The Erasmus+ DISH project

Committed to improving healthcare


The Erasmus+ DISH project aims at bridging the “missing link” between the progressive digitalisation of the healthcare sector and the lack of eHealth and innovation skills among health and social care professionals to fully benefit from the use of innovative eHealth products and solutions.

The project consortium, 19 organisations overall, is made of six regional triple helix clusters composed by health care providers, educational institutions and enterprise representatives that will test DISH concepts and outcomes in Denmark, Norway, United Kingdom, Germany, Spain and Poland, and is completed by two EU-wide organisations to promote its dissemination and stakeholder’s involvement.

Started in November 2018, the project runs over three years and will include a preparation phase, a development phase and a testing phase, where the triple helix partners will work closely together to ensure the fulfilment of real needs expressed by the health care providers, exploitability and scale up of achieved results.


The demographic change and the effects it has on the health care systems are among the key challenges the European society is facing. The progressive ageing of the European population increases demands from senior citizens who need integrated health and social care services whilst the care workforce is shrinking and less public funding is available to meet such needs.

In order to respond to this challenge, many innovative eHealth solutions have already been developed and many health care providers have invested in innovation. However, it often turns out that the solutions are not being implemented or are only partly used, hence the full potential of innovation is not exploited.

Many of these solutions do not reach full implementation stage for different reasons, such as:

  • – the solutions have not been developed in close collaboration with the health and social care staff,
  • – there is a lack of overall digital competences and specific eHealth literacy within the staff,
  • – there are barriers to changing organisational practices, pathways and models of working that enable smart solutions to be deployed.

Research results point out that one of the areas to focus on to succeed in applying and implementing eHealth solutions is the development of digital skills, innovation readiness and decrease resistance to change. The health workforce needs to have adequate instruments, capabilities and knowledge to face this rapidly evolving scenario, thus being fully aware and prepared to take advantage from the possibilities offered by the digital transformation in health and care.


DISH is aimed at strengthening the innovation readiness and digital skills of health and social care staff regarding development, use and implementation of digital solutions in their everyday practice.

The DISH project will equip the health and social care workforce with relevant knowledge and competencies as well as enabling them to use and implement eHealth solutions supported by national digitalisation strategies.

The objective of the DISH project is, therefore, to look into the present and future skills’ needs and develop, test and present different concepts, which will support health and care staff to better cope with the digital transformation of the health and social care sector.

Through work-based learning and training in a secure environment, the health and social care staff will replicate day-to-day situations where the use of eHealth is involved. The project therefore will deliver hands on education, in the form of on-the-job training, and provide the skills that the labor market demands from the staff. The project will use the concept of simulation in order to create a secure environment for learning.

Expected Results and Impacts

DISH provides a structured approach to the whole digital innovations’ implementation process. It is built around three concepts, main output of the project’s activities:

– The Learning innovation Units: An organisational concept providing a framework for co-creation which fosters multidisciplinary collaboration, innovative attitudes and team learning.

– The On-the-Job training: A concept oriented towards the achievement of concrete knowledge, skills, and competencies based on innovation and the daily use of the technologies in a secure simulation environment.

– Skills and Competences Assessment: A conceptual model to assess and acknowledge the digital and innovation skills within health care staff, which are obtained outside the official education and training system.

By making use of the DISH concepts, the six DISH pilot sites will enrol and offer training services at local level to a minimum of 600 health and social care workers and a plan for project’s results transferability and scale up will be included in the sustainability and sector skills strategy issued by the DISH partners at the project end.

Overall, DISH has the ambition of contributing to:

• the implementation of digitisation strategies on local level,
• the enhanced use of eHealth solutions by increasing the ability and confidence of health and social care provider in handling digital innovations,
• the lowering of mistakes and delays in applying eHealth solutions in treatment and care,
• the increase of time spent with the patient / citizen instead of figuring out how an eHealth solution works.

The DISH concepts

Illustrated from the users view point and by the Consortium partners in three video interviews.

The DISH concepts should be considered as “live outcomes”. They will evolve during the project lifetime, integrating DISH pilot sites’ feedbacks about their usability, relevance and transferability. The fine-tuned and final version of the three concepts will be made available in this section for implementation beyond the partnership and the project period.

What it is?

The Learning Innovation Unit (LIU) is an organisational concept providing a framework for multidisciplinary collaboration, regarding the obtainment of digital skills and competences.

A LIU schould be established every time a new technology is to be introduced and implemented in healthcare. The shared-decision-making is a fundamental principle within the DISH concepts. It is practiced in co-operation and open dialogue between parties and it is part of the conversations within the LIU meetings where all the participants define the framework for the training.
Concrete the LIU plays out as for instance multidisciplinary meeting concerning all stakeholder regarding the implementation of the technology. The meeting could consist of manager, IT specialist, heathcare professionals and maybe the producer of the technology/ the company.

From the user perspective

The LIU is preparatory meetings, which are planned in good time before the training and include clarifying issues such as:

  1. What is the purpose in the use of the technology?
  2. What desired changes in the skills/competences of health and social care professionals are there?
  3. Which main workflows are affected and what does the new workflows look like?
  4. Which arrangements should be made to ensure that a sustainable peer-learning culture will be established after the training?
  5. Where, when and how can health and social care professionals get access to support in the use of
    the technology after the training?
  6. Identify other workflows, which can be improved by the technology.

