Talking HealthTech: 297 – Harnessing the power of the crowd to make digital health work for humans. Ken Saman, Personify Care & Paul Lambert, Think Human

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There is a buildup of pressure on the public health system – growing wait lists, ambulance ramping and staff burnout. Though technology has a role to play in all of these issues, it has to be human-centred to gain traction. 

Joining Pete for this episode are Ken Saman from Personify Care and Paul Lambert from Think Human. They will be talking about harnessing the power of the crowd to make digital health work for humans; how to translate health strategy into practical, real-world solutions that will be seen in our lifetime.

Meet Ken Saman and Paul Lambert

Ken Saman is CEO and founder of Personify Care, an Australian digital health company that helps healthcare teams across Australia, New Zealand and the US to convert clinical protocols into a digital patient experience to eliminate the administrative burden of managing patient pathways. 

They considered both the patient and clinician perspectives from the start. From the patient’s perspective, they had to make sure patients get the information and support they need before and after a treatment, procedure or any other encounter with the health system. While from a clinician’s perspective, they provided clinicians the information they needed about their patients in a seamless way.

Paul Lambert is a director at Think Human, and he is a passionate advocate for human-centred solutions in health and human services and in building connections between health tech and industry. He is a qualified physio and has extensive executive experience across healthcare.

Think Human is an Adelaide-based company that has been working in health and human services for the past five to six years with a really strong focus on a range of techniques used to understand and account for lived experience. People with these real-world experiences could be consumers, customers or clinicians. Paul recently left the public sector in South Australia to join the think human practice to bring some expertise around human human-centred design into digital health and try to bridge that gap in public health.

Implementation Challenges

Truth is the roadmap to implementation can be shorter than perhaps traditionally thought. However, a clear value proposition is necessary. So, lessons around best models for implementation, best engagement models and being clear about value proposition come with time from a vendor’s point of view. 

It is equally important to find a willing customer, to walk that journey with you and understand that the implementation of that digital strategy is significantly different from a traditional implementation. The chosen implementation model is important, as well as the counter factor, like finding time to work with clinicians, customers or patients. If you do not find that time, you end up trying to manage the implementation through complicated change management.

The real challenge for digital transformation teams in the current climate is how to implement strategies in an environment with increasingly complex patients and a workforce under increasing pressure, and the organisation is relying on the digital team more than ever to deliver some of the benefits of what digital can deliver. New development within some healthcare services has seen such health services with more demand than ever on their time and their resources. 

Another shift currently being experienced is that those with limited resources are beginning to use models where digital transformation initiatives are being deployed by enabling the staff and the workforce on the ground to lead some of those initiatives. 

People should not have the notion that health services and staff do not want change. It has been proven that when solutions are well thought through, the problem is well understood, and there is a great match between the needs of the organisation, the engagement of the humans and the solution to be implemented. 

The Pressure on Transformation Teams

All organisations are at the moment weighing up where they are on that spectrum of staff pressure. There often comes a time when a company will have nurses working double shifts, doctors doing long overtime and support staff struggling to keep up. At such moments, something just has to be done. Furthermore, design methodologies can be used to manage the fear of failings or retributions. 

Within design methodologies are embedded the opportunity and the expectation that you actually prototype things at the front after understanding the problem. Expectations are often not met from the start, which is countercultural within the health industry. There are lots of top leaders in health in many different kinds of spheres who are very reluctant to step off into a risky space if they can not see what the outcome is. These persons need to understand that the design process has a fail-safe feature built into it, and they can rest assured that they are still safe if anything goes wrong. 

This conversation around change starts from a model of transformation that is by design top-down. If you go to any nurse or clinician that is working double shifts and is overloaded already and say to them, “we are going to change the way you are working”, then their first reaction is I am in survival mode at the moment, please go away, I have patients to look after. But if you introduce that change very clearly focused on how to take out a lot of that low-value work that is currently consuming a bunch of their time and free up some of their capacity to look after your patients better and more; definitely, there will be no pushback on that. 

Digital transformation teams are being really successful if they start with the premise that the solutions to some of these problems are already well known within the frontline teams. And if those teams are empowered to solve some of their problems with some good technology that does not lock in the existing broken process, then that is something that can actually accelerate some of the execution. 

Buzzwords and Their Potency

Buzzwords have meanings, and some of these design elements are important. For some industries, they may be new. The idea of actually working with staff and consumers is not a new concept. The crux of the matter is, working with staff and consumers consistently and authentically through that process. Even big organisations have struggled to have ongoing authentic conversations with either staff or consumers. 

The methodologies that can be deployed create a scaffolding to have those meaningful and ongoing conversations with people to give the best chance of understanding the problem you are trying to solve and getting a solution that will fit and remove that high volume, low quality, low-value work that many health workers are burdened with.

Human-centred design in any other sector is a well-travelled path. The added complexity in healthcare is that you can design a solution or a process that works really well for the patient but is almost impossible to deliver for a clinician or admin team or nursing team. And you can design the best and most efficient process for a cardiology team that makes no sense from a patient perspective. So the added layer of complexity here is that it has to work for both parties. 

Despite all the talk about patient-centred design, unless they can be connected to the current reality of what staff are dealing with, then it is a nice future state that may never be realised. Modern technology solutions open up the opportunity for an authentic, real-world co-design model. The best people to ask about what the best patient-centred model of care is, are the people that are dealing with those patients daily.

Throughout the pandemic, some lessons were learnt, but some assumptions were potentially challenged. It was thought that digital health solutions were really only for the young and digitally savvy, but it was learnt through the pandemic that the acceptability of telehealth, for example, was dependent on whether it worked and was easy to navigate. 

Digital health solutions may never reach 100% acceptability, but there is probably higher acceptability of them than pre-pandemic.

