Aims and scope
The objective of the MasterMind project was “to make high quality treatment for depression more widely available for adults suffering from the illness by the use of ICT” (http://mastermind-project.eu). Collaboration by 23 partners framed in a European H2020 project was created in order to accomplish this objective.
There were four core Spanish partners participating in this project, belonging to four different Spanish regions. They decided to join forces and create a partnership to implement this project in their respective regions because they had similar needs and they could share their experiences. In this case study, we analyse the implementation of the project in the Basque Country (Spain), since a private company participated in the development of the innovation in this region.
The innovation in this project was a Computerised Cognitive Behaviour Therapy (CCBT) for patients with mild and moderate depression. It allows people with these illnesses to receive distance therapy, involving fewer face-to-face appointments with health professionals. The main component of the innovation is a web application developed in HTML5 called “Overcome your depression”, which can be used through a computer, tablet or smartphone. By using this application, patients can receive therapy in six modules in the form of text, videos, images, graphs, etc. The application makes patients perform tests, which then serve to communicate the evolution of their illness to the health professionals. The health professionals check these tests periodically and receive an alarm if a patient’s results are a cause for concern.
Main collaborative innovation conditions
The ideas in the innovation process emerged from interactions between the partners in order to solve their respective problems. The combination of knowledge in a multidisciplinary team fostered this process, as did the inclusion of partners with different levels of experience. For example: (1) there were improvements within the initial protocol because of the experience of some partners, (2) there was a possibility of providing a first level of care by using nursing staff instead of psychiatrists or psychologists (reducing the cost of the service and the waiting lists) and (3) solutions to the similar barriers/problems of the partners were proposed in the piloting phase. The partners looked for similarities between ideas when they were different. Some partners initially disagreed in some situations (e.g. selection of the number of patients needed for the piloting phase), but there was usually a convergence towards the solutions proposed by the most experienced partners. The initial alignment of all the partners towards the project objectives also avoided an inevitable confrontation of ideas.
A treatment for patients with mental illness implies that physicians have less control over the effects of the treatment and the patient's situation when receiving the treatment. We believe there were two main reasons to involve healthcare professionals: their advice was needed to develop a validated online tool and they were necessary to involve the correct patients and supervise the treatment. The involvement of patients was also necessary for two reasons: 1) to check the effectiveness of the online tool and 2) to receive feedback to solve possible problems (e.g. usability of the online tool, usefulness of the contents and treatment received, etc.).
Implications and lessons learned
The innovation and collaboration process was very smooth. There were no significant barriers that inhibited the collaboration process. Some partners had collaborated previously in other projects and their perspectives and ideas were very much aligned with the project objectives. Partners behaved correctly in the collaboration process, as they attempted to align opposing interests rather than directly reject or disregard opposing ideas, being willing to share relevant information, and constructively trying to solve the problems that other partners communicated. However, the coordinator indicated that there was no active behaviour to spontaneously provide ideas for improvement.
The context of the healthcare system in which this innovation was implemented, has to be considered for a correct evaluation of the innovation’s importance. In the Spanish healthcare system, there is a general lack of physicians in some medical specialties. This innovation makes it possible to reduce dependency on psychiatrists for this type of treatment because part of the treatment could be conducted by the actual patients or by other professionals (e.g. nursing staff or general practitioners). The dispersion of the population in Spain also makes it difficult to ensure accessibility to healthcare services in the whole country and this innovation allows remote treatment. The number of people with depression has increased in the last decade in Spain and all around the world and so has the amount of medication taken by patients. The Mastermind innovation provides another possibility to receive cognitive behavioural therapy, a therapy that could avoid treatment with medication in some cases.
The most important lessons learned from this project are the importance of including partners that provide all the essential resources, a good alignment of all the partners with the project objectives and continuous communication with the users involved. Before a partnership is created, the individual objectives of each partner should be carefully considered to ensure that they are aligned with the objectives of the project and to ensure their active participation in the project. Communication activities with users should be carried out throughout the project to achieve support for the innovation and increase the chances of full implementation and use of the innovation. Finally, the involvement of partners with different levels of expertise helps to acquire new perspectives on the problem and might also help to disseminate the innovation.
To read more about the case study, see D7.1 – Practices of external collaboration for service delivery. Comparative case studies on external collaboration in eHealth partnerships report.
About the Authors
Lourdes Torres, University of Zaragoza
Vicente Pina, University of Zaragoza
Sonia Royo, University of Zaragoza
Jaime Garcia-Rayado, University of Zaragoza