Ijeoma Azodo: November 20, 2020
In our latest interview with members of the team, Associate Director for Clinical Service Design, Ijeoma Azodo tells us about her professional background, why she joined NDS, and what keeps her motivated.
Can you tell me a bit about yourself and your career?
I came to Scotland from Rochester, Minnesota (USA) ten years ago to do a surgical fellowship in liver surgery. Up to that point, my dream career was to practise liver cancer surgery. I enjoyed the interactions with patients and with members of the multidisciplinary teams… nurses, radiologists, physios, other surgeons. The types of operations were a special technical challenge and putting this together with working on a team to help patients was an amazing experience.
My surgical trainers suggested a combined fellowship in cancer and transplant surgery. Developing combined skills in transplant and cancer care would be useful in advancing my cancer surgery technique and seeing possibilities to extend the scope of my practice. Training in Scotland meant living and working in a new place, without adding more time to my surgical training. At this point, I had no expectation of seeing the outside of the hospital much. In this way, Scotland was also ideal with very long days in the summer, there was more time to spend outside. In the winter, it wasn’t so bad being indoors...
In addition to being a great place to grow professionally, the experience positively shifted the way I thought of and used patient care data to see patterns in patient outcomes and influence practice. It shaped the rigour I applied to service evaluation, practice development, and collaborative working.
After fellowship, I returned to the US for a consultant post. When an opportunity opened at the Royal Infirmary in Edinburgh, I applied. Here, my interest in outcomes, practice variation and service design for quality improvement with a focus on how technology can be of support grew. The Health Board was also shifting much of our documentation from paper to digital.
This is when I went back to school, completed a Masters in Public Health at the University of Edinburgh with a focus on complex public health interventions and technology implementation. During this time, I helped developed the NHS Digital Academy curriculum on leadership and transformational change for rising NHS digital leaders.
All these experiences have been hugely important in my journey to NDS, where we’re looking how technology, data and analytics can help improve patient health, care, and outcomes. It is a ‘zooming out’ to see the services, care processes, and workflows that are relevant and ‘zooming in’ to focus on people, their needs and motivations in designing care, products, and services.
We need to consider how can we focus on care to make sure that a person’s health improves. It’s not just about using more resources and more kit. Again, I think of it as a similar process to the systems-based practice I trained in for surgery, with more tech and more design. That is the approach we are embedding into the NDS way of working using the Scottish Approach to Service Design.
And where did you first hear about NDS?
With the NHS Digital Academy, I started the Expert Network to build partnerships with other national organisations to share case studies and knowledge for cultivating new ways of working. There was not a massive representation from Scotland and NDS was just getting going when I was first introduced to Geoff Huggins, the Director for NDS. When the post for Associate Director for Clinical Service Design came up, I had moved from university to building my own start-up in London. The post in NDS looked like a great opportunity to contribute my expertise within an existing team, with goals already aligned to my own. Alistair Hann and Rohan Gunatillake were already working here, both were bringing in really important experience from their respective backgrounds. I had also met NDS colleagues, Steve Pavis and Liz Elliot previously and had great conversations about the potential of data in health and care. I thought I could contribute from day one and build alongside the developing programme.
Can you tell me about your role as Associate Director for Clinical Service Design? What does it entail?
My focus is on translating how patients and health and social care professionals work in partnership toward better health, better care, and improved wellbeing. There is a space for technology to allow this relationship to grow, for patients to be better supported, and for professionals to work in better ways.
Starting from a systems perspective, I look at how we can protect and improve health while considering how patients interact with services, ensuring care and quality healthcare services. From the patient perspective, it is about factoring behaviours and elements of their lives into the process. For professionals, it is a parallel exploration to patients and the public. I focus on the care processes, service workflows, how these are distributed across team members and what that means for health and care service design (Figure 1).
As an example, the process might take the form of interviewing nurses and an administrative team member, reviewing care documentation, and observation of clinical consultations. What is communicated in the nursing conversation which should be captured within our products and services? How does the administrative work support clinicians to support a patient in cancer care? There are many connected elements that are not explicitly recorded.
