Recap: HETT Show 2021 - PRSB

Recap: HETT Show 2021

September 30, 2021

The 2021 Healthcare Excellence Through Technology (HETT) show was a huge success and had a full attendance across both days of what was many people’s first in person event since the pandemic. The agenda was wide-ranging, and attendees heard from clinicians, digital health professionals, and health tech suppliers and data architects on how we progress the digital transformation in care for better patient outcomes and operational efficiencies.

The PRSB was proud to feature on a panel with INTEROPen to discuss whether pragmatism or perfection is the best route to interoperability success, with our Chair, Professor Maureen Baker chairing the discussion. The speakers spanned the health and social care spectrum and included PRSB Clinical Executive, Dr Nilesh Bharakhada, Registered Nursing Home Association’s Digital Engagement Manager, Katie Thorn, Director of CASPA, Taffy Gatawa, INTEROpen’s Co-Chair and NHS London’s Regional Director of Digital Transformation, Luke Readman, and TechUK’s Interoperability Specialist Manesh Patel.

The panel agreed the need for pragmatism and identified that smaller results in implementing standards were more worthwhile in the journey for full interoperability than striving for complete perfection before achieving any tangible results for professionals and patients. Katie highlighted that while social care is behind on adopting standards, meaningful impact is already being made from smaller initiatives, such as South West London’s Red Bag scheme.

Responding to an audience question on what one practical thing the panel would prioritise to deliver practical results, Taffy emphasised the importance of an agreed framework before standard implementation and Nilesh chose PRSB’s digital care and support planning standard as it helps to share data across transfers of care. He explained the standard has a practical impact in a high-risk area and ‘is the delivery vehicle for integrated care’.

CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests.
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history.

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning.

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”