Jim Ritchie

May 10, 2021

Digital by design, not by default

Recently a colleague described a possible future for our hospital group as ‘Digital By Default’. This tagline isn’t new, having been popularised by the UK Government Digital Service. However, it’s worth reminding ourselves and others that this was not intended to position digital as a pre-selected option, but was much more ambitious:

By digital by default, we mean digital services that are so straightforward and convenient that all those who can use them will choose to do so whilst those who can’t are not excluded.”

As the phrase ‘Digital By Default’ is now used by some of the most senior physicians in the country it feels right for the digital health community to consider what this should and should not mean. Language changes over time in both its structure and meaning. If ‘Digital By Default’ is taken to mean ‘Digital Always’, then we will widen healthcare inequalities, drive costs up, create a view that technology can solve all of healthcare’s problems and worse…

The Digital By Default Service Standard is great but exists to “help teams create and run public services”. It  speaks more to the design and creation of tools than their application and implementation. 
In healthcare (and I suspect other sectors), this is often the greatest challenge - technologies which are good ideas, with minimal integration requirements can still struggle if the process design and user engagement is wrong.

This is where I think we need to change our language. Digital has or is becoming the default modality in healthcare, albeit at varying rates throughout the NHS. What we need to consider is how to become ‘Digital By Design’. We must move away from just asking ‘Is there a digital solution?’ and become more critical of our decisions:

 - Think more about the processes (and how these may change)
 - Think more about the staff who will use these tools (and what it will mean for them)
 - Think more about the technical architecture required to deploy these tools (and if it is being developed sustainability)
 - Think more about the data created (and how it is shared to care for and empower patients)
 - Think more about the interconnected nature of healthcare (and the unintended consequences of changing part of the system)

Digital is a default. This is not enough. Intentionally designed, highly usable, well architected and sustainable digital change needs to be the default. 
Digital by design, not by default.