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Transforming care and health through information and technology: Local Investment Programme – Interim Report

By Dr Adam Hoare

Local Government Association – Local Investment Programme

Local Government Association Local Investment Programme Interim Report

Local Investment Programme – Interim Evaluation Report

In 2017 the Local Government Association in collaboration with NHS Digital introduced the Local Investment Programme. The programme recognised that the imperative for local care services to transform has never been greater due to rising needs, citizen demands and expectations alongside sustained pressure on resources. Although technology will never be a replacement for the delivery of care it can, if used appropriately, support people to live at home for longer, enable professionals to work more effectively together and help commissioners target services where they have the greatest impact. The Local Investment Programme (LIP) supported transformation through one-off local investment funding of up to £50,000 for projects that seek to use information and technology to improve adult social care and health outcomes and deliver financial savings as well as supporting more resilient care services and in improving outcomes, including people’s experience of care.

The programme was underpinned by a number of key principles:

  • encouraging open and replicable approaches which enable other LAs to adopt digital ways of working
  • supporting innovation and new thinking within adult social care and health, assisting its digital maturity within a challenging financial environment
  • assisting cross-council or multi-agency use of information and technology
  • developing an evidence-base and tools to support ongoing local digital investment in adult social care and health.

It was expected that the outputs and learning from these projects would be reusable and replicable, enabling them to be shared and implemented widely across the sector.

Councils who were successful in their bids for funding received support from an external partner organisation to help evaluate benefits, capture learning and support dissemination to assist other local areas. Participating local authorities were required to actively support this work, over the course of the programme, including in the development of guidance and tools for the sector.

The Bayswater Institute and OPM Group (now Traverse) were successful in winning the opportunity to evaluate the 19 technology interventions funded by the programme. In April 2018 an interim report was produced capturing the learning on the ground as well as considering the programme itself.

 

Health care for all: effective, community supported, healthcare with innovative use of telemedicine technology

Abstract:

Almost half of the world’s total population reside in rural and remote areas and a large number of these people remain deprived of most basic facilities like healthcare and education. It is deemed impossible for government with scarce resources in developing countries to open and run a health facility in every remote community using conventional means. One increasingly popular unconventional mean is the use of existing technology to improve exchange of medical information for the purpose of improving health of underprivileged communities. Telemedicine implies the use of information and communication technology to provide health care remotely from a distance. With the induction of telemedicine, patients who live in rural and remote areas can have increased access to medical services. In many developing countries, use of telemedicine however has been limited mainly to teleconferencing between primary and secondary/tertiary care facilities for diagnosis and management of patients. This system still requires patients from remote communities to travel, often long and arduous journeys to the centre where telecom and medical facilities are available. Health Care 4 All International, a not for profit registered charity is providing primary care to patients by taking telemedicine into their homes in remote communities, thus obviating the need and hardships of travel for patient.

Journal of Pharmaceutical Policy and Practice Link

Tariq Kazim ShahEmail author, Tasneem Tariq, Roger Phillips, Steve Davison, Adam Hoare, Syed Shahzad Hasan and Zaheer-Ud-Din Babar, Journal of Pharmaceutical Policy and Practice201811:3

https://doi.org/10.1186/s40545-018-0130-5

The Future of Work: Automation and Continuous Change?

By Prof Ken Eason

Predictions for the future of Work

Christmas saw the publication of another forecast of the number of jobs that are at risk because of the march of robotics and artificial intelligence. This time it was the IPPR (Institute of Public Policy Research) forecasting that up to 44% of UK jobs are at risk across wide sectors of the economy.

IPPR Report on Managing Automation

There are now many forecasts of massive job losses and attention is being focused on a world where a small proportion of people (the highly skilled ones) will be employed and the rest will be out of work and poor.

But there is also another common theme in the debate about the future of work. It is that we exist in a complex, ever changing, interconnected, global economy and that to survive organisations have to be flexible, resilient and adaptive. The cry is that:

The Only Constant is Change

 Who will manage the change?

