Digital transformation is not a linear process. Technology evolves, user expectations increase and organisational structures and priorities shift. Things don't always go to plan; many organisations make mistakes on their way to digital transformation. And, as shown by the impact of COVID-19 on the NHS, there are factors outside of your control that can have an outsized impact on any digital transformational plans.
Get comfortable with not knowing everything at the start
It's important to set a clear overall direction for digital transformation, it's not possible or desirable to detail everything upfront. Most large organisations have structures that can encourage a false sense of certainty. Business cases, funding conditions and programme planning are all designed to reduce risk, but in reality, these are just educated guesses. In fact, the start of a project or new investment is the point at which you know least. Trusts should create a culture where teams feel they can talk about assumptions and risks, not hide them away. Testing risky assumptions early is one of the best ways to avoid failure.
Be prepared for things to go wrong
No matter how good your digital transformation plans are, things will happen that you don't expect. Trusts should be realistic about timing and benefits, and avoid becoming hostage to fortune. It's best to plan for things going wrong. Trusts should find ways to make their organisations more fault tolerant, limiting the impact of any digital failures.
Reprioritisation is a sign of maturity
There can be a temptation to stick to a plan that's not working for longer than is healthy – likely because a lot of political and actual capital has already been invested. However, trusts should beware of the 'sunk cost fallacy' – if something isn't working, it can be better to change paths rather than throwing good money after bad. It's OK to reprioritise – in fact, it's a sign of a mature, learning organisation. Organisations that have undergone successful digital transformations have adopted mechanisms that make this easier. Smaller, shorter delivery cycles, regular checkpoints and feedback loops to inform when an investment is working, and when course-correction is needed. Boards should make clear to everyone involved in digital transformation that what matters is not 'delivering to plan', it's delivering the right outcomes.
Key questions for boards:
- Do your business cases create a false sense of certainty?
- Are teams able to be honest about the risks involved in digital transformation?
- What mechanisms do you have to review and reprioritise digital initiatives?
Delivering electronic prescribing across a hospital group during the pandemic
Newham knows how to do Newham best. We had a plan for deployment, but the leadership accepted that each hospital site will have its own way of getting things done.Group Chief Information Officer, Barts Health NHS Trust
The trust had previously piloted electronic prescribing and medicines administration (EPMA) in a single ward six years ago, but found its infrastructure wasn't advanced enough and it hadn't properly engaged with clinicians and the wider workforce to guarantee successful adoption. Crucially, there was no business case post pilot. Work began again in 2018 to deploy EPMA to replace paper, with go live scheduled for May 2020.
Based on its previous experience, the board decided to avoid piloting and started straight away with widespread engagement and training. However, the work had to be paused in its entirety during March 2020 when many digital and clinical staff were redeployed to support the first COVID-19 wave. Training was cancelled and kit that had been earmarked for the new EPMA rollout was repurposed for the London Nightingale hospital set up.
After several weeks, the trust chief information officer (CIO), chief nursing information officer (CNIO) and chief clinical information officer (CCIO), along with the director of strategy, and chief medical and nursing officers worked through the pros and cons of further postponement. A 'drop-off point' was calculated, after which the trust would need to start over. As a consequence, the board took the decision to restart the EPMA deployment despite the ongoing pandemic response.
The trust began individual site roll-outs in September 2021, rather than a 'big bang' launch across the four acute hospital sites. The Bart's leaders recognised implementation would need to be tailored and localised; each site has different cultures and identities that the group needed to respect and engage. In addition to this each site has a clinical informatics lead and nursing informatic lead who have a forensic understanding of how to manage changes.
The individual site roll-outs surfaced several issues at each stage. For example, at one the team found certain medicine sets which were specific to a speciality were unavailable on the new system which was a particular problem with the rapid emergence of new COVID-19 treatments. But it also meant it could be addressed before the rollout at the next hospital. This iterative problem-solving model was used throughout the full roll-out schedule until all sites were live and full adoption was achieved.