Calling All Digital App Developers in Health and Social Care. Can an Online Clinic give you a head start with two critical issues?

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There are a lot of brilliant digital apps that have great potential to support health and social care but they face two hurdles that mean many will fail.

  • How to get them adopted in the complex and confusing worlds of health care and social care?
  • How to get good evidence of the effectiveness of the apps to convince commissioners and others that they would be a good investment?

We have been helping app developers with these critical issues for many years. We have worked with developers as they engage with user communities to get their apps integrated as regular features of health and social care. And we have worked with them to evaluate the impact of the app to provide evidence that will support future implementations.

Digital and Health

We know:

  • There are many different routes to successful adoption but they all involve careful engagement with user communities and their representatives. Planning that engagement can be a key to success.
  • There are many forms of evaluation, from quantitative, summative assessments at the end of a roll-out to more qualitative and formative procedures that collect evidence to guide the process of adoption.

What we offer:

If you are considering how to tackle either of these issues we offer a 2-hour online clinic on each to talk through the issues as you see them and offer our guidance on the way forward for you. Simply tell us what you are planning, where to find your website so we can get to know the technology, and give us access to any evidence of the impact of the app you have gathered so far and we will be in a good position to share our knowledge with you.

We are a charity with a mission to help organizations engage in change and adopt new practices and our prices are fixed to give as many people as possible access to our expertise.

A clinic on adoption: £500

A clinic on evidence gathering: £500

Visit our website to see the recent projects in which we have worked with app developers: https://www.bayswaterinst.org/case-studies/

And get in touch with us at: mail@bayswaterinst.org

Pathways to Market for Tech Companies Seeking R&D Funding

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Are you a technology company seeking R&D funding for an innovation in health and social care?

No matter where you are on the innovation pathway, we can help you by accelerating your progress towards the market.  There are many barriers to effective implementation of potentially beneficial healthcare technologies and we can help you to effectively overcome these in various ways including:

  • Advice on sources of Government funding for R&D
  • Advice on preparing bids for funding
  • Advice on preparing cost-effectiveness cases
  • Potential partnerships in R&D bids to undertake cost-effectiveness studies
  • Advice on considering the sociotechnical implications of technology implementation (including organizational and cultural issues)
  • Potential partnerships in R&D bids to undertake sociotechnical evaluation studies

Within the BI we have leading experts with decades of experience of working with technology companies in ways that seek to optimize delivery of potential benefits.

One of our team, when working for the Department of Health, led on setting up several of the NIHR technology-related funding programs (including i4i and SBRI) and has been an external assess to several EU and Innovate UK R&D funding programs.

Another of our team is a leading international expert in sociotechnical systems theory and in undertaking related evaluation studies, including action research.

We have worked in recent years with the National Innovation Accelerator program to support understanding of the organizational facilitators to health care technology implementation and we can bring this experience to bear to support companies seeking to take promising ideas into the NHS and to wider health and social care markets.

To discuss possibilities, get in touch with Dr. William Maton-Howarth at william.mh@bayswaterinst.org

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.

 

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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

V-connect device

EVALUATING OF THE USE OF LINCUS AND THE HEALTH EQUALITIES FRAMEWORK (HEF)

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Hft is a national charity that supports people with learning difficulties. They have deployed two forms of technology to help them provide improved support for their clients. Lincus provides easy to use tablet interfaces that enable people with limited language capability to communicate their needs and it can also capture a wide range of information about people with learning difficulties which can be used to manage the support they are given. Linus has been deployed with the Health Equalities Framework (HEF) which provides a series of scales enabling an assessment to be made of the degree to which people with learning difficulties are able to access support and services. The institute evaluated progress in the adoption of Lincus with the HEF in two Hft locations. The evaluation demonstrated there was considerable benefit for some people with learning difficulties in using Lincus to communicate their needs and that the use of the HEF highlighted inequalities of provision that led to local remedial action. The broader aim of using Lincus as a major management tool were to some extent hampered by difficulties in capturing all the necessary information.

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EVALUATING AN ACTIVITY BASED MONITORING SYSTEM FOR OLDER PEOPLE IN THEIR OWN HOMES (ALLY)

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The Institute has begun an evaluation of a system that is able to monitor the extent and form of activity in the home of an older person on a 24-hour basis. The activity monitor can be used to raise an alarm if activity differs radically from the norm and can also provide insights that might lead to changes in support plans.

The system is being deployed in two locations in the north and south of England and the Institute will evaluate the impact of the system upon residents, their families and services providing support.

Together these projects and others conducted in health and social care settings are revealing both the promise of new innovations and the difficulties of establishing them as normal parts of service delivery. Each innovation has consequences for the processes by which service is normally delivered and the issues are therefore not just about technical change but are also about organisational development and service re-design. These projects are enabling the Institute to refine its evaluation and action research techniques in order that it can better provide client-centred support for all the parties involved to enable them to tackle the sociotechnical challenges of embedding new practices in the normal delivery health and social care.

Video conferencing for people with learning disabilities

BETTER OUTCOMES FOR PEOPLE WITH LEARNING DISABILITIES – TRANSFORMING CARE (BOLDTC)

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VIDEO-CONFERENCING SERVICES FOR PEOPLE WITH LEARNING DISABILITIES

People with learning disabilities often have problems sustaining contact with their families and accessing health and other services when they need them. This project provided video-conferencing facilities that people with learning disabilities and their carers could use to ease these communication problems. The technology was deployed across five locations in England and the Institute played an action research and evaluation role to support the project in its search for the best way to exploit this technology for the benefit of people with learning disabilities. Early results suggest a major benefit is that the technology can be a significant benefit to families in maintaining contact with people with learning disabilities but that organisational issues in revising service procedures may hamper adoption of the technology within the health services. The project worked in an iterative way to support the learning of all parties about the value of this technology and how to overcome the organisational problems in its adoption.