• Trusts have made huge leaps forward in implementing digital alternatives to face-to-face interactions during the pandemic.
  • Many of these have been underpinned by relatively simple technology and tangible changes to culture, processes, governance and ways of working.
  • The pandemic provided boards with clarity of purpose, freedom to act at pace, and focused minds on delivering minimum viable services.
  • Boards are identifying learning and what can be applied more consistently, and at scale, in order to sustain and accelerate the positive cultural shifts within organisations.

Given the systemic challenges faced by trusts, many might have expected the Covid-19 pandemic to create a digital meltdown in the NHS. In many cases, the opposite happened. Trusts accelerated adoption of digital technologies at breakneck speed, changing service delivery and ways of working almost overnight. But perhaps the biggest impact was creating cultural conditions where digital teams can take root as part of a more fundamental transformation of health and care.

As one acute trust chief executive has said, Covid-19 provided her board with clarity of purpose, freedom to act and a focus on 'minimum viable service' when it comes to digital. Boards now face the challenge of sustaining these cultural shifts, while supporting teams who continue to juggle business as usual with new ways of working.

Covid-19 accelerated three emerging trends that are critical if digital teams are to flourish:

1. Pace: the necessities of the crisis meant trusts had no option but to deliver change quickly. Rather than extended governance processes and sign-off procedures taking weeks or months, more autonomy and authority was delegated to teams charged with delivering prototypes, testing and experimenting with different approaches before rolling them out to the wider organisation. Achieving this increased pace of delivery also involved more ruthless prioritisation of the IT department's efforts to focus on fewer projects at once.

During the peak of the pandemic the agendas for the digital hospital committee were condensed and discussions focused on immediate COVID-19 challenges. Since then the agendas have been broadened again but with a built in “show and tell” element that will still enable decisions to be made quickly.

Kettering General Hospital NHS Foundation Trust    

2. Purpose: One of the structural challenges faced by every trust is the need to balance different strategic priorities that may be in conflict with one another; not least the need to provide excellent care within a budget. Like crises generally do, the pandemic rallied the NHS around a clear and unifying goal, with many reporting there was a new culture and willingness to accept digital technologies in a way not done before. Discussions about new digital programmes were kicked off with the question 'what problem are we trying to solve'?, with the answer provided by clinical and operational teams in the same room as their digital colleagues. As one CIO said, "this placed the levers of control in the hands of the customer," putting digital at the heart of delivering the organisation’s core purpose, rather than sitting off to the side.

During the pandemic the CIO worked closely with all the divisional and corporate leadership, to identify their own service needs for a new machine learning tool. A business case has now been approved in principle by the board, and a new group has been set up to identify how each division will implement and make the necessary savings from the tool (rather than the IT team itself). With appropriate clinical leadership and involvement from the CIO and divisional/corporate leads, the group will also look to embed future programmes of work, maintain a focus on prioritisation, and ensure benefits realisation. They will be held accountable for delivery with appropriate levels of scrutiny and transparency.

Bolton NHS Foundation Trust    

3. Priority: Many trusts introduced gold and silver command and control structures as part of their response to COVID-19. As a by-product, in many organisations this approach also thrust digital into taking a far more central role in the trust’s activities. Many CIOs and CDIOs reported having unprecedented access to their chief executives that helped expedite approvals and unblock problems.

During the peak of the pandemic Medway launched their own innovation accelerator. The Medway Innovation Institute funds pilot internal projects with £10k seed funding, all of which are rooted in quality improvement. One successful example was the rollout of wearables and remote monitors which meant nurses could keep a safe distance from COVID-19 patients. The director of transformation reflected that before the pandemic the trust may have not prioritised these projects because of a lack of capacity, or because they may have become tied up in governance and business case approvals. Now three months on since launch, the institute has registered over 80 innovation projects and the institute’s tech start up-style ‘fail fast’ ethos will be important as the trust begins its EPR journey in 2021.

Medway NHS Foundation Trust    

Find out more about the Medway Innovation Institute

To retain this sense of boldness and agility, boards are now looking to identify the positive behaviours that need to be sustained over the long term.

The bottom line is that clear purpose and priorities at leadership level combined with empowered teams is the key to successful digital transformation. It also requires organisations to be both digitally able (i.e. competent in using digital technologies) and digitally willing (culturally ready to harness their transformation potential). Health Education England's digital capability framework provides a self diagnostic tool to support individuals identify their digital skills learning needs and signposts to further support.

The response to Covid-19 both demonstrated a clear track record of digital delivery within every trust and a crucial shift in mindsets. In short, it created a powerful impetus for more far-reaching change.