Global Perspectives on Digital Health

Caroline (00:00)
But there's one thing that's constant. People don't like change. And that's independent of if I'm sitting in a small health post in rural Mali or in the hospital in Geneva. So people naturally resist change. even if on paper something looks great,

It's coming into an environment that can be really messy. There are habits, there are routines, there are workflows, And then there's also often, a disconnect between what tech can do and what systems are ready for.

I think the first thing I'd say is, you know, don't think of implementation as an afterthought.

It's really the core of success for me. So you should really start by understanding the health system you're working in. That means spending time with users, not just decision makers. You know, you need to talk to nurses, frontline workers, district health officers, or, patients that are going to be impacted by that. Because

For me, implementation lives or dies really in the day to day. And then you want to look for a few kind of key partners, which is a local implementation partner, someone who knows the system, who speaks the language and can navigate kind of the political and regulatory nuances and also knows

the rules that are non-explicit in the context you're in.

Shubhanan Upadhyay (01:35)
Welcome to the Global Perspectives on Digital Health podcast. The podcast where we talk about challenges, insights and learnings people who have innovated or have expertise in digital health.

in underserved settings around the world. Today we are talking to Caroline Perrin who works

at Geneva Digital Health Hub. We're going to be talking things implementation science. Why do we need it? What are the challenges? How can we do it better? And we'll also be getting into a subject that I think is really important, failure.

As global health goes through funding shifts, within that I think is a conversation around how we propagate the learnings from challenges and things that haven't gone so well so that everyone can benefit, whether there's value to that.

Let's get into learning about implementation with the Geneva Digital Health Hub.

Shubhanan Upadhyay (02:34)
Caroline, thank you for taking the time to join us on the Global Perspectives on Digital Health podcast. It's a pleasure to have you here. Please take a moment to introduce yourself and the work that you're doing with Geneva Digital Health Hub.

Caroline (02:47)
Thanks, Shubs Thank you for the invite. First of all, I really enjoyed listening to the other episodes. It's really a privilege to be here. My journey to get into digital health was not a straight line. I started studying history of art and I worked in advertising and then I studied IT management.

And that's when I listened to a lecture, an invited lecture on e-health. And you know, that was the first time I was in contact with that. And I really had like an epiphany of that's what I want to do. ⁓ But the short story of how I ended up in digital health is probably, my mom's a medical doctor, my dad was a software engineer. So, I've always been kind of at the intersection of the health and the tech domain. And if you asked a psychologist, he'll probably say, that's why I ended up there.

Anyway, so all this has led me to where I am today, directing the Geneva Digital Health Hub, which is a hub that was founded in 2021. It's hosted by the University of Geneva, and it has been co-founded with the Swiss Agency for Development and Cooperation. But the hub itself is really based on 20 plus years of implementing digital health.

in different settings. And based on this experience, think that's really one of the things why we're here is really to connect the dots, especially between like the implementation layer, where tools are being built and used, and the policy layer, where decisions are being made and scaled. So yeah, at the hub, we really work across three pillars, evidence, ⁓

collaboration and capacity building and all with the goal of creating sustainable value and making digital health more impactful, inclusive and sustainable.

Shubhanan Upadhyay (04:37)
That's a really great summary and overview of your work. I've been interacting with the part where you're connecting dots, not only between layers, but across as well. Across geographies, connecting learning, connecting people, in that spirit of collaboration that you mentioned as well. That's particularly powerful. Before we move on, implementation.

How would you define implementation and why it's needed?

Caroline (05:07)
So, I mean, often when we speak about implementation, or when I speak about people who haven't ⁓ done a lot of implementation before, they often think it's about, deploying a tool. But it's not only deploying a tool, you know, it's not about the tech, it's really about

Shubhanan Upadhyay (05:17)
Yeah.

Caroline (05:23)
embedding it into real health systems. for me, implementation, this really includes everything from training, workflows, to thinking about governance, data use, community engagement, and ideally being honest about what works and what doesn't work.

