Last night the mHabitat team attended the EHI Awards as finalists in the Digital NHS Trust or Health Board of the Year category for our support to the digital journey of the NHS in Leeds – in particular Leeds Community Healthcare NHS Trust, Leeds and York Partnership NHS Foundation Trust and the Clinical Commissioning Groups in Leeds. Whilst we didn’t win the award on the night, it was gratifying to have an opportunity to reflect on the journey we have made so far and the plans we have for the year ahead.
We began our digital journey in January 2014 with me (Victoria) on a year’s secondment and a graduate trainee (Nikoo). Just over a year and a half later, we are a team of five running a wide variety of digital projects in Leeds and beyond. Our journey is one of constant beta – trying something new, making mistakes, learning from those mistakes, curating our knowledge, applying that learning, getting better at what we do, all the time expanding our networks and connections. In this emergent space, we’ve been continually inspired by the generosity of others, and have learnt from many fabulous people (you know who you are).
In the spirit of sharing our journey so far, here are six reflections on what works and doesn’t work when it comes to digital innovation in health and care:
Involve people/citizens from the outset – in the early days we occasionally (albeit reluctantly) initiated discovery work with health and care practitioners that didn’t involve the people they support. We quickly learnt that this meant at some point it would be necessary to go back to the beginning and start again. You can’t redesign services enabled by digital if you don’t start with the people whose experience and outcomes you hope to positively impact. Now we insist on it from the outset and throughout.
The people factor – our approach is always to focus on people first and technology second, but it can be easy to underestimate just how much time and care the people factor takes. This isn’t just about co-designing with practitioners, it’s also about spending time understanding the fine detail of how a digital technology will be embedded in day to day practice. Without paying attention and time (lots of time) to the people factor, digital technology is doomed to sit on the virtual shelf gathering virtual dust.
The curse of competing priorities – we all know the pressures that staff in the public sector are facing and, even when there is genuine enthusiasm for digital, teams can be pulled in many different directions and affected by all sorts of unforeseen changes. We’ve learnt to manage commissioner, manager and practitioner’s expectations from the start so they appreciate the time they will need to commit; we endeavour to make it as easy as possible by sorting all the project management and technical side of things so they can bring what they know best – their health/care expertise.
Finding a place to start – most teams intuitively understand that digital technologies can be an enabler in making their services better and improving experience and outcomes of the people they support. Most are completely stumped as to where to begin on this journey. We have found simple and easy things are a good place to start even if their impact will be limited. Running workshops with teams and appraising existing mobile applications on the apps stores can be a good place as a gentle introduction. Small experiments usually lead to big ambitions.
Top down and bottom up – we started our journey where we found a spark of enthusiasm from practitioners who were chomping at the bit to exploit digital technologies to make a difference. This was a great way to get traction, but without endorsement and support from the top of a large organisation, initiatives are vulnerable to getting blown off course as priorities change. Balancing generative practitioner led digital innovation with senior buy in and an organisational mandate are critical to success.
Waterfall eats agile for breakfast – our approach is informed by agile methodology – valuing the generative and emergent with an insistence on collaboration and codesign threaded throughout everything we do. However, working as part of and within large organisations brings with it many formal processes and controls. Endeavouring to hold these two approaches in equilibrium is more of an art than a science but something that we have learnt should always be paid close attention to – pragmatism wins the day.
As our work continues to expand, both beyond the NHS and city of Leeds where we started our journey, we’ll continue to share our learning with you here and through our various events and activities.