Why Digital Transformation Matters

• Successful digital transformation delivers multiple benefits, from improved clinical outcomes and patient/service user experience, through to financial savings.
• The benefits of digital can be realised at an individual trust and whole system level.
• Substantial medium to long-term benefits can only be achieved and sustained with organisational change that goes beyond quick fixes and technology upgrades.

In the immediate response to COVID-19, few trust boards had time to consider the reasons for prioritising new ways of working or digital tools. They just got on with it. As the immediate crisis settles, leaders will need to step back and consider where digital transformation sits in their list of priorities in light of what has changed. If delivered successfully, digital transformation can lead to a range of benefits.

Clinical outcomes and patient safety

The ways in which digital can improve clinical outcomes and patient safety are well documented. Like all other industries, there are trends in healthcare technologies and a constant flow of new opportunities on the horizon. Almost all seek to improve clinical outcomes, patient safety and the quality of care.
New digital ways of working can build consistency across services. Most importantly, this leads to a reduction in clinical variation and fewer clinical errors. It can improve communication and documentation within an organisation and across a system. In the NHS, perhaps the most obvious example is the Scan4Safety campaign, which encourages trusts to use barcode scanning and radio frequency identification software to identify the most appropriate use of equipment, medicines and resources. Trusts are using other decision support tools to improve clinical consistency, such as electronic prescribing. Artificial intelligence will increasingly have a role to play too, as highlighted by the trusts using AI to help improve detection of acute kidney injury.
Digital underpins better and faster coordination of care, which means patients and service users receive the most appropriate care in the most appropriate settings. Perhaps the most obvious example here is telehealth, which allows clinical care to be delivered remotely when appropriate. Beyond telehealth, eObservations and virtual multidisciplinary teams are also giving patients and service users access to the most specialist and interdisciplinary expertise. Meanwhile in the ambulance sector, new triaging software is improving response times and ensuring patients are seen in the most appropriate care setting.
Perhaps the most significant digital transformation for the long term relates to prevention. Digital can play a big role in keeping more people healthier for longer. At the simplest level, this could mean giving patients and service users more control over their own healthcare, such as through remote monitoring and wearable devices. More sophisticated use of data will enable earlier interventions and upstream prevention of avoidable illness. This has already started with the development of predictive analytics and risk stratification, but the continued expansion of the local health care records exemplars (LHCRE) is enabling system partners to focus on population level health outcomes as never before.

User experience

There have been lengthy debates about the appropriate term to attach to experience when discussing digital. Whether it is user, citizen, patient, customer or stakeholder, the essential point is that successful digital transformation can dramatically improve everyone’s experience of healthcare.
‘User’ is a helpful shorthand, because it captures the full range of actors for whom digital should enhance the experience – patients, service users, clinicians, visitors, support staff, managers, and so on – and the fact that the same individual can be a different type of user on the same afternoon. The word experience itself also has a different quality in healthcare to what you might see in other industries. Simplicity and efficiency are all valued just as much, but so are kindness, empathy and compassion.
Good digital services, underpinned by reliable data, can support a healthcare system that is more proactive and of higher quality, but just starting with the basics can make a huge difference to user experience and adoption. 47% of users will give up on a website if it takes more than 3 seconds to load. In 2018, Google tracked over 900,000 landing pages on mobile websites in an effort to understand their overall mobile performance and found that 70% of web pages needed significant improvements to enhance usability. ‘Light’ pages, clear language and mobile responsiveness are all relatively straightforward to deliver.
In healthcare this will often mean direct patient involvement in the development of new digital services. This is particularly relevant when designing services to enable patients and service users to actively monitor and manage their long-term conditions. Patient engagement in service design is also essential given the continued challenge of digital exclusion.
The central importance of user experience cannot be underestimated. The UK government digital service’s (GDS) mantra was ‘start with user needs’. GDS’ experience showed that by focusing on experience, the savings would come – the UK government saved over £3.5 billion on digital and technology between 2011-15. However, the GDS was never set a savings target – deliberately. Such targets were recognised as warping incentives when delivering services, leading people to make the wrong design, technology, policy and procurement choices, which leads to bad services, which are then not used, and therefore do not make savings. Focusing on user experience makes it more likely an organisation will find itself in a virtuous circle, rather than a vicious one.

