Innovation isn’t enough: Why health tech needs to be meaningful
The mantra, “move fast and break things”, reigns supreme in startup culture, particularly in the technology industry. Famously coined by Mark Zuckerberg, the founder of Facebook, the mantra encourages speed and innovation over perfection. Like many sectors, Canada’s health systems stand at a crossroads on how to enter a new era of digital and AI-enabled healthcare. Despite the growing urgency to develop and implement technology faster than ever, it cannot be at the expense of ‘breaking’ patients. We face the critical question, “How can we successfully implement technology without compromising compassionate care?”
Adopting new technology is a lot like getting a new smartphone. The latest spec upgrades will not convince most people to switch to a new phone unless they believe it will significantly improve their experience and make their lives easier. Dr. Carolyn Steele Gray’s research found that the same can be said for successful technology adoption within healthcare—it needs to feel meaningful and valuable to be embraced. When new technologies support what users in health systems care about, such as building trust and relationships and facilitating compassionate care, they are more likely to use it.
Dr. Steele Gray is a 2020 AMS Healthcare Fellow and an Implementation Scientist with several appointments with various organizations and institutes, including Sinai Health and Lunenfeld-Tanenbaum Research Institute and the University of Toronto. Dr. Steele Gray also holds a Tier 2 Canada Research Chair in Implementing Digital Health Innovation. Her research program examines the drivers that motivate individuals and organizations to change, particularly what is meaningful and valuable to clinicians and providers. While much of the focus on health technologies revolves around what it can do for us, Dr. Steele Gray is taking a closer look at how technology shapes the patient-provider relationship it is meant to support.
The question of value and meaning becomes especially important in the context of virtual care as it became the default during the pandemic. No different from any other relationship, a strong patient-provider relationship is built on trust, communication, and emotional connection, which underpins compassionate care. Dr. Steele Gray and her team found that a patient’s digital literacy, comfort with technology, and an established relationship with their provider became determining factors for how easily they transitioned to virtual care. Another important, often hidden, element that was uncovered is that how patients and providers think about technology more broadly in their day to day lives:
“If you as an individual are using technology in your life to build relationships in other places—gaming online, using social media, connecting with your family—then it makes total sense to you that this is a relationship maintenance or building tool,” explained Dr. Steele Gray.
Patients and providers accustomed to digital services and tools as a means to support connection and relationships building in other parts of their lives found virtual care as a reasonable way to continue to relationally connect to their primary care providers. Whereas patients who viewed technology broadly as a tool of disconnection, experienced that struggle in their primary care encounter. Healthcare providers found that virtual care allowed for more flexibility and reach for patients in rural and underserved areas and reduced no-shows. Much like patients, providers similarly experienced different levels or relational connection to patient which could also be influenced by how they viewed technology use more broadly. For some providers, face-to-face interactions were a core part of their identity and virtual care made it harder to build deeper, long-term relationship with patients, especially with new patients.
One major challenge experienced by both patients and physicians was the absence of body language and non-verbal cues in virtual care. Some patients found it more difficult to share their concerns and some providers found it harder to read emotions and discern patient concerns.
“For some clinicians, part of their identity is being good at building relationships with a person in a room. And then you put a virtual care environment over their work, and you’re asking a person to work in an environment that doesn’t resonate with how they see themselves,” elaborated Dr. Steele Gray.
In addition, Dr. Steele Gray and her team underlined while virtual care offers convenience and efficiency, it could exacerbate existing inequities faced by older adults, individuals with disabilities, and lower income patients due to limited internet access and difficulty using telehealth platforms. As a result, providers advocated for a hybrid model that combined virtual and in-person visits.
More broadly, Dr. Steele Gray’s research emphasizes the importance of starting with understanding what matters to the users of these health technologies. Her work has found that digital health tools are more likely to be adopted when their role in care aligns with how patients and providers expect the experience to feel: fostering the qualities of an authentic, compassionate interaction. Rolling out new technology and hoping patients and providers will catch up is often an ineffective way of driving change in complex systems.
Dr. Steele Gray continues to build on these insights through two ongoing projects. She is co-leading the AMS-funded Delphi study with AMS Fellows Dr. Jay Shaw and Dr. Marissa Bird. Working with a patient-led partner group, they are developing a tool that supports the implementation of digital health technologies aligned with the values of integrated care. She also leads the Digital Bridge project, which is co-designing and evaluating a communication platform to support hospital-to-home transitions for older adults with complex needs. The aim of the platform is to help keep hospital teams, primary care providers, patients, and families informed and connected around shared goals and their needs.
“We have an opportunity to step back and ask: where do these technologies sit in healthcare? Is it working for everybody? We need to transform the model of care so that we are supporting good therapeutic relationships and work environments for clinicians, where they feel like they’re doing good work.”
Years later, even Facebook modified their infamous philosophy of “move fast and break things” to “move fast with stable infrastructure”. For healthcare, perhaps the solution lies in moving with meaning rather than simply faster.
Dr. Carolyn Steele Gray is a Scientist at the Lunenfeld-Tanenbaum Research Institute at Sinai Health System and an Associate Professor at the Institute of Health Policy, Management & Evaluation at the University of Toronto. She holds a Tier 2 Canada Research Chair (CRC) in Implementing Digital Health Innovation and is a 2020 Compassion and Technology Fellow. She is also a Senior Associate with the International Foundation for Integrated Care (IFIC) and the Co-Founder of the International Learning Collaborative for Goal-Oriented Care. Her research focuses on the integration of digital health solutions in primary care, with an emphasis on patient-centered innovation and health system transformation.
Read Dr. Carolyn Steele Gray’s Publications:
Ramanchadran M, Briton C, Wiljer D, Upshur R, Steele Gray C. The impact of eHealth on relationships in primary care: a review of reviews. BMC Prim Care. 2023 Nov 3;24(1):228. doi: 10.1186/s12875-023-02176-5.
Steele Gray C, Ramachandran M, Brinton C, Forte M, Loganathan M, Walsh R, Callaghan J, Upshur R, Wiljer D. Digitally mediated relationships: How social representation in technology influences the therapeutic relationship in primary care. Soc Sci Med. 2024 July/ doi: https://doi.org/10.1016/j.socscimed.2024.116962.
