Lessons learnt from the Care City test bed

A recent NHS England Test Bed programme site involved the delivery of six digital innovations across three settings in East London. Nadia Crellin, a researcher for the Nuffield Trust, explores what we can learn from the programme when it comes to implementing innovation.

Despite huge potential, the full benefits of digital health innovations are often still not being delivered for patients and staff. Harnessing the potential of digital technology (whether apps, diagnostic kits or other tools) can transform health and social care services delivering the best care possible for patients, as well as benefits for staff.

Below we outline 10 practical lessons to support policy makers, commissioners, innovators and service providers successfully integrate technology into health and social care services. Lessons are drawn from the Care City test bed – one of the NHS England Test Bed programme sites that brought together NHS organisations and commercial providers of digital technologies to test ‘market ready’ innovations. The Care City test bed involved the delivery of six digital innovations across three settings in East London; domiciliary care, primary care and an acute hospital.

1. Dedicate sufficient time and resource to engage with end users

Engagement with clinicians and service users is important for understanding how an innovation best fits into a service.  Innovation should be driven by service needs rather than the technology. Engagement is vital for discussing potential risks and providing a realistic view about what can be achieved with a digital solution.  Time for services to test the technology to ensure that it is appropriate for end users must also be included.

2. Co-design or co-production with end users is an essential tool when implementing technology

Co-design or co-production is valuable for gathering feedback, to identify practical changes to help drive the implementation according to the end user need, and to identify issues as they occur and co-develop solutions such as changes to care pathways, or adaptations to the technology itself – a continuous ‘quality improvement’ approach.

3. Identify the need and its wider impact on the system, not a need for a technology

The implementation of technology in health services should be solution-driven by a particular service problem or end-user need. Consideration should also be given to how the digital innovation embeds into existing services, how the innovation might disrupt or impact on wider care pathways or whether changes to the wider system might be needed to for the innovation to provide its full benefits.

4. Explore the motivators and barriers that might influence user uptake of an innovation

Factors that might influence user engagement with a digital innovation include the method of referral (such as whether face to face or the involvement of a clinician), the role of friends and family in supporting the use of technology particularly for those users are less confident with digital technology, language barriers, digital literacy such as smartphone familiarity, and digital access such as not having access to the internet or technology.

5. Ignore information governance requirements at your peril

Gaining information governance approvals is a critical component of implementing digital technologies. The information governance landscape can be challenging to navigate. Sufficient time and expertise should be allocated to manage these requirements and gain all necessary approvals.

6. Don’t be afraid to tailor the innovation along the journey

It is often beneficial for innovators to make changes or adaptations to their product or process to respond to needs or adapt to new settings, pathways or situations. Being flexible and open to adaptations can enable innovators to spread to new markets or users, improve their offer or maximise the benefit for service staff and patients.

7. Ensure adequate training is built in for services using the technology

Staff within services delivering digital health innovations should receive adequate training in order to feel confident in using or referring to the innovations. Training should be inclusive, consider staff experience and confidence using technology, provide a clear understanding of how the technology functions, and be delivered within the context of the care pathway that it is being used.

8. Embedding the innovation is half the journey – ongoing data collection and analysis is key

When embedding a new innovation, data should be collected to enable you to monitor how well it is meeting its original aims, whether there are problems with access, to identify reasons why it might not be used, and end-user outcomes and experiences. Monitoring data allows feedback to be provided in real time. Data sharing between the innovator and services delivering the technology is pivotal for problem solving, allowing the delivery of the innovation to be as efficient as possible and for care to be aligned.

9. Ensure there is sufficient resource, capacity and project management support to facilitate roll-out

Digital solutions rarely stand alone but need infrastructure and support to be effective, whether this is provided as part of a package by the digital provider, or whether this needs to be provided by health services. It is, therefore, crucial to consider the funding and resource input required to implement innovations in order to ensure sustainability within services.

10. Recognise that variation across local areas exists and adapt the implementation accordingly

The same digital innovation will not be delivered identically across all services and will therefore need to be adapted according to the different organisational structures to be successful. Effort should be made to understand the variation in organisational and workforce structure and capacity. Services delivering innovations will require flexibility in order to adapt operating procedures to the specificities of their needs.