COVID-19 has accelerated the use of technology across many sectors, but the shift has been particularly marked in health care. Many patients and health care professionals adapted almost overnight to conducting consultations virtually, and the use of apps and devices for remote monitoring sharply increased too. There are now high hopes that technology can help the NHS deal with the huge challenges faced – in quality, productivity and workforce – as we recover from the pandemic. There are also ambitions for technology and data to accelerate the ability of the NHS to learn, adapt and improve, including through the development of ‘learning health systems’.
Getting implementation of technology right will be critical to both these objectives. After all, it is the use of technology that ultimately determines its success or failure. And embedding a technology effectively into a real-world health care environment can require significant effort.
What factors make tech implementation successful?
As part of the Health Foundation’s work with Health Data Research UK (HDR UK), we have developed a framework to help people who are engaged in deploying technology in health care services. This evidence-based framework highlights seven factors that have a bearing on the success of implementation:
- Skills and knowledge
- Motivation and attitudes
- User-centred design
- Ways of working
- Safety and equity
- Resources and infrastructure
- Culture and leadership
The supporting evidence for this framework is set out in the accompanying paper published by HDR UK, and includes learning from the Health Foundation’s programmes, HDR UK’s Better Care programme and an evidence review by the University of Sheffield’s School of Health and Related Research.
What do these factors mean for recent progress and future priorities?
We have seen rapid and impressive progress on the use of health technology during the COVID-19 pandemic. However, this increase in use is not necessarily a proxy for success. We need to understand the impact these changes have had on patient outcomes and experience, and revisit aspects of implementation that may have been shortcut, such as engagement and co-design with patients, to ensure they are done well. We hope this framework can support both of these aims, as well as informing future technology implementation.
Ensuring health tech works for all
Our paper highlights the importance of considering safety and equity throughout implementation. Rolling out a new technology is only part of the job; making sure it is safe and effective for all groups is critically important too.
Sometimes safety and equity risks arise from the design of technologies. For example, during the pandemic we’ve seen the rapid rollout of pulse oximeters to monitor blood oxygen levels at home and spot deterioration. But there is a growing body of evidence suggesting that such devices can overestimate blood oxygen levels in darker skinned patients – so we urgently need a rapid evaluation of pulse oximetry products.
On other occasions, risks may arise through the implementation of technologies. For example, patient-facing health technologies – like devices and apps for home monitoring – might be deployed without ensuring that patients have the digital skills needed to access or use them properly. These challenges underscore the importance of identifying key risks as an integral part of the implementation process, and taking action to mitigate them – for example, through training for staff and patients.
Creating the right conditions for successful implementation
The tech implementation framework also highlights the need to evolve new ways of working to accommodate technology within a health care service. The shift from face-to-face to remote care, for example, has required such shifts – from developing new triage processes to building technical troubleshooting into video consultations.
Patient and staff attitudes are also identified as a key factor for successful implementation, as these can affect motivation to use a particular technology. While some evidence suggests health care providers are positive about their experience using virtual consultations, this is not the case across the board, with some GPs remarking that it is like working ‘in a call centre’.
Concerns about the impact of new technologies on the quality of jobs, and quality of care, may naturally affect health workers’ desire to continue using them after the pandemic. This makes it vitally important to co-design new approaches with staff and patients, to help us get the right balance between virtual and face-to-face, and to ensure that virtual models (where appropriate) work well.
Leadership and culture also play a key role in fostering a conducive environment for adopting and sustaining innovation and technology – for example, through building a shared vision around technology-enabled care, and setting out how new uses of technology align with organisational strategy and values.
Making good implementation a priority
Our framework is intended to be a practical resource for people involved in the implementation of technology in health care services, shining a light on some key challenges and what can be done to address them. But this is not simply a task for those on the front line. It is also crucial that policymakers, system leaders and organisational leaders in the NHS all recognise the importance of implementation, ensure providers have the resources and infrastructure to use new technologies effectively, and provide the support needed by teams on the ground.
Only with a focus on good implementation at all levels of the system will we be able to realise the potential of technology to cope with the immense challenges facing the NHS, and to improve care for all.
Shakira Mahadeva is the Improvement Intern at the Health Foundation.