Factoring in All Stakeholders

Given the pressures that these teams are under to deliver something in our lifetime, you need to ask all of those different stakeholders those questions and deliver something in weeks, not years. There is no more luxury of having six months of consultation with different groups. You have to solve a specific problem in weeks. 

Furthermore, crowdsourcing is part of their DNA in Personify Care, and it was how they started the company. They have spent the last eight years using data on how patients and staff interact with these pathways to essentially do two things: reduce the friction for each patient interacting with these pathways and then reduce some of that burden on staff that are trying to provide different models of care. They do these in such a way that for every patient that uses one of these pathways, the friction becomes less and less for the next patient. The Personify Care team spends a lot of time in the background looking at data from three dimensions: 

1. what do they know about the particular pathway that is being updated by clinical teams regularly

2. what do they know about the consumers that are using those pathways 

3. what are they looking at on a screen 

They can vary all of those three dimensions and then see what is going to drive a higher response rate from that patient cohort, and where they are headed is the ability to predict what the response rate is going to be and then start to provide recommendations back to that clinical team. Bottom-up versus top-down approach to digital transformation.

There is a need to find a way to do both. There are always going to be solutions that would need views from across the organisation. Currently being observed in digital health is an uptick in ways to empower, educate and support frontline decision-making. Both bottom-up and top-down approaches are currently being used. Additionally, people will be more comfortable with a central strategy and deployment of those plans, but they have problems in terms of how easily they are implemented. There are certain limits within public health.  There are so many solutions and options out there, but there needs to be some sense of direction, and staff needs to be taken along on the journey. 

Finding Balance

Both bottom-up and top-down approaches are necessary. You need the big-picture strategy to set the direction of what the organisation prioritises in terms of what they are trying to achieve. The digital component of any health services strategy has to be about improving something. If, at an organisational level, they are trying to do something like improve the patient flow or reduce the wait list by X per cent over a specific period, the actual solution that gets deployed across one unit or another might be completely different. The range of solutions selected and the clinical workflow might need to be completely different across different parts of the organisation. Without that big picture, one loses track of what the priorities are in the organisation. 

The industry has reached the point of maturity of digital solutions where modern solutions can be deployed within the current clinical workflow, not as a means to an end in itself, but as a way of indicating it as step zero of how to get to that future state of what they want to accomplish. To address the change problem, the first thing to do as an introduction is to explain to those frontline staff how their life will be made easier in the near future. The intention is not to lock in that model of care forever but to free up capacity within their team immediately, which gives them data about how their unit and their organisation are performing and provides them with an opportunity for improvement. 

It also provides them feedback on what is working, what is not and how to improve without disrupting the clinical care.

Implementation in a Health System that Never Sleeps

Implementation takes planning, commitment and proper timing. Implementing large-scale digital health solutions in public health organisations has been pretty hard during COVID. It is simply essential that they do not lose that ability to be flexible and then make it a new normal to stop everything. Institutions need to continue to innovate the way health services are delivered. But also, it is important to improve the quality of care delivery.

When digital solutions infrastructure is provided to the teams on the front line, and they are given the capacity in bandwidth to think about the future of their practice, then the primary role of successful digital teams emerges as improvement roles like how to use data over the recent past to reduce clinical variation, improve clinical outcomes and enable new models of care with the newly freed extra capacity. 

Funding Initiatives with Unknown Outcomes

Multimodal is the only way to go. There will be certain initiatives that will sit very nicely in a research framework. That is the great thing about public health organisations- the partnership with universities and other institutes that allow them to actually explore through a rigid and ethically approved framework and how it delivers better care. 

There is also a recognition that in many areas, health services in Australia are being left behind in terms of comparison to the rest of the world. Hence, central governments do have a role there to educate and upskill both workforces and also to make available funding for large-scale change, like a shift into cloud technology, advanced analytics, etc.

Another mechanism is actually innovation, which happens from within. The recognition is that through the adoption and deployment of good technical solutions, there are more efficient ways to deliver services. 

Ken and Paul recently launched with a health service a rehabilitation pathway, so while a patient is on a waiting list, they try to identify the preexisting risk factors that the patient has and use that time to provide resources and information to the patient and engage with their GPs around how to reduce the underlying risk factors while they are waiting for surgery.

Similarly, If you are trying to solve the elective surgery waiting list, how do you improve the efficiency and flow of patients through things like pre-admission assessments that eventually end up being the front-end process of people having surgery? And then lastly, how do you enable models of care that can reduce the amount of time a patient needs to spend in the hospital while they are having a particular type of procedure or treatment?

So funding in those cases comes from the funding that is available to try and catch up on those waitlists, and digital just becomes a component of the overall solution.

Next Focus

One of the really exciting areas for Ken and Paul is that they are increasingly working with research organisations that are spending quite a bit of time and energy evaluating new models of care that are enabled by digital health solutions like those of Personify Care. For example, universities that are running very structured randomised control trials that are not measuring the clinical benefits of these models of care for patients, where digital health solutions are part of the model of care from day one and comparing that to traditional models. 

The really exciting thing for them is the opportunity to then connect that to health services in the real world and provide them with access to some of these models of care that have the clinical benefits proven from research and can also be delivered at scale. 

Think Human will continue to build on its core capability around supporting organisations to have those genuine conversations and hear those authentic voices through whatever their work is. They are trying to bring some of that focus into digital health and the health sphere. The granular issue Ken would want to solve is that issue nationally around waiting times for elective surgery. Interestingly, there are some really excellent solutions and ways in which Think Human can help organisations address that challenge. 

Another thing Personify Care is excited about is partnerships. One of the things that they are increasingly doing is partnering with other technology providers, digital health providers and service providers, like Think Human.

_{Source talkinghealthtech.com}