Digital Health Inequality Pioneers: sharing our learning
Background
At the end of 2021 NHSX (now the NHS England Transformation Directorate) opened a funding application for Integrated Care System (ICS) teams wanting to digitally transform a clinical pathway.
To be awarded funding the teams had to evidence that they had considered how the digital transformation could help tackle an element of inequality that they had identified within their ICS.
After two years exploring how digital innovation can help tackle health inequalities, and launching the Inclusive Digital Transformation Challenge to make sure the digital transformation of health and care doesn’t compound existing inequality, we were commissioned to provide support to the ICS's taking part in the programme. Our role was to enable them take an inclusive approach to their own digital transformations and we facilitated:
A rapid research review that was used to inform the design of the programme; specifically the theory of change and prototype self-assessment tool.
A bespoke CPD (continued professional development) accredited learning programme.
One to one coaching with experts on a range of topics.
A dedicated area within our FutureNHS workspace for the project teams to collaborate and share on an ongoing basis.
Throughout the programme our team worked with the 10 chosen Integrated Care System project teams. Getting to know them, understanding the context that they are working in, and identifying the enablers and blockers to Inclusive Digital Transformation in their system.
“This programme has been so much more than just the initial funding. It has provided networking opportunities, detailed insights from subject matter experts, a supportive environment and invaluable coaching opportunities”
Self Assessment
During the discovery phase of the programme we designed a self assessment tool for each ICS to complete. This provided a structure for the teams to reflect on their current capacity and capability to deliver Inclusive Digital Transformation and asked them to consider:
Where they are now
Where they want to be
How to get there
The self assessment tool was broken down into 11 themes for the pioneers to consider in the context of their work. The 11 themes were identified as critical for success through the rapid research review and later formed our 11-point Inclusive Digital Transformation Canvas which you can access below to support you in your work.
Learning Together
In the next phase of the programme we curated a tailored learning programme to help the ICS project teams overcome some of the barriers identified through the self-assessment exercises, to broaden their knowledge of both the theory and practice of inclusive digital transformation, and to allow them to interact with each other in activities where knowledge from their respective systems and projects could be shared. The learning programme gained CPD accreditation which means it contributed to the participants' continued professional development.
Read more about each of our learning programme sessions below.
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Our first session set out to develop a shared understanding of inclusive digital transformation and why it is important, to explore resources and tools that would practically support the pioneers, and to build connections and learn from each other.
In the session we defined digital exclusion, digital inclusion and inclusive digital transformation. Looked at the different barriers and factors of digital exclusion, the diffusion of innovation models and sustainable funding models for inclusive digital transformation. Then we explored taking this work forward in terms of adaptability, scale, spread and influencing national policy.
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The aim of the inclusive co-design session was to create a shared understanding of the theory and importance of inclusive co-design, to look at what good inclusive co-design looks like in practice, and to start exploring how the pioneers could take practical steps to an inclusive co-design approach in their own projects.
We explored the methods and principles of inclusive co-design, the power dynamics that come into play, the spectrum of user centred design and the barriers and challenges the pioneers could face in their workstreams. Then, to support the pioneers with implementing the theory in their work we looked at what inclusive co-design looks like in practice and gave examples of where we have applied it in real life, covering design thinking, iteration and the co-design steps; understand, define, ideate, prototype, test.
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Facilitated by Dr. Chrysanthi Papoutsi, Senior Researcher from the University of Oxford, this session introduced the pioneers to the NASSS (Non-adoption, Abandonment, Scale-up, Spread, and Sustainability) framework, designed to guide thinking about implementing and embedding innovations in health and care.
During the session Dr Papoutsi discussed different dimensions of managing and influencing complexity in innovation projects. She presented the NASSS-CAT tools and explored their use with the pioneers to help think about working in conditions of complexity, and taking in account different aspects of inclusion and stakeholder involvement in complex systems.
The practical exercises undertaken in the session will support the pioneers to use them on their live projects and future digital transformation activity.
“Adaptive capability is key when working with complexity – we need to be able to manage the tensions that arise when addressing inclusion challenges in innovation projects’’
Dr Chrysanthi Papoutsi, Senior Researcher from the University of Oxford
The NASSS-CAT tools are widely available and free to use.
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This session explored how to better understand and use data to support inclusive digital transformation activity. We looked at how data and human stories can help us to understand our population needs and identify where to focus our efforts and energy. How data can help to turn our understanding of needs into action, for example, getting senior buy-in and securing funding. And how to measure impact, find, use, and present existing data, and gather new data and do data analysis.