How do we reconcile these two different perspectives on the future of work?  Our clever technology may be very good at doing the operational work but it cannot help us make sense of the messy world of international trade, market forces, competitiveness, social change, government action and technical innovation. And it cannot determine what we should do to take advantage of new opportunities and defend against threats. AI may be smart but it is a narrow intelligence with a clever understanding of a specific work domain. Indeed, such narrow AI is also known as weak AI because it cannot replace the breadth of capabilities of a human. However imperfect they may be, human beings are currently the only general purpose intelligent resource we have that can make sense of a confusing, changing world – sentience is known as strong AI.

How is a work organisation to manage in a changing world with a small labour force and a large and sophisticated technological base that may be difficult and expensive to change? The small labour force may have a big agenda: to manage the technology and make sure nothing goes wrong, to monitor the outside world and spot opportunities and threats and to design and implement new ways of working to meet changing requirements. And to keep doing all of these things all of the time. There are many reasons to predict that this model of future work organisations will be ineffective and could be dangerous. One of the reasons for this prediction is what we know about how work actually gets done.

People as the adaptive, coping agents in work systems

 Every study of how work actually gets done shows that it is rarely done strictly according to the formal processes specified that may be embedded in the technology. The people in the work system embellish the formal processes with their own knowledge, often tacit and undeclared, in order to give work delivery the flexibility to meet varied and emergent requirements. They are the ‘oil in the system’ that ‘keeps the show on the road’. They recognize what is new and different, learn how to adapt, and add new, often unspecified, procedures to the repertoire of the organisation. In doing so they often have to ‘work around’ inflexibilities in the formal system to get work done and meet customer requirements.

As a result in any well-established work system there are people who have a deep but often implicit understanding of how the system actually works and a learning capability that means there is a bottom-up process of adaptation and evolution in place that responds to local changes.

The danger of the current narrative about robotics and artificial intelligence is that it implies the replacement of this human resource with technologies that will produce the work on their own. If that is the case not only will work systems become less resilient and adaptive but all the collective tacit knowledge will be lost. And as the saying goes ‘you don’t know what you have lost ‘til it has gone’.

There is always ‘Organisational Choice’:  changing the balance of task 1 and task 2

 To their credit, the IPPR recognize that it is only some of the tasks that can be automated and there are many other parts of jobs that are best done by people. So instead of just assuming technology will replace people we have to ask how the new technological capabilities and the very different capabilities of human resources can be harnessed together for the long-term resilience and adaptability of work organisations. The solution has to be sociotechnical change not just technical change. There will be significant organisational choices to be made to find the right solutions and we need some principles to guide this process. Here are a few to consider:

  1. Immediate cost-effectiveness may be a dangerous objective. The key argument for automation may be economic – you get greater and more reliable productivity from robots and they are cheaper than human resources. That may be so, but you also have to consider what you might lose….
  2. Knowledgeable and skillful human resources provide a sense making resource that can cope with the unforeseen. We need to keep a general sense making capability at all levels within the organisation; to keep a watchful eye on our technology and to provide flexibility and adaptability wherever it is needed. But to be effective people need to keep their knowledge and skills up-to-date and that means actually doing the operational tasks some of the time. So, enabling them to ‘keep their hand in’ is an important design criteria for future systems design.
  3. Having people who understand the task domain means there is a double-task resource to add significant knowledge to planning future developments. Task 1– getting today’s work done – has dominated.

People also have Task 2 abilities – to step back and reflect, to review their performance, to see what can be improved etc. The more they can do this, the better chance the organisation has of coping with the need for continuous change.

Helping people and organisations develop their Task 2 capabilities is an important part of the Bayswater Institute mission. It could be that one of the consequences of robotics and AI will be that people need to spend less time on Task 1 and they can spend more time on Task 2 – in particular thinking about how the work system may be changed to meet new challenges and opportunities. Exploring the potential impacts up-front would seem a good investment in that this is a global challenge and will generate new requirements of the work force that could benefit from planning rather than reacting.