Shubhanan Upadhyay (05:45)
And in some senses, the implementation layer can be, if I think about what an ecosystem looks like, implementation can be considered by someone who is deploying, i.e. a founder or a startup or something like that, they have to think about good implementation and they might have people who are working on implementation on their side, but also might be also in partnership with the health system itself or...

someone who's acting as an intermediary between the health system or government layer or the policy layer, and making sure that that piece, that connecting piece but then here are all the other things around it and make sure that they kind of like join up well. That's what implementation is all about. And I like what you said, because some people might have the assumption, well, you know, I'm a builder, I'm an engineer, I'm building something, I just need to deploy it. And there's so much more to that.

Caroline (06:39)
Exactly.

Shubhanan Upadhyay (06:41)
Yeah. Why is implementation hard Caroline?

Caroline (06:46)
I mean, it's hard because, real world systems are messy. And when we implement, you know, we have to change how people do things. And that's, think, one of the things we really learn from implementing in different contexts, in different countries, in different settings, where we might have challenges that can be very different, like

Shubhanan Upadhyay (06:51)
Yeah.

Caroline (07:10)
In Geneva, we don't need to worry about where we get electricity from. While if we go to rural Mali, this might be more of a challenge and we might have to think of other things. But there's one thing that's constant. People don't like to change. And that's independent of if I'm sitting in a small health post in rural Mali or in the hospital in Geneva. So people naturally resist change. even if on paper something looks great,

It's coming into an environment that can be really messy. There are habits, there are routines, there are workflows, but then there's also, sometimes power plays or emotions that are involved. it can, it takes time and it's a lot of work. And then there's also often, in my opinion, kind of like a disconnect between what tech can do and what systems are ready for.

And sometimes it's too many things in parallel, projects, too many projects, too many things that are in the process of being changed at the same time, so there is not enough coordination.

Shubhanan Upadhyay (08:20)
Absolutely, and I think that's one of the things that make being successful in healthcare so hard. When you think about scaling, you can create something that works in one context and that's already itself hard to do for all the reasons you mentioned. And then if you think about scaling that out,

it's not a simple case of copy and paste. You have to kind of do all of that, think about all those touch points again. the context and the workflows and the way things interact, people interact, can vary massively across different places. And so even within a country, going from an urban setting to a rural setting.

And so I think you've highlighted there, yeah, really the, I guess like the nub of why some of the challenges in implementation in general, but also why you can't just like copy and paste when you're thinking about scaling solutions within healthcare.

And one of the things you've done as part of connecting the dots with Geneva Digital Health Hub is creating space for allowing people to share the challenges and things and the insights and the things they've learned within their own contexts. And you've built this community called Implementome, community and a platform. Can you tell us about that?

Caroline (09:44)
So, when we worked in the field in different contexts, we really saw kind of the same questions being asked again and again in digital health projects.

And we also saw the kind of same challenges or errors repeated. But also the same tools being redeveloped by different organizations and tools that could have been developed in a way that could be more easily reused by others saving some resources there and being more efficient. And then we were looking around and there is not one platform where we can find all this information and

puts the community together. So Implementome is really our attempt to bring collective knowledge into one place, to help understand who's doing what, where, what worked, what didn't work, and how does it align with national strategies.

The idea of it is really to be like a knowledge management, but also kind of a matchmaking tool to defragment the space and guide hopefully, smarter investments.

Shubhanan Upadhyay (10:59)
And I guess that gives you a nice kind of broad overview of what's going on where have you got some data or stats on how many implementations you have, what type of common use cases there are, you got any data that you can share on some numbers?

Caroline (11:16)
Sure, mean, there is a lot of data in the platform now because we're working together with the World Health Organization and we incorporated the previous Digital Health Atlas in the tool. So the kind of mapping and project overview is the Digital Health Atlas now.

Shubhanan Upadhyay (11:30)
Okay.

