Good clinical decisions are based on having understandable, accurate information in the right place at the right time. The ability to exchange and use information is fundamental to offering better, safer patient care at all levels of your system and enables staff to do their jobs well.
Sharing data is often referred to as interoperability - the ability of systems, organisations, and people to exchange and make use of information in order to operate safely and effectively.
As a leader in the NHS, interoperability is fundamental in your management of risk. At best, poor quality, or missing data frustrates patients and staff, creating friction in an already overburdened system. At worst, it can become clinically dangerous.
Interoperability isn’t simply a technology problem - it’s also a people problem. Your organisation’s culture and ways of working will have as much impact on your ability to share data as your technology does. So, interoperability is something that every leader in the NHS needs to understand and has the ability to improve.
Thinking about interoperability in layers
Interoperability can be thought of as three layers - technical, semantic and organisational.
Technical interoperability is the basic ability to share data between organisations or systems, and to be able to read and understand the format it is in. A simple example is sending an Excel spreadsheet file which someone else can also open.
Semantic interoperability is about making sure the meaning of the shared data is understood by everyone. In practice, this is about everyone using the same language to describe specific concepts. Semantic interoperability relies on shared Data models which specify how individual data items are related to each other in order to represent real world things. Data models are created for everything from a blood pressure reading to a full pre-operative assessment. If different data models are used to represent the same things it creates issues with sharing data, sometimes resulting in data being incorrect or even lost. 2But data models are inherently subjective because they’re defined and agreed by people - which makes interoperability a human collaboration challenge.
Organisational interoperability is often overlooked. It is about alignment between how people and teams are working. Having technical and semantic interoperability won’t help if people and teams haven’t built up the necessary trust relationships, or don’t have a shared understanding of what you’re trying to achieve.
Without organisational interoperability we can’t release the full value of the data we hold, for the benefit of patients and staff. We can think of the NHS like a 'data archipelago’ - a series of data islands, each holding and valuing its own data. Establishing solid trust relationships between teams and organisations becomes essential because if people don’t trust the data they’re being asked to use, especially when it comes from outside their organisation, they just won’t use it.
So, good interoperability relies on being able to share data, making sure its meaning is clear to everyone, and building trust and alignment between teams and organisations.
How can you lead the way for good interoperability in your trust?
From working with hundreds of trust leaders as a part of the Digital Boards programme, we’ve found three initial questions useful for boards to frame this conversation:
- How will we make sure that we can use our data flexibly in the future? This is the long term goal, so asking how the data will be interoperable, where and how it will be stored and how easily you can access it and use it will help you assure the strategic decisions and choices you’re making now.
- How are we ensuring that we’re learning directly from our users? Are you involving your users (your patients and your staff) and your stakeholders throughout the design and development of your systems? It means building ongoing user research and iteration into your delivery. It’s not enough to gather their requirements once and assume you’ve got all the answers. This is about extending a continuous improvement mindset from quality and improvement into technology.
Finding out where patients and staff are most affected by inadequate interoperability or access to data will help you understand what problems you need to solve. This means watching staff struggle with systems and finding out why, or looking at where poor processes are creating failure demand (the cost created by poorly designed services creating pressures elsewhere in a system).
- How are we ensuring that our teams are able to balance risk and make informed decisions that are aligned to the same outcomes? Creating a culture of collective responsibility for digital across your board, directly linked to your overall strategic outcomes and direction, will support your operational and governance teams to think about risk and decisions in the right way. Multidisciplinary teams that include commercial, technical and clinical expertise and leadership can help make sure the right questions are asked by the team throughout the organisation. Having NEDs who understand technology and data can also support you in providing effective challenge and support.
How we can help
The Digital Boards development programme aims to build board understanding of the potential and implications of the digital agenda and increase confidence and capability of boards to harness the opportunity that digital provides through board resources, webinars, peer learning and free bespoke board development sessions for individual trusts. To learn more and explore how we can help your board lead interoperability and other digital discussions, please visit our website or get in touch.