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

Fractal image

The Law of Unexpected Consequences –
Download our guide to spotting knock-on effects

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Th The law of unexpected consequences

Government actions to combat the coronavirus keep having unexpected consequences: students returning to University spread the virus, an examination algorithm leads to school children from disadvantaged backgrounds having their grades downgraded, and closing bars at 10 pm leads to people not socially distancing in the streets.  

We should not be surprised about these unexpected consequences because it is a well-recognized systems phenomenon. When you make a change in one part of a system it has knock-on effects elsewhere and some of them may be disadvantageous to what you are trying to achieve. And in all the examples we are now seeing, changes are being made that impact wider systems whether it is the existing educational system or the night-time leisure social ‘systems’ of our towns and cities.

Why do we not identify these consequences when we are planning a change? They always seem so obvious after the event. Part of the answer is that when we are planning a change we are usually focused on the change itself and we are probably under time and resource pressure to deliver it. There may not be much time to lift the blinkers and look for wider implications. And it is possible we don’t want to know: we may have enough trouble planning the change without looking for things that may or may not happen.

But this is a shortsighted and potentially disastrous strategy: it might jeopardise the whole venture. Spotting potential problems early means there is an opportunity to find ways of avoiding them.

This is a systems analysis problem and there are ways of spotting potential implications before anything is implemented. In one of our current projects, (the WORKTECC project lead by the CORU, the Clinical Operational Research Unit at University College London), we have developed a framework for the systematic search for implications of a change programme which is based on sociotechnical systems theory. It is designed to search for implications in a work system. The framework is here as a free resource:

Download our guide here

We have often helped project teams work through this process but this framework is designed for people to use for themselves. If you are concerned about the implications of a change you are engaged with, please try it. And please provide us with some feedback so that we can go on refining it.  

Professor Ken Eason

Keeping your concentration when working from home

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Weapons of mass distraction

When you travel to work there are things that shape the day and help you focus on getting the job done: the daily timetable (arrive, go home, lunch breaks etc), the enclosed work spaces, the meetings and appointments, the deadlines to meet and so on. When we are working from home many of these ways of organising the day disappear and it is easy to get distracted and lose our concentration. We are thrown back on our own resources to create a discipline that will sustain good working practice.  

 Using psychological theory Will Bedingfield gives some excellent advice on how to sustain concentration when working at home 

https://www.wired.co.uk/article/how-to-concentrate-pomodoro-wfh 

 A major conclusion from psychological research is that we are ‘single channel information processors’. That is, we can only focus on one thing at a time. We may celebrate multitasking but the evidence says we do it by rapid switching of our focus and it is stressful and inefficient. So working well depends on cutting out distractions. At home there can be plenty of them so how can we sustain our work focus? 

  1. Cut yourself off from temptation   Try to create a workspace that is free of all other homely features. Not just the rest of the family but all the other temptations of your home – magazines, food, music, evidence of your hobbies or whatever.  
  2. Use the normal structure of your working life. No doubt there will be deadlines, zoom meetings, telephone appointments etc that will shape parts of the day but make sure there are chunks of time to do the things you have to schedule yourself and don’t leave them until you are tired at the end of the day. Try not to get over committed to video meetings because they need extra concentration. There is growing evidence that people suffering from ‘zoom fatigue’. This seems to be most pronounced when people go straight from one meeting to another throughout the day.   
  3. Limit engagement with on-line ‘distractions’. Your PC or tablet is full of possible distractions – Facebook to check and Google to search etc. Many of the distractions may come from work itself: all those emails most of which you can bin. Many people adopt a policy of only checking emails once an hour for example so that they can keep their focus on the task in hand.  
  4. Give yourself breaks.   Don’t expect too much of yourself. We work best if we take regular breaks whether that is to get some exercise away from the fixed posture in front of the screen or to give our brain a chance to relax.  

All this advice amounts to: give yourself a chance of a decent run at each major task you undertake. 

Professor Ken Eason

Telemedicine or Face-to-Face Consultations?

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Picture of girl sitting on her bed using her laptop.

During the Covid-19 epidemic many GP practices have been offering patients video or telephone consultations. The Health Secretary, Matt Hancock, is so delighted by this development that he wants GP practices to make telemedicine their primary means of serving patients. We have been researching telemedicine for over 20 years and the evidence is very clear: whilst telemedicine can serve many very useful purposes it cannot be a replacement for face-to-face consultations.

There is often a euphoria associated with a new digital technology that assumes it will replace existing ways in which people get things done. But what often happens in practice is that the new technology becomes a complement to existing practices rather than replacing them. The demise of paper has, for example, been forecast for over 30 years but it is a very useful and flexible technology and is still flourishing alongside electronic publishing. We have every reason to believe that the same will happen to telemedicine: it will find its own niche alongside face-to-face consultations but it will not replace them. The task now is to work out when it can be most usefully and safely deployed and when face-to-face consultations are essential. Then we need to promulgate this knowledge as advice to help all medical practitioners.

