Trust and confidence in technology-enabled care

Digital change is often understood simplistically. Too much focus is put on the technologies themselves rather than how to redesign care models or the testing and iteration required to derive the benefits new technologies can deliver. To truly enable digital transformation, services need to work with patients, staff and the developers to ensure technologies are user centred and challenge driven. They must also run iterative change processes to reconsider the many elements that make up existing services. There should be a focus on how technology can enable an improved model of service delivery rather than digitising the status quo or simply adding technology into existing pipelines. This would be enabled by robust co-design with all key beneficiaries, focusing on what challenge technology is trying to solve and what value and benefits it will deliver. This work is more likely to succeed if it draws on the expertise of improvement experts, industry and voluntary and community sector partners. All of this will take time, skill, energy and resource.  

Invest in co-design to build coalitions for change 

Co-design plays a dual role of ensuring that technology meets the needs of stakeholders (including technology partners, improvement teams and patient organisations) while also building the support and ownership among end users (including patients, service users and staff) critical for technology adoption.

It is important to work with a range of end users from the outset. This ensures that issues of trust and confidence are addressed at the earliest stage of development rather than during implementation. Meaningfully involving staff could also contribute to an overall sense of feeling valued and appreciated, thereby increasing their uptake of the technology.

Co-design should focus on understanding what matters to the relevant stakeholder groups and how to develop and implement technologies that will meet these needs. In doing so, trust and buy-in will be increased. 

By co-designing the Citizen Wallet app with people living with rheumatoid arthritis, the team was able to respond to patients’ needs in a more meaningful way. What the app does and how it is used were heavily influenced by the views of people living with rheumatoid arthritis. 

What we really wanted to do was… empower patients to design the solution for themselves… that they were in charge of, that they could shape what it was… a bit like plasticine to allow them to decide what features were important to them… They began to say, ‘Actually, it would be really good if we could do this, if we could do that. I’m less bothered about that. Could you explain that more to me?’ It allowed us to build in… more personalisation to individual context, expand and refine the whole self-management tool that we made available.
Euan Cameron, CEO, Cohesion Medical

The co-design process led to the inclusion of features that had not been considered, enhancing the product and ensuring it would meet people’s needs. For example, the original model was to support a dialogue between a patient and a consultant. Through co-design, it was expanded to also enable connections with voluntary and community sector support, a community pharmacy and other touch points like occupational health. The addition of these elements provides a much more connected model of care. 

Ideally, co-design processes should allow different stakeholder groups to work together to develop ideas and build collective ownership. Health Foundation work on developing learning communities offers some suggestions for how to include diverse voices and build trusting relationships in co-design.

Often, technology is developed away from the contexts in which it will be used. The need to involve staff in the development process is supported by recent Health Foundation research, which highlights how staff are often frustrated when technology solutions are not driven or informed by their knowledge of the service needs. Engaging stakeholders in the process builds a coalition for change. 

Establish a dialogue about the benefits and challenges 

Technology will not reach its potential if it is used purely as an add-on to existing services. It is important to understand what parts of an existing care model are working well and valued, whether a challenge is amenable to a tech solution and where there is potential for improvement using technology.  

The teams supported by Q Lab often found that patients and service users wanted to protect the human elements of care. 

We didn’t hear from patients that they were worried about tech giving wrong results. I think there was enough assurance that there were safeguards in place that any tech they would be using would have passed all the required safety checks. It was much more about the introduction of tech would take away the opportunity and time to talk with a health professional about how they were doing, how they were feeling. In terms of trust, it was, ‘How will I just not become a number?’ For many people living with kidney disease, the interactions with health professionals, that time to actually talk about how you’re doing, was highly valued. 
Joanne Smithson, Head of Implementation and Learning, What Works Centre for Wellbeing

Technology is more likely to be seen as trustworthy when there is an open dialogue around the overall benefits it can bring to care, as well as any limitations or risks it may introduce.

Bring in expertise and resources from a range of partners

Having a range of partnerships and collaborations can enable success. There is a wealth of expertise and capacity in the voluntary and community sector and in industry bodies that is often underutilised by the NHS. Additionally, different organisations can help secure the support of and build confidence with different stakeholder groups. 

The partnership between Healthcare Improvement Scotland, Cohesion Medical and the NRAS is an interesting example of this. The NRAS were critical in galvanising patient support for the rheumatoid arthritis app as it was being developed, brokering links with people who could test the system in its early stages and enabling a level of engagement often hard for NHS teams to facilitate. 

Putting the citizen right at the centre and giving us parity with clinical health professionals… really has worked well. The whole-system thinking has just widened the opportunities that we’ve had. Often, NHS projects are clinician or commissioner led. It was really exciting for NRAS to be such an important part of a project and really have our voice heard and listened to.
Ailsa Bosworth, NRAS Founder and National Patient Champion

The central role NRAS played in the partnership led to them taking on responsibility for running it. Alongside NRAS, Cohesion Medical, the technology developers, were integrated into the core team. This meant they were able to lead the co-design process, drawing on their existing user-centred design skills. Too often, NHS organisations find it difficult to work with industry, meaning they do not get the benefit of the expertise and resources industry partners can contribute to technology development, implementation and adoption.

The partnership between Chelsea and Westminster NHS Foundation Trust and Hounslow Council provided a springboard for better collaborative working in the borough. The team were recently given the MJ Achievement Award for taking ‘a whole-team approach to tackling health inequalities’ in this project.

Utilise expertise in embedding, scaling and spreading change 

The work of the Q Lab teams has demonstrated the important role improvement experts can play in understanding what is needed to embed, scale and spread innovative ideas. Too often, digital change efforts can be siloed or disconnected between digital, innovation, transformation and/or improvement teams. But embedding, scaling and spreading technology requires a truly interdisciplinary and collaborative approach. This idea is communicated succinctly in Healthcare Improvement Scotland’s model for enabling improvement within clinical teams, which highlights the need to align process, technological and workforce innovations. There is a wealth of expertise from improvement that already exists in our health and care system. This is demonstrated by the thousands of members who make up the Q community, which can support this work. The challenge for leaders is to make sure this expertise is well utilised in the significant task of digitising the NHS. 

 The Q Lab programme saw how improvement science enhanced the work of early technology innovations. The teams benefited from thinking through their theories of change and distilling what is core and what is customisable, incorporating learning from previous Health Foundation work on enabling the spread and scale of innovation.