Chapter 1
A system under strain
The pandemic placed huge pressure on traditional ways of delivering health and human services.
The COVID-19 pandemic changed the entire landscape within which health and human services (HHS) are delivered, placing immense pressure on systems and staff. Social distancing, infection control and lockdown measures created a plethora of challenges for the sector’s usual ways of working and delivering services.
Our survey of HHS organizations revealed that, across all countries and sectors, respondents had two overriding priorities:
- Maintaining the safety and well-being of staff
- Maintaining access to care for service users and patients
In the health care sector, the outbreak has not only overwhelmed ICUs with seriously ill patients, but also disrupted the delivery of routine services such as screening and cancer care. There has been a similar crisis in the social services sector, as soaring unemployment, poverty, domestic violence and mental health problems put additional strain on services that were, in many cases, already under-resourced or at capacity.
Before the outbreak of COVID-19 just 18% of HHS organizations had managed to embed digital tools in the way they work.
The ability of organizations to cope was hampered by the fact that HHS is among the least progressive areas when it comes to digital technology, even compared with other public services, let alone the private sector. Prior to the pandemic, the sector couldn’t afford to experiment because the costs of getting it wrong – including failures in service delivery and poorer outcomes for vulnerable groups — were seen as unacceptable.
Our survey revealed that, before the outbreak of COVID-19, just 18% of HHS organizations had successfully embedded digital tools in the way they work. More than half reported they had made little progress in implementing such solutions. Challenges included:
- Lack of funding. HHS organizations found it hard to justify investing in digital solutions due to lack of access to adequate financial resources an issue cited by 16% of respondents.
- Restrictive regulation. Stringent government regulations that HHS organizations were obliged to follow to was mentioned as a key barrier by 9% of respondents.
- Staff resistance. Digital transformations were seen as undermining necessary relationships and skills. Practitioner concerns included loss of human interactions with service users (cited by 18%) and reliance on data insights over professional judgment (10%).
- Technology issues. Siloes and an absence of standardization inhibited innovation. Our respondents mentioned lack of interoperability between IT systems (18%) and difficulties in adapting existing IT systems (15%) as key barriers. Meanwhile, 12% were concerned about protecting individuals’ identity and personal data.
Chapter 2
Rapid response
HHS organizations had to transform their operations in a matter of weeks.
There is no doubt the barriers to digital transformation were substantial. But the extraordinary circumstances of the pandemic swept many of these away, enabling HHS organizations to get rapid traction on potential new solutions and to pursue these without fear of failure.
All over the world, organizations made the leap to embrace solutions that would enable them to continue caring for patients and vulnerable citizens. Our survey reveals that 62% increased the use of digital technologies.
For staff, the shift to home working necessitated by social distancing was supported by an increase in the deployment of desktop or laptop computers (from 58% to 80%) and the use of mobile solutions for remote access to organizational networks (37% to 67%). The most dramatic change, however, was in the adoption of video conferencing platforms, which soared from 27% to 73%.
For service users, some of the most common solutions supported the shift from in-person services to remote consultations. Phone appointments were offered by 81% of organizations, up from 39% pre-pandemic, while video consultations were provided by 71%, up from 22%.
Many governments created digital information portals, AI chatbots, mobile apps and social media platforms to connect directly with people and help them protect themselves and their families from the virus. User-support tools also became much more prevalent, including service-user portals, online self-assessment, self-help and patient engagement tools.
The pandemic also changed attitudes toward data sharing, not just between HHS providers, but with community groups and voluntary organizations. The use of new digital tools boosted both the quality and quantity of user-generated and routine administrative data which HHS providers could then leverage to improve service delivery and outcomes.
Where jurisdictions had already established clear data sets and data-sharing mechanisms, they were able to use these to monitor risk and need, analyze the likely progress of the pandemic and build rapid responses. Where this infrastructure was lacking, most jurisdictions swiftly put it in place. Many moved closer to real-time intelligence sharing; South Australia’s Vulnerable Persons’ Board, for example, reviewed real-time data on a weekly basis – using a range of child protection, health, police and other indicators – to inform state-wide service responses and planning.
So what helped with such rapid progress in digitalization after years of slow progress? Factors cited by our survey respondents included:
- Increased demand from service users (16%)
- Rapid development of a strategic plan for digital (14%) and realigning of priorities (14%)
- Improving digital literacy of staff (14%)
- Emergency funding to purchase tools, technologies and equipment (12%)
- Alleviation of practitioner concerns around loss of human interaction (12%)
- Rapid leadership buy-in (12%)
Many countries and local authorities also temporarily eased restrictions on privacy and data protection to accelerate the implementation of digital and data solutions to combat the pandemic.2 For example, the UK introduced regulations requiring the NHS, other public health organizations, GPs and local authorities to share any confidential patient information that could help control the spread of COVID-19. Some regulators also fast-tracked procurement processes to expedite digital purchases and implementations. Partnerships with the private sector – for instance, in developing test and trace applications – further drove rapid adoption of these solutions.
