz Watson, Diarmaid Crean, and Peter Brook) to share their recent practical experience in the field. This is a summary of what they said:
Liz Watson - Livework healthcare associate
Liz identified four learnings she had taken from recent projects with the NHS:
The first was about managing expectations and that we need to think both in the short-term and the long-term about what needs to be done.
The second was service model design, where Liz sees a real opportunity to radically rethink how healthcare is being delivered.
Thirdly, it’s about being open to opportunities – especially when talking to patients to hear their ideas for how they think things could be improved. Lastly, it’s about the co-production of design – not only in transferring skills to teams in the NHS but recognising that service design projects often form part of a broader change project.
Diarmaid Crean - CDIO Sussex NHS Community Foundation Trust
Diarmaid Crean observed that too often new digital implementations simply mimic the existing inefficient processes. This ends up costing more, as well as creating more work and confusion for staff. It also means that opportunities to change and improve these processes are missed, resulting in worse outcomes delivered so the system needs to be re-implemented later on to make it work – all of which is a huge waste of scarce resources.
Diarmaid said that it was unfair to expect clinicians and those delivering the services to also be responsible for designing and implementing new digital systems to facilitate them. Collaboration with people who have different skill sets is required to make digital transformation and implementation work successfully.
Talking to staff and patients is crucial, but in addition it’s about understanding how their experience maps to the data. Really understanding that data and how that allows you to design a better process means those implementing new systems can be confident that they will work for patients and staff.
Diarmaid’s final observation was that although the NHS is fundamentally people centred it doesn’t talk to people to understand what they want and what they need from it as users. But if you take the time to listen to them and to understand what they want, they can tell you what the future should look like. Once you start to do this properly you also help everyone to understand what it means to ‘put patients at the centre of what we do’.
Peter Brook - Programme Director Transforming Integrated Care in the Community at Kent Community Health NHS Foundation Trust
Peter identified with the fragmentation of services in healthcare and how this fragmentation has left patients trying to pick up the pieces. He has used a service design approach in his work with teams in Kent to address two aspects that he feels can help: team culture and team dashboards.
Peter worked with Buurtzorg (a care organisation in the Netherlands) to create safe spaces so that staff can talk really honestly about why they do what they do. As he pointed out “no one works for the NHS because they want to get rich”. So to uncover people’s intrinsic motivations they talk about purpose, about trust, and about constructive disagreement.
He noted that outside the team everyone just looks at results, but for everyone inside the team it’s more about the presence (or absence) of trust, and whether you’re able to have a constructive argument – as you do in the design process. He said the premise of this approach is that if you’ve got the commitment, you then get accountability which in turn leads to better results. What’s really critical is that you’re supporting that conversation about purpose – but it’s a conversation teams don’t often have.
The second aspect of his work that Peter talked about is the team dashboard. He agreed with Diarmaid about the ineffectiveness of putting a digital layer on an existing process – and has often seen that happen. The key in terms of digital implementation was not to rush to a technical implementation but to ask teams ‘what data mattered to them?’. He said that the data which teams had access to were usually very delayed and cascaded via senior managers to team managers and only then to the team.
Peter’s team used their EPR system to put data into a data warehouse giving everyone in the organisation the ability to look at a dashboard for their team. This includes data on caseloads (numbers, duration, recovery time etc), sickness, annual leave, training, and quality (such as serious incidents and near misses, and patient feedback).
He’s just recently received the results of an evaluation and the impact of both aspects of the work his team have been looking at – culture and dashboards – is encouraging: a reduction in staff sickness, reduced intention to leave, and a reduction in average caseload duration by 29 days.
All of the panellists agreed that properly listening to patients and staff was vital if the right kind of digital systems were going to be implemented successfully. Part of this is getting the right data at the right time to staff – data they need to see, not data that other people think they need to see.
They also agreed that you shouldn’t just digitise existing systems and processes – as this just risks repeating past mistakes and missing out on massive opportunities to improve how things work.
Furthermore, you shouldn’t expect those on the front line delivering clinical care to do the separate job of specifying or overseeing the implementation of these systems.
Everyone agreed that using design approaches to co-create an atmosphere of trust, where everyone feels they can contribute, and where everyone’s opinion is valued, is the only way to really take a patient centric approach to healthcare.