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Dr Victoria Betton

Co-design for digital health

16 April 2019


My thanks to Dr Victoria Betton from mHabitat for presenting the first in our DHEZ Seminar series: 

Co-design for digital health

I also must say thank you to Bibi for being an excellent guest – much loved by attendees who made several offers to take her home with them.



DHEZ Seminar Series April 2019

It was great to welcome visitors to our first DHEZ Seminar - our audience inlcuded academics, innovation development officers and heads of research and business.  This is what the DHEZ programme is about for me; the bringing together of a cross-discipline/cross-sector group of people to learn, think, be challenged and join forces to identify good practice and bring about improvements in healthcare.

Dr Victoria Betton provided us with an overview of co-design and stimulated much discussion and left us with much to think about.....

Victoria first discussed the unintended consequences of what at first sight appears to be useful technology.  To illustrate this she signposted a great article “Why doctors hate their computers” by Dr Atul Gawande.  I’d recommend you read this – well worth the investment in time.  Dr Gawande's article brings into sharp focus why it's important to consider human factors and unintended consequences when looking to implement technology in healthcare.  We should stop talking in broad “digital transformation of healthcare” terms – something that sounds like it's being done to healthcare services (and so with the inherent problems highlighted by Dr Gawande), rather than a collaborative process which takes into account how people (professionals, users, funders etc.) view and use healthcare services. 


But three years later I’ve come to feel that a system that promised to increase my mastery over my work has, instead, increased my work’s mastery over me. Dr Atul Gawande, The New Yorker

Human Centred Design

Victoria then talked us through the principles of human centred design which requires an understanding of users’ needs and requirements.  The process is necessarily multidisciplinary and iterative and involves users throughout the design process.  She broke down the co-design process into a series of smaller steps: starting with the hypothesis and going through a series of iterative steps to ensure clarity of understanding of the intervention and its potential impact on stakeholders.  Victoria was also keen to emphasise the importance of incorporating an ethics layer into this process. 

Human Centred Design

We were reminded that taking digital health innovations, at scale, into clinical practice is a significant challenge.  Victoria referred us to the work of Nesta’s Eddie Copeland which puts forward Nine big messages on digital government that public sector leaders should understand”.  In this document, Eddie Copeland proposes that operational excellence and agility are amongst the key enablers of success in the implementation of digital technologies in the public sector.  It is hard to disagree with this, but the challenge we face is how best to acheive this in complex NHS organisations.

Another significant challenge that digital health faces is in ensuring equality of access to digital innovation in healthcare.  Victoria drew our attention to the work of the Good Things Foundation which looks at barriers to accessing online information and which promotes inclusive digital literacy programmes.  The Good Things Foundation’s “Digital Nation 2018” survey identified that in the UK there are 6.5 million people who never use the internet and a further 7.4 million who report limited internet usage.  Deployment of digital health tools therefore needs to take account of these people, and incorporate processes/systems that can avoid discrepancies in healthcare use and delivery.

Holistic approach to technology implementation

This was a great way to start our DHEZ Seminar series: positive about the potential of digital technologies in healthcare but mindful of a holistic approach to its implementation.

If we are to achieve the vision of the Topol Review of technology providing the “gift of time” to enable healthcare professionals to spend more time caring for patients, then a multi-disciplinary co-design approach is the way to do this..... bearing in mind the unintended consequences of technology.

Innovation and implementation will be strengthened by healthcare professionals, industry and academic researchers working together and with service users to design necessary and effective interventions which can be deployed at scale. 

If you found this interesting - take a look at our DHEZ Seminar Series and join us at one or more of our future events.



Topol Review 2019