hello and thanks for joining us this afternoon welcome to the my hcpc standards webinar my digital skills and new technology Dr Kate Granger started the hello my name is campaign in August 2013. she was a patient in hospital frustrated by how many Care staff failed to introduce themselves to her so her campaign asks people in health and caring roles to introduce themselves to their patients in order to make a human connection before they start doing the care a bit so without further Ado I'm going to introduce myself I am Hugh regarding professional leaders and consultant for Wales I'm also a registerant of the hcpc of a physiotherapist by background I've worked in the NHS in Acute Care community and also in the private sector I do continue to practice to this day so in a sense I have skin in the game in terms of how regulation is done I'm joined today by Mark boatel Deputy head rehab engineering at Swansea Bay University Health Board and also a clinical scientist httpc registrant and Mark will introduce himself in just a moment so let me run over some brief housekeeping if I may for today's session so in order to protect the learning environment in events of this scale we are required to automatically disable camera as microphones and chat we will be using the Q a function here on MST so take a moment to familiarize yourself with where that is previous experience shows us though uh that even though we try really hard and there's this whole team in the background working on it we're unlikely to be able to get to all your questions but we'll Endeavor to do so and publish many of them in the Q a tab so just a reminder that this event is being recorded for everyone watching at a later date a very warm welcome is extended to you and whilst you may not be able to participate in live interactions you are invited to contact us connect with us if you have any questions or queries after the session this is just a short plug for the previous my hcpc standards webinars which have also been recorded and are now uploaded and available on our website please do catch up on any that you may have missed secondly I want to highlight that the httpc website has a number of really useful resources for registrants employers and members of the public so I'd encourage you to go over take a look uh see what's there and also let us know if there's something that you would like us to develop and look at in the future so this is a second plug really for our Student Competition I encourage you to head on over to the website you can either use the QR code there or just search for it on the website and this is about designing a learning session about health and well-being and the winner will have a 300 pound voucher prize so what are we going to cover today this is a road map of our session so we're going to start by talking about why regulation why do we need to regulate we're then going to focus on digital skills and new technology what's the reason for focusing on this in regulation at this time I will then outline what the updated standards are and then talk about how we might implement the changes and then we'll land hopefully uh around the kind of key takeaways of this session so why regulation so this is a little trigger warning here this section is going to talk about preventable harms that patients experience firstly to explore this question I'm going to talk about some Vital Statistics in healthcare so they're estimated to be up to 9 000 preventable deaths a year in the NHS it is also estimated about 1 in 12 experiences preventable harm so the 9000 figure is the equivalent of around the number of people that are fit in around 18 jumbo Jets so my question really is what would the civil aviation Authority not do to help the country prevent losing 18 jumbo Jets per year and Aviation itself can be a great example of learning from error have this instance to drive safety and excellent care so William Wilmer wrote that of every 100 British military pilot deaths during the first year of World War One 90 came from Pilot errors eight from aircraft defects and only two from any reaction yet now according to research by Harvard University flying in the U.S Europe and Australia is actually significantly safer than driving a car so you're also being in an accident during a flight is one in 1.2 million and the chances of that accident being fatal are one in 11. so what Journey has Aviation gone on and that is an intended pun bad one I'll admit so what Journey has Aviation gone on to get such an enviable safety record so there's a second question around this and that is around the data how do you measure preventable error and harm and some of us on the webinar may be in trades where that's actually quite difficult to do to some errors in Healthcare systems are more obvious than others for example surgical errors or medication errors are easy to measure but what about inappropriate discharges what about failure to complete sufficient assessment that leads to an adverse Health outcome for a patient how good are we measuring these kinds of errors in a systematic way and learning from them and do we have our own version of the Black Box critical friend that helps us regularly think about and reflect on our own practice to identify when things haven't gone as well as they could so what are the standards of proficiency well the thought formula goes like this the standards are a road map to good care and not Sat Nav it's like an ordinary survey map for hiking and not a GPS kind of like the highway code I'm not a driving instructor so the httpc regulates 15 different professions and even if it was just one like the nmc and the GMC how many multiple and varied contexts do the individual professions work in so the standards are deliberately high level in the sense that they often won't provide specific or prescript prescriptive advice on how to act in certain situations to take the highway code it lays out the laws of the road in an easy to understand language and it helps when we learn to drive or it might help us know what to sit and sign means or who has