I look at what a person’s experience of care can tell us about the quality of care, and alert patients and their care teams to problems. For example, a common ward round question is ‘how did you sleep?’. Unpacking this may reveal that a patient is sleeping poorly because they are in pain. There are options for pain medications, however, they might not have not been used. A follow-up line of questioning would try to understand how the patient responds to the medicines they are taking. Does the dose shift their pain to a manageable level? Do they think they need more pain medications at a time? Or, pain medication more often? I have skipped the option of a complication causing pain to emphasize the patient’s perspective. There are ways we can design medication administration and writing orders to better support patients. There are ways to equip patients to understand that their restlessness and difficulty sleeping might be due to pain. We need to find a way to appreciate these signals and gaps to reflect them in the design of services. Details tell you a lot and it’s these contextual details we need to consider as we design care with and for people.
As is the case now during the pandemic, if you can’t physically meet a clinical team, we need to consider how we build products and services to bridge that gap. We also need to understand what part of visiting with the care team is beneficial and accommodate that for both patients and teams. Our technology should support the patient and health and care professionals.
Technology can expand the role of the clinical care team, contribute to support self-management, and reduce some unnecessarily manual processes. We need to consider how we can improve, transform, automate (if appropriate), educate … and where these capabilities are best placed.
Speaking of the pandemic, what are the challenges of COVID-19 to your work?
I think there are three main challenges – care, research, and ‘health debt’.
The first is the way in which teams are delivering care has changed. If that is by phone instead of being face to face, we need to understand whether health and care professionals are delivering the same kind of care and empathy as before. We also need to think about what we’re missing from a patient perspective. It is not clear what will stick and what will go back to the old ways of working.
The second challenge is around our research processes.
When you observe healthcare processes in person, you see the differences in what people say and what they do. How they interact with patients can be subtle. These silent but visible signals are important for us to understand and incorporate into the design of our services. Not being in place with care teams and patients has an impact on how we think about designing products and services that is difficult to quantify.
It’s also important to know what health and care professionals are doing differently, what they want to stop doing, and what they want to keep doing post COVID-19 and track these changes to outcomes, quality, and safety.
As a concrete example, in NDS we’re working on ‘Cancer Treatment Summaries’ to support cancer care. We are being creative replicating our research processes. Through video conferencing, to some extent, we can get a window in to the care teams as they do their care documentation. We are closer to their processes in some ways. However, it’s not entirely clear what the effect is on cancer care, though it obviously has had a detrimental impact.
The third challenge is around debt. In one of his earlier posts, Alistair Hann describes ‘technical debt’ around engineering with some good metaphors. Is there a parallel metaphor when we consider the health and clinical aspects of our work? I have a bit more thinking to do on this. There is a relationship to the two previous challenges. How are we providing care and support all along through our work? How well is our research and ideation process understanding what matters?
What are the main opportunities in what you’re doing?
Our work on the Shielding Service based on smartphone and SMS technology has really made a difference by connecting to existing local resources in analogue form. The services we’re producing in NDS also allow us to get feedback from people using our products and improve the products and services. If someone abandons a process, we can explore that to learn and revise. We can also do this while the services are running in a planned way.
Clinicians and health and care professionals assemble information from a variety of sources to make decisions. With the National Digital Platform, we are cultivating the capability to do that in real time, across the traditional care contexts of primary care, secondary care, social care and the council. Information is presented with the appropriate level of detail to make an informed assessment and guidance. We think about how that information is assembled, designed, and presented to best effect with protections on access and viewing.
The other exciting part relates to how well health and care professionals are providing care. We’re capturing data in a modelled way, that helps people learn from the data without another labour-intensive collection process.
How we engage with people is fundamental, particularly in understanding their mood, pain, quality of life, and health conditions. These are things we might capture on the platform to determine how well a patient feels and is cared for.
Finally, what motivates you in your work?
It's about doing work that’s useful, using my experience and skills to be of service to people.
Others might see it differently, but medicine has always been infused with technology. Now that we have digital technologies and more computational power, we can draw patterns between different aspects of care, operational processes, systems and how they link together. We can help people learn more about supporting themselves, and request help, as well as structuring our services to provide better support and care to people. There is still some way to go in reaching the full potential of technology in healthcare, however, even in these last 6 months, so much has been achieved.
And to close, we need to partner with and learn from how people are adapting their services due to COVID-19 and, in general, to do impactful work. We are developing an ‘expert network’ of clinicians, administrators, managers and trainees across primary, secondary, community, care, and research sectors to speak with from time to time about what’s happening and what’s on the horizon in those fields.
For NHS members, consider joining the Scottish Digital Health and Care Network via Teams.