Representing Socio-Technical Systems Options in the Development of New Forms of Work Organization

Abstract:

It is widely accepted that effective implementation of new technology into work organizations needs an integrative approach in which developments in both technical and social systems are considered. Furthermore, success depends upon the effective participation of significant stakeholders in this process. This article reviews the methods available for this purpose and concludes that a particular weakness is the methods that can be used to generate and review socio-technical system opportunities early in the development process. Whilst methods exist to support stakeholder participation at this stage, they need to represent future socio-technical opportunities if they are to make an effective contribution. This article presents the ORDIT (Organizational Requirements Definition for Information Technology Systems) methodology, which uses responsibility modelling as a basis for constructing socio-technical systems opportunities. The application of telemedicine in health care is presented as a case study to demonstrate how this method can be used to construct and evaluate socio-technical scenarios.

Socio-technical Systems Work Organisational Development Information Technology

Publication at Taylor and Francis Online

Eason K.D. Harker S.D.P. and Olphert C.W. (1996) Representing Socio-Technical Systems Options in the Development of New Forms of Work Organization. European Journal of Work and Organizational Psychology 5(3) 399-420

DOI Link

Understanding the Organisational Ramifications of Implementing Information Technology Systems

Handbook of Human-Computer Interaction (Second Edition)

Publisher Summary:
Information technology is a major force for organizational change. Every organization that applies the technology experiences organizational ramifications. This chapter charts the development of different models of organizational effects over a 40-year period. During the 1960s and 1970s, many studies of organizational impact were undertaken that produced conflicting results. As a result, a contingency model of computer impact emerged that accounted for the different impacts by reference to different forms of technology and application. In the last decade, it has become clear that this is also an inadequate model because it does not allow for the active nature of organizations that act to shape the impact of the technology. The chapter examines nine case studies to explore the processes by which organizational impact takes place. The active manner in which these processes operate is summarized in model three. This is an organizational assimilation model in which the three sub-systems of an enterprise interact and create outcomes in each sub-system. The chapter ends with a review of the many methods now available to support this approach and outlines the need for organizational stakeholders to play significant roles in new system developments.

Human Computer Interaction User Centred Design Organisational Impact Information Technology

Google Books Link

Science Direct Link

Eason K. D. (1997) Understanding the organisational ramifications of implementing information technology systems. In ‘Handbook of Human-computer interaction’ M.G. Hollander, T.K. Landeaur and P.V. Prabhu (eds) , Amsterdam, Elsevier

DOI Link

How to Fail When Introducing Electronic Technologies into Organisations

The challenges of large scale IT projects viewed through the National Programme for IT – NPfIT

Abstract:
The history of computer applications is littered with examples of large and expensive IT systems failing when they were implemented in organisations. This paper illustrates how this happens by describing the case of the NPfIT, the National Programme for IT, in the UK National Health Service. It was introduced with a great fanfare in 2004 to standardize electronic patient records across the NHS and was ‘dismantled’ in 2011 having cost somewhere between £12 and £20 billion.

The paper concludes this programme encountered major problems because it adopted a top down, technocentric approach that led to a ‘one size does not fit all’ response from health agencies of widely different types. A major lesson is that these developments have to be treated not just as technical developments but as sociotechnical developments, i.e. the organisational and technical changes have to be treated in parallel and as interdependent entities. The paper offers six principles for the implementation of new technology into organisations that may improve the chances of users being able to harness the potential of new technology.

IEEE Explore Link

Eason K.D. How to fail when introducing electronic technologies into organisations. Proceedings of DESE 2016 (Developments in eSystems Engineering’, Liverpool September

 

A Socio-Technical Approach to Evidence Generation in the Use of Video Conferencing in Care Delivery

Evidence of outcomes across multiple uses of video conferencing in health and social care delivery – a socio-technical perspective

Video conferencing in care delivery telemedicine socio-technical v-connect Adam Hoare

Use of Video Connection Platform in Multiple Verticals of Care Delivery

Abstract:
Care and support services need to respond to the rapidly changing demands of the population and available resources. The authors will present evidence that video conferencing can underpin many of the aspirations for future care delivery. However, if the necessary scale and pace are to be achieved a new model for evidence generation needs to be found. Using the experience of deploying video across health and social care a new model of evidence generation will be proposed based on a socio-technical approach where complexity and human capabilities are features of the intervention. A practice-based approach utilising action research will be used. The model will focus on four dimensions that are key to the success of an intervention using video: Practice, Outcomes, Technology and Evidence. Addressing the interactions between these four dimensions promotes a system that can evolve services that, in cooperation with the video technology platform, can satisfy changing care demands

The effects of current economic and demographic pressures on care and support systems are well documented. The need to do more with less is an established requirement of new models of care. However, there are significant barriers to the innovation of new ways of working in care delivery. Some of these barriers will be described through the experiences of one of the authors (AH) in deploying video conferencing to support people in their own homes or in a care environment.