Caroline (11:35)
there are around 1200 projects and after it's really depending on the different regions. We have regions where we have really many more projects and we have regions that are completely underrepresented like Central Asia, the MENA region. Unfortunately, we do not really have projects and so that's one of the

things we're working on because I think it's also important to have representation of all the regions and ⁓ also to bring in implementation insights from the higher income settings. I think there can be lot of bidirectional learning also.

Shubhanan Upadhyay (12:18)
100 % I mean, I think that's that's a key thing bi-directional learning is like I mean I think that's a really a concept that brought us together as well I think one of the things that I want to mention is like around this

tool that you have that gives you this visibility is also a community, right, that is very active and talking to each other, sharing resources, sharing their learnings, etc. Can you tell us a bit about that as well?

Caroline (12:45)
If I had to describe it in one sentence what Implementome is, I think it could be like, you can think of it as like LinkedIn meets Wikipedia of digital health implementation but with a purpose.

Shubhanan Upadhyay (12:59)
Yeah, very good. I like that. And yeah, so if you're interested in working in this space, definitely get yourself and we'll share it in the show notes on Implementome, join the community, it's a place to share your work. And I think from what you've said as well, if you are based in Central Asia, if you're based in the MENA region, wherever you are, if you're working on deploying, implementing, you've got things to share.

and you want to make your work visible in kind of a bigger picture, that's definitely a place to get your insights and get your learnings. So yeah, big call to action.

Caroline (13:35)
And maybe just to add, it's available in eight different languages. So we hope that also facilitates sharing across different cultures and communities. So everything is being translated and you can see if it was translated what the original language is. yes.

Shubhanan Upadhyay (13:54)
Have you got any examples of ways that people have connected or learnt from someone else who's been on that community? Have you got any examples of either stories of information or the ways, like a good story of where people have connected and it's led to something happening?

Caroline (14:09)
Yeah, I have one example, recently example is we had ⁓ in the mental health space, Jana from I think was based now in Rwanda, but originally is from London, who was connecting with Yeah, yeah, exactly. He was in one of the previous episodes. He was we met him at the Global Digital Health Forum in Kenya.

Shubhanan Upadhyay (14:20)
we've had him on the podcast. Yeah, awesome. Yeah.

Caroline (14:30)
We were connecting, he was putting his information in Implementome in the Digital Health Atlas, but then we also had a webinar where he participated and through that they met one of the other people we have been working with, which is Joy Sophie

who was also ⁓ participating to one of the webinars. And then they actually met in person and they shared some images and they connected. And I think they're looking now for ways to collaborate together. that was a real nice kind of ⁓ example of something virtual that led to some connection in the real world.

Shubhanan Upadhyay (15:09)
I mean, I think that's, leads me back to what you said around Wikipedia and LinkedIn, but with a purpose, right? I mean, that's the power of community. You need a digital space to be able to kind of connect, because that's how we connect these days. But if it leads to that in-person or deeper collaboration, that's really a good marker that you're doing the right thing. So that sounds good.

And before we move on from implementation, it seems like there's all of these layers to think about if you're building in this space, how do you approach if you're a founder, if you're a product manager, if you're a developer, and you're looking to build something that's gonna be, you're hoping is gonna be adopted within an underserved population setting?

How might I approach this conversation whilst I'm planning?

Caroline (16:05)
So, mean, I think independent of if you're a vendor, developer, someone with a great idea from academia, wherever you're from, I think the first thing I'd say is, you know, don't think of implementation as an afterthought. It's not the final step.

even like in the timeline, it's the final step, but it shouldn't be the final step. It's really the core of the success for me. So you should really start by understanding the health system you're working in. That means spending time with users, not just decision makers. You know, you need to talk to nurses, frontline workers, district health officers, or, patients that are going to be impacted by that. Because

For me, implementation lives or dies really in the day to day. And then I think in terms of partners, you want to look for a few kind of key partners, which is a local implementation partner, someone who knows the system, who speaks the language and can navigate kind of the political and regulatory nuances and also knows

the rules that are non-explicit in the context you're in.

