Building a new social contract through leadership, collaboration, and reflection

Sciana Fellow Rishi Das-Gupta shares how collaborating with other healthcare leaders has empowered his own work advocating for technological innovation in healthcare

Rishi Das-Gupta is the chief executive of the Health Innovation Network (HIN). The HIN is an NHS organisation with 55 members in the health, social care, local government, private, and voluntary sectors. It is dedicated to accelerating the adoption of technology and improvements to serve the residents, patients, and staff of South London and is a national leader in digital innovation in health and social care. 

Before this, he was chief innovation and technology officer at Royal Brompton and Harefield NHS Foundation Trust and worked as a hospital operational manager and medical doctor. Rishi has spent the past few years focused on effecting technology-enabled clinical and operational change to improve patient care and experience. He is a member of Sciana's fourth cohort.

This interview has been edited for length and clarity.

Sciana Network: We understand you are passionate about the use of technology to enable clinical and operational change. How could a new social contract for health encourage the spread and adoption of technological innovations in healthcare?

Rishi Das-Gupta: It's really important. I think that the healthcare industry as a whole tends to be relatively conservative compared to other industries I've worked in. That's understandable, given the need for patient safety and the fact that we're trained by apprenticing with people who've worked in the profession for a long time. However, we are at a time now [with] the opportunity to do things differently through the use of technology and so are entering a period of rapid change.

I see three main opportunities: Firstly, there are new medical devices and digital products that improve care and enable patients to care for themselves. Secondly, there [is] a range of communications technologies to deliver care remotely and to support colleagues who are practising in a different region or a different area. Thirdly, there is a huge opportunity around the use of data, and particularly 'big data' from individuals used collectively to improve overall pathways. 

All this requires us to learn and practice in a different way and to share our information for the common good. That requires a renegotiation in the way that the social contract for data and for healthcare works, and also requires us to build trust in our institutions which are handling that data.

SN: How does Cohort 4's Sciana Challenge relate to your day-to-day work and previous experience? Why is this Sciana Challenge of interest to you?

RDG: One of the things I found as a leader in an organisation within the NHS is [that] it's quite easy to focus on the particular challenges that I'm facing in my organisation now. The Sciana Challenge we've framed as the social contract for healthcare has forced me to take a step back and look at how what I do fits into the broader picture. 

It has been valuable to have a chance to test ideas and articulate this to a group of leaders from other geographies who may have a different understanding of the way our health system works and also to stimulate me to think about it from the point of view of what's happening in Germany and Switzerland. Those two things together have helped me talk to my team, colleagues, and other stakeholders across London about what we as a Health Innovation Network do, how it fits with their agendas and how we might work together to improve health and patient care.

SN: What is the role of leadership in enabling a transformation in health towards a new social contract?

RDG: In the group that I'm working with, we've focused on how we develop participatory approaches to leading in developing a new social contract. That's because for a new social contract to work, it requires lots of different kinds of stakeholders with varied interests and different levels of trust in the system to work together, and that is not a straightforward process. 

In developing the role of the leader, trying to be inclusive about the groups that are involved, [and] trying to develop a collaborative approach to developing solutions is key—but balancing that against the need to move quite quickly. That dichotomy, that challenge, is in all the work that we're doing. 

What we've been focusing on in the group work is thinking through: What are those trade-offs? Which ones do we want to make? How do we be transparent about when we are moving quickly and when we are deliberately taking more time to be inclusive? I think that that inherent challenge is going to be core to a lot of the leadership that we do: the need to be inclusive but the need to move the conversation on at various times in order to get us to a better solution quickly. 

SN: How can Sciana Fellows across cohorts work together to bring about this fundamental transformation in health?

RDG: One of the benefits of the Sciana Fellowship, now that we're into Cohorts Four and Five, is that there are other leaders who've been through a similar process [to] whom we can reach out to for support. 

I've done that probably more in my own country than I have in other countries, but particularly talking to leaders from Cohorts One, Two, and Three has helped me to frame the digital challenge in terms of the national challenges that exist and the London-wide challenges that exist. 

Conversations with leaders in all the cohorts [have] also reminded me how things that I take for granted, having been deep in the digital field, aren't universally known, even amongst a group of like-minded, very bright fellow leaders. Taking the time to be able to articulate those in a useful way has been very helpful. There are a couple of more concrete collaborations [that] are developing as a result of conversations with previous Fellows, such as rolling out ambient voice technologies for clinical documentation in the UK (working with colleagues from Cohorts 1, 3 and 5). 

SN: What have you learned from your time as a Sciana Fellow?

RDG: One of the things I've developed a new emphasis on is being able to constantly reframe what I'm doing on a day-to-day basis. I would previously have probably focused on reframing that in the context of my local health economy and what it means to my day-to-day stakeholders. 

What Sciana has pushed me to do is to reframe what I'm doing in the context of the national health system and society as a whole. That is incredibly helpful in engaging a much broader group of people in thinking more strategically about what we want to be doing in the future. In terms of my own personal resilience, being able to tell the story of what we're doing in a societal context is very helpful when I've faced challenges.

SN: Is there anything else you'd like to discuss that we haven't covered?

RDG: [I'll] frame it in terms of what advice I would have for someone else who's thinking about doing Sciana or something similar. One of the benefits of this programme is taking time out of the day-to-day work to come and spend time thinking about much bigger-picture issues and conversations with colleagues. The discussions we've had have been almost mind-blowing! I've taken time after each of the sessions to try and put my thinking together, write up my notes from the sessions, and "connect the dots" for my own context. I would say that the conversations are constructive [and] supportive, but also somewhat challenging, and therefore, a bit of time to think through it and what it means for me has been really helpful, and I advise anyone else doing the programme to build in personal time to do this.