The current use of video in care delivery is predominantly clinician-to-clinician communication between care organisations. Established examples are stroke or cancer networks. When developing a strategy for deploying a video intervention targeted at people in a residential environment it soon became clear that there was not a precedent to follow. In terms of Porter’s Five Forces the intervention was neither a new entrant to an industry that already exists or a substitute for a current product. Clearly any adoption of the video approach was going to disrupt internal systems in the care organisation and result in changes to practice. From a resources and capabilities point of view any strategy to deploy video requires close collaboration between the resources of the care organisation and the video service provider. This is a challenging engagement for care providers as they are more accustomed to transactional approaches where products or services are bought to a specification. Hence, each video deployment required sensitivity to the resources and capabilities of the customer and a collaborative approach to lowering the barriers to use of the technology. For example, modifying the user interfaces of the video conferencing equipment could lower some barriers and this has been done extensively to improve the experience of the people receiving care and of the clinicians providing it.

A further challenge to any deployment of video conferencing is the initial modelling of the economic benefits. As each deployment creates a network of contacts there is no template for a specific intervention. Within health care, each disease, e.g. diabetes, has its own ‘silo’, i.e. has its own care pathway, its own specialists, seeks its own technical support and is evaluated in terms of its ability to meet disease-specific outcomes. Engaging with a particular silo is very dependent upon the context of the engagement and each deployment raises its own challenges. Therefore, before video can be deployed in the residential environment its benefits and cost effectiveness within current siloes of care have to be proved.

IGI Global Link

Hoare, Adam and Ken Eason.  A Socio-Technical Approach to Evidence Generation in the Use of Video Conferencing in Care Delivery. IJSKD 6.2 (2014): 36-52. Web. 2 Nov. 2017. doi:10.4018/ijskd.2014040103

Afterword: The Past, Present and Future of Sociotechnical Systems Theory

Introduction:

Afterword: The Past, Present and Future of Sociotechnical Systems Theory Ken EasonIt is a rare privilege to have been the inspiration behind the production of this collection of papers and I warmly thank all of the contributors, especially Patrick Waterson, for reminding me of so many debates and giving me so much to reflect upon. I was especially pleased to find such a strong theme running through these papers, a theme that has been an obsession for me for over 40 years: sociotechnical systems theory. Throughout my career I have been concerned with systems approaches in ergonomics because they enable us to recognize that people at work often engage in tasks as part of a complex system and this has profound effects on them and their task performance. Of all the systems approaches that are available I have found sociotechnical systems theory the most powerful way of explaining systems behaviour and the most useful in designing new systems. My aim in these pages is to use the insights that the authors in this volume have provided to reflect on what has been important to me about sociotechnical systems theory, on where this approach is in the present day and what contribution it might make in the future.

