Ageing, marginal gains and #BigitupforOTs


IMG_7292I suspect that part of the problem about aging is that it’s an insidious process; it’s not like you wake up one day and suddenly you are ‘old’. It’s a gradual process noticeable by a series of small incremental changes; stiffness when you get out of bed on a morning that wasn’t present before, a memory that just isn’t as good at recall as it used to be and a fondness for reminiscence. I also know that for some older member of my family time starts to get stamped by loss; funerals become less unusual and more routine, if you can ever say a funeral is routine. What I mean is they appear more frequently in your diary as you lose family and friends.

For me it is important that I stay as independent as I can. I’m trying to exercise more, eat well and lose some weight. But there is likely to be a time when I need to take more steps to maintain my independence.

Julopi

Gill on her Jalopy

My Mother-in-law, Gill, is one of my role models. At 85 she is still independent and despite increasing problems with her mobility and the occasional fall she is adamant she will do what she can to cope. She has had bi-lateral hip and knee replacements and now her ankles are the problem and she can’t face 3 months in plaster that a fusion would mean.  She also enjoys life most of the time and has a sense of humour.

 

So that’s why I encouraged her to have an Occupational Therapy (OT) Assessment. It seemed to me that OT’s are often brought into care far too late and after this assessment I am convinced I am right.

I asked Gill today what it was she wanted to achieve and she told me she didn’t want to fall and that she wanted to carry on doing things she liked to do at home, such as cooking meals for family and a bit of gardening. She is lucky; she already has help with cleaning but maintaining independence is more than existing, it’s also continuing to do things you enjoy, while staying safe.

 

IMG_7295So, what did the OT assessment show us?

It’s about marginal gains. There were no big shock recommendations just a reasonable list of things that collectively will improve Gill’s living experience; some handrails positioned correctly in the shower, removing all the loose rungs, a ‘perch stool’ in the kitchen, a small walker so she can carry things without risk of falling and some exercise classes in the local pool. She is going to try them all. A list of marginal gains that I hope will help her to reduce her risk of falling and feel safe.

Sadly we had to have a private assessment; this means other people who can’t afford this will miss out.  Keeping people safe and well in their own homes should be a priority. I luckily found Lucy Leonard on Twitter (@lucyOTL) and she was fabulous. Gill loved her and the fact that she did a full assessment. She respected her professionalism and so do I.

So, aim for marginal gains and big it up for OT’s. If you have an elderly relative and can possible involve an OT, like Lucy, I whole heartedly recommend it.

#BigupOTs

IMG_7294

Jazzy, Gill’s companion

What does ‘frugal’ mean to you?


img_6503For me ‘frugal’ has a very personal meaning. I was brought up in a frugal household; rarely did we throw anything away. Recycling was an art; buttons cut off items of clothes that were worn out, then the cloth used for clippy rugs. Shirt collars and cuffs turned and boots and shoes re-heeled. Post war habits lived through my parents and grandparents.

Some of those habits have persisted into my adult life and my husband has much stronger frugal habits than I.  I delight in nice jam jars that I can reuse for jam and marmalade and I increasingly recycle ribbon from parcels and paper, if I consider it special. I find myself looking at buttons as having potential.  I sometimes reflect that I am turning into my Mum or Grandma!

My husband has a garage full of ‘stuff’. The pleasure he gets when we have a practical problem to solve and he says ‘ah, I have just the thing for that!’ and off he goes to return with a surprising solution, usually something I would have thrown away, something that we can repurpose.

So, what is frugal innovation?

‘Through minimising the use of resources in development, production and delivery, or by leveraging them in new ways, frugal innovation results in dramatically lower-cost products and services. Successful frugal innovations are not only low cost, but outperform the alternative, and can be made available at large scale. Often, but not always, frugal innovations have an explicitly social mission.’

Nesta 2016: See more here

So some of the aims of frugal innovation are the same as my parents or my husband; that is to use resources wisely and in unexpected ways for solutions that work well. Perhaps it is the very scarcity of resources that makes us more creative and focus on something unexpected that sorts out a problem.

