Whatever happened to the scientific method?

februari 03, 2017

The NHS has the heritage, the ambition, and the people to provide better digital services. The missing piece is a better delivery method.

Much has been said over the past few years on the topic of digital innovation, digital transformation, and the role of technology in the NHS. Yet relatively little has come to fruition so far.

We are half way into the Five Year Forward View. In the same timeframe Uber went from a start-up to the world’s biggest taxi company. Yet the NHS still suffers from the same problems as in October 2014. Paper-based systems and fragmented services remain the norm, and true patient empowerment is still a fair way off. As Dan Sheldon commented at The Digital Health Summit last Tuesday, none of this is for lack of investment. The government spends more on technology than it does on Wales. It is also not a question of heritage, culture, or skills. The NHS has a long, proud history of innovation, and NHS Digital has doubled headcount in the past two years.

So if not any of this, what is holding the NHS back?

Our view is clear – the traditional approach to delivering tech projects is broken.

To draw an analogy – old IT projects have been treated like surgery. Certainty was a pre-requisite before making the first incision. Risk was a dirty word, the result was permanent, and learning was relatively low on the priority list.

This is not to say that such an approach was completely without merit. But in a world of digital disruption and constant change, this approach is no longer appropriate.

We believe that developing digital services needs to be approached in the same way we develop drugs and vaccines. Hypothesise, test, and learn. Start with theories and ideas, make them tangible, and get them in front of the right people fast. Iterate based on user research, and launch once you feel their needs can be met. And then continue to test, learn, evolve, and improve. Your users will thank you for it.

None of this is new. If anyone understands the true and lasting value of the Scientific Method, it is the medical community. Now is the time to bring it back and apply it to the world of digital services.

We have recent experience of delivering re-imagined digital services across the NHS. Our work with the likes of MyNHS, NHS Choices, and NHS 111has been governed by the following principles:

Start with user needs

Why does or should this service exist? Who does it serve, and how? Focus on the desired outcome, not just the output. Digitising an existing but broken service is not an acceptable policy, however pretty the design is. It will not make life easier for anyone.

Start small, start fast

Focus on a core set of user needs. Then work to identify a Minimum Viable Service, rather than try to solve everything at once. This not only reduces cost, effort, and risk, it also helps you get your ideas in front of users faster. From there you can build your service outwards, based on evidence and value, rather than a set of untested assumptions.

Co-locate

Working in the same room has been proven, time and again, to be the most efficient way to work. Decisions can be made, quickly and more effectively. Your team feels more engaged, more empowered, and deliver better outcomes.

Bring everyone

Digital services cross every part of the NHS. Seek to break down silos and bring people together. Build multi-functional teams, steering boards, and stakeholder groups. Involve the “digital pariahs”. Those in policy units, compliance, security etc., and clinicians feel disengaged from digital services. Receive and value their perspectives. The earlier you bring them in, the more they can help, and the less likely they are to be blockers. Revel in conflicting ideas. The more assumptions you can gather at the start, the better the hypotheses you can generate, and the better the resulting service will be.

Value learning

Without learning from your users, you will quickly forget they exist. Make learning a vital part of any project, and don’t be afraid of mistakes. They often lead to the best results.

Digital transformation cannot succeed as a top-down initiative. It starts with those on the front line, those who work with patients every day. You are the ones who can spot the gaps, the areas where digital services can make a real difference. We believe that these 5 principles can help get you started. With our support and that of NHS Digital, you can turn your ideas into reality.

As Mr Sheldon said on Tuesday – the internet is eating everything. Digital transformation may well be done to the NHS before it can be done by it. Significant pressure and constant change is your reality. Fortunately, as we all know, these have been constants since the founding of the NHS. And you are well versed in handling both.

So let’s work together, combine your experience with ours, and make the NHS work even better in this digital world.