Chapter 3
Fit for the future
Have recent advances made the case for the permanent adoption of digital solutions in HHS?
The surge in digital transformation has revealed many benefits for HHS service users and practitioners alike.
The majority of respondents to our survey believe that the use of digital technologies and data solutions since the outbreak of COVID-19 has been very or somewhat effective in improving:
- Quality of experience (63%). One-third of respondents reported phone and video consultations among the most impactful tools. And 58% agreed that these solutions had proved effective substitutes for face-to-face contact.
- Access to care (64%). For example, through research conducted for a client organization, we found that virtual contact with social care organizations was well received by some vulnerable families, who found it more convenient and less intimidating than a home visit.
- Productivity of staff (64%). In some areas, physicians were able to schedule more appointments, while social workers spent less time traveling and more time online with clients.
Digital technologies and data solutions
66%of respondents’ staff adapted to new tools quickly.
Respondents also reported mostly positive experiences of using digital technologies and data solutions, with 66% agreeing that their staff had quickly adapted to the new tools. This is an indication that practitioner concerns have been allayed and digital literacy issues overcome – an encouraging sign that gaining workforce buy-in for future projects may be more straightforward than in the past. Sixty percent of our respondents said they had experienced an improvement in cross-organization collaboration – something that will be essential to understanding and addressing increasingly complex user needs in the coming months and years. And 59% reported that operating models had become more efficient, another critical success factor as HHS organizations are required to do more with less in the face of rising care needs and the inevitable post-crisis squeeze on public spending.
However, our survey revealed that opinion is divided on whether the changes will be sustainable over the long term.
Forty-eight percent of respondents say their organization is planning to continue to invest in technology in the next three years, with 33% expecting a significant (more than 50%) increase in investment and 19% expecting a substantial (more than 100%) increase in investment. Respondents’ top objectives for future digital investment were: improving quality of care, reducing the administrative load, enabling better communications and streamlining work processes.
However, 47% of our respondents think the introduction of digital and data solutions was a temporary measure to address challenges during the pandemic.
There will undoubtedly be forces – for instance, a dwindling of political and financial support – that could slow the momentum as the emergency subsides. Many governments are on the verge of a financial crisis, with the economic downturn threatening to reduce revenues in an environment where ageing populations were already putting HHS provision under pressure.
It is also true that the quality of some services can suffer when provided remotely. For example, social workers may miss red flags that they would have picked up during in-person contact. Organizations face the challenge of ensuring that much-needed human interaction is returned to these services as soon as it is safe to do so to avoid compromising long-term service quality and user well-being.
The rapid deployment we have witnessed also creates some risks and uncertainties regarding the effectiveness and sustainability of digital tools. For example, the fast-tracking of digital technologies to save lives during the crisis may risk allowing solutions to reach the market before they have been adequately trialed and tested. Many decisions were made in haste, and trade-offs in service quality, access or oversight that were necessary during the crisis will not be acceptable in the longer term.
These issues notwithstanding, the majority of respondents indicated that their organizations are likely to continue using all of the digital technologies and data solutions they have used during the pandemic to some degree, particularly phone and video consultations. Tools that give users direct access to self-help or care information look set to proliferate, as do remote monitoring tools that complement and support remote care.
The majority of respondents also indicated that they are likely to continue using all staff-facing digital technologies and data solutions to promote flexible or remote working, reduce the burden of administrative tasks, and make assessment of needs quicker and more efficient.
It seems that COVID-driven changes have made significant improvements to people’s everyday working lives, and this is likely to help secure employee support for any future tools that organizations may wish to introduce.
Chapter 4
Maintaining momentum
The five key ways that organizations can support ongoing digital transformation.
We have identified five key ways for HHS organizations to ensure that the benefits of pandemic-driven progress are not lost once the crisis is behind us.
1. Create the business case for adequate funding and payment incentives
Many HHS providers received emergency funding for new digital or analytical solutions throughout the pandemic, but in future they will have to compete with other government priorities. In the past, it has often been hard to make the business case for digital investment in HHS. However, the use of digital solutions during the pandemic has helped to prove the financial business case for further investment through improved staff productivity and lower-cost delivery models.3 Many smaller, localized initiatives have quickly shown positive results and strengthened the understanding of the potential of digital.
