Alistair Ewing: March 10, 2020
I recently wrote about my tour of Scotland, meeting people involved in anticipatory care planning. I was most surprised by the role technology played in a care home in Hawick. Rather than getting in the way, the care home manager described her software as improving the care provided. Their enthusiasm for the software suggested that it was more than just functional, but surprisingly good (a value that we at NDS hold dear).
From these conversations we could see a clear need to share information about people between health and social care. In my previous blog, I mentioned product management is really about people and asking questions. An essential product skill in product management is also the ability to tell a story. The story we took from these visits was how life in a care home could be different with the National Digital Platform and ReSPECT. We wanted to keep the story realistic and grounded. So, no robots or AIs providing care. Instead, technology supporting carers to concentrate on the people in their care.
Here’s June’s story:
'Imagine it is 2022, and ReSPECT has been completely rolled out across Borders health and social care. June is a 75-year-old with a COPD diagnosis and a preference for treatment in her own home. She has recently been treated in the Elderly Medicine ward of Borders General. Here, she had a conversation about what care she'd wish for in an emergency following the ReSPECT process. When she is discharged, she and her family are given a copy of the ReSPECT form to take away and they are shown how to access her information online.
Back at home, June's general health and ability to care for herself continues to deteriorate. After a conversation with her family, she decides to move into a local care home. Speaking with the manager of the care home, June's family have an initial chat about emergency care for June. The manager reassures the family that she had the ReSPECT form completed earlier with June's initial assessment and that these wishes would be reviewed in the context of the move into the care home.
When June moves into the care home, one of the first activities is to complete a more detailed care plan to guide the care team on June's overall care.
June's health deteriorates considerably, and it becomes clear that she would prefer to stay in the care home. She's happy to be in the care home and she has a good relationship with the care team. The care home team recognise the signs of deterioration and contact June's family to discuss the options. As part of this conversation, they agree to update the ReSPECT form. They want to recognise June's preference for place of care and ultimately place of death. The care home manager discusses these changes with June's GP. She updates the personal wishes section of the ReSPECT form and highlights the changes to the family.
Suddenly one night, June suffers a major deterioration and its clear she's unlikely to make it through the night. The staff on duty at the care home phone Out Of Hours GP service to ask for support, as well as informing the family. Seeing June's updated ReSPECT form, the OOHGP sends a district nurse who is able to make June comfortable during the night. By the early hours, June dies in comfort and surrounded by her family.'
We found writing this story helped. It encouraged us to concentrate on why we were doing this work and what we were trying to achieve. Rather than how we would use technology to achieve it. The story also gave us a tangible example of how that vision might look in practice. We’ve used this story in public, telling it during the plenary session of the recent Digital Health and Care event. We’ve used this story with our ReSPECT stakeholder groups to describe what we’re building. We’ve shared it with our development partners at Person Centred Software to describe the service experience we’re aiming for. They had a similar story about their persona: ‘Jean’. And we’ve turned the story into a journey map and stuck it on our office wall. This encourages conversations and flushes out questions within our Product and Development Teams.
I’m looking forward to returning to that care home in Hawick to see how ‘June’s story’ plays out for real. And I’m looking forward to many more conversations with passionate carers and uncovering more ways in which the National Digital Platform can help transform health and social care in Scotland.