on digitisation in care homes
Professor Maiden, thank you for taking the time out to meet with us. If you could please start by giving us an introduction to yourself and a brief outline of your current role and your area of specialisation?
I am a Professor of Digital Creativity at the Cass Business School where I also direct something called the centre for creativity and professional practice. It’s a research centre that seeks to reframe most professional work as creative even if it’s not in the creative industry and dementia care is one of those domains. We work in domains ranging from Manufacturing, Health and Safety, Design, Journalism and newsroom work through to Health and Social Care – all of these being treated as a creative challenge to enhance the creativity of work within those sectors.
We’re aware as you previously mentioned that you’ve been involved with three projects. Would you be able to elaborate on what these projects entail and if they are in collaboration with any care homes?
All of these are in the public domain. We have an Innovate UK funded project with an organisation called Evalucom and it is to develop, essentially a digital visitor book for care homes, residential care services where people can provide feedback, which is more challenging than it sounds. This is not just necessarily a relative, who is visiting their relative in the home. It may be a G.P., maybe a nurse assessor, it maybe professional services, ambulance crews. Finding a system that will provide meaningful feedback that can improve the quality of care in those homes. There’s a gap in the market and we are in the early stages of a three-year project developing essentially a mobile digital solution with AI underneath it to try and meet that need.
The second one is funded by the Nominet Trust. We are working with an organisation called ‘Ladder to the Moon’ who deliver improvised theatre experiences into residential care homes. They are essentially a trooper of strong lead players who go around the country turning care homes into theatres and cinema experiences with huge films like South Pacific and that genre of films from the 50’s and 60’s that people might be familiar with in homes and everyone fulfils a role. So, it’s about changing the culture of a care home through an experience. We are building a digital platform to enable that to be rolled out much more widely. So, part of the experience is digital rather than just face to face because that is limited by how quickly and widely that can grow. Because there are only so many actors that can go out there at a certain cost. So that project is just up and running.
The main project is a large EPSRC (Engineering and Physical Sciences Research Council) Project, it’s one of the UK’s research councils and we have just shy of £1m for a project called SCAMPI - which stands for Self-Care Advice, Monitoring, Planning and Intervention and it is essentially a tool that is trying to deliver new kinds of visual care planning for people with early Dementia and early Parkinson’s. So, these are people living in their own homes trying to maintain their quality of life themselves without needing any external health care services and we’re developing a smart solution, a toolkit that enables them to use visual languages to express their needs, the qualities of life that they seek. The tool is providing recommendations on how they can achieve that most effectively and what trade-offs they have to make and all of that is informing a set of sensors underneath so domestic sensors are providing feedback and recommendations on how they can improve the better achievement of that care plan. That’s in a nutshell. It’s a three-year project with about £1m so there is quite a lot of work to be done there and that’s been running for two months. That project is probably the vanguard out of these projects – visual care planning.
Very similar in some sense to your video that I saw a week ago about ‘Sunnyside Home’ (Watch the video here) with task lists. We are trying to take that and one of the limitations here is that people with the early stages of conditions don’t really have control of their own care plans. They can’t do it themselves. So, the idea is to empower people in care
Based on your previous experience of working alongside care homes, what is your perspective on digitalisation of workflow in care homes?
I find it very hard here in this country, I think it’s very difficult. The work that you are referring to was reported in 2013, we started it in 2011, so you can see it was quite a long time ago. We developed mobile apps and dropped them into care homes with some of the AI that we talked about. I think we achieved some successes but we achieved more fails than successes.
Most of the problems are socio-political. You can put a kit into the care homes and do the setup and get everything to work. You can solve that with some money and creativity. The real barriers are socio- political. For example, some of the carers didn’t like using mobile apps because it meant they had to wear glasses and they didn’t like to wear glasses on shift because occasionally they would get dropped or broken or an older person might grab it. All of these issues that are just day to day care issues. The political issues were that younger carers were more familiar with how to use tech so it inverted the power structures within the organisations, so you got a backlash from some of the staff, not going along with the change. So, socio-political barriers rather than tech.
The longest trial we ran was in Nightingale Hammerson, in their dementia wing for 12 months. We replaced their paper-based system. And because we were doing academic research, we measured the benefits. We collected all the care data from 7 weeks before and then for the entire duration of the research. We were successful there because we had management support and buy-in but we had to go back and do lots of tweaking, to fit that particular home’s needs. I think we succeeded in that and I was proud of that work.