We profiled one of our recent projects with Norfolk and Waveney Integrated Care System where population data and data indicating levels of deprivation helped us to map out areas at risk of digital exclusion and where to focus intervention activities.
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To round-off our learning programme and plant a final seed of inspiration we brought together a panel of trailblazers already doing some incredible work across their respective systems with inclusive digital transformation. Key topics that we covered in the session were formulated based on on-going conversations with the pioneers around the barriers they continued to face, and so we picked our panel's brain on strategic influencing, sustainable funding and fostering partnerships.
We made the final learning programme session publicly available as part of Inclusive Digital Transformation Week.
“Engaging and interactive learning sessions with inspirational speakers providing in-depth analysis of real case scenario’s. The delivery of sessions over a period of time enables the processing and embedding of knowledge into daily practice. Brilliant concept of including the training within the bid award and it is the most effective training I have undertaken and which I am utilising every day.”
Bespoke Coaching
Recognising the varying levels of maturity within projects, teams and the Integrated Care Systems themselves we supplemented the learning programme with one to one coaching sessions for each of the ICS project teams. This allowed our pioneers to develop a deeper understanding of specific areas or challenges.
We matched pioneers with suitable coaches and developed coaching plans consisting of six hours of one to one coaching for each pioneer.
Expert coaching was provided on a range of topics including:
Engaging people with living experience and community leaders
Understanding the needs and engaging seldom heard people
Engaging Service Leads and clinical staff
Understanding the capacity needed to deliver
Support with Facilitation & Evaluation
Identifying ongoing sources of funding
How to use findings to develop monitoring on health inequalities
We encouraged the coaches and pioneers to work together flexibly and use the six hours of coaching however they felt it benefited them most. When required we were able to match the pioneers with coaches earlier in the programme to help get individual projects off-the-ground.
“ICSs identified in advance issues on which they would appreciate advice. A recurring theme was how to build the right alliances and policy engagement to ensure sustainability of digital inclusion support. The ICS project managers particularly appreciated connections being made with initiatives with relevant learning, in other parts of the country or even within their own ICS.”
Knowledge into Action
Integrated Care System for Devon which covers Devon, Plymouth, and Torbay were successful in their joint funding application with partners Devon Communities Together, a voluntary and community sector organisation within the ICS, who later took on the role of project manager. The aim was to increase the confidence, knowledge, support and skills within rural communities in Devon to help tackle digital and health inequalities, and the project had four key objectives:
To discover what concerns people most about using digital access (virtual consultations) to secondary care.
To explore barriers to accessing secondary care digitally.
To map existing initiatives that support people to access health care digitally.
To find out what makes a “good” virtual consultation.
We are grateful to colleagues working on the project for allowing us to share their project impact report, Rural Digital Health Inequalities, which demonstrates theory getting put into practice and case studies from their live project work.
Next Steps
We hope that the programme will have a ripple effect both within the 10 Integrated Care Systems that we have been working with and nationally. We think of it like the Trojan Mouse approach. The Trojan Mouse’s job isn’t to solve everything at once, but to be nimble, to test, to listen, to iterate and to influence and inform. Every one of our pioneers is now a Trojan Mouse infiltrating the system. Taking back knowledge, experience, tools and resources, and building an evidence base from the outcomes of their current project.
We have committed to sharing the research, findings and tools from the programme so that other colleagues within systems and working nationally can learn from it. We started this with some of the resources that we shared across Inclusive Digital Transformation Week, including the Inclusive Digital Transformation Canvas, and will continue to share on our FutureNHS workspace.
Feedback
“Inclusive Digital Transformation in the Health Inequalities domain is central to the delivery of NHS England and Improvement’s strategic priorities. Through innovative programmes that establish and employ digital guiding principles and digital solutions that are co-produced with the input of community groups, we are seeing progressive examples for other Systems to consider, as they develop their own initiatives that mitigate against the misery of digital exclusion.”
“I’ve hugely enjoyed working with Thrive by Design on such a high quality and well thought out programme. The course detail was pitched just right and has equipped us to not only explore, but to also implement initiatives to reduce digital inequalities for people identified in the NHS CORE20PLUS5. I hope we get the chance to work with Thrive by Design on future projects, I would highly recommend them”
We are continuing to work with other like minded people at a national, ICS and local level to ensure we take an inclusive approach to digital transformation of health and care. We invite you to join us on that journey by joining our Inclusive Digital Transformation Challenge FutureNHS workspace, a community of over 300 members.
