Clinical salesmanship and better information: making the most of digital technology in the NHS

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Digital technology is developing rapidly and is providing opportunities to change and improve care across a range of settings. Last year, we started work on a project with provider organisations that have already undergone significant organisation-wide digital transformation, attempting to find the common challenges and benefits brought by their projects. We will publish the full report on that work in June, just ahead of our Digital health and care congress in July, at which some of the organisations we are working with will be presenting.

In the meantime, though, we thought we’d share some of our early findings based on the experiences of two of our case studies: Liverpool Clinical Commissioning Group, responsible for NHS services across the city which is implementing a shared patient record amongst other technology developments, and Essex University Partnership Trust, a community and mental health provider covering one of the largest geographic areas of any single trust. Liverpool’s project aims to improve the health of its residents through the use of technology; Essex University Partnership Trust has been using digital technology to change the way it delivers services to its patients. Both areas are pursuing similar projects, such as providing access to online materials, using electronic records and giving staff the ability to access their office facilities through mobile working.

We visited these organisations late last year and spoke to the people driving through change at all levels. There was agreement about the benefits of technology, as well as the factors that help or hinder efforts to implement it. The most consistent message was that clinical engagement was important throughout any change process, but in particular where some people feel more uncertain about what the coming change means for their work, as they might with digital technology.

What does ‘clinical engagement’ mean in practice though? Interviewees in both Essex and Liverpool emphasised the importance of peer-to-peer communication and clinical leadership, as well as allowing the people working at the front line to design the service they would be using:

I was a commissioner and somebody who worked in IT, so there's no way a clinician who didn't necessarily believe in the technology was ever going to listen to me. It needed to be in the peer groups that you did that. That's been a big change for us … we now engage and we now have clinical leadership in digital that we've never had before, and that's where it gets driven from.
Commissioner, Clinical Commissioning Group

It isn’t just clinicians who need to ‘buy in’ to digital change programmes, however. Several people emphasised the importance of support and belief at board level, which allowed project leads to keep their organisation’s senior management up to date but also reinforced the importance of the projects to other staff:

The joint programme we're doing, that's got executive-level ownership from both organisations, you've got your finance director there. And if it's ownership at the top and they appreciate some of the challenges and the size of the undertaking, the messages then flow down into the organisation. 
Chief Information Officer, provider trust

None of our interviewees found digital change easy; they shared important lessons to help others avoid the same difficulties they ran into, which we’ll present fully in the final report. A common thread across many of the provider organisations was the difficulty in resourcing a project in terms of both the technical support needed and ongoing training:

I don't think that the investment in training and support is large enough. We underestimate that. It's make-or-break. It's not the system that's the issue, it's the people who are using it... I don't think it's about us not having the money, I think it's because we've never asked for that... Can someone use it [the system] when they get on? I think we haven't taken that to its fullest extent. 
Chief Information Officer, provider trust

But what of the benefits of implementing digital technology? The main benefits seen in Liverpool and Essex have been in improved patient safety resulting from better information:

In medicine, you are always working with certain levels of uncertain information... the amount of missing information has dramatically reduced. 
Chief Clinical Information Officer, provider trust
If our clinicians have access to up-to-date information themselves, whether it's a detailed patient record or other things, then they're able to make a better and more informed decision. I think that then ensures better quality, better safety and should also improve the patient experience. 
Chief Executive, provider trust

The keys to success in digital projects seem to be: the quality and level of clinical engagement and involvement in project and system design; the belief in your work and involvement at board level; resourcing your support and training correctly.

This is a small sample of the data we’ve collected and the themes and issues we’ve identified. Our full report will bring in information from three more case study sites and dozens more interviews. I hope it will be useful to all those looking to make the best use of digital technology in the NHS.


Tech Review

Technical Manager,
Comment date
20 May 2018

In asset-intensive industries such as medical or healthcare, no amount of talent or money can accomplish all the prescribed best practices without error. In fact, most organizations fail at the first of the recommended practices: creating comprehensive inventories of the company’s hardware and software assets. That is a huge shortcoming, because you can’t secure what you don’t even know you have.

Mr R W Ebley

Comment date
16 March 2018

In order that change is effectively undertaken all levels of government and other public funded organisations need to demonstrate good management

Independent management accreditation is required to achieve this

Thank you

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