priority at a roundabout but when you're out driving it's not going to help you no tell you exactly what to do when you encounter a skidding car or a cow in the middle of the road or hazardous driving conditions and that sort of thing so the code can be used in the corpton law to determine the right course of action in hindsight but it wouldn't necessarily give you really specific and drilled down advice for every circumstance so another way looking at this could be when you're planning to take a walk out one of my local local Hills or mountains if you like is Snowden this is aerial photograph it's not a satellite image of Snowden so imagine if you were trying to get to the summit of Snowden which is marked by that little Waypoint on the top there if you look at it just from the satellite view you can see what appeared to be relatively easy ways up and more difficult ways up so there's water obstacles there's potentially some steep Ravines some big Cliffs and potentially further out there's some roads and forests and woodlands and Marshy areas so these are all the things you'd have to think about when planning your route to the top and of course there are maps and this is a map showing the established routes up Snowden and some are known to be technically more difficult than others so you could plan your route based on the map and the known routes but of course there are other variables like weather your capability is a leader the individual or the groups that you are leading and so there's lots of factors to take into account to plan a safe and effective and hopefully fun route to the summit of Snowden and the standards are very similar they may show established methods and routes to a minimally acceptable level of service but they allow you the freedom to determine which is appropriate way to reach your goal will reach The Summit in your context so why focused on digital skills and new technology so I'm going to introduce you to a friend of mine some of you may have heard tell off and or interacted with in the last few months Just for kicks I'm going to call this friend T2000 and yes that is a reference to the Terminator one movie where a cyborg from the future actually 2029 uh comes back to assassinate the mother of the of the future leader of human resistance so top marks to anyone who predicted we'd be talking about Terminator in this session and of course I'm joking what I'm actually going to do is put same question and asked you earlier to allow large language model AI system chat GPT so I'm going to ask it why is it important to regulate Healthcare professionals use of digital skills and new technology so let's see what happens if we ask that question and hopefully the video will work so on this version you take the question in the text box and he pressed off it goes so I'm just going to talk through some of the things it's covering I realize there might be a slight delay on the video so chat GPT is talking about patient safety uh quality of care privacy and data security ethical considerations uh professional competence and then let's go on to give a really good summary of its argument really so it's made some great points if I'm being picky it didn't mention about professional reputation reputation of Health Care and the NHS all of which are really important considerations when you think about why we regulate and particularly why we regulate digital skills and new technology so if I'm going to read a summary because I think it's quite helpful so by providing clear guidelines and standards regulations help harness the potential of the digital Innovation while minimizing the risks so that was all done in 24 seconds that many of you may have played with chat GPC and I would encourage you to do so and obviously other large language model ai's it's a mouthful do exist so what's also clear is Terminator is on the side of Regulation which won't be a surprise to anyone who's seen the movies so in in the movie Terminator one one of the characters says listen and understand that Terminator is out there it can't be bargained with it can't be reasoned with it doesn't feel pity or a loss or fear and absolutely will not stop ever until you're dead and I say this tongue-in-cheek but there is a deeper point with this technology changes very quickly an AI is just one area what about the potential in use of digital Tech and smartphones to monitor our health and to support management conditions and what about the growth in telemedicine Connected devices smart Tech and wearables Robotics and many other Technologies which are changing all the time how will these impact our practice in the next 10 years so if we go back to the AI example it's of course very clever but also predictably dumb in the same way that I as a human being that is dumb so what do I mean well take the issue of buy-offs so AI is only as good as the data it relies on if we use AI in practice to produce materials documents patient education leaflets for example are there potential ethical safety concerns AI doesn't have a conscience or a material ethical framework and is vulnerable to bias and potentially manipulation and perhaps these things will be ironed out in time but it does exemplify a strong argument for keeping up to date with digital skills and new tech change is inevitable and it's our job to adapt and respond appropriately to this change so if you're the way for the need to keep abreast the impact of digital skills in new tech is that digital exclusion the digital Technologies now play a key role in the economy in many people's lives and they do obviously have the the potential to transform Healthcare especially in economically tight circumstances but evidence suggests that often people with the greatest Health needs who at least like to be able to engage with and benefit from Digital Services so recent Kings fund report which will be available on the post event resources State digital exclusion is most likely to affect older people those living with disabilities ethnic minorities the homeless sex workers people from Gypsy Roma and traveler communities