By Dr. Marcella McGovern, Change Team, ARCH

Person-centredness is the holy grail of modern healthcare systems. I have recently completed a PhD in Social Policy exploring the implementation of integrated primary care. A key learning for me was that person-centredness is the unifying principle around which the diverse range of stakeholders in a healthcare system can find shared value. If an integrated care initiative can be clearly articulated as generating improvements for service users, then it is less to encounter resistance, or worse, disinterest when it comes to implementation. Similarly, connected health solutions are enablers for integrated care and their adoption requires a clear articulation of how they generate improvements in the care delivered to service users.

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Integrated care is the best-practice model of health service delivery being pursued in Ireland and internationally. Ageing populations, a rising prevalence of chronic illnesses and comorbities, the spiraling costs of new pharmaceuticals and technologies, as well as more informed and engaged service users are some of the key reasons why the traditional siloed model of healthcare delivery became unsustainable. An integrated care model attempts to improve three things, which Berwick et al. (2008) describe as the “The Triple Aim”: improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations. This shift in focus to people rather than diseases and population health rather than clinical specialities, involves a fundamental change to how healthcare is planned, organised, delivered and received. Organisational and governance structures need to be reorganised around newly formed interprofessional teams and interorganisational partnerships, who in turn need to engage and empower service users in the co-production of health services. The concept of co-production has received a great deal of attention amongst policy makers and clinicians in recent months, with the publication of the ‘Six principles for engaging people and communities: putting them into practice’, by National Voices; a leading coalition of health and social care charities in the UK.

Having recently joined ARCH, I wondered how technologists who develop Connected Health solutions incorporate the principle of person-centredness into their work. I don’t mean how do their technologies enable person-centred care, I mean how do they engage their end-users in the co-design of connected health solutions? As discussed in a recent ARCH blog on Incentivising the use of Connected Health, a failure to engage with end-users may result in innovation for innovation’s sake rather than a technological solution that addresses an unmet need which is valued by end-users. The concept of user-centred designs, requiring technologists to move out of the ‘control room’ (Hughes et al. 1994) or adopt a ‘living lab’ (Hyysalo & Hakkariainen, 2014) approach are well established in computer science. Although there are some nice examples of user-centred designs for connected health solutions, e.g. Assistive Technologies for Healthy Living in Elders (www.atheneproject.org) the Connected Health literature is not dominated by the concept of user-centred design in the same way that person-centredness dominates the integrated care literature.

A possible explanation as to why user-centred designs are not more commonly adopted in the development of connected health solutions is that gaining access to clinicians and health service users poses ethical challenges not ordinarily encountered in creating technological solutions. ARCH’s research team can support start-ups or established companies in overcoming these access issues. For example, the Change Team have conducted a participatory action research project with eHealth Ireland to capture the perspectives and feedback of the various stakeholders in Phase 1 of the national rollout of electronic outpatient referrals – see our infographic. Insights gained on the utility and useability of the electronic referral solution at phase 1 are being incorporated into ongoing work to optimise this Connected Health solution. Likewise, the Care and Technology research teams are working with various industry partners to gain an understanding of what their end-users consider to be the strengths, weakness and potentialities of their connected health solutions.

The competitive advantage of having adopted a user-centred design is that you will have data to illustrate how your Connected Health solution generates direct or indirect improvements for service users. As the Connected Health industry continues to grow rapidly, user-centred designs are likely to become more and more important for technologists to convince end-users that their solution is the best available on the market.

References

Berwick, D.M., Nolan, T.W., Whittington, J. ‘The Triple Aim: Care, Health, Cost’, Health Affairs, 2008; 27 (3): 759-769.

Carroll, N. ‘Incentivising the use of Connected Health Solutions’, ARCH Blog, 7th October 2016, Available at: /blog-post/incentivising-ch-solutions/

Hughes, J., King, V., Rodden, T. & Andersen, H. (1994) ‘Moving out from the control room ethnography in system design’, Research Report CSCW/9/1994.

Hyysalo, S. & Hakkarainen, L. ‘What difference does a living lab make? Comparing two health technology innovation projects’, CoDesign, 2014; 10(3-4): 191-208.

People & Communities Board (2016) Six principles for engaging people and communities: Putting them into practice. National Voices, Available at: http://www.nationalvoices.org.uk/sites/default/files/public/publications/six_principles_-_putting_into_practice_-_web_hi_res.pdf

www.atheneproject.org

You can contact Marcella on marcella.mcgovern@ucd.ie or follow her on Twitter @Marcella_McG. Check out our website for more information about Marcella’s research interests.

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