Staff engagement

Without staff in every part of an organisation playing some role in digital transformation at the right point and time, it generally fails. If digital transformation is delivered (or perceived) as a top-down, management consultant-led exercise where staff are ‘managed’ through the process, it is almost guaranteed to not work as intended.
Successful digital transformation recognises that frontline staff are very likely to offer many of the keenest insights on user needs that need to be addressed – both of patients and service users, and from themselves. These are usually uncovered and addressed by making frontline staff an essential ingredient of a multidisciplinary delivery team, rather than through occasional consultation. Digital transformation is best thought of as a combination of a mandate (from the top of an organisation) and a movement (from within the organisation, at all levels).
Many trusts will have a group of staff very willing to get involved, provided they’re given a team to be part of, the time to commit to it, and a level of empowerment to get on with it without distraction. In government, GDS had a mantra: ‘find the angry people’ – shorthand for those who were passionate and committed to the organisation, and desperate to fix the broken things they could see.
More generally, the response to coronavirus has seen a change in clinical attitudes towards digital. In recognition of the urgency and challenging nature of crisis response, more are willing to tolerate imperfections in new services and ways of working, provided they are continuously improved upon. This tolerance, and a greater appreciation for starting with a ‘minimum viable product’ quickly rather than waiting for a perfect solution to arrive much later, is a behavioural shift that is essential to making digital change stick.
Like quality improvement methodologies, the point of digital should be to get the best from all staff, improving not just quality of care, but also reducing the day-to-day frustrations that impact job satisfaction. It should make it easier for staff to perform the tasks they are best at and automate or eliminate those that are drudgery. It could mean clinical staff operate at the top of their license. Returning to the carer’s allowance example, the DWP reduced headcount in the carer’s allowance unit by 11% due to the efficiencies brought about by the digital service, yet a staff survey showed that 91% of staff preferred working with digital claims as opposed to paper submissions.

CASE STUDY

Cambridge University Hospitals NHS Foundation Trust
Inspiring the workforce to embrace digital

The context

Cambridge University Hospitals NHS Foundation Trust (CUH) is a university teaching hospital providing acute and specialist care across the east of England.
In 2014 the trust deployed Epic: a new electronic patient record (EPR) system. This ‘big bang’ implementation presented a number of challenges for the organisation, and a major incident was declared one week after go-live. Since then, CUH has worked hard to ensure it has the right culture, workforce strategy, transformation capacity and training plans in place to align its digital vision with the wider trust strategy. The board has made clear that future investment into its digital programme is linked to continuous improvement, safety, transformation and connectivity, rather than simply technology.

The challenge

One of the lessons learned from the Epic launch was about clinical engagement. Clinicians had expressed concerns during the EPR deployment that they felt were not taken on board by the trust leadership. While Epic had lots of technical capabilities one senior leader described the situation as “owning a sports car but driving it in gridlocked traffic”. The CUH board has worked hard since then to regain the confidence of the clinical community. Emphasis is now on building change management capacity and encouraging more integrated working between clinicians, operational and digital teams.
At the leadership level, the trust’s chief clinical information officer as well as the director of improvement and transformation have strong links into the clinical workforce and feedback any frustrations or concerns to the board. There has been a greater recognition of the need to invest in staff training to ensure the benefits of new technologies can be realised over the long term.
The trust has built a narrative for staff on its digital journey, focusing on getting the building blocks in place to enable wider innovation, and highlighting the progress made to date: “we are better and more efficient as a result of implementing Epic, and we are getting better all of the time.” The board believes establishing this narrative will support its digital strategy in the long term, regardless of any personnel changes at board level. The narrative has also been important in retaining and recruiting staff, not just to IT teams but also across the organisation: people want to work at CUH because of the progress it has made on the digital agenda. The trust’s brand is intrinsically linked with its digital maturity

The impact

Like many trusts, implementing an EPR system is important in laying the foundations for more advanced digital transformation. As part of the trust’s response to COVID-19, order sets (a form of dynamic protocol used in EPR systems) have been developed that are guiding clinical-decision making on testing. This allows expertise about infectious diseases to be shared more effectively and leads to better consistency in the application of evolving trust guidance.
Junior staff members continue to come forward with ideas for new digital solutions and apps, reinforcing the trust’s digitally innovative narrative. CUH is already beginning to think about the use of machine learning and artificial intelligence in radiology and cancer multi-disciplinary teams with the use of natural language processing.
Source: https://nhsproviders.org/a-new-era-of-digital-leadership/why-digital-transformation-matters