people live in rural areas like me people from low socioeconomic background and those with low digital or literacy skills digital exclusion can be well exemplified by the stat around digital devices during the pandemic so if you remember pivoted very quickly to Home Learning for pupils and it's estimated that one in five didn't have access to a suitable device so there were stories about children taking it in turns around the mobile phone to to do their lessons which was really really challenging so these are some of the obvious stages of a really fast pivot to new tech and of course there are many Health inequalities today so take just one of an s data says that there's a difference in life expectancy of birth between the wealthiest and poorest UK men of up to 10 years so there are cities in the UK who are in the most affluent areas men will live 10 years longer than their counterparts in the least affluent now obviously there are complex reasons for disparities in health outcomes but digital exclusion is likely to be in that mix and may play a growing role in the future so it does highlight the need for us to regularly reflect on practice and the service that we're working in and see who accesses those Services easily and if there are groups that don't access it so easily and what could we do about that so for example one learning from this session could actually be to keep multimodal delivery options could you have a more manual process or do you need more digital enablers or Champions to support and advocate for those potentially excluded groups so what are the updated standards so hopefully you've been to some of our previous webinars so we've talked about centralizing the service user registrants mental health equality diversity inclusion and Leadership at all levels and obviously today we're focusing on digital skills and new technologies so these updated standards in brief do place an increased emphasis on active language and they encourage registers to be proactive in applying the new principles so digital skills and new technology the updated standards ask us to recognize that confidentiality and informed consent extend to all mediums including Illustrated clinical records such as photography video and audio recordings and digital platforms it's obviously ties in with existing standards on confidentiality and informed consent and reflects the changing nature of both opportunities and threats in the light of new skills and Technology secondly the updated standards ask us to use information communication and digital Tech appropriate to our practice and encourages us to consider the impact of the different digital skills and Technology on equity and access to healthcare as we've just discussed updated standards also ask us to consider the use of digital record keeping and previously the standard said we needed to be able to change our practice as needed to take account of new developments or changing contexts but this standard now specifically refers to new developments and Technologies so I thought it'd be useful at this point to cover some some myths about the standards of digital skills and new technology first question do the standards significantly change the game around confidentiality a consent hopefully you've already worked out that the answer is no so new technologies can bring additional threats and opportunities and these may need to be reflected on and mitigated against but the principles around confidentiality and consent are exactly the same so a simple example of this could be around the sharing of information so sharing key information is key to effective care and new to LG makes it easier than ever to share more information and faster whether that's by a sort of a digital portal or as simple as email or other methods but that means that the risk of sharing something we shouldn't is also probably higher so we may need to reflect on this reflect on incident so make sure our processes are robust enough to make sure that we've mitigated against these risks so secondly in the area of learning do you have to learn all the digital skills and new technology relevant to you or to your practice and of course the answer is no so you just need to use Technologies appropriate to your practice and of course things like budget organizational size team skill set and your level of influence and Position will all have an effect on which digital skills and new technologies you may be able to access the standards me ask you to upskill in an area and most of you will do this already when you encounter a gap say in your service or in your knowledge so for a good example of that is the use of Telehealth during covet so many services weren't using it before and then very quickly to adapt to use it during the pandemic so thirdly do the standards mandate that all nodes must be digital at a certain time in the future say September 23. of course the answer is no so it is accurate that the NHS long-term strategy is to digitize patient records and this can obviously have significant Advantage but again it's all dependent on the context in which you work budget will have a factor if digital notes are an option they could be superior to clerical notes especially if you've got messy handwriting when you're rushing just like me but you will need to explore the cost benefit and risk of changing and not changing lastly in the context of changing landscape around digital skills and new technology is the hcpc mandating that you have to learn that particular skill or that particular technology that perhaps they're using it in a hospital across the County border for example and of course the answer is no so there's no specific set of rules around which digital skills you need to use and which technology you need to be competent in and some of those things are mentioned earlier around levels of expertise budget autonomy to make decisions and commissioning and that sort of thing will will play a role in that so it's important to say some new technologies are genuine game changers such as wearable devices in Diabetes Care and