Partnerships between patients, clinicians and other health and care professionals are key to how we improve our current models of care. Advances in technology now enable us to develop these partnerships in new ways, for example, through enabling patients to readily share data with their health and care teams.

In my previous role as Director of Innovation and Digital Health in NHS England (NHSE), I had the opportunity to see technology-enabled transformation happen across the country within health and care services. Organisations embracing this opportunity are now seeing the benefits for their staff and patients.

These include:

• admission avoidance and reduced length of stay for people in hospital
• reduction in unnecessary trips to Emergency departments for care home residents (and associated reduction in ambulance conveyances)
• an improved ability for people living with long-term conditions to safely self-manage.

For me, embracing technology means paying attention to both the cultural and technological components of change. Without this, the benefits on offer will not be realised and the scale we require will not be achieved.

We are poised to shift into a world where patients can take much greater control over their health and wellbeing. Health and care providers across the country are now deploying remote monitoring technology, including wearables, to maximise the benefits these new approaches offer, and to provide the most appropriate health care for the patient in a safe and supported care environment. Very often this is in the comfort of the patient’s own home.

We are poised to shift into a world where patients can take much greater control over their health and wellbeing.

This opportunity for better care partnerships is dependent on collecting high quality data and ensuring it can be interrogated in a way that is meaningful – whether for the patient or the clinical team member providing care.

In my experience, getting this right is dependent on designing systems and processes alongside users to ensure the system works for them.

Whilst in my role at NHSE, my aim in working in partnership with Q community programmes such as Q Lab UK and Q Exchange (Q’s collaborative funding programme), was to bring these two dynamic worlds – improvement and digital health care – to a common understanding for the benefit of patients and staff.

This piece touches on a few of the ways that Q is helping to make this happen.

Q Lab UK

The world we are moving toward is not about clinicians ceding their power to patients, it is a far more fundamental system-wide change than that. Together we are moving to a modern, personalised model of care based on a spirit of partnership from the first point of contact. This involves embracing new ways of approaching health care and moving away for what has traditionally been a paternalistic model of care.

These models of care involve real partnerships between patients and their clinical teams, supported by technology.

The partnership between Q Lab UK and the NHS England Digital Health team is currently supporting four teams to test care models that enable patients to use technology to monitor their health at home. The technology enables them to do this safely in the knowledge that their clinical team can remotely monitor their condition in the background.

These models of care involve real partnerships between patients and their clinical teams, supported by technology that enables monitoring of the relevant vital signs or qualitative data relevant to their condition.

This enables the patient to take control of their health and make informed decisions in their own interest, such as adjustments to their medication, with continual support from their clinical team. These care models also enable clinical teams to support larger cohorts of patients safely using intelligent alerting alongside monitoring trends in response to interventions.

Working with Q Lab UK, these local teams are gaining an understanding of the challenges and benefits of these models of care in order to build staff and patient confidence in how and where technology can best support them. The focus is on the people and process rather than simply considering the technology. This is essential to ensuring we develop robust, scalable models of care.

Q Exchange

A big part of the work of Q Exchange 4 was helping to inspire the culture shift necessary for teams and their leaders to get their heads and their hearts into designing technology-enabled systems that work for both patients and staff. The range of projects here is much broader than technology-enabled remote monitoring, but I believe the learning from both will add to our growing knowledge of how to support technology-enabled change better.

Having people with improvement and digital expertise collaborating with patients and clinical teams will really enable us to deal with this challenge.

Technology aside, I believe that truly meaningful, sustainable transformation in an organisation arises from open, honest teamwork and insightful, collaborative leadership, underpinned by high quality data. High quality data is ideally collected electronically as a by-product of care delivery rather than requiring additional extra effort from staff or patients. Having people with improvement and digital expertise collaborating with patients and clinical teams will really enable us to deal with this challenge.

Q draws together people working to improve health and care from across the clinical and operational landscape. It enables the inclusion of colleagues with digital skills who can work with patients to develop user-centred models of care. It is fabulous to see more individuals who have purposefully developed their personal expertise in many of these disciplines getting involved in this work.

Co-designing new models of care: a shared risk approach

I sometimes hear clinicians express uneasiness about the risk of taking on new technology, which is understandable. I also hear patients express concern that they will lose access to face-to-face care and only have remote care.

Both are valid concerns but there is also a great risk in avoiding the use of new technology and continuing to rely on out-of-date methodologies and tools. For many people, technology-enabled care is their optimal model.

One of the most effective ways we can manage this tension is by applying Quality Improvement approaches grounded in the principles of co-design with all users.

Q Lab UK and Q Exchange are providing the tools we need to develop improvement models enabling patients, carers and clinicians to work together to design and optimise processes and technology, and share concerns and ambitions.

Bringing all these elements together to collaborate in a controlled, iterative learning environment allows organisations to collectively pool our resources, test opportunities and understand and manage risks to get to optimal solutions.

Towards whole-system improvement and high-quality data capture

Technology provides huge opportunities, but we need to collectively create the environment to maximise these opportunities. We have developed some great methods for interrogating data after it has been collected, but there is still work to do to design fluid, flexible ways of capturing consistently high quality data from patients and staff.

This involves welcoming the potential of new, disruptive technologies and releasing ourselves from negative past experiences with information technology.

The great strength of the Q community is its willingness to embrace the spirit as well as the science of improvement. It is this area where I think we have much to gain in terms of aligning digital health with our improvement ambitions.

Want to share your learning and experiences, find out about new methods and innovations, and discuss the ethical and social implications of technology in health care? Join our Digital Special Interest Group.

Resources

Learn more about the Q Exchange 4 projects and how they are bringing about change in this area:

Find out about the latest Q Lab UK project, exploring Technology Enabled Remote Monitoring

Find out more about NHS England’s work in this area on their Digital transformation page.