Some distinctions are obvious. There are many diagnostic procedures that depend upon the doctor making a physical examination of the patient and face-to-face consultations will remain essential for these purposes. And there are many circumstances where the patient needs the doctor’s best ‘bedside manner’ to support them through anxious times. Who can imagine giving a patient bad news via Zoom!

What of the value of telemedicine? We have found examples where it adds substantially to what the medical profession can offer. One example is offering the patient support whilst they engage in home medical care: for example, having a diabetic nurse available via a telemed link whilst a new diabetic patient gives themselves an insulin injection. Recently we did some research with home dialysis patients who were supported through this complex process by a telemed link to dialysis specialists in the local hospital. We have also been working on the value of telemed links for people with learning disabilities for whom a visit to a GP practice can be a traumatic event: far better for them to ‘see’ the doctor in the familiar setting of their own home.

But some more general lessons have emerged from an evaluation conducted by Ipsos-Mori of the Babylon ‘GP at Hand’ service.

https://www.hammersmithfulhamccg.nhs.uk/media/156123/Evaluation-of-Babylon-GP-at-Hand-Final-Report.pdf 

Patients who join ‘GP at Hand’ leave their existing GP practice and opt for a telemedicine-first service. The evaluation found that the service was popular with young, fairly healthy patients who were busy with work and could not easily get to a GP surgery during the day. It was not so popular with the elderly or those with complex needs. And when the young patients found they had a more complex condition and they wanted a face-to-face consultation they often became dissatisfied with ‘GP at Hand’ and reverted to their original practice.

On this basis telemedicine has an important role to play in routine consultations but there needs to be an easy way to switch to face-to-face consultations if conditions become complex and patients become anxious.

Image of a person with their hands up in the air, reflecting the title of "don't shoot" in relation to action research

‘Don’t shoot the messenger’.  Can we face reality?

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As the Covid-19 crisis has deepened relations between politicians and their scientific advisers have become increasingly frayed. Politicians want to hear we are making progress and that the actions they are taking are being effective. They may want to highlight statistics that point in this direction. The scientists however must stay true to their data and if that says the infection rate is still too high to support some lockdown measures that is what they must advise.

Anyone who has practiced action research will recognise this dilemma. The people responsible for action want to hear that it is working and they may find it uncomfortable to hear from those responsible for the research what is actually happening on the ground. And if they don’t like the message the next step may be to ‘shoot the messenger’; perhaps to ignore what they are told, to question the competence of their researchers or even get rid of them. It is a very human characteristic. As Paul Simon wrote, ‘Still a man hears what he wants to hear and disregards the rest’ (The Boxer). And it may not just be a question of information about an action that is not working: it is even more difficult if the information challenges fundamental beliefs and ideologies. 

But if we are to deal effectively with a very dangerous and unfamiliar opponent like the virus we have to deal with reality not with our own favoured construction of it. If we don’t, we run the risk of having to deal with a much worse situation later.

So how can we help people take on-board information that may be difficult for them? What we don’t want is pressure on the advisers to hold back from presenting evidence for fear of their own future. They need to be given a kind of immunity, a license declared at the beginning of the process to report things as they find them. Another necessary requirement is that the people responsible for the action plans do not receive research information in any kind of public forum in which they may feel they have to defend their actions. They need a private space in which they can consider and reflect on the new information, question it as appropriate and explore its implications. The process also needs trust between colleagues and confidence in their judgement.   

Professor Ken Eason

"MiSt" book cover

Just published: A New Approach to Mindfulness: Mindful Stories – MiSt

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Professor Simon Bell with his new publication. Mindful Stories: A Parable

This book provides a new and innovative approach to mindfulness using short stories. Written for individuals and for groups, the book encourages readers to examine their lives, past, present and future. The 100 stories, written in 25 quartets, ascend from the ‘Base Camp’ of self-awareness, through the various levels of the ‘Slope’, and the ‘Crest’, to the ‘Summit’ of a new personal and collective understandings.

Simon Bell. A New Approach to Mindfulness: Mindful Stories – MiSt. Cambridge Scholars, 2020. 

Mindfulness Through Fiction: A Parable is something of an introduction to MiSt. It is available to download as an e-book on Amazon. It contains 20 of the 100 stories in one single story. If you want to explore Mindful Stories, it might be a good idea to take a look at Parable first. 

