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Healthcare systems such as the NHS are often criticised for being slow to adopt innovations and make change. There might be pockets embracing the latest innovative practice but mainstream adoption takes too long. But how quick is quick enough? And what are the critical factors that affect this speed of adoption and can they be address?
The British Secretary of State’s speech on the 28th January titled “Better tech: not a ‘nice to have’ but vital to have for the NHS” had a fascinating piece of information.
NHS Improvement estimate that it takes 17 years on average for a new product or device to go from successful clinical trial to mainstream adoption.
17 years. That is far. Too. Long.
Seventeen years is a very long time, it means that patients and clinicians are missing out on innovations that improve working conditions and unmet need. But what speed can we expect? Instantaneous is unrealistic, how does adoption in the NHS compare to the uptake of consumer technology.
Smartphone adoption figures for the US (technology adoption rates, as the percentage of households in the US) are shown below:
Year | % adoption
2011 | 35%
2013 | 54%
2015 | 68%
2017 | 73%
2019 | 81%
Arguably the first smartphone was launched in 1995 but the iPhone launch in 2007 catalysed this technology. It’s taken 6 years to get to 50% adoption and 10 years to reach 73% adoption (3 in 4 households), 100% adoption is largely unachievable. UK smartphone adoption figures as a percentage of individuals matches the US figures closely. Taking the 73% adoption as a realistic definition of mainstream adoption - even one of the most rapidly adopted technologies has taken 10 years to become widely adopted. Of course consumer technologies have their own barriers and challenges to adoption but for smartphones many hurdles were already overcome. Upon launch smartphones already had existing infrastructure, content and demand furthermore they also don’t require training to use. Smartphones are not clinical devices and consumer purchasing isn't the same as healthcare procurement but this gives a figure against what is quick looks like.
We never discuss how quick is quick enough but if the NHS adopted innovation as quick as consumer technology at the most optimistic rate it could still take 10 years to reach 3 in 4 users. What are the potential avenues to improve this?
Training and co-development
“Tell me and I forget, teach me and I may remember, involve me and I learn.”
– Benjamin Franklin
Too often new tools are made available without sufficient training or time for staff to learn how to absorb the tools into clinical workflow. This results in duplication of activity and inefficient systems and workflows. Training and co-develop can help to overcome this, but training takes time and money. Additonally costs escalate when trying to speed this up and eLearning only goes so far. Instead of training for each new tool can we provide more foundational training to elevate the general base knowledge and what topics should this consist of? A tool user doesn't need to be an expert in how a tool and system works but need to understand and be familiar with best practice. In consumer technology human interface guidelines (HIG) are well established, these are documents which offer a set of recommendations to improve the experience for the users by making software more intuitive, learnable, and consistent. The NHS Common User Interface standards have been depricated, this is an opportunity to reconsider these and the interface with training and learning to better enable intuitive design that requires less training for use.
Change is in everyones interest
Related to training is change management we don’t teach change management to every individual but every innovation implementation needs change management and we are all part of the process. Rather then create the capacity for change management we instead more commonly see product and service providers developing their own expertise in change management. If a healthcare provider organisation is better able to undertake change management instead of relying on companies this may improve the rate of uptake. We could take this one step further and consider how healthcare organisations empower staff to be the drivers for change. Related to change management is also winning hearts and minds to open opinions to new approaches but this again takes time for culture to change.
Impact, evidence and evaluation
A common hurdle is the need for tools to be piloted to demonstrate efficacy in a specific demographic and local system context. If a tool has a well planned evaluation this will generate evidence and a healthcare economics case. Each locality can be very different from a neighbouring region with different demographics, staff, services, pathways and tools available each can impact the efficacy of a new tool, product or service. Currently there are no tools which map the geographic differences in healthcare services and demographics. If this information was accessible known differences between regions combined with evaluation and pilot information could enable high confidence predictions of the cost v benefit of a tool. Avoiding time consuming and resource wasting pilots which don't allow all options to be assessed to find the best solution for the locality.
Instantaneous switch on
Apple has been tremendously successful in creating a cohesive uniform digital ecosystem. They control the hardware and software this means they know exactly what the IT infrastructure is capable of and as a result can turn on a new function for millions of people at the flick of a switch. This isn’t possible in healthcare systesms like the NHS. With ageing IT infrastructure, differences in operating systems (including obsolete unsupported systems) and differences in GP systems the fragmented IT systems and functionality mean there are significant challenges to being able to have a tool or function that can be simply made available across all systems. It can happen in patches of sites all using the same system but for all users. Interoperability and open APIs might enable this but the current priority is sharing information. Facilitating spreading of new tools and functionality will most likely be a lower priority.
How quick is quick enough?
Uptake of innovations in healthcare systems like the NHS are not as fast as they should be or could be. With requirements for training, change management and IT limitations it’s unlikely that mainstream adoption of new tools in healthcare will ever be as quick as we expect. Realistically with these requirements and constraints, it’s likely only that only a minor of tools will even reach adoption speeds seen in consumer tech which is still about 10 years. Is this quick enough?
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