Industry View: Best Practice and Lessons Learned

In our final feature as part of HTN Digital Week we asked a handful of providers to share their advice, best practice and lessons learned in digital health.

Contributors include: Inhealthcare, Royal Cornwall Hospitals NHS Trust, Nova, OLM, InfoFlex and Channel3 Consulting.

Bryn Sage, chief executive of Inhealthcare

In our experience of working in digital health, the most important lesson we have learned is to make sure there is a genuinely collaborative approach to each and every project.

We are proud to have worked alongside some talented clinicians, inspirational patients and far-sighted commissioners in designing, rolling out and refining more than 50 digital health services that improve patient outcomes and increase capacity in the health and care system.

Fundamentally, service transformation is about people, rather than technology, and to be successful you need to ensure that all of your stakeholders are involved at every step of the way, from service design to implementation.”

Phil Alton, a Clinical Entrepreneur at startup cofoundery Nova, and an Emergency Medicine Doctor at Aintree University Hospital

The best advice I could offer to healthtech startups would be to adopt a problem-focused mentality from the outset, rather than focusing too much on a preconceived solution. For clinical entrepreneurs on the front line of our health services, it’s easy to identify problems. Yet it’s also incredibly easy to be biased about how to solve it; inevitably, there will be a lot of assumptions built into that ‘solution’ based on their own personal experiences. 60% of startups fail due to building something nobody wants, so accepting that you probably haven’t already arrived at the silver bullet is the best approach to take.

Dropping all previous assumptions and working in a non-biased way involves interacting with all the different stakeholders, to understand what the problem means to them and what their requirements are. Healthcare has a complex ecosystem, in which healthtech users and customers are disparate groups. You can build something that works for the end users (doctors, nurses, patients) but that could still fail if it doesn’t also work for the customer (wider NHS Trusts that will procure the technology). This means that exploring the problem from all angles and not becoming susceptible to tunnel vision is crucial to success.

You don’t need to think of yourself as an ‘entrepreneur’ or ‘innovator’, because these very terms imply that you need to have come up with an amazing solution. If you’re a front line clinician, all you need is a significant problem. Start with understanding that – and the solution will define itself.

I’ve launched two digital health startups in partnership with Nova, six months apart. During the first phase of my second project, I learned the importance of securing key validations early on, so it took me much less time to reach critical milestones.

With the first business, I was quite blind to knowing who to speak to in order to validate my idea, and I also tended to avoid asking difficult questions if I was worried the answer would be negative or non-committal. Second time round, I quickly identified the relevant people and was more willing to ask direct questions, such as “what do I need to show you to take this to procurement” or “what would you use this data for”? Through asking this type of open question, not only did I glean uses and values I hadn’t previously considered, but it also meant I could confidently go to investors knowing that I could get buy-in from the top.

Building guidance panels comprising both users and buyers, and adopting a fail-fast approach by asking difficult questions as soon as possible, ultimately means you’re not wasting time and resources on the wrong thing. This approach is applied to startups at the very beginning of the Nova process, so that we get a lot more idea evolution before any money is even committed to the project.

Marc Warburton, Chief Executive of InfoFlex 

When implementing a new system either in a department or across an entire trust it is critical that the very senior influencers within the organisation are completely supportive of the change. Although updating to a new system is choreographed to be as seamless as possible, it is inevitable that the end users – whether nurses, junior doctors or consultants for example – need time and support to learn how to use it once implemented. Even more so, if it is instigating significant change to the day-to-day way they work. Without buy in and support from the senior individuals in the department the transition process can be longer than needed, slowing up efficiency and unnecessarily delaying uptake.

When implementing any new solution we consistently advice customers to be as prescriptive as possible with their needs from the outset. Another key consideration is ensuring the project lead – whether that’s IT or a clinician – understands exactly how the end user will be physically using the system when in place. Nurses and junior doctors might have very different needs to the consultants and vice versa. Co-ordinating with those who will be using the solution is really important to get maximum benefit from the convenience and efficiency InfoFlex brings to departments.