Then I would also look for a policy partner, at least someone who understands how to align with national strategies, because without that, your tool might never be scaled or sustained. So you really need this anchorage from the beginning. And then, if possible, a research or evaluation partner to...

to help you learn from what's happening in real time and build evidence as you go. But I think finally, you should be humble, be flexible. Implementation is not ⁓ a linear trajectory. The best tools succeed not because they were well built, but because of the teams around them that built them.

Yes, so I think, you know, as a takeaway, your tech might be brilliant, but if you don't understand the context, it won't matter, and implementation is really team sports. And I think humility is your best asset, especially if you're entering a context or culture that is different from yours.

Shubhanan Upadhyay (18:27)
⁓ You've highlighted so many important things there and yeah, I think I think the bite-size takeaway is yeah, I like that humility is your best asset ⁓ and Invest early in understanding your context and preparing for that and don't have it just at the end of your waterfall or whatever your process is

I guess it's like assume that your assumptions will be wrong basically, assume that they will be wrong and do the work to uncover them early.

Caroline (18:53)
Exactly.

I have one example here, where we did everything right. I speak about it's called the Concerto. It's an application that has been implemented in the Geneva University Hospital. And the tool came out of a Hackathon from the Innovation Center in the hospital. So, you know, from the beginning, you had end users, so you had patients, had nurses, doctors. ⁓

Shubhanan Upadhyay (19:15)
Yep.

Caroline (19:23)
all the ones involved in it that were ⁓ conceptualizing it from the beginning. It ticked all the boxes, it followed all the rules, but in the end, in the implementation, we still had adoption issues and it was taking a lot of time from the care professionals. And then we stepped back and we looked at it again and looked at how we can address it. And what we did in the end was integrating

a function that has nothing to do with the tool itself. So the application itself is really about giving the patient more information about his stay in the hospital. So you would see who are the care professionals that I will see today. And you would have access to like good knowledge and good sources of information on certain disease and things like that and see your schedule. So what we added was that people can order their food.

the app now. So normally in the hospital in Geneva you have someone who comes to your bed and asks you okay for lunch you want fish or meat, you can choose. And so we integrated that in the app and that was kind of the killer function and that really made it being adopted because the patients like ordering their food to the app. It gave more time to the care professionals.

Shubhanan Upadhyay (20:34)
Haha.

Caroline (20:47)
So I think that's kind of illustrate why it's important to be flexible, to rethink, even if you have done everything right. In theory, there still might be things that haven't been explicitly said. So it's really important to stop question and see if there are things you need to adjust.

Shubhanan Upadhyay (21:07)
I think to me this is really interesting because when you think about monitoring and evaluation and the considerations you need, because you mentioned that as a piece that you need to think about how you're going to do that, you might need an evaluation partner. And often you're thinking about, okay, these are going to be the primary endpoints, these are going to be the secondary endpoints that we're thinking about. So how do you make room for these other

these other things because obviously people, other stakeholders and metrics of success are defined as part of assumptions as well as your planning,

Caroline (21:38)
.

Yeah, so I think one of the things is to really kind of redefine success, what means success, it's not just scale or downloads. It can also be like, did we learn something? Did we engage users meaningfully? Did we reduce inequity? After and I think this is something that a lot of people will still agree with me.

I also think we need hard metrics on outcomes. We're still not very good in understanding what does it really mean in terms of improving outcomes. Does it reduce mortality? Does it improve different outcomes? I think this is something that the community as a whole still needs to work on.

