Weeknote E2 — joining the dots within interoperability and standards in adult social care

Balloons floating in the sky. Photo by Luca Upper on Unsplash

Over the last 4 weeks, our small team have been looking at standards and interoperability in adult social care. We’re calling this a discovery, for want of a better word, but the reality is that we’re not starting a narrative from the beginning — we’ve joined it late, speaking to people who have lived and breathed interoperability for years and years. I hope our work, whatever we call it, can coherently articulate the collective needs from the sector to NHSX in what will be the start of the story.

What I’ve been up to

Here’s our activity from the last two weeks:

• we were able to prioritise use cases based on a criteria of reach, benefit and whether it was already being addressed or not
• a useful exercise in understanding, at a very broad brush stroke, the areas where more could be done
• joined up with teams internally and stood under scrutiny with suggestions and how they link back to problem statements
• we took these use cases and insights and turned into ideas which we consolidated and shared with stakeholders

Good things

Overall, a good week because of the following reasons:

• enjoying my role as a delivery manager in this piece of work (most of you know me as a content designer but with hidden ninja skills in delivery that come to the fore during complex projects)
• good continued stakeholder engagement this week despite time constraints.
• recurring themes such as the need for — “person-centred care” which sounds so inherently important but is often overlooked when thinking about the needs of professionals when giving care
• the challenge of absorbing, analysing and making sense of all the voices we’ve heard has been challenging but rewarding.

Prioritised use cases

Here’s our list of priority use cases based on the criteria mentioned above:

• access to shared health and care information, enabling health and care professionals to provide personalised care
• access remote primary and secondary clinical consultations in a care home / home care setting*
• support for care providers and local authorities to buy and implement interoperable and effective digital services
• discharge patients from hospital to a care home, nursing home or home care setting (includes whole discharge process)

I anticipate there is more work to be done to standardise these use cases and link them back to a specific journey.

*We learnt that other teams in NHSX are looking into both short and long term needs when it comes to video consultations.

Difficulties

Making the leap from identifying problems to ideation was big and more collaboration could have helped bring others along the journey. We got a small number of responses when asked to prioritise ideas which could suggest:

• disagreement with ideas
• disagreement with an exercise in prioritising one over the other

Of the limited responses we had, the need for a collective, holistic response was articulated bluntly and directly. It made me stop and consider our recommendation for methodology — less about sequence and more about a programme of activity happening concurrently.

5 things I learnt

1. It’s never too late to change direction

The reminder from a stakeholder arrived late last week: look at things holistically. It made me question the methodology of sequencing ideas. The ability to listen and change direction where needed is key during exercises like this, quantum scientist Jim Al-Khalili offered advice which I thought was relevant to this work:

“always have doubts, think like a scientist…be prepared to entertain other points of view, listen, always be prepared to change your mind in light of evidence coming in” Jim Al-Khalili

Now is the time to question our original question: what are the broken journeys within patient care which could be improved by sharing data and standards? This question pre-supposes there might be untrodden turf but our research has shown the opposite; there are countless exemplars of both local activities and nationwide initiatives which are delivering good results within standards and interoperability. But more work is needed, and the big question is “how do we get there?”

Perhaps the question to ask now is: “what would it take to benchmark progress made to date and set a common goal which we can collectively work towards and measure?”

2. An evidence-based strategy to scaling effective local efforts to a national level and setting a common goal. Something that identifies what the relationship looks like between local and national organisations. The incredible local efforts seen during the peak of coronavirus is a powerful reminder of the bloodline that local government offers. Future activity must include a clear communication path between local and national (and vice versa) so evidence and data is used meaningfully and direction is communicated clearly.

3. A need for central co-ordination from NHSX is vital in improving awareness of what activity is going in to support better data-sharing. To me this looks like a group of active stakeholders engaging and discussing on a regular occasion. Collectively the group can share insights, pass on lessons learnt, reduce chances of duplicate activity and move forward in a progressive user-centred way.

4. It’s all connected — there are complex inter-dependencies that suggest nothing should be looked at in isolation

One example. Creating a common care record exchanged between health and social care is great, but cannot be done if people don’t know how to buy and implement the technology in the first place. Capability and confidence with technology is arguably more important than the technology in the first place.

Second example. A personalised care plan would be wonderful, but what goes in it? How do I know if the technology I buy for my care home can receive this? Without the right information governance on who can access it and when, there will be perceived barriers about when it can be used.

5. We all need to get better at listening

Dropping this one in here, I’m currently training as an Executive Coach and the skill of being able to actively listening is wonderful but so rarely used. Now, in 2020, it’s more important than ever to listen to what others around us have got to say.

Here’s a good article on how to practice active listening.

Next week, we’ll take this forward to senior leadership team in NHSX where we will articulate lessons learnt from above and in our wider research. We hope it will help inform a bigger programme of work in this area which utilises the vast experience, insights and knowledge that we tapped into during our project.

Until next time.