Getting technology decisions right: a challenge for all board members

Dr Ayesha Rahim profile picture

03 December 2021

Dr Ayesha Rahim
Deputy Chief Medical Officer and Chief Clinical Information Officer
Lancashire and South Cumbria NHS Foundation Trust

It's now said often that digital ways of working are radically changing the way health and care is delivered. Digital will help us address the biggest challenges facing the NHS: workforce shortages, care backlogs and financial sustainability. But it also creates new opportunities too: population health management, empowerment of our citizens and truly integrated care.

To unlock this potential, the NHS needs access to the right technology. And our leaders need to be making the right technology decisions. It doesn't mean they need to be experts, in the same way not every board member needs to be an accountant to discuss finances. But leaders do need a basic understanding and confidence to ensure technology decisions are owned at board level.

Launching our EPR during the pandemic

For NHS trusts, undoubtedly one of the biggest technology decisions the board will make is about their approach to electronic patient records (EPR). At Lancashire and South Cumbria NHS Foundation Trust, we rolled out our EPR during the middle of the pandemic, with minimal disruption to services. We achieved this because our leaders took the necessary steps to ensure success.

Ahead of launch, we focused on a "tripartite of readiness": operationally, technically and with regards to clinical safety. Crucially, each of these areas had board executive oversight. Throughout the build up to go live we held regular deep dives that were always chaired by either the chair or chief executive, and with several executive directors present. This was important for staff: it demonstrated that the board understood the biggest risks and challenges, showed they were accountable, built relationships and ultimately created a buzz and momentum about the new system.

I won't pretend we got everything right. We received some negative feedback from staff about the new system. Some reporting went missing. We didn't always anticipate the struggles that staff might have with the new system. In short, this is because change is hard. People don't read their emails. They forget their training. Not everyone lives and breaths it in the same way.

The initial problem was getting people to use the new system. But it is only in the weeks after launch, when people were regularly using the new EPR, did we understand the more granular issues around usability and functionality. Some of this took weeks and even months to manifest. So, my advice to others is to avoid being lulled into a false sense of security after go live. And remember, implementation is just the start not the end of your EPR journey.

My role as chief clinical information officer 

My job as chief clinical information officer was to help the board feel comfortable. I made sure trust leaders felt they could ask the difficult questions. And this wasn't just about presenting to the board. It required individual conversations and relationships with different executives and non executives. This is where the awkward questions were asked, including some that leaders would not normally feel comfortable asking. And I made sure I was giving honest answers.

The role of the board

Based on our EPR experience, we would share the following key lessons for other trust boards.

From the get-go, the board needs to have realistic expectations about return on investment. Leaders should understand that in digital this is often measured in years and not months. Any decisions must be based on evidence: speak to peers, networks and other organisations about what has worked for them. As part of this, the board should have a sophisticated understanding of what they're trying to achieve from a wider system perspective too.

This will only be achieved by asking the right questions. There is nothing in a boards' business that is not capable of explanation to a board leader whose professional expertise lies elsewhere. NHS Providers' new Digital Boards guide Making the right technology decisions is designed for those who don't have specialist expertise in this field. It gives introductory information to help board members frame these key questions ahead of any decision on technology.

This blog was first published by the HSJ.

About the author

Dr Ayesha Rahim profile picture

Dr Ayesha Rahim
Deputy Chief Medical Officer and Chief Clinical Information Officer

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