Also us, I we have been implementing, we are in academia, so I'm saying we also need to do more. But it's really, really difficult and it's not easy to evaluate, it's not easy to monitor, particularly outcomes. Often to measure outcomes, you have such a long timeline to being able to really measure outcomes. Like for maternal health, I think it's 10 years. So by the time...

you would be able to measure outcomes. Often the projects don't exist anymore, or there have been so many confounding factors that it's very difficult to make a direct line. yeah, I think looking at proxy indicators, that are closer to the intervention could be something, but yeah, in general, I just think it's really important to also focus on understanding what does it really mean in improving outcomes.

Shubhanan Upadhyay (23:28)
This is a really hard topic and it's come up in so many episodes Yeah, the need to show movement on real outcomes that matter versus the ability to move the things that are within your locus of control of the technology and the implementation part. And this is one of the, I guess, like the biggest challenges. Do you have any...

tips on choosing the right types of proxy metrics or thinking about how to approach what are the right proxy metrics that will be within my locus of control and make a good argument. Yes, that these also contribute to health outcomes or operational outcomes.

Caroline (24:09)
Yeah, so I mean, in general, proxy metrics are really, things you could measure that have a large evidence base on improving

outcomes. And one of the things we are doing, for example, is in now in Mali in Nepal. We are running currently a study that is finishing at the end of August. So, hopefully we'll be able to share some concrete results soon on this. Having telemeds in rural settings really improve ⁓ access to care for, particularly women, children and the elderly or vulnerable populations.

And for that we are measuring, I think, 70 variables, different variables, that, looking at them all together will give us a pretty good idea if ⁓ it improves outcomes or not. Saying that, it's really complicated, to collect the data, it's very costly, and I think organizations sometimes also underestimate the costs of really measuring.

Shubhanan Upadhyay (25:07)
Mm-hmm.

Caroline (25:17)
But then once again, I think it's really important. if I'm taking the example of measuring those telemeds and really provide a more equitable access to care or not, think if we want to be able to scale, we need to give policymakers kind of the tools, which is evidence of investing in that. Because now everyone agrees, it's a great tool with a lot of potential to improve ⁓

access to care, but as long as we don't have the evidence, how can a decision maker justify investing larger amounts of scaling?

Shubhanan Upadhyay (25:56)
Two takeaways then, yeah. So one, everyone underestimates how hard it is to collect, the measurements and data and the metrics that matter. And two, I recently talked to Smisha from Johns Hopkins and we were talking about this and it's hard because...

people in those positions in policy and decision-makers need the black and white, go no go decision based on these hard facts. Whereas the people on the ground, people who are implementing are also in the, well this is hard and it takes time to get those things that will move you towards a yes decision. And we were talking about some of the challenges there and you've highlighted it again. It's really tough. Let's...

zoom out You've got a good view with things that are happening globally with, more than a thousand ⁓ examples of implemented technologies.

What's your view with everything that's going on with governmental development funding being reduced, particularly in the US, but also other countries now, the UK, et cetera?

Have you had anything from the community that has given you a picture of the impact of this?

Caroline (27:15)
Yeah.

Okay, so yeah, I mean, I think I see on the left and right, you know, people in my network that are losing their jobs, projects that are being stopped, medication, like vital medication that is being stopped to be given out to patients from one day to the other. the impacts are devastating. At the same time, you know, that's the situation how it is.

We cannot change it. we ⁓ cannot all sit in a corner and be angry about what's happening. think we need to look how we can move forward and how we live with this new reality. And I think one of the things that we probably need to look at more is, integrating the private sector stronger in this and, creating services that have...

a business model behind because these can be services that will be more sustainable, that are less dependent on this unstable environment.

Shubhanan Upadhyay (28:18)
I've just talked to Rowena Luk who is from Africa Health Ventures, and she was saying something very similar around, like, the time is now to invest in organisations as a whole, they're, I guess, like, economic resilience. So we connected it also to what you'd mentioned around, okay, well, if the health outcomes are going to be in, like, 10 years that you're trying to go for, then, yes, there is a reason to be economically viable for the next 10 years, so you could actually, like, make that thing even like...

see the value that you've created and see those outcomes. yeah, absolutely having resilient business models behind you, I mean, there's a thriving private sector ecosystem in many parts of the world and things don't just need to rely on governmental or philanthropic funding. So I think it's a good opportunity for lots of parts of the ecosystem to rethink

Caroline (29:13)
Okay.

