Five key reflections for boards
- Be ready to commit to a long journey. Digital is the golden thread that runs through the trust, not just a flash in the pan.
- Fully engage as a board member. Our distributed board leadership means each exec leads on aspects of digital, even if it's outside of their comfort zone.
- Empower a digital culture. The board sets the tone for the rest of the organisation. People and culture are more important to digital progress than the technology.
- Build trust and confidence with your suppliers by proactively managing these relationships.
- Expect benefits in the form of improved quality of care and a reduction in admin time first, as cash-releasing benefits take time to amount.
Digital has remained a golden thread throughout everything we've done over the last 30 years. And the results speak for themselves:
- In 2021 Sunderland Royal Hospital attained HIMSS EMRAM Level 7 status and was the first in the NHS to complete all requirements of the national GDE programme. South Tyneside District Hospital subsequently achieved HIMSS EMRAM Level 5 accreditation in 2022.
- Our emergency department (ED) at Sunderland Royal Hospital was also one of the first to become paper-free in the country.
- The trust has achieved Cyber Essential Plus accreditation over three successive years.
- Our MEDITECH electronic patient record (EPR) is integrated with the Great North Care Record which is enabling clinicians from across the region to share information at the point of care.
These have translated into a number of efficiencies:
- A 99.4% reduction in inpatient and a 95.8% reduction in outpatient paper case note requests.
- An 80% reduction in medical record staff whole time equivalents.
- A 60% reduction in the time taken to action results once an electronic notification has been received by a clinician.
At the NHS Providers Digital Boards "member spotlight" event, my team and I shared lessons learned from the last 30 years.
As a chief executive, I have high expectations of the board
Board engagement is crucial to the success of digital delivery across a large organisation. The key is to ensure each leader can explain the benefits. For example, can the nursing director explain the benefits of a new decision support tool to nursing teams?
South Tyneside and Sunderland NHS Foundation Trust has a distributive leadership model, and while "digital" may be outside of some board members' comfort zone, it is a part of board development. We've already got plenty of people who understand technology within our organisation – that's not what I am expecting of board members. I want leaders to be inquisitive, and to challenge and support our major digital initiatives, drawing on previous experiences.
Executives and non-executive directors participate in digital subcommittees and we run whole-board workshops that deep dive into specifics of our digital agenda. I personally attend an annual chief executive's meeting with our EPR supplier MEDITECH. All of this is a serious time commitment but establishing good relationships and building confidence and trust is important to us as board leaders.
Culture is set from the top down
Changing the culture of an organisation starts with what the top teams are doing and saying. This sets a tone that will flow down to your teams and to your recruitment. For example, in our consultant interviews we spend less time on the nuts and bolts of the job and more time learning if the candidate understands the ethos of our organisation, including our commitment to digital. The culture you want will self-perpetuate if you recruit people who have this as their DNA.
For me, taking a hands-on approach to our digital transformation means chairing the GDE programme board. This signals the importance of digital transformation to my board colleagues and the rest of the organisation.
Start with the hardest thing first – but take it in strides
At times, boards may shy away from initiatives viewed as 'too hard' and instead focus on more straight-forward, albeit less impactful, wins. But sometimes a board must 'swing big'. It's worth remembering you don't have to do it all at once. Even a large project can be broken down into small sprints and phased testing grows momentum overtime.
South Tyneside and Sunderland NHS Foundation Trust set an ambition for paperless working and knew that achieving this in our ED would probably be the hardest service to start with. Not only did this deliver the expected benefits, but more importantly the change in ED were visible to staff and patients. This enabled us to fast-track adoption in other services: everyone wanted a piece of the action.
Bake-in clinical engagement
Clearly communicate the reasons why the organisation has committed to digital transformation and how it will help patients and staff. Once clinicians realise the reasons behind digital initiatives, they will start to lend their expertise to the cause and help reveal gaps and areas of improvement.
For example, representatives from multiple staff groups, including clinicians and administrators, led the development of a new EPR module for our ED. Clinically, it would have been difficult to dedicate two or three full time equivalents to digital work, so instead digital responsibility was shared widely across the teams. It was crucial to have clinicians involved at every stage, and as a consequence the ED module was a huge success.
Adaptability is a measure of digital maturity
Some tension will arise from the varying levels of digital maturity within an ICS. But it is important to keep in mind that digital partnerships are not about the tech, but are about the people.
We have experience of joining up differing strategies (reconciling a best of breed and single supplier EPR approach) during our merger in 2019. We focused on people and process as a first priority – technology was secondary. We learned that willingness and capability to adapt is a good measure of an organisation's digital maturity and this is becoming increasingly valuable.