Reimbursement also needs to be addressed. A recent survey of 284 healthcare, life science, and digital health professionals in the US revealed that 60% of respondents believed that “strongly entrenched business and reimbursement models make it difficult to bring digital health products to market.”4 A solution was found during the pandemic, as many services delivered virtually or through digital solutions were temporarily approved for reimbursement. In the US, for instance, the Centers for Medicare & Medicaid Services approved reimbursement for 80 types of telehealth services during the crisis. However, in normal times, only 20% of US states required equal payment levels for in-person and telemedicine services.
Unless governments and payers adjust payment incentives to promote digitally supported services and solutions, these will not be sustainable, even if they do deliver equivalent service quality at a lower cost. Germany’s new Digital Healthcare Act, which entitles all individuals covered by statutory health insurance to reimbursement for certain digital health applications, could provide interesting lessons for other countries.
2. Focus on user needs
Service users have become much more comfortable with using digital technologies and analytical solutions during the pandemic, meaning they are likely to be more amenable to these once the crisis ends. EY Global’s recent Connected Citizens program involved a multi-country survey of 12,000 citizens in 12 countries. It found that 64% of respondents believed technology would change healthcare services “a great deal” or “a fair amount” for the better, and that 52% would be fairly or very likely to replace a routine doctor’s visit with a video call.5 Citizens are likely to opt for technologies which are easy to use and decrease wait times. Therefore, solutions which focus on speed and convenience are most likely to stick.
But there is still a lot to learn about the impact of these technologies on patients, service users and practitioners. Governments should evaluate where and when remote care is appropriate, rather than taking a one-size-fits-all stance. This will require HHS organizations to adopt the private sector’s customer-centric approach to better understand the needs and preferences of service users and to use this insight to design and deliver services.
Governments must also ensure that the benefits of digital technologies and data solutions reach across the population, particularly to vulnerable groups with limited digital access, such as rural populations, low-income groups, and the elderly. Countries that do not make sufficient investments in infrastructure and digital literacy risk increasing inequities in access to services.
3. Support provider adoption and buy-in
Our survey found that the need to train practitioners to adapt to new ways of working was the top priority for organizations planning for the future. Accordingly, solutions should be user-friendly and incorporate seamlessly into existing workflows, rather than creating an additional administrative burden. At the Hong Kong Hospital Authority, for instance, new digital tools are designed to be intuitive – requiring no training for staff. Tools that need significant staff up-skilling may be more difficult to sustain in the long term.6
Many employees will have acquired new digital literacy skills and confidence during the pandemic, but some, including front-line practitioners, will need further support in using new service delivery approaches such as virtual consultations. Communication skills should also be a key focus as practitioners support patients, carers and families virtually, while collaboration skills will help them work more effectively with colleagues and enable cross-agency working. And IT teams must acquire the necessary capabilities to deploy and support new applications and the integration of systems.
4. Promote interoperability and data sharing to unlock actionable insights
The ability to collate and share high-quality data generated by health and social care systems will be ever more important as HHS organizations eye machine learning and AI as a way to deepen insight and deliver new benefits.
There is still much to do to enable better data sharing across the wider ecosystem – not just among health and social service providers but other government agencies (such as police, justice and education) and third parties (such as care homes, nonprofits and community organizations). Data is often locked away in siloed legacy systems that are difficult to integrate.
Interoperability is a major issue across this fragmented landscape, a problem that is often exacerbated when solutions are rapidly implemented without rigorous testing.7 Currently, many systems require intermediary solutions to allow disparate applications to communicate and share data. A decentralized and networked infrastructure, built on common data standards and structures, could unify disparate information from multiple sources and make integration seamless.8 Estonia, for instance, has a digital innovation platform that integrates all health and social care across the country, thereby eliminating interoperability issues.9, 10
If organizations make a concerted effort to develop national or regional strategies and infrastructures to support digital solutions and data standardization, they will be much better placed to derive the full benefit.
5. Rethink attitudes to risk
The environment for continual innovation must be consciously designed and nurtured to ensure progress is maintained. HHS organizations need to find ways to safely embrace innovation and experimentation. This requires a culture where risk taking is accepted and mistakes are viewed as part of a learning journey. As a counterbalance, however, there must be sufficient protocols in place to ensure risk management and service-user safety are considered. This is particularly the case as emerging technologies such as AI become more prominent.
The actions of regulators, payers, service providers, vendors, and service users over the coming months will further affect the use of digital technology and analytical tools within HHS organizations across the world. It is imperative that these parties work together to address the challenges and maximize the potential benefits of these solutions to deliver improved services to all citizens.
Resumen
After an intense period of innovation during the pandemic, health and social service organizations have proved the power of digital technologies to deliver better, more efficient services. Governments need to act now to ensure these benefits are secured once the crisis is past.
