New ways of working

Reimagining the care pathway: The digi-physical approach

Tina Marshall

<span id="hs_cos_wrapper_name" class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_text" style="" data-hs-cos-general-type="meta_field" data-hs-cos-type="text" >Reimagining the care pathway: The digi-physical approach</span>

While slowly emerging out of the pandemic and armed with a full arsenal of progress and valuable lessons from the last year, the NHS is looking ahead and acting towards increasing efficiencies. The challenge in increasing efficiencies lies in the fact that the NHS is called to respond to a population with an increasing need of care with the same resources. Nevertheless, it is not impossible; One of the most powerful tools and valuable new lessons in the new era is digital technology and innovation.

When change is underway, it is only expected to see apprehension and an urge to mitigate the risks that come with uncertainty – especially when this change involves digital technology. In our conversations, we very often find ourselves across a misconception that manifests with this comment: ‘Digital tools are helpful but they cannot solve everything’. Without an exception, any tech aficionado or change management expert fully agrees. Digital technology cannot solve everything; Not every patient case can be managed fully digitally; The misconception lies in the perception that this is the proposal of medical technology. The actual proposal is a digi-physical redesign of the patient pathways – one that is a) clinically led and suitable for the specific requirements of each healthcare service, b) inclusive and patient-centric, and c) enables the NHS to reach the initial goal: increase efficiencies by reallocating the existing resources – including the ones involved in physical services and treatment.

We have seen a provider approaching the clinically-led customisation of the digi-physical pathway in one of the most complex healthcare services: Livewell Southwest, a social enterprise providing physical and mental health, and social care services. When Livewell Southwest partnered with us to provide their digital services, we held an interactive session with the department. This approach gives clinicians the mandate and liberty to use their knowledge and expertise in order to drive real innovation and creative problem-solving. In this session, we saw the healthcare professionals analysing their options – pre-consultation forms, messaging intervals, conditions prioritised for a digital treatment – and applying the designs to free up time and physical resources for the patients who need it the most. On a side note, a year later with redesigned patient pathways, Livewell Southwest have managed to double their recovery rate for IAPT services to 54% – 4% over the NHS goal.

Digital inclusion is a conversation we cannot overlook and a risk that should simply not be accepted as is. After all, a digital offer that is not used does not have the capacity to help anyone, no matter how cheap it may be. However, at a first level, the digital offer that is deployed should accommodate everyone in our diverse society that can and wants to access healthcare digitally: The digital service needs to have a translation service, needs to be accessible to the visually impaired, and needs to be designed in a simple and user-friendly manner. Having said that, there will still be a portion of our population that cannot or will not access healthcare digitally and the physical pathway needs to be open and available to them. However, the digital pathway will have done some of the prework, freeing up clinical time and physical appointments for these patients who need or want to access healthcare physically. That is the essence of the digi-physical approach.

The last part of the digi-physical approach is always met with scepticism by healthcare providers: Certain pathways need to be accessed and bookable by patients. Our response to the scepticism is evidence: Our Swedish partners who have opened up digital pathways to patients see a DNA rate of 2% in patient-initiated appointments. The patients feel empowered and are more inclined to use a digital tool when they perceive that they have increased accessibility. Moreover, with the NHS being one of the most beloved and respected institutions in the UK, we may overlook the conscientiousness of our population towards it. The results of our report are strongly indicative: During the first lockdown, when the patients were asked to ‘protect the NHS’, the appointments in primary care dropped from 24 million to 16 million. This initiative proved to do more harm than good as the results of avoidable harms skyrocketed and may continue to do so.

Follow-up appointments can be an excellent initiation of the patient-empowered digital access. Presently, secondary care is flooded with follow-up appointments every few months, which the patients themselves may not even feel the need for. Personally, I have a condition which I manage well and have done for 20 years. I don’t want or need to take up an appointment every 3 months, where I have to take a few hours to attend to. I would much rather be able to drop the department a line when I feel that I need help. This is a key ingredient to dropping the DNA rates and freeing up resources to provide care to patients who truly need it.

Emerging out of COVID-19, our most valuable lesson as healthcare providers as well as suppliers is awareness: Awareness of the complex, multifaceted reality in healthcare and its administration, of what we can achieve, under which conditions, and at what level – and what we cannot. The digi-physical approach of clinically-led, patient-centric care is the amalgamation of our knowledge – now it requires our actions to apply it and redefine healthcare in a light that is perceived positively by our NHS staff and the patients alike.