Technology and professional competence cannot be separated, therefore bringing the technologies into practical use is a matter of both being able to understand and being able to deal with the technology.
Dealing with and understanding technology have several dimensions, and one of them is getting to know the technology and pressing the buttons. The other dimensions are related to the relational aspect; to the shared commitment in the use of the technology in practice; to the complexity in the daily work and to the intricacy, of which the technology should become a part of. Finally, they are related to the development and changes in professional competence and workflows.
Each dimension affects chosen relations between the clinical practice and technology, to which the health and social care professionals should relate to, and each dimension should be seen as an element in developing technology comprehension, which also contains dealing with the technology. Therefore it is essential, upon implementation of new technologies, to reflect over the technology’s influence on clinical practice and start from this point.

The LIU also consist of follow- up meetings after the training

What it is?

Each training is based on the need in the clinic and the end-users define the training. For instance – it is the technology users, who define the need for the training and the technology set-up together with the trainers.

The skills’ training is based on practice-related cases, drawn from the daily work of healthcare staff. The training should be based on the concrete technology, which has either been introduced but is not in use, or which should be introduced into the clinical practice. The staff should be trained in how to use the technology, based on cases from their work. The training can take place in specifically set-up simulation facilities or in the own wards/own areas with on-the-job training, as well as across professional groups and sectors.

From the user perspective

The training can last from 2-6 hours, depending on the case, and the extent of training needs. To start with, the training will focus on when the technology is working and is responsive, and in the second half of the training session, the training is oriented towards troubleshooting and handling the situations when the technology is not working (unresponsive).

The recommended team size is 8-12 participants, because it is essential to give each participant a chance to actively participate in the hands-on training.

The target group is health and social care professionals (irrespective of professional background).

The training itself increases in complexity of learning levels from:
Training elements with emphasis on usage, such as technical and manual skills, practical data and information
Training to be able to use the technology in relation to professionalism and ethics, as well as training in understanding the applied technologies
Training skills to be able to participate in digital communication, as well as training the skill of teaching others, hereby colleagues, patients and citizens to use digital tools.

Overall the training, which gives the staff the possibility to take part in the development/implementation of new digital technologies, as well as to be able to organize the use of digital tools and see the organizational changes, which a new technology has the potential to bring at the workplace.

Follow-up training:
By the end of the training session, the participants are offered follow-up in the form of participation/support at the first use of the technology in the ward. Meetings and/or workshops at 30, 60, 90 and 365 days after the training are held together with the clinic/involved parties. These activities have the purpose of ensuring the quality and development of the training, in such a way, that support is given for maintenance of the new workflows. Finally, the need for repeating the training is addressed.

Health and social care professionals should be able to use technology in relation to:

• their own work area and workflows
• professional and interdisciplinary cooperation
• supporting the citizens’ use of technology

The training should in general qualify the staff to:

• Be able to use the technology in a secure and competent manner (the hands-on aspect of the training)
• Be able to support citizens’ use of technology
• Be able to adapt to technological transformations (the behavioural aspect of the training)
• Be able to participate in technological innovation
• Be able to critically and ethically reflect on technology

What is it?

The assessment concept is developed in relation to the  ‘On-the-job-training’ concept. This means that assessment of competences is approached as an integral part of training and implementation of technologies in healthcare. The actual design of an assessment process  also, beside reflecting the content of the training, takes into account the organisational and professional context of the training. 

From the user perspective

Tools have been developed for the recognition, assessment and documentation of digital/ technological skills acquired by health and social care professionals elsewhere than their formal educational system.
These tools consist of:

• Recognition: releasing a course certificate based on the evaluation of achieved skills
• Assessment: evaluation tools, which evaluate the participant’s own learning and the training itself (for instance, in situ evaluation, see below for details)
• Documentation: a portfolio for storing materials for potential later use

The aim of using the three tools is to develop a competence assessment framework, which can be adjusted to the specific learning situation and to specific technologies.
The assessment process shall – besides reflecting over learning content – also be based on the organizational and professional context for the training/teaching.

Emphasis is placed upon assessment as a process which supports teaching and provides documentation, which can be used as basis for a formal recognition of skills. The main idea is that health and social care professionals participate in training/education related to the various technologies throughout their entire work life, and they should have the chance to have these skills recognized, so that they can be used later in a different context.

In-situ assessment
This tool for the assessment of participants’ knowledge, skills and competences shall be adjusted to each specific learning situation. The reflective questions are mainly a suggestion; questions may be added, removed and/or adjusted to be relevant for the learning situation and for the learning outcome.
A web 2.0 Learning Management Platform (LMS) can be used to store the documentation. Course materials such as programme and other relevant materials can also be saved on the platform and the participants can download their certificate from it after the training.

For instance in Denmark Mobile phones can be used to produce documentation through the use of the It’s Learning app ( Learning Management Platform (LMS)) and hereby the participants have access to the in-situ assessment.