How to keep humans at the centre of NHS digital transformation

Healthcare Leader

For several years, digital transformation has been promised as a solution to the rising pressures on the UK’s health service. Digital as the default delivery method is believed to be the solution to speeding up access to care, freeing up physical access for those most in need, and meeting financial pressures. And it’s not just the UK; globally, health leaders are advocating and driving the digitisation of care.

Yet for digital transformation to be successful, research persistently shows that service users must be central to the development and roll-out of digital solutions. To include service users, novel techniques are required. That’s where Human-Centred Design comes in.

In our recent paper, published in JMIR Human Factors, we discuss the complex challenge of including service users in the design and delivery of digital transformation. We focus specifically on mental health.

Mental health services are an especially promising area for digital innovation. Digital diagnostics can speed up signposting to necessary services. Chatbots are promised as a cheap, scalable, and rapid solution for psychiatric treatment. Health promotion, education and prevention can be supported remotely through digital resources. As can rehabilitation.

However, in 2022, it was estimated that there were over 15,000 mobile mental health apps already, with more predicted now. The problem is making tools stick. Research on uptake of digital tools shows that only where these tools are developed alongside users are they effective. For example, platforms for peer mental health support, or parent-led therapy for children, have been developed with their stakeholders and led to improvements in care.

How can this be achieved? In our paper we outline the method of Human-Centred Design (HCD). HCD is a method developed from design and commercial user-experience. It requires iterating between problems and solutions along with relevant stakeholder groups, or ‘actors’. In mental health, these actors include service users, clinicians, caregivers, public officials, and many more. The process requires:

• empathising with the situation;
• a discovery phase to understand needs;
• defining the problem at hand;
• designing the correct solution;
• prototyping and testing the solution
• planning and implementing the best option.

To be even more specific, we have defined HCD for mental health services as:

A practical iterative approach to the design, development, and reform of mental health systems, services, and products, that is achieved through communication, iteration, and empathy with users’ needs, desires, experiences.

The UK government, a long-time global leader in digital transformation, showed this is viable. We write about how NHS Digital, under the guise of NHSX, led HCD discovery projects to support the reform of the Mental Health Act. The primary recommendation emerging from this was that there should be electronic ‘advance choice documents’ to set out future care preferences, especially in cases of detention. Such a suggestion does not require artificial intelligence, but could make significant improvements to the dignity people receive in severe cases. However, it does require ongoing resource and commitment for success.

Readers might note that at no point in the HCD process I outline above did I specify the solutions were digital. One key message, both from our stakeholder engagement and from reviewing state-of-the-art literature, is that ‘the solution may or may not be digital’. We call this ‘digital solutionism’: assuming that digital transformation is going to solve all our healthcare problems.

True service user involvement requires openly identifying the problems in service delivery. At times, certainly, digital transformation can lead to more efficient and even higher quality delivery. Yet those designing and delivering policy and services must recognise what is vital: we must choose the solution for the problem, not pick up a hammer and look for a nail.

For digital transformation of all health services to be successful, we must include the most important people in that design and delivery. As well, we must recognise its limits. Human-centred design offers us an approach for both.

William Fleming is a Research Fellow at the University of Oxford’s Wellbeing Research Centre