Last week we were joined by Dr. Lawrence P. Petalidis, Head of Innovation and Impact at CW+ and one of the DigitalHealth.London Accelerator NHS Navigators, for our first Lunch&Learn of 2018. Entitled “How to get your Digital Health Innovation into the NHS”, Lawrence shared his views and experiences from getting innovations into Chelsea and Westminster NHS Foundation Hospital Trust.
Lawrence kicked off by explaining a little about CW+ and their work. CW+ is the charity for Chelsea and Westminster NHS Trust. They have a grant programme for staff (and industry partners working with staff) for projects which promote innovation, transformation and new service development. He then shared a number of case studies of DigitalHealth.London Accelerator (DH.LA) companies in their first cohort that had built successful partnerships with Chelsea and Westminster.
The first case study involved a colorectal surgeon - Dr. Christos Kontovounisios who partnered with DH.LA company 11 Health on their digital stoma bag solution. Over 100,000 individuals live in the UK with an excretory stoma with 50% still having a stoma 18 months after their operation. As well as decreased quality of life, there are huge risks to the patient including dehydration, acute kidney injury, and skin complications.
The company had received £45,000 funding from SBRI Healthcare but were looking for a partner hospital to conduct a trial. Even with the SBRI funding, external investor funding and the backing of Lawrence and DH.LA, the first proof of principle agreement still took four months to get and 12 months later they are now only completing their trial, showcasing the long lead times in the innovation process when working with the NHS.
The second case study concerned a company called Perfect Ward whose solution digitises ward audit and accreditation. The solution is now deployed across 40 wards and specialist departments at Chelsea and Westminster and is a good example of how an easy to use, immediately useful technology can help change culture. The staff went from thinking about quality from an audit sense to weekly quality control. The tool has an estimated six hour saving per inspection and only costs the Trust £13,000 for an annual licence. Lawrence explained that they made this culture change by having an involved sales team that did not just sell the product and disappear but made sure they were hands-on with helping staff with implementation.
A third case study was led by consultant Dr. Sunita Sharma who has dedicated her career to improving patient experience for new mums. Dr. Sharma was aware that although the mums to be had a great experience in the delivery of their babies, afterwards they felt abanLumeon who are using their software to digitise the patient pathway and experience and link it to the hospital systems, processes and data.doned and there were long delays with discharges. She partnered with health startup
Interestingly, even though the solution saves the Trust 1,000 bed days per month in the neo-natal ward, because of tariffs and other reasons, this doesn’t actually save any hard cash for the Trust. However it does improve patient experience and patient safety which is important to them.
Lawrence then shared a summary of the impact that the seven DH.LA collaborations have had on the Trust, patients and staff. Over 45 staff have been involved and engaged over 43 wards and departments with over 13,000 patients reached. He also shared some current projects and collaborations that they are pursuing including gestational diabetes, teledermatology and Artificial Intelligence, and digitising Patient Reported Outcomes (PROMs.)
He then shared a useful flowchart showing the many steps and complexity in the collaboration process starting with stakeholder engagement and ending with communications. Lawrence highlighted that matchmaking and funding are the two areas that companies tend to focus on but he advised that a company needs to focus on all stages of the process and is important to keep enthusiasm high and have strong leadership throughout.
Lawrence then shared some strategies he has learned from working with these companies, clinicians and staff to make the process easier.
The first strategy is what he called the Two Triangles of Clarity. The first triangle (on the left above) is about knowing your company inside out. You need to be able to articulate the problem your are solving, why your solution is the best, and what the impact will be - all in clinical, operational and financial terms. The second triangle is identifying your champions or change agents (Lawrence called these “foxes”) at all levels of the organisation from front line staff to executive level.
To succeed in digital health is difficult and Lawrence explained some of the reality checks that he has to do with his portfolio of companies. Firstly, focus on user-centric design at all times not what you think your users want. Recognise that there is a lot of noise out there in the digital health space - you need to be crystal clear about your need, your Unique Selling Point, and your competition. Health is a tough place for quick bucks - don’t get into this space if you want a big exit in 18 months time. Realise that you may need to spend money to get an evidence base but evidence is needed to sell into the NHS. Internal communication is fragmented in the NHS - you can’t rely on endorsements to get support. It’s even hard for Lawrence to get this consent and he works within the organisation. Acknowledge that the NHS is a fragmented market. It’s not a whale to be harpooned, it’s a shoal of fish - just when you think you have it speared, it dissipates. The NHS also suffers from what Lawrence calls “Acute Pilotitis” - even if you have got the evidence in one Trust, another Trust will want you to prove you can do it there before committing. Lastly, healthcare has long business development and sales cycles - do you have enough will (and cash) to survive?
But it’s not all doom and gloom. Lawrence shared his advice about how to make the process easier. He outlined the the power of accelerators and incubators like DigitalHealth.London, Bethnal Green Ventures or even Health Foundry as providing “friendly bags of supply” to the health sector. Being accepted onto a programme such as these is a badge of approval. The Academic Health Science Networks can also provide vetted supply and are worth making friends with.
He also emphasised the role of funders. The UK is unique in that there is a lot of research and government funding available for innovation. Can you leverage funding pots to essentially buy your way into the health system by paying a Trust for a trial like 11 Health did.
Collaborations and partnerships is another way to go. Lawrence said a bit of something is better than 100% of nothing - joint venues are a good way to go. Evidence is of course key. CW+ can help companies working with Chelsea and Westminster structure their trial to gather the right evidence and build an impact case. Try to be lean - learn fast and fail fast. Lawrence reminded us that those who work in healthcare are not Gods – don’t be afraid to challenge creatively when appropriate, but be prepared and know your stuff inside out.
Lawrence left us with the thought that digital health is a big market - $11.5 billion was invested in 2017 globally. The NHS alone spend £5 billion on procurement. However, the NHS is not the only market - many startups have used the NHS for validation and then built successful markets abroad.
Thanks to Lawrence for taking the time to share his wisdom (full slide deck can be found here). The next Lunch&Learn is on interoperability in the NHS on Tuesday 30 January.