Times have changed:
Even then many people said that we would not be able to get the carers to use the technology. However, they were wrong because, by the end of the trial, we had difficulty getting the system away from them. And that was a decade ago. Nowadays many care staff have smartphones and are very proficient with them. There is progress in Care Planning systems now taking hold and there are success stories out there. I think things are changing. It is happening.
On Data Protection:
Information Governance rules aren’t show-stoppers. To be fair most enlightened people in care understand that the benefit of being able to share and communicate this information far outweighs the risks. These are views that I have and it's not to dismiss issues of privacy and security. We have to adhere to all the standards and that’s what we are trying to do. But at the same time, people become rather worried about the negative consequences at the expense of what communication and sharing can give.
You have been working within this sector for almost a decade now and you have obviously seen many solutions in your time. What in your opinion makes a solution good or bad?
Yes, I have. Some good and some not so good let’s put it that way. I haven’t seen something yet that has blown my mind away. You’re going to put me on the spot here. I have seen some solutions with Simon. Some with potential. My criticism is that most try to automate the manual process. They look at what happens now in paper form and just digitise it. And that is fundamentally wrong. The rest of the IT world learnt from that mistake 20 years ago. So, I don’t think there is enough rethinking of care. Trying to get your share of the market and lock it down has led to a very conservative approach in this country.
Benefits of a digital system for various stakeholders within the organisation:
One of the things we found in Nightingale was that we considerably improved the communication between the carers and non-carers such as occupational therapists and physiotherapists. That was one of the upshots actually. That they were able to understand for example why people fell. They were able to go through the notes. They could extract keywords and look at what happened to a person that particular week. They started to detect patterns. In fact, one of the ideas we had was could we write an algorithm that could detect patterns indicative of what could happen based on an analysis of what had already happened. So, I think it’s about communication. I think that is the real benefit.
There was a secondary effect that because people knew the minute they pressed the finish button on their care notes, it was visible to everybody, they did take more effort towards them. There was a significant improvement in the quality of notes over the 12 months. And one of the drivers was that because people are going to read this, they made more of an effort. That social driver was quite important. The visibility of notes changes behaviour. I thought that was an important lesson.
If a relative calls and asks about what their mum had two days ago at a certain time at night, the carer is able to give them that information within a matter of minutes.
What do you think in the current situation is the most pivotal need in the care sector at the moment?
Just thinking about that, that’s a fair question actually. I think there is a need (and I think this is in your video as well), it’s about time –and the productivity issues. I think we solved that years ago with our mobile app which demonstrated that carers were far more productive in terms of the care notes. People shared it a lot more and read it a lot more. So, I think to help with that productivity so carers can spend more time caring. It is something that is a win-win, if you can just achieve it, show it.
I think upskilling care staff is something that is very important. I think an increase in their social esteem. That’s one of the things that we have with technology. We took away a scrappy piece of paper and pen and gave them an iPhone or another touch device. One of the unexpected consequences was that they felt they had prestige, they actually felt better about their work, they felt valued like a professional and that they were trusted. I think upskilling and related improvements to social esteem with care is a big issue and I think technology has a way of doing that.
We are also trying to get people to see themselves as creative professionals rather than mundane workers.
Finding the balance between Communication and Privacy, is also key.
One of the things we talked about at the SCAMPI project is that we should stop calling it a care plan, it’s a life plan, my life’s goals. And it could actually be used by anybody. It does not just have to be used by someone in care. It is valuable generally.
Empowering people to be more involved in their own care. I would hate to have a system forced on me that takes away the power from my life, why would any of us design for that? So I think empowerment is a key message and giving people tools that they can use. At the moment, we provide tools to the carers. But we have to get away from that at some point and empower people to take control of their own care. It’s not just care, it’s life.
Neil Maiden is Professor of Digital Creativity in the Faculty of Management at the Cass Business Business and co-founder of the Centre for Creativity in Professional Practice at City University London. He has published over 175 peer-reviewed papers in leading journals such IEEE Transactions on Software Engineering and Communications of the ACM and conferences such the ACM/IEEE International Conference on Software Engineering. He is a recognised thought leader in his disciplines. His work has been recognised many times through awards from his peers. His current funded and doctoral research is in 3 main disciplines:
1. Digital creativity support for professional work
2. Specifying and designing complex digital systems
3. Digital support to improve the care of older people with dementia
Phone: +44 (0)20 7040 8412