Technology plays a critical role in health and care today, with some arguing it is a key determinant of health, as better digital tools and access to real time health data enables the delivery of better care. However, we know from our work that trust leaders find themselves ill-equipped to make the right technology decisions that will enable their organisations and systems to collaborate and innovate.
Start by asking what the trust is looking to achieve before considering any technology solutions. You need a clear vision that flows from your overall strategy. This will help you avoid being distracted by shiny new technology that won't help you deliver your vision. Start these conversations early, before the business case stage is reached.
Focus on the data – what is it, how will you use and share it, how will you keep it safe? Too often this data layer gets less attention from leaders until it's too late.
Take the threat of cyberattacks seriously. Attacks on public sector organisations are increasing, and most attacks are opportunistic, using known techniques. No technology has a monopoly on security, it's down to how it is set up, the controls around it and – ultimately – how it is used by staff and patients. Doing nothing carries its own risk, for example not investing in new technology, relying on outdated legacy systems.
Make sure honest conversations about risk, failure and realistic mitigations are had early and often. Avoid the sunk cost fallacy or projects that become too big to fail. Smaller technology projects delivered incrementally with more flexible commercial terms is one of the best safeguards against this. Start small where possible, solving real problems, and test and learn before committing. Make sure your commercial teams are well briefed and understand the sorts of things you want to guard against in any longer-term contracts, and the consequences of not having that flexibility. Ideally you're already taking a multi-disciplinary approach to procurement, so that your commercial team is not working in isolation from your technical leadership.
These changes will not be achieved in a single leap. Our ambition is to build maturity over time.
Think about the decisions you need to make – some will have lower impact or can be easily changed. Some technology decisions will be one-way doors with longer-term consequences where you will need to build for flexibility, particularly making sure that you leave your options around data open for the future. Consider how you will work with your ICS, provider collaborative or place partners on these decisions, making sure you're putting appropriate focus on getting those decisions right.
Beware of fake 'commercial-off-the-shelf' (COTs) solutions. There's a lot of debate about buying vs building when it comes to technology decisions – in truth you will probably already have a mix of both, and continue to do so. Any system you buy will need to be configured to work within your technology and data ecosystem. Buy when it makes sense (where it's a known commodity like email, payments or cloud storage), consider building when it is not. The right answer to technology decisions changes over time as technology evolves.
Consider how you can use technology decisions to further collaboration across the system. Keeping the user front and centre of conversations will help drive the right decisions. Look for quick wins to help level up organisations across your system – your
system is only as strong as your weakest link. Make sure your ICS and ICB colleagues are engaged on digital.
Why making good technology decisions is important
Technology literacy is as important to leaders now as human resource, quality or finance literacy. It's part of the toolkit of a modern board leader because technology is a fundamental part of how organisations are run. When technology fails it can have a devastating impact on the trust's ability to deliver for its patients. But equally if the technology you rely on just isn't playing its part in helping you collaborate and improve services, it will be acting as an underlying barrier for change.
Finally, while technology is important – it's also important to remember that it's your wider operating model, ways of working and ability to design services to meet user needs that will determine the success of your digital transformation. A new piece of shiny new technology won't be the answer on its own.
Hear from a trust leader
Watch the video below for reflections on making technology decisions from Patricia Miller, chief executive for Dorset Integrated Care Board.
Making the right technology decisions for Dorset County Hospital NHS Trust
Common pitfalls
- Trusts who go after new sources of funding for specific technology, when that technology isn't what they need.
- Time spent discussing but ultimately not making a decision, where the risk of doing nothing isn't considered.
- A focus on the technology and the procurement/business case that doesn't answer key questions about the data layer and interoperability.
Questions to ask
When you come together as a board to discuss your technology decisions, these key questions can help you assure whether you are setting the right conditions for success:
- Are we making the right technology investments? What principles are we using to
guide our decisions? - How does our approach to Electronic Patient Records (EPR) fit with our wider strategic organisation and system mission and goals?
- How usable and how safe is our data?
- What's our plan for both care and technology system integration?
To learn more, read our longer guide to making technology decisions – in it you'll find more about how to think about and how to set your organisation up for success.
Four more things you could read on this subject
- The Lancet and Financial Times Commission on governing health futures 2030: growing up in a digital world – The Lancet
- Board toolkit: five questions for your board's agenda on cybersecurity – National Cyber Security Centre
- "Fake COTS" and the one-day rule – Sean Boots
- Tackling the challenges of sharing data effectively in the NHS, and why it matters for NHS leaders – NHS Providers