It is well acknowledged that we are living in a time of rapid technological advancement which is unparalleled in history. Scientists, politicians, and philosophers are openly debating the impact of mass automation on the future of society and the resulting transformation of the job market. We almost all – probably unwittingly, but generally willingly—have sacrificed our digital privacy for the sake of being able to access other people’s photos, know our way around a new place, or have our choice of music tailored for our tastes. Some futurists are preparing the way for humanity to live on the moon; others for living in a virtual reality.
But against this backdrop, the pace of healthcare innovation can sometimes feel stagnant. Everett Rogers first described his theory for the diffusion of innovation in the 1960s. His bell-shaped curve is well known—the majority of us are sandwiched in the middle of a tiny group of innovators, and a somewhat bigger group of laggards. Perhaps more importantly, his theory also proposes the four key factors which influence adoption: the innovation itself; time; communication channels; and a social system.
My experience of innovation spread and adoption is supported by Rogers’ theory. Innovations which have face validity and feel like they pose little risk (like many digital apps) are likely to be adopted more readily than those where the benefits might feel more esoteric (like a new care bundle or pathway). Time is the rarest commodity in the NHS, and any innovation which looks like it will lose time will have difficulty being accepted by our most precious resource (our staff). The NHS has recognised the need for improved communication in order to accelerate change, and a multitude of networks, including academic health science networks, the NIHR’s Clinical Research Networks, and the entire NHS itself, are there to support dissemination of knowledge and experience gained from attempts at implementation. Efforts are being made to bring together interested parties to openly discuss the challenges to implementation and find ways to overcome them.
However, our desire to rapidly progress must not overwhelm the need to evaluate new healthcare technologies. Even innovations with a low risk of direct harm may have unforeseen consequences or knock-on effects which are not necessarily predictable from the design studio or the boardroom. Simply developing a new gizmo which works in a research environment may not be sufficient to ensure improved patient care or outcomes— understanding barriers and enablers to implementation are critical for any kind of change at scale. Our biggest current problem though, is that the process of evaluation can be clunky and slow, and itself needs re-thinking and re-designing. The development of rapid evaluation units and rapid evaluation research methodology are good steps forward, but even greater, quicker progress could be made through wider collaboration with clinicians who would willingly participate in prospective evaluations of new tech or services, as long as it was made easy for them to engage and did not place an unreasonable burden on their time.
Critically, for rapid evaluations to work, we also need to quickly negotiate ethics, R&D and/or service evaluation governance, but despite continuing attempts to harmonise these processes, there remain substantial bureaucracy and efficiency challenges. Our biggest opportunity to secure change here is through working with patients. The systems which have been created to protect them from harm may be having the opposite effect, if investigators become so fatigued they give up or if governance processes take so long that the evaluation has lost meaning by the time it is completed and published. Where there is a pressing health need, innovative solutions have been found to these challenges—such as the Ebola vaccine team B approach. Only by working with patients will we address these barriers to more cost-effective and efficient evaluations, from streamlining governance processes, developing alternative approaches to trial enrolment (such as point of care randomisation), and perhaps most importantly, taking a progressive approach to data usage, sharing, and storage.
The NHS is potentially the world’s greatest research environment and technology test-bed. Our unified nationalised system with a diversity of patients and a clinical workforce prepared to engage through citizen science approaches is almost unique. We need to use this opportunity to ensure that as we develop and implement new technologies or services, we also faithfully—but efficiently—evaluate them in practice. The trust that exists between the NHS and our patients is not to be toyed with: if we implement new technologies which are untested or unproven, then it will only be a matter of time before that trust is broken. Both patients and the service will benefit from clinicians, academics, and innovators trusting patients to guide us on how we can balance the need for evaluation with the pressing urgency to improve care.
Ramani will be speaking on a keynote panel on the “implications of the future for improving health care” at the Health Foundation annual event 2019 on Thursday 23rd of May.
That session, and other keynote sessions from the event, will be livestreamed and you can register now to watch them here.
Ramani Moonesinghe is a Health Foundation Improvement Science Fellow, Professor of Perioperative Medicine at UCL and a consultant in anaesthesia and perioperative care at UCL Hospitals. She is Director of the NIAA Health Services Research Centre at the Royal College of Anaesthetists, and associate National Clinical Director for elective care at NHS England. Twitter: @rmoonesinghe
Competing interests: Co-director Bloomsbury Innovation Group Community Interest Company – aiming to bring technology to the NHS at lowest possible cost.