I am really looking forward to the debate tomorrow for #PDDigital16 – this is the motion:

This house believes frugal innovation has the potential to create better solutions to citizen challenges in health and care than traditionally designed digital technologies

The debate will be streamed live so why not listen in to see if you can learn more about frugal innovation (follow #PDDigital16 for more information) and meanwhile here is a short video from RSA with Charles Leadbeater to whet your appetite!  How can we use the limitless opportunity we have to connect, to create solutions with scarce resources, for social purpose?

 

img_6506

 

Apps – hitting the target but missing the point? for #PDDigital16


52287225 - concept for mobile apps, flat design vector illustration.I had a developer say to me recently ‘It’s OK, we do lots of user research where we test our products and how well they work!’ – he was clearly proud of his product and through this research thought they were very well connected to their users. Clearly their plan couldn’t fail? Or could it?

I was less impressed. I was unclear if they understood what the issue was that they were trying to resolve and had made a huge leap to creating a solution that they were then going on to test. Their intentions were honest and good but I wonder if we can do better if we understand what it is products need to ‘do’ to help in the health system.

I also recently read this blog from Mike Fritz at Userzoom that eloquently describes the issue; fundamentally you can create a highly usable (probably very beautiful) application but it will possibly never get used, unless you understand utility.

41935551 - road sign to diabetes managementHaving Type 1 diabetes means I understand utility very well. There are hundreds of digital tools/apps available to me, a simple search in the apple app store shows the variety; carbohydrate counters, games, coaching, glucose monitoring. But the truth is, I only use one consistently and that’s an App called Carbs and Cals. It has a clear utility for me; it easily helps me to identify the carbohydrate content of food just by looking at things – no scales, just looking.

I think I am a reasonably activated patient, so why is it that I only use one app and does that make me different to everyone else? I think that the research is starting to show that most of us only use 5 apps that are not native to our device and if you think about your own use (Twitter, Instagram, Facebook, Whatsapp) you are likely not to have too much room in your smartphone life for much more than a very special few apps. Despite this the health system continues to see Apps as a potential solution to the challenges faced by health and care systems.

Potentially it’s a classic case of hitting the target but missing the point.

So how could we reverse this? How can we help to make sure technology offers valid usable utility solutions? I believe that utility is the key not beauty; we will tolerate poorer user interfaces to achieve beneficial utility. It’s about what it does to support and help people not whether it was merely a great idea in the mind of someone or has a very smart user interface. The best example for me of hitting the target but missing the point are Apps that ‘help’ people with Diabetes to monitor their blood glucose but require extra entry of information into a separate and standalone app… in the days of interoperable devices why would you bother? No one I know likes them or uses them in a sustained way. Their utility does not stack up.

So, if we are to capitalise on technology how might we do it, how might we find the pieces of utility that really help?

app-developmentThe answer for me lies in where the ideas and solutions arise. If we look to citizens and patients who have real skin in the game they will know where technology has real utility. From this, great designers and developers can collaborate with citizens and patients to create high utility AND high usability solutions. My view is that this type of ideas generation and co-production has the potential to create innovative scalable solutions. But only if we stop thinking the system knows best and properly tap into the ideas and creative thinking that sits behind People Drive Digital. Co-production in the digital development space could have real potential to help but it requires more working together to identify areas of potential utility and then combine these with fantastic design and development. We have the skills and talent – we just need more conversations.

Follow #PDDigital16 for more conversations.

More information here

people-drive-digital

 

Personal Review of 2015


2015 has been a strange year; at home my other half stopped working, probably for the last time (but never say never is our mantra), meaning that I am the only person at home working! We lost my beloved Henry, our old Ginger boy cat that we had nursed for 3 years through chronic renal failure. I moved back from my secondment at NHS England to the Health and Social Care Information Centre. Of course these are just some of the things that have happened!Anne Rob and SWC black and white

It’s been a strange year of transition and loss but in the tradition of looking back and forwards here are some jewelled highlights:

 

PDDigital unconference and awards

This was definitely a highlight of the year for me. Working with a great group of people, led by the inspirational and stellar Victoria Betton, we put on what felt like a very different type of conference. We were determined to do a different type of event, more open and inclusive, less talking from a mainstage and accessible for attendees from a cost perpective. Our collaborators, all worthy of mention (and some I am still slightly star stuck by) were Mark Brown (@markoneinfour), Michael Seres (@mjseres) Catherine Howe (@curiousc). I think we set out what we wanted to achieve, a new way of including people, not the big, glossy event but one that people enjoyed and felt able to participate in vs being talked at.

