[Summary: Instead of funding new ‘online’ services, what happens when we fund ‘blended’ services: can we get realistic cost-savings, and enhanced provision – rather than inefficient pseudo-savings and restricted services]
Each face-to-face contact in the delivery of service is expensive. On online contact can be a lot cheaper. Plus, quite a lot of service users are asking to be able to access services online. It might be a support group for carers; careers advice for young people; mentoring and counseling, or any number of other services that I could be talking about. I’ve seen a number of cases where services take note of the above, and quickly decide that what they need is an online service. Perhaps to replace their current provision, or perhaps as a pilot in addition to it. But generally as a distinct service from existing offerings, and more often than not, with plans to build some new platform for delivering their online service – with a very linear process of consult->build->use.
But, as some of the presentations and discussions at today’s imh2011 (internet & mental health) workshop suggested, that doesn’t really make much sense.
Firstly, evidence was presented from trials of online Cognitive Behavioral Therapy (CBT). Broadly – it was only with a blend of online self-service CBT, and continued direct meetings with practitioners – that positive outcomes, equivalent to those from existing face-to-face services were maintained. Comparing the £50 per-contact cost of a face-to-face session, with the £5 cost of an online intervention, and supposing online offers a £45 saving* only makes sense if the two lead to equivalent outcomes. If what’s really needed is £25 worth of practitioner time, and £5 worth of online provision, including online in the mix can still lead to savings, and significant savings: but it’s important to have a realistic sense of what the savings can be.
Secondly, the challenge with delivering online services is widely acknowledged to be not so much to do with having the right tools, as with having skills and organisational culture to be able to work in new digital ways. So spending all the budget on building an online platform (and expecting that a £5k, £10k or £20k budget is going to deliver a platform to rival existing off-the-shelf offerings that have had £millions invested in them) doesn’t seem the most worthwhile investment. Investing time instead in exploring different ways that a service should communicate digitally – iteratively negotiating different platforms to find those that work for service users and staff – makes a lot more sense.
(There was some, in my opinion, unhelpful talk in a few presentations and workshops about ‘digital natives’ and presentation of statistics on particular technology platforms with the largest market penetration (SMS; Mobiles; Social Networks), with the implicit or explicit suggestion that, as these were the widest used platforms, these were the ones which services should be adopting as digital service-delivery channels. It’s far too easy to gloss over the subtleties of how different communication tools work in practice: and to miss the dynamics that mean how a tool works will change as different network effects kick in. Even if the majority of service users say they want access to services via mobile phone for example, it’s only when you pilot and take an ethnographic or grounded approach to researching how your service works over SMS or smart-phone channels that both you and service users can come to understand whether such a service really makes sense and will have enough uptake to justify more investment. And even then, chances are that changes in the market (e.g. when low-cost data plans on mobile become available to young people), the structure of the network (e.g. when parents started joining Facebook), or innovations (e.g. when the next platform comes along…) mean that you’ll need to take your service to new spaces within the next few years at most. The notion of ‘digital natives’ is particularly unhelpful when trying to understand how young people and adults with complex needs and different life-experiences use, adopts and appropriate technology. Finding low-cost experiments that can help staff teams and service users explore different potential communication tools (why not try holding a planning meeting via skype? take notes on an etherpad? or even try a field-trip to a virtual world or other online community?) and then reflect on their various merits may prove much more valuable than many meetings spent discussing statistics on popular platforms or drawing up specifications to build new platforms).
Thirdly, the culture change needed to engage effectively with digital service provision – a culture change involving being more agile in moving from platform-to-platform – needs to apply to ‘offline’ services as well. If you’re running an online support group, and it becomes apparent that members would find a face-to-face meeting useful too, can you easily find meeting space and resources to help that happen? Rather than booking rooms and times for regular sessions, and then worrying about making sure there are always people there: are there some groups who would prefer online engagement, with the option to organise face-to-face meetings on-demand – perhaps even choosing the coffee shop over the community centre as the meeting place. If the available budget is more transparent to service users, how can they negotiate the balance of how much of it gets spent on digital services, and how much is spent on enabling other provision? Some ‘blended services’ (blending online and offline) might be predominantly face-to-face, enhanced by a bit of online interaction (as simple as using Doodle.com to arrange meeting times, or Facebook to remind people about sessions); some ‘blended services’ might be predominantly digital enhanced by the occasional face-to-face meet up or service. Some blended services could turn out to have no face-to-face at all, but retaining it as an option.
Of course there are big challenges transforming services to work in these ways – but if the alternative is either seeing more services set up ‘online-only’ side-projects based on false cost-saving or demand assumptions, or seeing services fail to take advantage of opportunities to enhance practice, and find reasonable efficiencies through delivering some of what they do in digital ways – then the challenge is, I think, worth engaging with.
So, this post rather unexpectedly seems to have got me to three draft principles of blended provision:
- Identify realistic cost-savings from going digital if you budget for a mix of online and face-to-face
- Invest in skills, understanding and iterative development rather than platforms
- Allow services to be agile in how the mix digital and face-to-face provision; engage service users in setting the balance.
What do you reckon?
(*Figures are illustrative only.)