Technology challenge

Daloni Carlisle

Clinicians identify problems that need solving, technologists develop solutions that the NHS then adopts as a way forward. Neat, but obviously in the real world it doesn’t actually work like that.

In the real world there is a gap between the clinicians and industry that means innovators do not know which are the real problems that need solving and instead work on problems that don’t exist. If by chance they do get the right problem, then solutions fall into the yawning chasm that is the product adoption problem.

So Brian Winn, head of technology and product introduction at the National Innovation Centre, thought one day, wouldn’t it be great if innovators could put their investigations into something that was really wanted? “And that’s how we created the ‘Wouldn’t It Be Great If…’ (WIBGI) programme,” he says. “It involves going to frontline services and broad groups of clinicians and asking them to complete the sentence.” The results are up on a website developed with the healthcare knowledge transfer network where clinicians can share their statements of clinical need with industry.

One of the groups to have carried out a WIBGI was hip surgeons tackling the 18 week wait.

Work was led by the 18 Weeks Technology Project team, in association with John Egan of the Association of British Healthcare Industries and Peter Kay, president of the British Hip Society and chair of the 18-week Orthopaedics Coordinating Group for the Department of Health. He says: “One of the problems is that some technologies which prove to be really good take a long time to be adopted. So the really nutty question is how do you know what is going to be a good technology early on? It’s like horse racing. If you could put your bet on at the end of the race it would be obvious which horse to back.”

Well, we all know you can’t. What you can do in orthopaedics is agree the problems. So in summer 2008 Mr Kay helped set up two meetings to do just that – but in a systematic way that would hopefully be more consistent and rigorous than studying form in the Racing Post.

The first was at an international innovation meeting at Wrightington Hospital, Wigan, where he is also a consultant orthopaedic surgeon. He invited some colleagues from the DH, including chief scientific officer Professor Sue Hill, and the Association of British Healthcare Industry.

“We had local, national and international delegates,” says Mr Kay. “So it was a perfect opportunity to explore the challenges.”

He gave six leading innovators two minutes each to say where they see the future. They covered issues such as new prostheses, diagnostics and imaging as well as IT.

Then there was an interactive voting session during which Mr Kay posed some questions to the delegates about future innovations such as hip arthroscopy – or key hole surgery for hip operations –computer aided surgery, data collection and minimally invasive surgery.

“It was quite a sophisticated system where we could see the answers by different groups,” he says. And it showed up some startlingly different results for these groups. For example, 44 per cent of the industry representatives thought current hip arthroscopy techniques would increase patient through puts; none of the surgeons thought so. The medics, meanwhile, were near unanimous in supporting good data collection to validate outcomes.

A second meeting in London in September 2008 brought in a wider section of industry representatives asking fairly similar questions. “The interesting thing was that industry was much more optimistic about the use and potential impact of technology than surgeons,” he says.

Mr Kay does not necessarily expect the work so far to tell him which horse to back. “These meetings were more about identifying a methodology,” he says. It will be further refined at the forthcoming British Hip Society meeting where surgeons, nurses, physiotherapists, industry and policy makers will vote on a range of questions around the five high impact technology advances identified by the 18 Week Programme.

The stakes are high. Technology is expensive to develop and expensive to adopt. “The problem is that this is a bit like divination,” says Mr Kay. “You are trying to predict the future. If you are going to encourage people to adopt a piece of technology you want to be sure it’s good technology adopted for the right reason.” A method to help see through the mist would be most welcome; WIBGI might just be one method of predicting the winners.