Shubhanan Upadhyay (29:15)
Yeah. Okay. Let's go into... It touches on evaluation and it touches on what we talking about earlier on the need for, health system decision makers, et cetera, to think about, okay, I need these hard metrics to know if this is a go or whether this has been successful or not. I kind of wanted to talk about success and failure with this.

Because a lot of evaluation work is trying to answer this question. And perhaps we miss a opportunity to think about it in a different way. If we think about, that's not to say we need that, but if we're solely focused on what I would label as a finite game. yes, no, did this work or not? And evaluation being hyperfixated and answering that question.

or actually flipping it around and saying, okay, we're aiming for this overall health outcome. We've got current hypothesis on how we might do that. We built the tool, we think it's gonna be able to work in this way. We're working hard on implementation, adoption, making sure that it works within this context. And then we're setting up our evaluation mindset and infrastructure in a way that allows us to continuously learn and improve. ⁓ That for me is a different...

Caroline (30:20)
you

Shubhanan Upadhyay (30:39)
way of setting up evaluation rather than just trying to answer a yes and no

question. And it also helps us think more infinitely about failure because I think this ecosystem doesn't think about failure in the right way. I wonder if you have any thoughts about that or reflections on that given what you've seen.

Caroline (30:57)
Yeah, I mean, I fully agree. think, we need we need to actively share our experience and be transparent and challenges what we see as failure and, you know,

seeing it as an opportunity also to improve and just by coincidence, yesterday I was reading an article on an industry that's completely different. It was an article on Domino's Pizza and I don't know if you're familiar with them, but you think it's US based, but we do have them in Switzerland also. And I think it was 2006 or quite a long time ago.

Shubhanan Upadhyay (31:21)
Yes.

Caroline (31:30)
they received really bad ratings. People were saying like, the pizza tastes like carton, the sauce is like ketchup. And what they were doing instead of kind of hiding this and trying to advertise on how great they are, they were taking the bad comments they were receiving and actively sharing them and saying like, okay, we heard you. We know that things are not ⁓

as they should be, but help us to improve. And they were reaching out to the people who were giving like the worst critics, to the focus groups. And they were working with them to really improve the product and what the result was. And I think that's really interesting. They did not only end up with like a great pizza. They also became a really tech oriented company. They were changing processes around, they were developing, you know, tech quality. ⁓

control systems, systems and things like that. they really saw it as an opportunity to, rethink processes, redevelop. And I think that, yeah, that's a really ⁓ interesting story. And even so it's like a complete different industry.

So, yeah, think rethinking success and failure is super important, but also sharing what didn't go well, you know, and being open about that.

is kind of key to help others avoid making the same journey.

Shubhanan Upadhyay (33:00)
100 % and that's such a good example of how a company has embraced failure and said, okay, we'll take that on the chin. and using that to improve ourselves? Because if you look at it in the snapshot of, okay, well in that year, they were terrible and Domino's is just terrible. I mean, they could have internally looked at it like that and taken a different path.

I mean, people could argue that, well, that's well and good for a big organization like Domino's, who have lots and lots of resources behind them, and they're able to invest in doing that. And it's still great that they did that. But if you're a small company or a founder with very limited resources, and also the system that you're in is set up to only make these yes and no decisions, I think this is what we're saying,

Caroline (33:49)
.

Shubhanan Upadhyay (33:50)
that becomes really tough.

you almost have the selection pressures within the system that are like, ⁓ I can only talk about my successes, or I have to really kind of cherry pick some data to be able to only tell the story about the things that went well. And not only does the, I guess, like the company and the health system and that local context miss out on, ⁓ actually, well, wasn't it interesting that this thing didn't go well?

