Image of a men receiving treatment, representing healthcare in the community

WORKTECC: Workforce Operations that Realise Knowledge-based Transformational Efficiency gains in Community Care

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This was a four-year project begun in 2017. It was funded by the Health Foundation and led by CORU (The Clinical Operations Research Unit) at UCL and worked with North East London NHS Foundation Trust (NELFT), the London Boroughs of Redbridge and Barking & Dagenham and the innovation test bed CareCity.

The aim of the project was to identify workforce changes that could improve the efficiency and effectiveness of the delivery of community healthcare to older residents in the two London Boroughs. CORU used their OR expertise to identify eight candidate changes in service delivery that could offer significant benefits and the Institute examined the ‘readiness to change’ in the boroughs to understand the issues that would need to be addressed if these changes were to become embedded as regular practice in the delivery of community healthcare.

In the project we reviewed 16 change programmes that have been undertaken in community healthcare in recent years in order to understand how changes were made and the outcomes that were achieved. There were several examples of major structural changes and of the implementation of significant new technical systems.

All of these changes were successful although each required considerable resources to implement them. There were also many attempts to make role changes and changes to local work practices. These all involved behavioural change and have so far been less successful. The aim of the project was to carry forward the lessons from these change programmes to examine what would need to happen if the OR changes identified were to be successfully implemented.

In the course of the project we developed a toolkit to assist local staff in the identification of the issues to be addressed in making changes. It is particularly useful for the early identification of unanticipated implications of a change programme for the local work system. The toolkit called the Planning for Change Framework (PfCF) can be downloaded from here.

 

Image of a woman pushing an elderly woman in a wheelchair in a field, representing care meeting social needs

Evaluating the West London Primary Care Navigator Scheme

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The concept of Social Prescription has grown in importance in recent years as it has been recognised that many people have both medical needs and social needs. Elderly people, may for example, find themselves isolated in flats in tower blocks or may not be sufficiently mobile to attend GP or hospital appointments.

There are services in most communities that can help people with problems of this kind but how is the person in need to connect with such services? In West London the local Clinical Commissioning Group working in association with AgeUK, recruited a team of Primary Care Navigators who each worked with two or three local GP practices to identify the social needs of patients and ‘navigate’ them to an appropriate service.

The Institute undertook a qualitative and quantitative evaluation of the service, assessing whether, for example, patients helped in this way made fewer visits to A&E, undertaking focus groups with the Navigators and interviewing other stakeholders (GPs and their staff, the patients, the service providers and the commissioners).

The patients really valued the service, the GPs valued being able to refer patients to the Navigator and the quantitative evidence demonstrated that the service was decreasing the load on the health service.

There were, however, many issues about the establishment of the role in GP practices: for example, what access was there to patient records, what part should the Navigator plan in multi-disciplinary meetings about patients, what technical system supported the Navigator’s work (none were planned) and in the blurred line between health and social care, what part could and should the Navigator play in health care?

 

The evaluation report is here.

Image of older woman looking at phone, in relation to digital social care

Project Evaluations in the Local Government Association (LGA) Social Care Digital Innovation Programme (SCDIP)

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The Local Government Association (LGA) in conjunction with NHS Digital launched two programmes (LIP and SCDIP which funded local councils to implement new technology innovations that addressed issues in the integration of health and social care. The Institute working with Traverse was commissioned to evaluate the progress of the projects funded under these schemes.

Many of the projects funded in LIP made slower progress than planned and one of the main issues identified was that, as the work got underway, it was found that the initial specifications for the projects did not match the needs of potential users. As a result of this learning, in the successor programme (SCDIP), the first part of each project was a ‘discovery phase’ in which the project team engaged with their user community to develop a fuller understanding of user requirements for the technical innovation being planned.

Twelve projects received funding for the discovery phase and the Institute and Traverse undertook formative evaluations with the teams to support their learning from this phase. Nine of the projects were funded to proceed to the implementation of the technology. This study confirmed the Institute approach to projects of this kind: introducing new technology into a complex and changing organisational context, (in this case where new forms of integrated health and social care were emerging), requires an evolutionary approach in which regular summative evaluations of progress serve to progressively shape subsequent phases of the work.

 

The evaluation report of the discovery phase of SCDIP is here.

 

Image of a garden with "NHS" visible in the grass

Evaluating the Adopter Role in the NHS Innovation Accelerator Programme

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The NIA (NHS Innovation Accelerator Programme) is a programme of support for innovators who have demonstrated that their products have the potential to provide benefit within the NHS. The Institute was invited to evaluate nine applications of the innovators’ products not from the perspective of the innovators but from the perspective of the NHS organisations that were adopting their products.

The focus was not, for example, on the initial application of a new form of digital technology but on its subsequent delivery in a different part of the NHS. The results showed the work that was required by stakeholders in the NHS organisations to achieve adoption. We adopted a ‘lock and key’ metaphor to describe the need for a match to be obtained between the way the NHS organisation worked (‘the lock’) and the way the innovative product worked (‘the key’).

For adoption to be successful there had to be adaptation in both. For adoption to occur in a complex organisation it was also necessary to have more than one ‘champion’ for the innovation in the adopting organisation: it often needed a concerted and persistent programme of work by a variety of stakeholders to achieve sustained adoption.

 

The report is available at:

https://nhsaccelerator.com/wp-content/uploads/2018/11/NHS-Innovation-Accelerator-Understanding-how-and-why-the-NHS-adopts-innovation.pdf

 

Two of the case studies are discussed in more detail in:

Eason K., Hoare A. and Maton-Howarth W. (2021) ‘Getting the benefits from connecting digital health applications to complex healthcare systems’ In Soares M. Rebelo F & Ahram T. (eds) ‘Handbook of Usability and User -Experience: London, Taylor & Francis Vol1, Chapter 10.

Image of a man using his phone representing the use of the My Health Guide app

The Use of the ‘My Health Guide’ Digital Application to Support People with Learning Disabilities

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My Health Guide (now called Hear Me now) is a digital app that enables people with learning disabilities and/or autism to store photos and videos, follow detailed guidance about their daily routines and communicate their needs and desires to others. In a project in the NHS Digital Social Care Pathfinder programme the care provider Hft worked with the technology supplier Maldaba, to roll-out My Health Guide within Hft and in other care providers.

The Institute evaluated the adoption of the app in eleven social care providers and assessed the benefits that were obtained. The results showed that although the app is designed as a tool for an individual to use, its adoption was a sociotechnical change challenge because it depends on changes in the complex health and social care environment that supports people with learning disabilities. In particular, if the app is to be successfully used by people with learning disabilities, the support workers who assist them on a daily basis have to be fully engaged in the adoption process.

In addition to evaluating the adoption process for My Health Guide, the Institute also evaluated the planned benefits and the benefits actually achieved from the use of the app. In addition to the benefits for people with learning disabilities there were potentially significant benefits for other stakeholders including the support workers, families and local healthcare agencies.

As a result of the project we produced a ‘blueprint for the adoption of digital apps in social care’ and a ‘process for establishing and assessing the benefits of digital apps in social care’.

An extended summary of the project is available here together with the blueprint for the adoption of digital apps and the process for assessing the benefits of digital apps: My Health Guide