The POTE Framework

What is POTE?

POTE (Practice, Outcomes, Technology, Evidence) is a four-dimensional iterative framework for the co-development of technology and practice in complex care delivery settings. Developed by Adam Hoare and Ken Eason and first published in 2014, POTE addresses the false choice between technology-centred and practitioner-centred design by insisting that all four dimensions are dynamically and iteratively interdependent.

The central question POTE poses is: "Within a given context, how do we successfully couple practice to the technology to produce evidence that the desired outcomes are being generated?"

Practice

The full range of ways different Gateholder groups must change their practice to engage with the intervention. This is not limited to front-line practitioners — it includes patients and clients, informal carers and families, clinical professionals, social care workers, commissioners and managers, and IT and information governance staff. Practice must be developed in co-production with technology; each shapes the other.

Outcomes

The outcomes sought by all Gateholders at all context levels, defined from the Gateholder's perspective rather than imposed from the system level. A commissioner may seek efficiency savings; a patient may seek reduced anxiety and greater independence; a nurse may seek better clinical decision-making. All are legitimate and must be explicitly mapped. Outcomes address the full range of value: economic, social, and clinical.

Technology

The technology developed or adapted to deliver the intended outcomes and generate the necessary evidence, in the most appropriate and usable way for each Gateholder group. Technology in POTE is always in service of outcomes — never developed in isolation. The Technology dimension is where the platform approach is activated: reusable infrastructure that can be adapted across contexts without rebuilding from scratch.

Evidence

The range, format and accessibility of evidence required by different Gateholder groups to engage with, trust and adopt the intervention. Different Gateholders need fundamentally different evidence: clinicians need outcomes data in clinical terms; commissioners need economic evidence; patients need experiential confidence; regulators need safety data.

Evidence in POTE is both formative (generated continuously during deployment to guide iteration) and summative (capable of accountability reporting at project closure). This dual role requires evidence to be instrumented into the platform, not collected retrospectively.

The Five Classes of Evidence

The Five Classes of Evidence framework maps onto the POTE Evidence dimension: Class A (Activity data — how the platform is being used); Class B (Service reviews — cycles of planning and reviewing); Class C (Sociotechnical evaluations — stakeholder experience); Class D (Social impact — dignity, independence, confidence); Class E (System impact — statutory data including A&E, GP, length of stay).

POTE in Practice

POTE was the explicit governing model for the BOLD-TC project (technology for people with learning disabilities across five geographies), and its clinical logic is visible in the Renal Remote Clinic at Lister Hospital. In the Local Investment Programme, the consistent failure of LIP projects to embed evidence collection from the outset reflects a failure to operate the Evidence dimension of POTE from project start.