Caroline (33:52)
you

Shubhanan Upadhyay (34:22)
Let's explore that deeper. Why didn't people adopt this? We had these assumptions. We talked about at the beginning. Assume you have assumptions and then you have your plan and things will likely also not go as you planned. No plan will meet contact with the battlefield or whatever the saying was.

what I observe in the past within this space have been, we need to tell a certain story to be able to get the next cycle of funding. And that story does not include things that were hard and things that didn't go well.

with all this in mind, what needs to change from your perspective?

Caroline (35:03)
Yes, I mean, you're fully right. I think there really needs to be a paradigm shift. we, you know, it's, even if you want to share it, it's difficult to share, there's publication bias, like, often studies that are not being successful are not being published, neither. So, it's very difficult to even find a space. So that's also why we

We were working on that with JMIR at the Journal of Medical Internet Research. We developed some guidelines on how you should report on implementations to kind of standardize and maximize the learning for others. And then we created this kind of new article type, which is called implementation reports that are peer reviewed PubMed, Medline indexed manuscripts articles.

that really give you the space to document the surrounding processes of an implementation and are seen as valuable scientific contribution because describing these processes in detail is a significant contribution, even so it's not maybe the classical scientific contribution in adding something specific new.

it's still being considered as something that is added of value to the community. you know, I think it's important to have this kind of paradigm shift and giving space to share, you know, in publications, but then I think also in real life, and that's why at the next Geneva Digital Health Day, we are going to introduce the FAIL Festival, to really celebrate failure.

Shubhanan Upadhyay (36:51)
Absolutely, first of all just on this implementation reports, it's great because I guess like it's one thing to have a mindset and change the mindset of an industry but to be able to do that you have to give them a space to do that and to change behavior and so this seems like a great space like within these implementation reports with a structure and having the space to like ⁓ this is a valid scientific contribution to share the things that went wrong.

share the things that we've learned, et cetera. So if you've got pertinent learnings from your own context that you know that might, will be easy to be replicated in other settings and you think it will be valuable for other people to know, that's a great place to share that. So we'll share that in the show notes.

This is one of the reasons we connected on this topic. We need to talk about this in the industry more and what better way. So we've got a great event coming up, Geneva Digital Health Day. What better way to take up the mantle and create the space for us as an industry. This is one of the biggest meets of people in the global digital health space, to come and meet and talk about their implementations. So what a way to lead.

need the conversation on this, right? So really, really excited to be working with you on creating ⁓ this conversation in this space in the FAIL Festival because, yeah, I think we need to do this better as an industry and being able to have people have very, very exciting guests who are coming really at the top of their fields, top of their industries to talk about their own learnings and what they've done, I think will be a good model for us to say, hey, yeah, look.

maybe the space is now being created to have a better structured conversation around this.

Caroline (38:37)
We are going to see some great examples. Dr. Frédéric Heller from the Geneva University Hospitals, who's going to speak about something that worked extremely well.

in the Swiss context and then they wanted to transfer it to a different setting and it failed. We are going to have Patty Michel who will speak about why it's important to include women. And then we are also going to have someone from another industry from the European Space Agency to speak, share one of...

the mega failures that I think a lot of people are familiar with. So yeah, really looking forward to that and there will be some more.

Shubhanan Upadhyay (39:20)
Yeah, mean, genuinely looking forward to conference itself. think it's great. I didn't manage to go last year. I heard a lot of people who had gone to it last year say that was really, it was a really, really great event and bringing people together in this space. And in particular, yeah, this session, I think it's going to be something that's not done enough anywhere, I think. And so, yeah, being able to have the chance to talk about this with that caliber of ⁓ example.

is going to be super exciting.

Caroline (39:48)
we're really looking forward to welcoming everyone who's in Geneva in person because I think there's a lot of happening on the sidelines also. But I just want to point out that for the ones who are not able to be in Geneva, it's going to be live streamed through our community platform. So you can just go to our website, go to Geneva Digital Health Day and register for getting all the information for the live streaming.

