Horizons team member Sasha Karakusevic writes about an NHS Expo session led by the team: 

Designing and implementing large scale digital transformation in healthcare is difficult!

We don’t often pause to understand the complexity involved in moulding the expertise of multiple disciplines to create services that do the jobs our patients want – and that are easy and intuitive for the workforce to use.  And we are aiming at a moving target – many of the tools we are learning to use today did not exist even five years ago.  The Global Digital Exemplar (GDE) programme is providing an opportunity to accelerate the learning process.

Patient involvement is an area that many providers find challenging. Our Expo session gave an insight of how two providers are successfully involving patients to create new services.

Alder Hey

Being in hospital as a child can be an unsettling experience.  Quite apart from the change in environment, there are the inevitable fears about what is happening. There are also the challenges of helping children learn about managing illness to stay healthy.

Children learn through play, and using the idea of ‘gamification’ (put simply, turning boring processes of recording stats in to a game that is fun) the team is working to develop an app that builds familiarity with the hospital and rewards positive behaviour.

The GDE has enabled the team to work with an experienced app developer using an ‘agile’ process. This enables prototyping and rapid development on a two-week cycle working towards a goal, without needing to know all of the detail at the beginning.

Input from users is weighted to roughly 70% children; 20% parents and carers and 10% staff.  The process is allowing rapid progress to be made and it is envisaged that a “white label” app (allowing local customisation and branding) will be available soon.


Patient engagement underpins all work at Merseycare.

Merseycare has set themselves the challenge of achieving zero suicides.  This is massively ambitious (there were 5688 suicides in the UK in 2016).  The team are working to bring together international evidence of best practice, making full use of the potential of mobile technology to support vulnerable individuals and seeking to tackle difficult ethical issues regarding the balance between support and privacy.

Both stories were inspiring, and demonstrate the potential to provide increasingly personalised services at a scale and reliability not previously possible.  These providers clearly understand the value of the knowledge and expertise that patients as well as health care providers and technologists can bring in order to co-produce a successful product.

To summarise the messages from our session, with some tips for sharing similar successes in your organisations:

As designers

  • Actively involve patients and staff in the design process, recognising their distinct and individual needs.
  • Think about how to create a user experience that helps the patient manage their own care – help the condition fit in with their lives.
  • Consider the key messages coming from artificial intelligence and the deployment of chat bots to ensure steps are broken down to easy to interpret stages and reduce unnecessary process steps.
  • Think about how the technology will work virtually, and how it will enhance the effectiveness of face-to-face encounters.

As change leaders

  • Spend time creating a vision or goal, ensuring you consider how to involve key stakeholders such as patients in the process from the very beginning.
  • Create a process that supports emergence. This might require a very iterative approach incorporating what is known about delivering large scale change and agile approaches to software design.
  • How will your project scale? New technology enables global reach, but unless the detailed design is right your intended users are unlikely to use it, so a lot of work to co-create the user experience is critical – and this needs time to emerge.

As technologists

  • Recognise the challenges of designing and developing in the health sector.
  • Spend time with the patients and staff to build solutions that address a need.
  • Be ambitious, but understand what your value proposition is – simply put, why should or would your intended user use your product?
  • Adding more technology and features is rarely the best solution.
  • Create a space to test learn and iterate.
  • Apps and digital solutions are a crowded market, do your market research and understand whats already out there.
  • Question what  the purpose of your digital solution is, and why your solution is better than what is currently available. Focusing on the people and not the technology will give you a better platform to go for the much more disruptive and technologically advanced ideas that you may have.
  • Think like a startup with no money and you will find you will have the creativity to get to solutions that have an impact quicker.

The last word goes to the patients.

If we are to make the most of the GDE process, we need to recognise that patients are part of the solution.  To adapt the old saying from medicine: ‘first do no harm’ …doing something is the best way of achieving this!

There is much to learn… and the GDE exemplars in Alder Hey and Merseycare are clearly taking action and making great progress.