Driving improvement through technology

Dr Malte Gerhold, CQC’s Executive Director of Strategy and Intelligence talks about our approach to innovation in health and care and introduces a new resource for providers, you can view this on our website.

Dr Malte Gerhold, Executive Director of Strategy and Intelligence

New technologies are changing the way we live our lives. Smart phones, voice assisted home devices, movie and music streaming, autonomous cars, and trucks, and trains, are here, or nearly here. And the pace of innovation is ever more increasing, as is the way we adapt and adopt them. My daughter, barely 18 months old, knows how to use an iPad better than my 80-year-old father (insert your view here on how to bring up children in this day and age!). In the words of Terence Mauri, a future thinker and coach, when it comes to technological change, today is the slowest day of the rest of your life.

Over the last few years, this development has started to arrive in health and social care services too. How we communicate with doctors, how we access services, how we get diagnosed, and how we can look after ourselves is ripe for change through technology. Faster (and cheaper) processing, smarter AI and deepening science (particularly our understanding of genetics) have the potential to revolutionise care in ways we probably can’t yet quite imagine.

This is exciting. It means that we, and certainly our children, will probably have more accessible, more precise and more targeted care than the generations before us. It also is an opportunity to make sustainable (and affordable) aspects of care that we currently struggle to maintain.

Where there is excitement, there should also be caution, however. We know that all change and innovation comes at a cost. Some things will not work, or at least not in the ways we anticipated. Failure, and learning from failure, is part of innovation.

This takes on a very specific dimension when it comes to care. Whereas in some industries we can fairly easily try out several approaches, see which ones fail, and back the winners, this does not work in ours. We don’t build things that we can discard or discontinue if they fail — we look after people, their well-being, and their lives. Indeed, what it means to ‘innovate’ and to ‘fail’ in care is a question that is somewhat underexplored, but probably one of the most important issues to discuss and agree if we want to encourage innovation in this space.

For our work at the Care Quality Commission, the regulator for quality in all health and care services in England, this has two important implications.

First, we want to encourage an open debate — between people who use services, providers of care, and technology industries and entrepreneurs — about what it means to ensure quality and safety of care while changing it in the radical ways described above. This debate has many angles. Personally, I believe it starts from a good, public understanding of the benefits of technologies, and their risks.

If we know now that things can go wrong, what is the conversation we want to have had with the public, and people who use services, that means these risks are understood? If someone comes to harm or has a poor experience with a new technology — an app, a triage mechanism, a diagnostic tool, or whatever else — what do we want our society’s reaction to be? For an innovation that may still be hugely beneficial to be disregarded, or an honest debate about managing and mitigating risks as best we can.

To be clear, the emphasis here is on mitigating risks in the best possible way, not to be careless about people’s lives and simply accept any failures that may happen.

There may be a lot we can learn from other industries, including the pharmaceutical and engineering industries, where we have arrived at publicly accepted ways of innovating, testing and managing risks that we know can never be 100% eliminated. This includes clear standards and processes, transparent evaluations of academic rigour, and most of all years of conversations with the public, particularly those groups most likely to benefit from an innovation, and who can become powerful supporters of change. And we can learn, too, from areas where risks and failure maybe weren’t initially well managed.

Second, the way we regulate health and care services has to evolve alongside the technological changes, and those who make them. I say alongside because in a world where none of us quite know what the future will look like, the only way we can arrive at the right way of supporting, managing and — yes — regulating it, has to be by working and learning together, between developers of new technology, providers of care, people who use services, care professionals and us, as regulator. That means overcoming some traditional barriers between us, from both sides — improving the quality of care has no place for ‘us vs them’, it’s all of us together sharing the same aim.

One of our strategic priorities at the Care Quality Commission is to encourage innovation and improvement, including through new technologies. This is why over the last months we have started work on what it means to regulate quality in this world of rapid changes (partly funded by a new Regulators’ Pioneers Fund set up by the Department of Business, Energy and Industrial Strategy). To start with, we are trying to understand what it could look like for providers of care to introduce and manage innovation well, particularly where it doesn’t work in the way anticipated. The ‘exam question’ I sometimes give my team is this — what would it mean for CQC to be able to assess the leadership of an organisation as ‘good’ (one of our ratings) even if that organisation had just failed to make a new innovation work? If we can’t answer that question, then we cannot encourage (or indeed expect) organisations and their staff to innovate. It’s a difficult question, but it’s the right one.

Alongside this, we are also exploring whether there are ways for us to engage with developers of new technologies, and services that want to adopt them, at a much earlier stage, so that questions of what good looks like, and what we as regulator are likely to expect, are understood before the new approach gets underway. Working this way (sometimes referred to as ‘sandboxing’, though that term doesn’t quite work for me) not only means we can learn together better, but also that improvements can be made, and risks mitigated — as recognised by both the provider and the regulator — as part of the implementation of the technology. Doing this means working differently on both sides, with mutual trust, and we hope to try out such an approach later this year.

Finally, we are working to improve some of our ways of working now, so we can better assess and recognise new technology where it is already deployed in care services. This includes how we describe new technologies in our inspection reports, helping our people to better understand what new technologies now exist or are soon to be expected, addressing some gaps or inconsistencies in our current methodology, and better explaining issues particularly relevant to care settings, such as consent, privacy and people’s rights.

To support this work, we have now also published a new online resource with 15 case studies that look at different ways in which technology is being used to improve quality in health and care services. Our aim is for these case studies to contribute to the debate set out in this blog, and for others who are using technology in interesting ways to get in touch with CQC — to help us understand what you are doing, and us in turn being able to provide a regulatory perspective.

As regulator, the quality of care and safety of people who receive it is paramount for us. But that does not mean that regulation has to be a barrier to innovation. Quite the opposite. We want to see the great potential of new technologies in improving the quality of care and safety become reality — and are determined to help make it possible.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

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