and these devices can be significantly experienced to older Technologies so there are ethical questions about not offering them where we can but in most cases with technology it's not as clear cut as that and therefore we need to use clinical judgment to make those decisions and also discuss it with the line manager if you're in if you're not working on your own that is and do Gap analysis speak to your professional body and digital Champions if you have them available lastly I want to just very quickly reflect on this so many of you may have read Stephen coffey's book Seven Habits of Highly Effective People other self-help books do to exist but he talks about the circle of influence so similar to the the diagram on the slide and the idea is that we spend a lot of time and energy focusing on things that concern us but we have no influence over so for example things like world peace or climate change so our opportunities to influence these things are relatively small they're obviously very significant and the same is true in healthcare so what we have to control an influence will vary from Context to context and the httpc doesn't expect you to have control of how your budget is spent or which Technologies you've trust board organization will invest in rather we ask you to be thoughtful as you practice which I'm sure you're doing already look for gaps in the opinion of service and focus your efforts within your circle of control and influence so how do we Implement these things so another thought experiment here let's talk about leadership because implementation and leadership are intrinsically linked and of course if you watch a recent webinar on leadership you know that the standards now please require on all registrants to show leadership at all levels so we probably all have an idea of these we admire based on certain characteristics but a key factor I'd like to argue is that leaders have the ability to see where their practice is so be honest about that and where it needs to be and to plot steps in between to try and close that Gap so one part of the answer to the implementation conundrum is to look for gaps or be mindful of in other words to practice thoughtfully and that can only come from people on the ground inside your own unique context the ultimate example of Gap finding is in aviation and the black or red box flight recorder so this is a photo of the recovered black box of Air flight 447 which class crashed in the Atlantic Ocean during a flight from Rio to Paris 2009 and lost 228 passengers and crew the search cost 31 million euros and took almost two years and one commentator described the search as like looking for a bottle of water in the middle of the ocean so my question is how Keen are you how Keen are we to learn from adverse instance to look for gaps in practice in order to get better at what we do in order to prevent harm and diverse instance as individuals and as organizations would we look for two years to find the reasons for an adverse event especially if that might open us up to criticism or potential cost how and how comfortable would we be sharing the lessons of that investigation so others can also improve and I'll leave that one with you so taking the warning on board that we cannot drill down to every situation that you'll all find yourselves in or give specific answers I'm going to try and help you ask some useful questions and as you can see on the slide we have each of the 15 professions represented by their own icon and yes before you ask on the Q a it did take me hours to find all individual icons for all your professions and I realize I've been highly reductionist about what what you do and to all the videos out there please don't message me saying no one uses those crutches anymore I'm playing Microsoft for that um so starting with standard 6.5 this is
around confidentiality and consent I'd like you to just think about practitioner psychologists working independently from home using home Wi-Fi for Telehealth appointments so she worked in a home office and Records notes digitally and has two young children so there's some potential questions that she may need to ask so what's the security like of the home Wi-Fi to guests today who have access to the password are the home computers secure does she have a separate business Wi-Fi account would that be beneficial the note system that she knew no she uses does she know how secure the notes are on that system so for example if she works with sensitive Industries like Security Services all the police is the level of data security sufficient for those clients and what a more secure system be better if not and lastly the physical setup so is there a possibility that people may interrupted during his sessions especially if they're counseling sessions and can steps be taken to mitigate against that so moving on to standard 7.7 so using information communication and digital Technologies appropriate practice so think about a speech and language therapist using AI technology to reduce materials and content to support a patient who has communication challenges so obviously this can be a fantastic way to generate large amounts of material which could be really useful for the client but are there potential issues around the efficacy of information especially if it's not appropriately checked a AI models may not securely deal with data as well so there are examples of Corporations asking AI to work difficult problems out and putting sensor sensitive business informations in those models without realizing that they've been taken away to data center and processed and crunched and learned from also about potential bias or an access in the data source and what is her employer's policy on the use of AI or has her employer caught up does it even have a policy and are there ethical issues posed by the use of AI in some context so to be clear it could be a fantastic way of producing really useful content at speed and free up valuable clinical time but clearly some thinking to be done on it so standard 9.3 use digital record keeping tools where required so think about physio working independently as a sole practitioner in doing home visits and writing notes clerically if his handwriting is hard to read especially on a busy day when rushed then could he look at potentially using digital record keeping tools so what if you needed to share information for example with a multi-disciplinary team or write a referral letter to to somebody or write a letter to the GP but what if the notes needed to be audited or you simply needed to rerun outcome measures so digital notes could help with all these situations but obviously you would need to look at which which provided he uses and the security of that system as well and lastly standard 13.1 so being able to change practice as