The output of the day is here and worth a review:

Fdigitalawards VB, RL, AClushed with the success of the conference we went on to host the unawards a few months later. Stressful and challenging we managed to deliver the events with no cost to anyone at the event but where there was much networking and meeting of minds, connections and chat. The innovations we unearthed are all pretty incredible and the award winner’s worthy.

You can see a summary of what happened here:

Menopause

Back in the spring I blogged about having Diabetes and being menopausal.  It set off a chain of events that led to brilliant connections with a fantastic group of women.  This led to change day connections and some of these publications on Evidently Cochrane. These women are like a force of nature and I love them.  I know that we will all meet properly one day 🙂 Thanks all of you: @drhannahshort @northnatasha @junegirvin @gussiegrips and especially @sarahchpaman30 who tirelessly pulled the blog together.  Its a shame we never made Woman’s Hour but there you go!

The Academy of Fabulous NHS Stuff

[Click the link and look it up if you don’t know it!!]

acad fab awardsOn a similar vein (I would like to think they adopted some of the things they saw at PDDAwards) attending the Academy of Fab NHS Stuff awards was pretty amazing and a highlight of the end of the year. I have never been to an event like this. It was really fabulous but was truly celebratory of many great NHS ideas and solutions. The awards were given based on public voting. I found myself sat on the same table as the fabulous 5 Boroughs Partnership street triage team who won the 5127 Award. If you haven’t read about the awards you should, they are quirky and fun. The 5127 award for example is to recognise:

Absolutely committed. Fiercely determined. Brim-full of self-belief. Refusing to compromise. Dedicated to perfection. The winner of the 5127 award will have demonstrated all of these attributes. 5127 refers to the number of prototypes that Sir James Dyson developed before finally marketing his first Dyson ‘Cyclone’ vacuum cleaner.’

A worthy winning team who were given a toy Dyson Vacuum cleaner as the award. It all made me smile a lot and again made me think about how we ‘do’ awards.  They are in the picture with me above.

Thank you Roy Lilley (@roylilley), Terri Porritt (@gbtpo) and John for not only showing us the way but also inviting me to be there to witness it.

On being a Fellow of the Queens Nursing Institute

qni awards

Professor Viv Bennett (CBE) and me at the awards

In October I received an email from the inspirational (do you see a pattern here – a few inspirational women have crossed my path this year) – Crystal Oldman, CEO at the QNI I was invited to become a Fellow at the QNI. It’s hard to explain why this meant so much to me but here goes:

 

Back in the olden days when I was a student nurse we did community placements and I remember wanting to be a community nurse. I can still remember nursing the lady in Scarborough, at home, with her family, in their tiny house, where I realised this was how it should be. I remember going to the house to turn her every day of my placement. I attended her funeral when she died.

Somehow life got in the way of this nursing being my destiny. I think then, as now quite often, community nursing was not seen as a career for an ambitious young nurse and I was definitely one of those. I don’t regret my subsequent choices – I enjoyed being an acute nurse – but I do wonder what could have been different.

Now in 2015/16, especially having visited Buurtzorg in the Netherlands too, I strongly believe that nursing needs to invest its efforts more in community nursing as the way forward. It should be seen (and I hope increasingly is) as a brilliant career choice where we can help to change lives for the better especially in older age.

I am very very proud to be a Fellow of the QNI and I hope to make myself as helpful to this relatively small charity who in my opinion bat well above their weight (in a really good way).

Working in social media

Facebook_BackyardFence_SoMeFilmStillEarlier in the year I was lucky to be able to work with the NHS IQ team to produce a short video about using social media. It was a personal challenge that had been set by Steve Wheeler (@timbuckteeth) when I visited him in Plymouth the year before. Although Steve’s challenge was to do a series of interviews I decided that using another media for sharing was what I wanted to do and thanks to Helen Bevan (@helenbevan) this became a reality in 2015.

