Let's be honest, the NHS has a chequered history on digital transformation. With highly variable levels of digital maturity within the sector there have been high profile failures as well as some great success stories.
However, what has been striking about the response to COVID-19 is the consistent theme of innovation from across the NHS, including accelerating digital ways of working. From the increased use of video consultations to the introduction of robotic automation to supply oxygen to COVID-19 patients, digital has been pivotal to the sector’s pandemic response.
With the burning platform of responding to a pandemic, discussions about digital have been elevated within many board rooms. And now, as we move through the first wave of coronavirus, trust leaders are eager to lead their organisations into the next stage of digitisation. They want to build on their successes, lock in the learning of COVID-19, and sustain new ways of working.
To be effectively led and managed digital must be the collective responsibility of the board and it is trust boards that must harness the opportunities it provides.
With this in mind our new development programme, Digital Boards, has been launched to support boards in leading digital transformation and is being funded by Health Education England.
As part of this programme we are launching our the first in a series of publications, A new era of digital leadership, with our partners Public Digital. These publications will support boards to increase their confidence and capability to lead the digital agenda.
One of the most important roles of boards is to ask the right questions. In our first guide we set out a set of questions board leaders can ask themselves to reflect on their own digital leadership:
Does the trust have a shared understanding of what 'digital' means that goes beyond IT?
We know the term 'digital' can mean different things to different people. But it’s useful for boards to be on the same page about what 'digital' means for their patients, service users and staff. In our programme we are defining digital as "applying the culture, processes, operating models and technologies of the internet-era to respond to people's raised expectations".
Can you explain which areas you chose not to focus on in your digital strategy, and how you made these decisions?
When it comes to digital strategy, prioritisation is the watchword. For example, during the first phase of the NHS' response to COVID-19, one IT department slimmed down its list of priorities from 30 to just two, allowing them to deliver digital transformation at pace and at scale.
Has the Board experienced what users of the trust’s digital services experience, rather than just read a description on paper?
We all know a good trust leader walks the floor of their organisation to understand the experiences of patients, service users and staff. So it should come as no surprise that the same approach should be taken to digital services.
Does the trust's leadership take collective responsibility for the digital agenda, as it does for quality and finance?
Digital should not be the responsibility of one board member. At Milton Keynes University Hospital for example, the board take collective responsibility for all aspects of the digital agenda. While the HR director might focus on e-rostering, the finance director concentrates on automating administrative functions and the medical director may lead on telemedicine. Digital is core to everyone's role and each executive portfolio.
Is the board sufficiently technologically informed to hold digital leaders to account, especially on major contractual arrangements with suppliers?
Digital can be treated in a similar way to finance: not everyone has to be an expert, but everyone is responsible for delivery. Boards should know enough to understand the opportunities and implications of new digital services.
Does the board have the confidence and knowledge of digital working practices, processes and technologies to take a proportionate approach to digital risks and opportunities?
Trust leaders tell us their organisations have a high-risk appetite for innovation, but a low risk appetite when it comes to safety. This has perhaps been even truer during the response to COVID-19. But risk appetite shouldn't remain fixed, and as a trust's digital aspirations become more ambitious, they will increasingly need to balance risks and rewards.
Does the trust have a shared commitment and vision for digitally-enabled health and care across its STP or ICS? Is the trust clear on the system's investment priorities?
Now more than ever there is a need for ICSs and STPs to share data and for new digital services to be interoperable with systems in other organisation. We know that trusts are already agreeing system-wide investment priorities to ensure a pipeline of digital programmes that will cover multiple services and organisations. This approach only serves to strengthen system working and the aspirations of true population level health management.
Is the trust taking opportunities to copy and adapt learning and work from other trusts, the centre (NHS Digital/NHSX) and other industries? Is it sharing its work?
The Digital Boards programme focuses on sharing best practice and peer learning. We know that board leaders benefit from understanding 'the art of the possible'. The global digital exemplar and blueprinting programme has already facilitated much of this learning. It will be important for trust leaders to continue these conversations with their neighbours and peers.
Are teams in the trust empowered to experiment with new ways of working, and is the organisation well placed to scale up innovation when it succeeds?
Many trust boards have told us their role is to create an 'enabling environment' for their digital teams to innovate and experiment, which might include giving 'permission to fail'. One of the key learnings from the digital directorate at Sussex Partnership has been to let go of the 'quest for perfection' and instead focus on a minimum viable product.
So as trusts make their way through the pandemic, and consider their digital futures, we hope that our guide, including these questions, provides a useful prompt for board level discussion about digital. We know the pressures facing boards have never been higher, but it is also clear digital technologies and ways of working are going to be essential during the recovery phase and beyond.