needed to take account of new developments Technologies and changing contexts so think about Healthcare scientists who uses 3D modeling of a patient's head to make bespoke protective headgear to someone who's repeated head trauma who has repeated head trauma so some potential questions does the scientist or the team have appropriate expertise to deliver this effectively and does the benefit justify the crops especially if you have a kind of systems approach to it is there Equitable access to such approaches and techniques across the service and if this is a really effective method in a complex case can you justify not using this approach if it's available and feasible and unlikely to reduce harm for the patient so what I'd really like to do now is give you a real life example of how one team has looked at a challenge and looked at patient harms and used digital skills and new technology to help overcome that challenge so to do so I'm going to hand over to Mark boatel Mark thank you Hugh such a pleasure to be involved in in such a stimulating webinar um and my name is Mark boatel I work in a team in Swansea called Rehabilitation engineering and as part of that team we are a specialist service helping those in the community with stubborn pressure ulcers with the pressure ulcer prevention and intervention service and as part of that we're able to do a couple of areas of innovation and prevention and wanted to share a couple of those with you today um next slide please you foreign so I won't go into this in in detail and I'm sure a lot of you are aware of the cost of pressure ulcers four percent of the NHS spend is on on pressure ulcers uh the personal cost you could probably say is is far higher um and there's anything from loss of Independence to infection surgery and in some cases death as a result of pressure ulcers the other thing to note is that um statistics say that 90 are avoidable and what we really recognize is that those that are at risk don't really know that they're a risk um they don't understand the implications uh one particular poignant um patient that stands out to me and he said to me I wish I knew the risks it was the pressure ulcer that disabled me not the spinal cord injury um and so that lasting loss of Independence is clear but also the the impact of not having that awareness from an early stage as to what the implications could be and the fact that they are at risk and the second thing and if we're really honest we're seeing lots of inconsistency in terms of the uh how much informed and engaged the nurses and Healthcare professionals are um in in doing something about pressure ulcers and so what we wanted to do is to compile um information uh put it all in one place in an easy to access format in order to equip the Frontline workers and and in turn would be able to engage vulnerable patients and hopefully we'd see some prevention and and improve management as a result we started within our own Health Board and we had over 300 Community nurses and therapists using the app um we've had a period period of development now and looking to take it out wider some of the feedback was that it has had a real impact on how I position myself and move once I realized how effective I was next slide please you so this gives you a little bit of idea what what it's like there's um various bits of visual and videos in and tools on there to help interact in a more interactive way um I'd hope to say that this is free to download today it is free to download but it will be available from next Monday so please put it in your um in your diary to have a look on the App Store it's only available on the iPad currently other tablets are available um next slide please you so secondly and this is something I'm particularly passionate about um we go into Care Homes a lot this problem isn't just in Care Homes people in their own homes as well um and many of you may recognize this as a challenge not just for pressure ulcers but um many people out there are not moving when they could be moving they they could be getting out up and about a bit more or maybe doing small movements within seating um and so we wanted to look at how technology could help those people and maybe they'll help the people that are caring for them to recognize oh you haven't been up for two or three hours um let's let's help you get up and and have a little walk around so as as you may know as well immobility is a huge risk when it comes to pressure ulcers it's pretty much the fundamental one and and maybe there's something about a cultural shift here and when we do things about pressure ulcers we put things under people we put new surfaces under there we may be if we're really astute we might adapt their seating and um uh change the surfaces in other ways but do we do much about the time and really how do we change that culture engage and Empower people to reduce the amount of time they spend in one position so that was the goal and we knew the technology could help it there's very expensive pieces of equipment out there that could do it but in some ways we just need to tell how long you've been sitting for and so simple technology could be used I was lucky enough to get some funding for a Welsh um social hair social care hackathon that's hard to say um and um that got me in touch with other people some tech enablers as well as some others within