The NHS is a complex customer to work with, with opportunities, challenges, and processes that can vary significantly. As she leaves the ranks of DigitalHealth.London after two and a half years, Rose de Mendonca reflects on some of the top tips she and her team have picked up for innovators hoping to work with the NHS.
The fragmentation of the NHS was a huge revelation for me during my first few months at DigitalHealth.London, and is still the thing I start with when people ask me why bringing new innovations in is so hard. It is by no means the only reason, but serves as a good illustration of the enormous complexities of this system, and gives some insight into why things aren’t as straightforward as suppliers might hope. As I once heard the CEO of a large NHS Trust say, “the NHS is not in fact a whale, but a shoal of fish.” A shoal of 8,765 fish*, that when you look closely, seem to be made up of hundreds of different species, with slightly different swimming techniques.
As a relatively straightforward patient, my experience of the NHS is normally seamless. I go to my GP, they either send me away with advice, a prescription, or a referral, and away I go. I can pick up my prescription from the pharmacy on the way home, and if I have to see a specialist, I see a clinician who knows why I am there. If I go back to my GP for follow-up, they have the information they need to do so appropriately. In general, I experience one “NHS.”
Suppliers to “the” NHS often do not have the same experience. Let’s say a digital health company has an innovation that could help GPs triage patients and deal with simple cases remotely, enabling them to save consultation time and spend it with more complex patients. They could go to a GP surgery directly, and present their innovation, have someone sign on the dotted line, and immediately get to work. But once the surgery has decided to go ahead and use the innovation, do others follow their lead? Not wishing to labour the analogy too much, but does one fish changing its direction influence the entire shoal?
There is no simple answer, but from what I have seen so far, it’s often no. Bodies like CCGs and STPs can and do help change the direction of pockets of fish, but uptake can still be patchy. So how can an innovator, or innovators, influence the entire NHS segment they hope to work with? What should they consider when working with an NHS partner (and conversely, what mistakes do they make when trying to do so)? My team and I sat down to discuss the top tips we’ve picked up over the last few years.
1. Don’t treat the NHS as a “normal” customer
The NHS, regardless of its faults, is viewed as a world-class institution. It has been an innovator in national healthcare systems from its inception right up to the present day.
Unsurprisingly when starting out, and like I did, innovators can often make the assumption that there is one unified NHS, and treat it as such. They might not always take the time to understand and appreciate how complex (and difficult) the journey of integrating into the NHS and its multiple constituent parts might be. But NHS structures, needs, and direction should be a part of all innovators’ market research when they make the decision to include the NHS as a customer.
All parties of successfully embedded innovations will tell you the importance of their relationship and a collaborative co-design process. Co-design and having teams ‘bought in’ may not be unique to the NHS as a customer, but the curation of the pathway certainly is. Regardless of how passionate a founder may be (and they will need passion and self-belief in bucketloads) and how revolutionary their product is, without support between all levels of staff within the department, successful implementation becomes much harder to achieve.
2. Make sure you consider what happens once you get the green light
We’ve seen healthtech innovators so desperate to secure a contract or pilot, having worked for so hard and long to ensure all the right regulatory requirements are in place, that when they get the green light, they find they haven’t always spent enough time thinking about how to deliver on parts of the project that require monitoring or adaptations.
Examples might include:
- How to work with and provide the right information to the NHS clinicians involved in the project, for example day-to-day reporting and troubleshooting
- How to keep on top of the monitoring of the pilot/contract deliverables in practice
- How to keep momentum going by engaging their on-site “NHS champions”
- How to escalate any issues and implement a business continuity/recovery plan if things go off the rails
By not setting these processes up at the start, companies can risk losing track of the KPIs they are meant to deliver on, losing the support of their clinical champions, and effectively slow down the running of the pilot. Having no business continuity plan and no risk mitigation actions builds in time delays when things go wrong and can seriously affect credibility in the long run.
3. Spend more time listening than talking
For NHS staff on the receiving end of a pitch from an innovator, it can sometimes be a bit overwhelming, especially when it’s not a normal part of their job, or something they have experience of (i.e. most NHS staff). We’ve learnt that when people feel uncomfortable they are more likely to close down. Talking too much, no matter how well-intentioned, can come across as assuming the person listening doesn’t know the problems or have any thoughts about the solutions. It closes down opportunities to apply expertise/technology in novel use-cases. Companies can miss opportunities to refine their product or pitch, or even worse, to understand the problem fully.
When we’ve seen it done well, companies that ask lot of questions and actively listen to answers find that they can more successfully pitch their product in the context of the wider conversation and link them to the heart of the particular challenge.
Taking time to listen, ask questions, and think, without offering up a solution, can help innovators understand the challenges, and collaborate to come up with the right solution. That (hopefully) doesn’t mean tearing up all the hard work taken to get to the point of making a pitch, but may mean adapting the approach to fit the need
4. Speak the same language
Some innovators we come across find it difficult to adapt their language away from academia, their clinical experience, or their technological understanding, to reflect the needs of their particular NHS audience. These areas can be a really good way to start conversations, but innovators do best when they adapt their messaging – for example focusing on financial, safety, IT integration, or other areas of crucial importance to the person they’re talking to. Using the wrong language, or pitching wrong can be the difference between getting that second meeting and being “ghosted” – innovators should always spend time researching their audience and preparing accordingly.
5. Be open to feedback
Digital innovations promising to change the way things work can unfortunately be prone to scepticism from leaders or commissioners in the NHS, particularly those who have been working in the organisation for several years and may have seen several innovations fail.
Innovators that are open and brave in their acceptance of feedback are often able to create more collaborative and trusting relationships in the long-run. It’s a small ol’ world in healthtech, so reputations – good and bad – can be made and broken in a short period of time if the word gets around.
Taking the time to listen and understand the challenges faced by the staff and patients that innovators want to work with can be an undervalued investment. Whether highly motivated to take a leap into change and try something new, or cautious about making any change at all, we all tend to trust those who listen to us.
With thanks to Tom Carlisle, Katya Masconi-Yule, Ruth Bradbury, and Natalie Savage for their thoughts and input into this piece.
*NHS Confederation: NHS statistics, facts and figures 2017