Making change happen from the kitchen table

Arden Tomison, Founder and CEO of DigitalHealth.London Launchpad company Thalamos, writes about some of the positives and negatives of running a digital health SME during the COVID-19 pandemic.

The kitchen table start-up story is such a well-trodden narrative, it’s almost become cliché. The plucky founder’s who, with an old lap-top and a good idea sits down at the kitchen table to make their idea a reality. COVID-19 has now ensured that the kitchen table story is no-longer the preserve of irascible entrepreneurs, every household across the country has their own story of home working. That is, if they are fortunate enough to have a kitchen table to work from. Many are not so lucky and have been finding ways to put in a hard day’s work in living rooms, bedrooms, or corridors.

COVID-19 has forced millions into homeworking. There is understandably much anxiety in the uncertainty of how long this will last. There are many disparities in people’s experience of working from home during lockdown, not least between those living on their own and those at home with loved ones, those providing full time childcare or dealing with major economic challenges as a result and the many who just miss the collective experience of a shared office. Many of the long term impacts on business, work places, transport, flexible working practices, house prices and of course people’s mental and physical health are much hypothesised.

Managing my own team, I’m find it challenging to keep an eye on their well-being. Zoom, Microsoft Teams etc are fantastic but they are still a comparatively impersonal means of communication. It’s easy to put on a show for an hour in front of your boss. Accordingly, from a manager’s perspective it is not easy to spot if someone is behaving out of character and needs more support. My focus must be on the person using the technology and what their needs are.

However, I want to share with you some of the more positive changes that that have been taking place within the mental health sector.

I quit my job in 2018 to set up Thalamos, working from home and really missing the camaraderie of working in an office with co-workers and friends. But, from my kitchen table we have developed a Digital Mental Health Act solution. Our product modernises a process established in 1983, which involves actual pieces of paper being completed by hand and physically passed between several staff and services. Thalamos has made it possible to complete these digitally. Much more than digital forms, we facilitate real world interoperability, meaning multi-agency, multi-disciplinary teams can operate and communicate properly in the often challenging and distressing situations they find themselves.

Making the Mental Health Act process itself more efficient, Thalamos is able to support health and care professionals to get their patients access to care much more swiftly and safely than before.

We work with all stakeholders involved in the care of those with mental illness. We work with social workers and doctors in the community, nurses and therapists in hospitals, administrative teams and managers normally in the office, but all currently working from home.

Health technology over the last 3 months has seen three seismic changes all happen at once:

1. The requirement for technology across healthcare has been laid unarguably bare.
One of the homeworking solutions currently being practiced is that individual team members are going into the office to collect paper forms before posting them to colleagues at their respective homes. Clearly in 2020 this is not sustainable.

2. There has been a massive technological upskilling of the entire healthcare workforce.
Throughout this period Thalamos have been delivering training to teams up and down the country via video conference. The vast majority of those we’re speaking with hadn’t made a facetime or video call 3 months ago; and yet now when we join a call we’re met by an array of jazzy backgrounds, filters and smiles. Even though it’s been uncomfortable, we are now nearly all familiar with video conferencing, it’s becoming second nature.

3. Money long denied to healthcare decision makers has been made available.
The Government, through debt write off’s and new investment has made promises to the NHS which have allowed decisions to be made more swiftly.

For healthcare technology providers, like Thalamos, this represents a huge opportunity, albeit one born out of horrid circumstances. For those of us with solutions that are simultaneously able to improve outcomes and reduce contamination of COVID-19, the opportunity is greater still. Thalamos has seen our list of Trusts grow from 3 to 14 over the last 3 months.

The way NHS Mental Health Trusts have reacted to COVID-19 has been hugely impressive. Streamlined decision making, unbridled by bureaucracy and taking decisions based on key metrics of patient outcomes and staff safety.

It is easy to forget that change is still challenging, even if there’s lots of it happening. Learning new ways of working is stressful, particularly if you’ve been working that way for a long time. This can be compounded when that change is a technology one. Just as the move to working from home is a very current change for millions of people, many of those using Thalamos are not “digital natives”. Some aspects of technology that are second nature to many today have not been introduced to mental health settings until now.

As with most other health technology companies Thalamos’ goal is to improve outcomes for patients, it’s the burning motivation that got us started in the first place. But, in all the clamouring to deliver new solutions for patients, we absolutely must remember that someone has to use our technology for it help patients. Technical innovation is never really about the product itself, rather its success is entirely driven by the people using it. For us that is doctors, nurses, social workers, carers and administrators.

Technology can often focus more on functionality, features and users than on outcomes. To avoid this trap, at Thalamos we measure three KPIs.

• Simpler to use than the status quo
• Swifter than the status quo
• Safer than existing practice

If we are not able to demonstrate an improvement across all three then, frankly we don’t think the change is worth it.

These tests should be measured not by super-users or early adopters, but by the self-confessed luddite who’s still rolling a Motorola flip phone (we have one of those). If they find it’s simple to use… we’ve succeeded!

To achieve this, we need brilliant design so that it’s simple to use in the first place. We also need brilliant support to reduce as much anxiety as possible. Even if that means being on hand to diplomatically explain to a doctor the reason they can’t log-in is because they’ve spelt their own name wrong (it’s happened). Though this may seem amusing it was an opportunity for us to see if we can make that process even simpler and so we are keen to look at integrating with NHS Log-ins. Every barrier or occasion someone is having an issue with our product is an opportunity to reflect on how we can make it better.

The opportunity to affect positive change with technology has never been greater but technology is not a panacea, particularly in a Mental Health setting. A huge amount of mental healthcare is tied up in human interaction itself. It can be a moral and ethical minefield with one such example being the ongoing debate about video assessments in acute care. The amount of complexity meaning that there is no one size fits all solution, it’s always nuanced. We think the ultimate objective of technology should be, to act as the enabler which allows healthcare to become more human, not less.

So, to those who miss the office, the banter, a natter, the cups of tea and the after-work beers, well done! You have my absolute admiration; not only have you kept the wheels turning, you have achieved a level of technological change that would have been unimaginable, even to the most ambitious technologist, just a couple of months ago. Our recent work achievements are because people in the mental health sector made a quick decision to embrace technological change in order to keep mental health services running.

Fingers crossed those of us who’d like to be back in the office will get there soon enough, and that our kitchen table stories will become fond memories of kids and dogs on video calls. But I am also hopeful that much of the change we’re achieving together now, the advances in the use of digital technology in health care, will make all our lives easier in the future whilst improving outcomes for patients.

Until then Thalamos will be doing what we can to make the change as simple as possible, from my kitchen to yours – keep making change happen.