With digital health technologies growing at an exponential rate, there is a temptation for health organisations to implement them in clinical settings as quickly as possible to enable safe and high quality patient care.
However, when implemented poorly, these technologies can exacerbate the very problems they are purported to solve.
For digital health technologies to have desired outcomes in practice, not only should they be evidence-based, but health organisations should also implement them in a safe, iterative and human-centred manner.
Guidance and awareness has increased on the crucial need for digital health technologies to be evidence-based for safety and effectiveness. However, there is limited coverage on best practices of implementing new digital health technologies in clinical care.
In Public Digital's recent engagement with a health organisation, we learnt how digital health technologies used in inpatient mental health wards were impacting staff and patients’ experiences. We saw just how harmful the impact could be, if implemented poorly, especially in highly emotive areas like this one.
During our 20 semi-structured interviews with patients, carers and clinicians, we heard their first-hand experiences of life on mental health wards, and individuals' experiences of digital health technologies.
Although opportunities for technology as a potential enabler were widely recognized, we found examples of poor implementation undermining these potential benefits:
Staff were instructed to use the technology when they came on shift without being told why and where the data from the technology was being stored.
Patients were unable to obtain a clear explanation from staff as to why there were new technologies on the ward, and how this bettered their care.
This massively impacted staff and patients' experiences on the wards.
Patients told us that regardless of the positive impacts of technology, the consequences of “not knowing” (the reasons why they were used), caused “fear”, leading to “mistrust” towards the healthcare staff. This affected therapeutic rapport and trust between staff and patients, therefore affecting safety and the quality of care they received.
In some cases, these approaches exacerbated poor practices and hierarchical cultures in which patients and staff were being told what to do with limited opportunities to critique and ask questions.
We concluded that new technology may function well and be supported by ample evidence of its safety and effectiveness. However, in a setting like this where the consequences of misunderstanding and conflict can be severe, poor implementation can be extremely harmful.
Based on this learning, we have shared lessons aimed at health organisations to consider when implementing new technologies.
Positions on technology
Before any implementation processes, health organisations need to first establish their positions on technology.
Technology will not solve the root causes of organisation's problems. It may help with surface level problems and symptoms, but it is not a standalone “fix”. For instance, it cannot fix cultural or political problems in an organisation as it intervenes in a system at a low leverage point.
Technology is an enabler for better care not a replacement for it. It should be used to strengthen relationships, not automate them away. Organisations establishing this as a status quo and communicating this to staff and patients can alleviate any fears, mistrusts or anxieties around the use of new technology.
Lessons for implementation
1. Start by understanding unmet human (staff and patients) needs before technology. Bringing everyone at the organisation closer to the realities and experiences of staff and patients can help identify the unmet needs they have when using your services. This helps the organisation to identify, articulate and communicate the problems technology can help solve to improve human experiences.
2. Cultivate a culture of transparency to bring everyone on the same page. Communicate the what, why and how of the implementation process openly and widely to staff, patients and carers as early in the care pathway as possible. This will allow patients and carers to better understand the technology, the impact it could have on them, and make informed decisions around how they might like to use it. This can engender trust and openness.
3. Identify people who will be most impacted by the use of technology. Work with them to design how it should be implemented. There are complex nuances in mental health, and digital health technologies will not be appropriate for certain groups of patients or in certain clinical scenarios. It is essential to work with staff and patients to: identify use cases, assess risks and benefits, plan how technologies would be introduced in clinical settings, how they would be monitored and governed and plan to gather user feedback.
4. Start small, test and iterate. Adopt agile delivery practices. Especially in clinical settings where consequences can be high, test assumptions early with users - staff and patients, just like how you might test a new drug on a clinical trial. Use their feedback to evaluate and iterate the roll out. It might even reveal the technology is not safe or useful in some clinical cases.
5. A good onboarding experience makes a huge difference for staff. All staff no matter the seniority need to be equipped with the right knowledge and tools to deliver the best care with new technology. In addition to training, design opportunities for staff to practise and master the skills to enable behaviour change.
Being human-centred matters
Organisations need to re-imagine how they might transform the services they deliver with the help of new technologies and innovations. They need to consider the impact it will have on the actions and behaviours of staff and patients, how it could change day-to-day operations, processes, infrastructure, and the ways people work with one another.
By understanding this impact, organisations will be able to proactively design and create conditions for technology to have positive effects on its users and the overall system. This is why Public Digital’s definition of digital deliberately covers culture, processes and operational models which need to be put in place before technologies.
Being human-centred is at the heart of effective delivery in any service. This means involving real people who are closest to the problem and taking their perspectives into account when designing, developing and implementing services.
Technology is more than just a set of tools. It has a direct impact on the experience of its users, and those who design and implement it must always be wary of that impact.