You can see the video here:

I was also very proud more recently to be ‘in-print’ with Alison Inglehearn (@mrsgracepoole) – she is another incredible lady. I wanted to publish something that went beyond the social media rah-rah and gave a more honest view of some of the risks of working here. Here is the result with grateful thanks to The Journal of Research in Nursing and in particular Elaine Maxwell (@maxwelle) for believing in us!

http://jrn.sagepub.com/content/20/7/625.full.pdf+html

I also attended the Diabetes UK conference this year as a patient and spoke about using social media.   Speaking there has been an ambition of mine for a long while and it was great fun alongside Alex Silverstein (@alexYLDiabetes), Partha Kar (@Pathakar) Roz Davies (@rozdavies) and Laura Cleverly (@ninjabetic1) – you guys rock :0)

The prezi we used is here

I have continued blogging this year too with 17K views of my sporadic blog. I know that’s not many for some people but I still think it’s pretty awesome!

The arrival of #RoryCat

henry

#Henrycat selfie

Losing Henry, the family cat was a blow, even though I had known he was unwell for such a long time but at the end of March it was time to let him go. He was a great friend and a brilliant member of our family. I didn’t think that the hole he left could be filled and in truth it can’t. But in September I decided that we were a family that should have a cat and as a result of contact with my fab vet we were linked to a local cat rescue, a small and amazing tiny charity who do great work especially with feral cats.

 

Rorycat

#Rorycat

Rory has arrived and is a blessing. Zag is shortly to arrive too. We are #catstaff once again at the Coopers!

 

Looking forward

I’m planning some changes in 2016. I can’t yet say what they are as they feel fragile still but I’m getting more and more confident as the weeks go by. I’m aiming for radical change and trying hard to demonstrate that I do as I do, not just as I say.

Wishing you all a happy, health and successful 2016. My only resolution is to laugh and smile more – I wish that for you too.

Zag cat

Zag due to arrived the week commencing 4th January 2016

People Drive Digital Reflections


networkI have been to NHS EXPO today. As always it was great to meet lots of people I have met and worked with over a number of years; I love seeing them, giving them a hug and re-connecting with them (you all know who you are). It is one of the privileges of my working life that I have met so many fabulous people.

Today was interesting for me as I didn’t go to EXPO in my professional capacity but in a personal one, as someone who has an interest in digital innovation but from the perspective of a citizen and patient and today felt very different – but is it EXPO that has changed or me?

PDDigitalToday I briefly presented with Victoria Betton and Mark Brown the work we have done on People Driven Digital and the PDD Awards (HT to the others too Michael Seres, Kat McComack). I realised that I had changed from a year ago.

I spent many years as a nurse giving patients advice and information. We thought it was the right thing to do and of course it is but it’s also paternalistic, based on the assumption that ‘we’ know and ‘they’ don’t.

Over the last year my experiences of working in collaboration with other people like my fellow collaborators for #PDDigital, and many others in my social network with Diabetes, has made me realise that the system doesn’t know what problems people face as intimately as they do. We can make assumptions, we can guess and in doing so we may well get it wrong; we may hit the target and miss the point. Mark spoke eloquently today (you can read what he said here http://thenewmentalhealth.org/?p=182 and it’s well worth a read) about focussing on trying to find digital solutions to those issues that really matter to people, not necessarily the big things but those that in people’s lives make a real difference. You can see our presentation here

So today, whilst I wandered around EXPO, I reflected on what felt ‘real’ and what maybe mattered the most. There was little evidence of people driving solutions and creating ideas and I realised I had changed. I have come to realise that unless we engage at the start with the citizens, we are unlikely to make the differences we need to make. We might create elaborate solutions but may completely miss the point. We need People Driven Digital Innovation.

pump openerI have an example: I was a grateful receiver of a new insulin pump a few months ago. It has a snazzy screen and some new functionality that means if you are a user of a continuous glucose monitor (I am not funded to be one) then it will switch off the delivery of insulin if your blood glucose goes too low – very clever indeed. But what was it that delighted me when I collected my pump? On my old pump, in order to access the battery to replace it (yes insulin pump are powered by a traditional AA battery!!) I had to carry a 20p coin in my bag. It’s the only reliable way to be able to open the battery space – it’s tricky but fairly crucial to be able to get in! On my new pump there is a removable clip that had a snazzy little device on the end that enables you to open the battery space. A simple remoulding of the clip – inexpensive and functional – I know, I know, so simple – but it was the snazzy solution for the battery opener that delighted me. A small but delightful improvement and now I don’t worry about 20p pieces. Let’s try focussing on the small things that might matter to people.

How do you think we could develop the ideas from #PDDigital? Let us know.