Guest blog by Dr Jay Shaw: What I learned from the SCALS Research Program at the University of Oxford
Technology will save our health systems. Right?
Well, at least not unless we take a step back and ask ourselves what technology will actually help us achieve.
To steal a slogan from Canadian think tank The Change Foundation, health care deserves our finest thought. During my month with the SCALS research team I caught a glimpse of what that finest thought might entail. It includes sociology, psychology, political science, engineering, design, management studies, and biomedical science. It includes researchers, clinicians, commissioners, analysts, and patients. It includes discussion, debate, disagreement, and lots and lots of lunch meetings.
And it includes the tireless commitment to question our assumptions about what technology means for health care and why we’re so excited about it.
This was my biggest lesson learned from my time with the SCALS research team in Oxford: We tend to take the promise of technology for granted. Many of us think of technology as health care’s “saving grace”, tweeting our support for new investments in health innovation, e-health, and virtual care. These buzzwords find their way into national health policy documents and organizational strategies, but they often remain abstract and imaginary for those of us interacting with real life health care systems.
Where exactly is this technology? What does it mean for the health systems we so eagerly want to improve?
These questions motivate the central theme of the SCALS research program: To understand how health care “works” when technology is thrown into the mix. It’s not about idolizing technology as the single force that will change health care, but about understanding how the effects of technology happen in the course of everyday, usual care. It’s about understanding technology, without taking technology for granted.
SCALS is looking closely at what effects some particular technologies have on the ability of patients and health/social care providers to do what they need to do. Patients are people living their everyday lives while managing some unique health needs. If some new technology is added into their lives, what happens?
Technologies don’t just get “bolted on” to the usual approach to managing health needs. They mix into a collection of practices and create a brand new system of people and objects. They create new practices of health care and “self-management”. These new systems and practices are what we need to understand if we are going to come to terms with the actual effects of technology in health care, and in peoples’ lives.
The SCALS team is working hard to bring insight and intellect to bear on the issue of technology for assisted living solutions in health care. And they’ve already learned a great deal. Here are 4 other key lessons I learned that I’m going to build into the work I do on technology in health care going forward:
1. Technology isn’t a panacea. It can help solve some problems in health care, but it can’t solve all of them. We still need to pay attention to things like inequality in income and education, two of the most important influences on whether and how people manage their own health needs (and how they use technology too).
2. The effects of technology are unpredictable. Technologies have their intended purposes, but they aren’t always used as designers intended. The only way to know exactly how technologies will be used, and what effects they will have for specific patients, is to take a look! (A close look.)
3. Policy isn’t just boring legislative documents. Policy is all the stuff that gets said, written, and practiced by politicians and others involved in the worlds of health policy. This is important, because if a politician exclaims the promise of a particular technology in a press conference, such as a virtual video consultation in primary care, the broader health care community will take notice. This is not legislation, but it’s certainly “policy” in a broad sense. It is about the strategy and direction of the health system, from the voice of someone who others look to for guidance.
4. We need to re-think our approaches to research and evaluation. We tend to think about the way we should evaluate technology the same way we think about evaluating medicines. But if we pause and think about this, it’s actually quite silly. Technologies have different functions for different people, they interact with beliefs, expectations, and home environments, they depend on the situated, coordinated actions of many people, and they change rapidly (I’m ignoring the “updates ready to install” notice on my Mac right now). This means that technologies need methodologies that can match the complexity of their effects in the social worlds we inhabit.
This is a lot take in, but these insights strike me as essential for anyone working with technologies in health care – and for realizing the potential of technology to help us meet the needs of health systems well into the future.
Jay Shaw is a Scientist at the Institute for Health System Solutions and Virtual Care at Women’s College Hospital in Toronto. Twitter: @jayshaw29