Have you ever had an idea that you knew was going to help people but struggled to get others on board? This is one of the main challenges that Saquib Ahmad, Senior Psychotherapist at the Grenfell Health and Wellbeing Service faces as he creates a digital pathway in a historically ‘analogue’ service. In this blog, he reflects on how others in his position can overcome the struggle to get people on board.
Traditionally, therapy services are given to patients in a face-to-face environment, but this is not always convenient for patients for various reasons including distance, time, work commitments, lack of childcare or disability. For the last two years, I have been creating a digital pathway for the Grenfell Wellbeing Service, enabling those who need psychotherapy to have a choice of receiving it digitally.
My biggest challenge thus far has not been getting patients to use the digital service, but buy-in from the clinical team.
“Therapy is traditionally face-to-face, but offering a digital solution is important because it helps to overcome barriers to access, making our service more inclusive”
Persuading my colleagues has not always been an easy task, but without a digital clinical team, I could not provide a service.
I like to keep the “spoon full of sugar to help make the medicine go down” analogy in mind when overcoming the challenge of getting people on board. Here’s how I used it to help overcome the challenge:
- The Medicine (evidence base): As a clinician, I love evidence, and as scientists, most clinicians tend not to argue with evidence. Every time a doubter had questions around evidence, or more often than not, told me that “digital therapy can’t be as effective,” I would present them with the evidence that the how of delivery is less important than the what of delivery. In a nutshell, how you deliver an evidence-based treatment is irrelevant, as long as it is an evidence-based treatment you deliver. Kiropoulos (2008) and Spence et al. (2011) for example, compare digital therapy to traditional face-to-face therapy in adults and adolescents, and find them as effective.
- The Sugar 1.0 (social inclusion): At the core, clinicians are caring individuals and want to make their patients better. The idea of denying treatment therefore doesn’t bode well. Digital pathways can make treatment more inclusive for patients who may otherwise not get it because their particular social background impedes it. I reminded clinicians that there are those in society who do not readily engage currently, but may do if we could make it easier for them. Examples include men from black and minority ethnic backgrounds, some young adults, and parents who don’t have readily available or affordable childcare.
- The Sugar 2.0 (clinician wellbeing): Clinicians are creatures of habit and likely to engage with things that makes their lives easier. Digital therapy gives access to flexible working. I have helped incorporate margins of flexibility to job plans, allowing clinicians to have some flexibility in where and when they work. Many of my colleagues including myself travel long distances to get to work on public transport, so working flexibly can ease the burden of travel and improve quality of life.
- “Direction” rather than “destination”: During my project my final destination has changed already several times. Initially, I imaged specific adult patients receiving a specific type of therapy, but now I include children and young people and different therapy modalities, which I had previously rejected, as the conservative nature of my initial cohort was too limiting. Broadening has allowed more patients to access services.
- Senior management support: For me the Children and Young People’s lead was this person. She is an advocate for digital innovation with children and young people and it was she who I involved in creating our service’s digital therapy protocols for adult, children, and young people’s pathways. Having senior management provided the “oomph” I needed as they were good at the getting people on board part – they knew their teams better than I did, and had the necessary influence.
The peer support I have received in the NHS Digital Pioneer Fellowship has been instrumental in shaping these points. The diversity of my group has given me insight to problems and solutions I would never have even thought of.
I am aware I will encounter challenges along the way. I am also aware some of the end points I have in mind may not materialise as I imagined them. Having these five points in mind when pitching a digital solution has helped me formulate what I want to achieve.
“I feel for most people it’s not so much ‘does it work,’ but ‘why should I do this,’ and ‘what’s in it for me?'”