Even if you're not available on the day, it's also going to be recorded. we hope there will also be some interaction in the community platform between the people who are not going to be able to be in Geneva. But I just wanted to highlight that. So even if you cannot make it to Geneva, you can still participate and follow the conversations if you're interested.

Shubhanan Upadhyay (40:32)
Yeah, thanks. And your whole team, you and your whole team has done such a considered, careful and thoughtful work and hard work on making this a

So we've talked about an event and kind of bringing people together. You've brought communities together within the Geneva Digital Health Hub as well. And I wanted to talk about communities of practice as well. I think these are also good ways to share things that have gone wrong within a psychologically safe space. ⁓ I know you guys have some experience with ⁓ facilitating, running communities of practice. Do you have any insights from?

examples of like does that happen in those and what our communities practice as well.

Caroline (41:19)
I mean, communities of practice are quite, I think, self-explanatory in the name. It's like getting people together that are interested in one topic. We do host different communities of practice, so some of them are more wider, like, general digital health interests.

But then we also have some that are focused on real use cases like telehealth or clinical decision support, space and global health and so on. So there you have more target conversations. But then, as you mentioned, think it's one thing to share learnings about in a standardized way or to share learnings in a platform. I think if you really want to get into the nitty gritty details of it.

And in many of the cases when we spoke with people from the ecosystem, I mean, they really want to connect to a person behind and have like this human to human interaction and ask more questions. we see a lot of sharing, obviously also in kind of webinars that we are organizing and conversations, but then it's really a great way to meet people, to get in contact with people who have.

Shubhanan Upadhyay (42:12)
Yeah.

Caroline (42:28)
worked on the same things, who were faced maybe with similar or the same challenges and that you can then also connect and really go into the detail of discussion that you need to apply this maybe to your project or context.

Shubhanan Upadhyay (42:44)
Yeah, that sounds good. we'll put a link to the community of practice that you are within. If you want to be able to contribute and also learn from people who are in similar space to you, get involved and be part of that as well.

Before we wrap up, any other key things, insights, that you want to share with people in this space?

Caroline (43:06)
So yeah, we spoke a lot about, failure and things that went wrong and why it's so complicated and difficult to do that, which might give the questions to some people, why are you even doing that? You know, why are you still working in it? And I just want to highlight that, you know, there are also things that give me hope. And I think that the first thing that really gives me hope is the incredible people we work with in the ecosystem.

And that people still believe in change and that despite all the complexity, we keep showing up to make systems better, more just and more human. And I think that's really one of the things that keeps me going, seeing all these dedicated ⁓ people in this ecosystem.

Shubhanan Upadhyay (43:53)
So a great reminder that despite things being hard, There's a lot of work still to do. And there's a lot of awesome people who are behind all of this. Great.

Caroline, what a pleasure to talk to you, finding out about the work that you're doing with Geneva Digital Health Hub. Lots of great insights about how to think about implementation, investing in it upfront, think about failure as a way to continuously improve. I really love the Domino's Pizza example. I love the way that you've created a space through community.

but also in terms of academic structure to give people the opportunity to talk about failure in a way that we can all learn from. also leading by example, by having this as like a key thing at the Geneva Digital Health Day as well as a, let's get people at the top of the industry and people who...

you wouldn't normally see talking about this, kind of open up and maybe we can all do that in our own context as well. Thank you so much for your time talking to us and yeah, join Implementome, I would say, if you're in this space, join Communities of Practice if that's relevant and yeah, come to the Geneva Digital Health Day, it's gonna be a fun day.

Caroline (45:15)
Definitely. Really looking forward to deepening the conversation on that and having more discussions and learning about more failure examples.

Shubhanan Upadhyay (45:26)
Definitely. All right, thank you Caroline.

Caroline (45:28)
Thank you. Bye bye.