We need to separate the research from the policy making

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The Government process for dealing with the Covid-19 crisis has revealed many of the issues at the heart of creating an effective action research strategy. The Government is responsible for policy making and they have SAGE (the Scientific Advisory Group for Emergencies) to provide scientific and technical advice.  SAGE assesses the data on the progress of the virus, models the impact of possible actions and collates all the relevant information. The Government says it ‘follows the science’ but that is not the same as ‘we do what the scientists say’. Scientists advise but ministers decide: weighing up the trade-offs between the health risks and the economic consequences of different ways of coming out of lockdown is a burden politicians must bear.

The structure we have at Government level mirrors the separation between the research phase and the action phase in action research. This is a necessary separation so we get evidence that is as objective as possible.

Any organisation seeking to use an action research strategy to find their way out of lockdown will need to separate the responsibilities for planning and action (the policy making) from the responsibilities for research (the gathering and processing of the evidence). In a large organisation this separation of function may be relatively straightforward: the senior management may determine the action steps and staff from functions such as information analysis, business analysis, Human Resources and Health and Safety may undertake the research. It is also possible that a separate organisation, such as ourselves, takes responsibility for the research and evaluation functions in the action research cycle.

But in a small organisation there may be no pre-existing separations of role to make use of. If this is the case it can be useful to give somebody a specific responsibility for gathering the evidence to underpin the debate about the next action steps.

How well this separation will work in practice will depend upon the level of trust between members of the organisation and the degree of openness that people display to the evidence that is gathered. This is a topic we will attend to in the next post.

Professor Ken Eason

Covid-19: How will we know how well we are doing?

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The Government mantra is ‘our actions follow the science’. The scientists collect evidence of how the virus is spreading in order to give the politicians the advice they seek. But what evidence to collect?  And how long is the lag before you know whether actions taken are being effective? 

Problems about gathering the evidence have bedeviled our national response to Covid-19, so much so that our strategy has been likened to ‘driving blind’. These same issues will confront every organisation that is trying to find its way out of lockdown, albeit on a more local scale. If careful steps are being taken to get going again, how can we avoid ‘ driving blind’? If the aim is to scale up business activity without endangering staff and customers, what evidence can be collected to show the plans are working?  The obvious hard data includes the number of staff, customers etc who test positive and the number of customers prepared to come through the doors. The Government test and trace system is gradually providing more local data but there have been lags in getting information that is sufficiently detailed to be useful.  

There are, however, lots of other indicators that may provide more immediate and useful feedback. In action research every new action phase has specific aims and we need ways of measuring whether these aims are being achieved. If the aim is to create safe workplaces for staff, regular surveys are needed to assess how staff are feeling. Ideally there should also be opportunities to discuss specific problems and these can be addressed in the next action phase. Similarly, as shops, pubs and restaurants re-open there will be a crude measure of how many customers arrive but, if the response in slow, more effort needs to be put into discovering why and what can be done to give people more confidence that they will be safe. As schools re-open ways are needed to assess whether children and their parents feel confident about the measures taken and opportunities need to be created to discuss any concerns they may have.  

The basic message is that if you are going to take ‘baby steps’ into the unknown you have to have measures in place to warn you if you are about to fall down the stairs.

Professor Ken Eason

Top-down or bottom-up: who makes the decisions in a pandemic?

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We live in a blizzard of regulations, requirements, guidance and advice that changes regularly as the Government tries to find ways of guiding us out of lockdown. People crave clarity so they know exactly what to do but in reality there are so many different circumstances that we must all to some extent find our own way forward. For companies, how we solve the riddle of getting back to viable business activity whilst at the same time protecting staff, customers and everybody else, is going to be largely a matter of making local decisions.  We will all have to take our own ‘baby steps’, review the implications and gradually in an iterative way find our own ‘new normal’. Government may be treating getting us out of lockdown as a top-down decision making process but there will be a lot of bottom-up decisions to be taken as well.

So how can we prepare for the bottom-up process?  Here are four action research suggestions:

Set up a task force to ‘design’ the new way of working and monitor how well it is achieving its purpose

Work out what is a regulation that is enforceable by law and what is advice or guidance. This will define the discretion the task force has to create ways of working that meet local needs. Schools may have to abide by the social distancing regulations, for example, but they may be able to decide for themselves whether children come back full time or part-time, what spaces they can press into service for teaching, how to manage lunchtimes and playtimes and so on.

Be clear what the new system is expected to achieve and measure whether it is being achieved. Are people able to work following the social-distancing rules and face-mask wearing or do further adjustments need to be made? Above all are customers confident they are safe and are they willing to follow the procedures that have been set up?

Make regular reviews and be ready to change. The results of internal ‘research’ may suggest changes but there may also be outside changes. Government may change the regulations and create new restrictions or opportunities. Mandatory face-masks today: who knows what tomorrow.

Agility and invention will be needed.  There are plenty of examples of how organisations are adapting that can be our inspiration.

Professor Ken Eason