the field that were interested in collaborating and it's got a long story short we're at the stage where we're developing a bespoke app and we're trying out the the equipment and we're learning a lot we did a massive piece of scoping with a care home and that was really key to find out really what do they want um I think sometimes with tech Innovation we can think we've got a solution but without scoping what the end users uh the challenges they have in that exact environment um it could be a bit Limited that's the next slide please Hugh the main message I wanted to get across though is that I really believe that small Tech Solutions can make a big difference and so if you think about any part of a patient pathway people coming into you for a period of care and how they leave you as well um there's there's a lot that we could do to uh to better support that process um some some examples are here but that you've probably got various examples of things that you're doing within your own services and that's the other thing to recognize here I think we a lot of us use technology without recognizing it and some of these things can make a big difference so having a really informative website for example um that tells them what they're coming to do and what how to be prepared with their goals maybe we'll get more appropriate goals from our episodes of care when they know what you're there to do for them um there's been lots of um lots of people doing lots of remote consultation Telehealth is a big thing and different software available for that just getting bespoke feedback that could be really help um a lot easier to do when using um different form different tools like Microsoft forms and others are available another thing I'm passionate about is patients having their own data and their systems out there and different services that are really moving on this far more than we are but how do we really put patients in control of their data sharing data between Services is a real challenge that the NHS has and there is some some way behind the curve compared with other Industries in wound care for example there are some apps that are helping us with that and then just a bit more technical here but um thinking about how we can measure the outcomes particularly those of you that work in a physical sense with your patients um how can we digitize things and use software to tell us whether things are getting better or getting worse so the take home really is what will technology do to make things better and in the end let's not just do technology for the sake of it we need to be making sure that it's either going to make things more efficient more safe or with higher quality for those that we serve um thanks and back over to you Hugh fantastic thanks so much Mark uh so interesting and really helpful to have your insight into how you and the team because I'm sure it's a team approach um you've just uh Incorporated digital skills and Technology to solve a clinical problem and reduce harms uh so we've also had some questions submitted in the Q a there's one in particular that I'd like to address around I think I've kind of covered the question about AI just in the fact that it could be really useful in clinical practice but do think about the sources of data do you think about dental security and think about to company policy and getting advice from your organization uh if you work on your own think about engaging with professional body if you're a member of a professional body and and other experts in the field and there will be some links in the resources which we'll share for you I use the way of asking questions around that is to think about the internet because we're used to the internet now so if I was to say how useful is the internet for producing content for patient resources you would of course say it depends what are you asking where are you asking the question and have you tried to eliminate buyers from check for inaccuracy so second question that we've had submitted is around barriers to implementation so what if you know what would help but you don't have the authority influence or budget to implement it what if there are is resistance in your organization and I think this is a hard one but I would firstly think about really knowing and doing the research on the new technology or skill have a gap analysis on hand about what needs it might meet and sort of think about sensitively making the case for change if you have a digital champion in your organization can you link with them for advice support or advocacy I remember the circles of control and influence so you may not be in a position to influence decisions about which new tech are invested in or reinvested in but you can still be engaged and highlight what your views are you might want to put that in writing and remember you can speak to us you can speak to the professional bodies if you want further information or support of that so key takeaways digital skills and new technology so in regard to confidentiality and informed consent remember that these are not new principles understand the opportunities and the risks presented by new technologies and processes and where necessary to take steps to mitigate them use technology appropriate to your practice so consider carefully the relative strengths and weaknesses of Technology you're using and access to it and take steps to mitigate so you did use digital record keeping tools where required as it may meet all of the criteria for full clear Acura notes which are not likely to be damaged or lost but there obviously may be additional questions to think about when you're sourcing digital record keeping software and be able to change your practices needed to you may want a horizon scan join networks of support speak to digital Champions and colleagues and work out what changes are coming down the line and that brings us to the end of our session today so thanks so much for joining our webinar hopefully you got some useful hints and tips and that's it thanks for attending and I hope you have a good rest of day
2023-06-25