Sociotechnical systems studies 1970-1990

I was very fortunate in the 1970s to work with Lisl Klein and Harold Bridger who were at that time stalwarts of the Tavistock Institute of Human Relations in London, widely acknowledged to have been responsible for the development of sociotechnical sys- tems theory. The theory was developed to explain the human and organisational ramifications of the introduction of mechanization into coal mining, weaving and other industries. By the 1970s it was computer technology in all its forms that was beginning to have a major impact on work systems and when we started the HUSAT (Human Sciences and Advanced Technology) Research Group at Loughborough University, so graphically described by Tom Stewart and Leela Damodaran (Waterson, Stewart and Dam- odaran, this volume), it was natural for me to apply sociotechnical systems concepts in order to understand the impact of this new technology on people at work. At that time the main issue was that this technology was being used via ‘remote terminals’ linked to mainframe computers by ‘naïve users’, i.e. people who were not computer professionals, and these new users had to adapt to the unfriendly, rigid and literal ways in which computers operated. This started a major programme of work to render these devices easy to use for their new users leading to the ‘user friendly’ graph- ical interfaces used by most of the population today. My preoccu- pation, however, was that within each organisation there were different kinds of users whose work roles and tasks require specific service from the computer system. As a consequence we were soon writing papers about the needs of different kinds of computer user and my contribution to an early issue of this journal was a paper on ‘the manager as a computer user’. Sociotechnical systems theory, because of its emphasis upon the way technical and human resources are deployed to serve the needs of a collective task, was particularly well suited to examining how effectively the task needs of each user were served by computer systems and in most cases we found they were very badly served with the result that many systems were either rejected or ‘worked around’.

Science Direct Link

Ken Eason, Afterword: The past, present and future of sociotechnical systems theory, In Applied Ergonomics, Volume 45, Issue 2, Part A, 2014, Pages 213-220, ISSN 0003-6870, https://doi.org/10.1016/j.apergo.2013.09.017.

Better Outcomes for People with Learning Disabilities – Transforming Care

Better Outcomes for People With Learning Disabilities Transforming Care Using Communication Technology Adam Hoare

 A project exploring the use of communication technology in support of person-centred care for people with learning disabilities

A collaboration with people, their families, carers, practitioners, technologists, academics and charities in pursuit of new models of care that utilise communication technology. Taking a practice-led approach to the development of the technology and considering the evidence required to demonstrate outcomes. The goal-to produce a transferable approach to evolving practice in cooperation with technology as a continuous learning process.

This was a £1m project funded by the Small Business Research Initiative in health administered by InnovateUK and Health Enterprise East.

SBRI Health

The project brought together a wide range of stakeholders in the support and care of people with learning disabilities to see how technology could form part of a person-centred approach to care provision.

Project Partners

Project Lead: Red Embedded Systems Ltd – provides v-connect, a video communications service. www.v-connect.co.uk

The v-connect service

Technology Partner: Rescon Ltd – provides Lincus, a data capture, storage and analytics tool.

Rescon Technologies

Care Provider: Hft – a charity supporting people with learning disabilities and their families.

Hft

Commissioner of Social Services: Sandwell Metropolitan Borough Council – a local authority covering 310,000 people in the West Midlands.

Sandwell Metropolitan Borough Council

Health Commissioner: Sandwell and West Birmingham CCG – Sandwell and West Birmingham Clinical Commissioning Group is a membership organisation involving 100 GP practices serving around 547,400 patients across the Sandwell and West Birmingham area. www.sandwellandwestbhamccg.nhs.uk

Sandwell and West Birmingham CCG

Service Development and Transformation: Changing Our Lives – a charity working with disabled people of all ages and backgrounds to deliver solutions to each particular need, and strive to achieve positive, individual-focused outcomes around rights, health and social inclusion.

Changing Our Lives

National Disabilities Charity: The DLF at Shaw Trust – The DLF brings together comprehensive knowledge of assistive technology with expertise of practitioners to provide information, advice, training and business tools. Working within the Shaw Trust, one of the largest, national third sector providers of welfare to work and social care programmes, the DLF can draw on the direct experience of people with learning disabilities and their community supporters.

Disability Living Foundation at Shaw Trust

Evaluation and Action Research Partner: The Bayswater Institute seeks to help organisations integrate human and social considerations with economic, structural and technical ones in the design and development of organisations and work.

Bayswater Institute

This project followed several years of developing communication technology in collaboration with practice and developing an approach to evaluation and evidence generation that would support its continued sustainable use. An example publication:

A Socio-technical approach to Evidence Generation in the Use of Video Conferencing in Care Delivery

Expert Support

Janet Cobb – an independent health consultant with considerable experience in learning disabilities.

David Atkinson – an independent consultant nurse and co-developer of the Health Equalities Framework.

Better Outcomes for People with Learning Disabilities – Transforming Care Project Overview

BOLD-TC Project Overview (PDF Link)

DOI 10.13140/RG.2.2.29687.52647