Ignore the hype
Trust leaders can feel pressure to innovate by adopting new technologies. However, this often results in the "appearance of innovation without changing anything that matters".
The hype cycle is a well observed phenomenon in technology. New technologies emerge, with early adopters attracted by the novelty. Media attention raises awareness, causing a surge of interest in the technology. Vendors use it as a buzzword, customers feel pressure to try it out. These high expectations are difficult to live up to, and the initial enthusiasm in the technology wanes. Eventually, organisations figure out how to get the most out of these technologies, and they enter the mainstream.
Blockchain, robotic process automation, artificial intelligence and digital twins have all gone through this cycle. Boards should be cautious about these kinds of hype technologies, especially those promoted by vendors and consultants. Often, these are presented as a 'magic wand' that can solve difficult problems, but the reality is usually far less impressive.
Limited bets on emerging technologies can be useful, but not at the expense of applying proven technologies to your trust's problems. Given the NHS' limited means, it is important to have the fundamentals in place first and avoid getting distracted.
The board needs to understand what its areas of expertise are, but you can't expect everyone to know everything. You'll need access to the right level of understanding in order to ask the right questions. But you should also be alert to what is driving the advice you're receiving. Make sure you're having the peer-to peer conversations to understand how it's being done elsewhere.
Chair, Nottinghamshire Healthcare NHS Foundation Trust
Adopt a problem-first mindset
Boards should be cautious of technology-led approaches that lack clinical involvement and clear outcomes for patients and staff.
Digital transformation is about more than just applying technology to your organisation. The right approach is often to work backwards. Start with a clear outcome, find out who your users are, understand their problems, design a service to address them and then figure out what technologies (if any) can help. This is harder than just implementing an existing system: it requires thinking in terms of problem statements and outcomes rather than specific types of systems.
However, this can sometimes be too heavyweight an approach. Often the right approach is to pattern-match. If something has been solved many times before, there is no point in trying to reinvent the wheel. If you need an email system, you don’t need to run a discovery and design your own system – you just need to adopt a commodity service tried and tested by others. All board leaders should consider joining networks and communities that will allow them to share ideas, case studies and learn about pitfalls to avoid.
You will, however, need a team responsible for any new tool: even if it is a system you buy, you’ll need to configure it, improve it and make sure it is adopted across the organisation.
Many new off-the-shelf systems fail because organisations don’t have a team responsible for spotting when pattern-matching has gone wrong, and lack the feedback loop necessary to fix it.
The approach you end up taking will depend on the skills, experiences and – to some extent – biases of your teams. In the NHS, technology teams are usually expert in procurement, project management and operations within healthcare rather than software design and development. This is part of the reason why buying technology – especially systems marketed specifically to NHS organisations – is far more common than building software.
Boards should help the trust build a diverse technology team with experience of different approaches and a strong understanding of modern technology.
And any decisions on technology should be made by diverse groups with inclusivity at their core, otherwise you risk prioritising the needs of one group over another. Diversity of culture, experience and thought helps you avoid making bad decisions. Board leaders should consider joining groups such as the Shuri Network and take an active role in fostering equality, diversity and inclusion within the digital agenda.
Case Study
Widespread engagement at County Durham and Darlington NHS Foundation Trust (CDDFT)
“From a chief executive perspective, it is key to establish what it is you are trying to achieve. What is the aim and ambition, and then ask how does the technology play a part? For CDDFT this was about enabling clinicians to spend less time on administration and more time caregiving.”
Chief Executive, County Durham and Darlington NHS Foundation Trust
Context
County Durham and Darlington realised that their previous 'best of breed' approach to EPR was no longer viable. They were faced with around 25 legacy systems in place, several of which required repeated patching. Staff were frustrated by these slow systems that required multiple sign-ins.
Approach
The board quickly established a clear and single ambition that any new system fundamentally needed to allow clinicians to spend less time on admin and more time caregiving. This would be the driving force behind any technology decision. Improvements to back office functions and cost savings would be important but secondary aims. This clarity of focus guided the board in their strategic discussions, clinical engagement and the EPR supplier tendering process.
The trust's leaders decided to pursue a large EPR system to replace their previous 'Clinical Portal'. The trust moved quickly to build project teams and rollout engagement across the organisation, led by the medical and nursing directors.
They proceeded with a "ground up" scoping process in which digital champions were heavily involved in articulating the clinical needs, and engaged in due diligence. A CIO, CCIO and digital nurse matrons were appointed. All clinical staff were encouraged by board leaders to speak with other trusts and potential suppliers, in order to investigate the available options. Over time, County Durham and Darlington has appointed one sixth of its workforce as digital ambassadors for the EPR programme.
The trust's two staged approach of aligning on the vision and then empowering clinicians to do "ground up scoping" has given board members the confidence that their chosen system is clinically suitable and strategically aligned with the wider needs of the organisation. The high level of staff engagement puts the trust in a strong position for success during implementation.
Automate the right things
Technology isn't always the answer: sometimes organisations try to implement technology when a manual solution would be better.
Trusts should avoid automating too soon. If a process is new, it’s not usually advisable to build a system for it. Let it bed in and improve, otherwise you risk burying it in concrete: it is much harder to improve processes that also require technology changes.
Some processes – even mature ones – are ill-suited to automation. Technology is the best solution for some problems, for example, standardised, repetitive tasks and complex calculations. But things that require judgement and empathy are probably best left as manual processes.
You also cannot 'automate away' inefficient clinical processes. Even where automation may eventually bring benefits, you will need to do the hard, human work of solving the process problems before you involve technology.
Within the NHS, there is often too much reliance on the 'digital' bit of digital solutions. You need to holistically consider processes and everything else that goes around the technology. EPRs cannot be implemented differently in different parts of the organisation. Trust leaders must therefore break down any reluctance to the organisational development work that is needed for implementation to be successful.
Director of Finance and Deputy Chief Executive Officer Gloucestershire Health and Care NHS Foundation Trust
Key considerations for boards
- Outcomes-first – but don't reinvent the wheel: It's always a good idea to start with the outcome you're aiming for and work backwards. But for problems that have been solved many times before, there may be tried-and-tested solutions you can adopt quickly.
- Start with the basics: Solving real problems for patients and staff with mature technology may not be as exciting as adopting cutting edge technology, but it is where trusts should focus their attention.
- Technology isn't always the answer: Sometimes a manual solution may be better than automation, especially for new or rapidly changing processes.