Finally, on a higher level, many customers we work with will focus on a solution for an individual department or for the trust. This is how budgets tend to work within the NHS. However, if departments or trusts had the opportunity to partner and share costs, solutions that are then implemented – be that InfoFlex or others – could be done to support shared care in a more efficient way. In the long term, solutions that incorporate use across the full patient pathway, linking acute, primary and community, are essential and will improve NHS efficiencies and patient care.

James Leaver, Chief Procurement Officer, Royal Cornwall Hospitals NHS Trust

As one of the Government’s Scan4Safety demonstrator sites, Royal Cornwall Hospitals NHS Trust has secured significant benefits from the programme, and has adopted innovative technology to generate greater efficiencies.  We implemented inventory management system, Ingenica Solutions’ 360 IM which has enabled us to improve clinical productivity and increase procurement and supply chain efficiencies; in line with the Scan4Safety objectives.

Since our selection as a demonstrator site in 2016, we’ve achieved great progress and are now in a position to share some of our lessons learned:

  • Set up a project team with Executive (high level) sponsorship and involve clinicians from the outset
  • Communicate what is happening in advance of the project launch, at project launch and throughout the implementation. Good communication is key.
  • Clinical staff and managers need to own the project, as post implementation it will reside with them.
  • Before implementing an inventory system, ensure that all the basics are in place, starting from storeroom set up, capturing product information, setting par levels, establishing and agreeing ranges and cleansing data. This was the hardest task we had to achieve as we spent the majority of the time gathering the product information and merchandising our storerooms in a similar way to retail. After that the technical side was much easier as we only had to update our Ingenica Solutions’ 360 inventory system with the information.

Peter O’Hara, OLM 

ECLIPSE now has more than 25,000 users signed up, with many more on the horizon. It is an achievement that we are immensely proud of and there are two pieces of advice that have been essential in its development.

1.         Challenge your own thinking: You always need to keep an open mind and this is never more important than when you create a solution to a problem. This is why we worked alongside hundreds of practitioners to create the ECLIPSE platform, with each component being carefully crafted to solve an existing problem in the manner best suited for the user.

2.         Challenge their thinking: You need to consider everyone, from the service users to the social worker, to those in the hospital or even those in the care home when designing software for health and social care. You need to look at the problem from the top down, look at the desired outcomes and whether or not what you are proposing will work.

Gareth Dellenty, Consulting Partner, Channel 3 Consulting

One of the main priorities we are working on with our clients is planning and delivering digital health effectively at regional or ‘place’ level. This is less about technology and more about leadership and organisational development.

Regional teams tend to be made up of people working for different organisations, often on secondment, who have to balance their own operational duties, challenges, resourcing and budgetary issues alongside regional transformational roles, which often become a second priority. A more consultative leadership style and organisation than many in the sector may be used to is needed to leverage experience, and encourage cooperation, collaboration and drive towards a shared digital vision.

Regional digital strategies are relatively new to the NHS and require a different approach from single organisation strategies which tend to follow an established pattern. Place-based digital strategies present a genuine opportunity to innovate and work in partnership to push the boundaries of healthcare. But teams need support to unlock a new style of thinking. For example, we’ve successfully undertaken stakeholder engagement and development projects  – including facilitated discussion among partners – to develop a vision and encourage collaboration and innovation. This opens up discussion and debate to form the basis of a shared digital vision.

With a vision established, we apply a structured methodology to help teams consider the variety of factors that will influence the content and implementation of their strategy, whether that’s establishing a basic level of digital maturity to build on, or investing in new technology such as shared records or cloud technology to support more agile ways of working.

As ever, the most ambitious digital projects require the basics to be in place so that new innovations work well and deliver the full benefits to patients, staff and wider communities. However, as greater emphasis is placed on integrated care, supporting leaders as they tackle competing priorities and adapt to new ways of working will be key to delivering digital health.