By Ciarán McInerney
In late 2019, the Academic Health Science Network hosted an event exploring the effective use of the National Early Warning Score version 2 in Yorkshire and Humber. Such tools for monitoring patient deterioration are very relevant in the midst of the COVID-19 pandemic where healthcare practitioners are still learning how best to treat the disease. The Yorkshire and Humber PSTRC Digital Innovation theme was invited to run a workshop during which we posed the question “Digital Innovation in the NHS: Is it safe?”.
The NEWS2, the National Early Warning Score version 2, is a metric to indicate the health status of a patient based on six physiological measurements routinely collected in clinical practice (1). The integration of the NEWS2 into electronic health records is a good example of the type of innovation that the Digital Innovation theme evaluates for safety.
At the Academic Health Science Network event, we met with clinical, administrative, operations and managerial staff to discuss the safety implications of digital innovations and technology in healthcare. Through two collaborative activities, the attendees discussed attributes of digital and technological innovations in healthcare using case studies and their own experiences. Together we reflected on the stakeholders, rewards, risks, issues and solutions.
What did attendees think?
We summarised attendees’ views using the SEIPS 2.0 model, Systems Engineering Initiative for Patient Safety version 2 (2). At its highest level, the model has four parts that provide a lens through which we can view the safety of a healthcare system: Work system, Work processes, Outcomes, and Adaptations. The image below visualises the relative proportion of comments made by attendees that were associated with each part of the model.
When reflecting on their experiences of digital innovations in healthcare, attendees most often spoke about the Work System, which dealt with people, tasks, tools, rules the environment, and the relationships between them. Attendees recognised that digital innovations can improve patient safety often by streamlining care for more efficient use.
The Winter Pressures project from the Digital Innovation theme is an example of our work addressing a Work System. We are modelling the efficient flow of patients in the context of increased load during periods of heightened pressure (see our recent blog). We’re finding that modelling patient flow can be a useful application of digital technology that supports the decision-making capacity of healthcare staff.
In contrast to the Work System, attendees had little experience of the use of digital innovations for Adaptation, which describes how outcomes and processes are fed back to the system and what effects the feedback has. Through group discussion, attendees identified that risks and issues arising from digital innovations were associated with unanticipated and intermittent events. Networking, situational awareness, back-up plans and IT support were suggested by the group as solutions to these risks. The Digital Innovation theme’s Micronarratives project is investigating digital innovations that are specifically designed to promote these types of adaptive solutions. We aim to evaluate the effectiveness of these technologies at addressing the concerns put forward by the attendees.
Are digital innovations safe for patients?
Over the afternoon of workshops, attendees contributed a wall’s worth of perspectives on the stakeholders, rewards, risks, issues and solutions associated with digital innovation in healthcare. In this blog, we could only skim the surface of what was discussed so we have produced a visual report of the workshop that presents the views of the attendees in greater detail.
Each of the two workshop deliveries ended with a question for the attendees that introduced Erik Hollnagel’s [1] distinction between Safety-1 and Safety-2: should we focus on finding and preventing harm, or on finding and encouraging safe practice? For some attendees, considering safety in these terms was a change of perspective that made for a more nuanced question of whether healthcare is safe. The overwhelming answer to the question posed was “It depends”; stated factors included the activity being actioned, the expected outcome, and the available resources.
In the Digital Innovation theme, we recognise the complexity in considering the safety implications of digital technology, not least because it is interwoven into the systems, processes and reporting structures of healthcare. Through continued interaction with healthcare staff like those at the Academic Health Science Network event, we hope to understand the components, relations, levers and consequences of our combined efforts to deliver the best and safest care for patients.
How can I get involved?
The conversation doesn’t end in workshops like these. We want to know what you think.
Should we focus on finding and preventing harm, or on finding and encouraging safe practice? Let us know in the comments below.
References
- Royal College of Physicians. National Early Warning Score (NEWS) 2 [Internet]. London, UK; 2017. Available from: https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2
- Holden RJ, Carayon P, Gurses AP, Hoonakker PLT, Hundt AS, Ozok AA, et al. SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics. 2014;56(11):1–30.