Digital technologies are transforming the NHS and social care, changing how care is accessed, provided and experienced, by both patients and staff, and the effectiveness of services.
Leaders have an important part to play in creating the conditions in which digital technologies to be effectively implemented and used, but this requires a significant change in leadership behaviours.
Typically, the NHS operates with funding, benefits and risk all enclosed within a department or organisation. However, using technology changes this and fragments resources, risk and benefit between departments, organisations and staff.
The NHS is a system and with digital transformation changes ripple through the system more than previously. For example, using electronic health records can mean clinicians spend more time in front of a computer and less time with patients, which can understandably be frustrating for both clinicians and patients. In addition, using electronic health records can increase the organisational risk of cyber-attacks and digital failures. But, on the plus side, the data from electronic records can bring benefits for individual patients, eg, through increased clinical safety, and for communities, eg, through population health initiatives. But these benefits are not directly felt by the staff who are spending more time in front of the computer and less time with patients. And so resources (staff time), risk (cyber-security) and benefit (clinical safety and population health) are split across multiple people, organisations and places.
'If leaders work in isolation, perpetuating silos, implementing digital technology is likely to increase pressure on some parts of the system.'
A second example is virtual wards – an approach that combines technology with remote oversight by a health care professional in order to reduce avoidable admissions and/or support early discharge. Virtual wards are becoming more important to the future of the NHS, highlighted as a key pillar of the urgent and emergency care delivery plan. For patients, virtual wards can provide care in their own home. For health services, virtual wards increase the overall capacity of a hospital without increasing the number of physical bedspaces with the caveat that a hospital employs more staff to monitor both onsite and virtual wards. However, the hospital receives funding to increase overall staffing and meet this increased need for patient support in different settings. So, the increase in resources usually flows to the hospital. However, it’s also likely that care needs of virtual ward patients will use resource from community health care staff, who now hold more patient risk but receive limited or no resource increase. Again the resources, risk and benefits are distributed across multiple people, organisations and places.
Successful technology-enabled change happens when the full potential of technology is harnessed while mitigating the negative impacts. This requires leaders to work across departmental, professional and organisational boundaries to achieve a shared goal; in essence creating a peer group of leaders sharing resources, risk and benefits. If leaders work in isolation, perpetuating silos, implementing digital technology is likely to increase pressure on some parts of the system.
'Successfully implementing technology means embracing a new kind of leadership.'
Elvis once sang: ‘We can’t go on together with suspicious minds’, and so it is with leadership and digital transformation. As technology in health and care becomes more pervasive, it disrupts leadership, and demands shared and collaborative leadership to avoid creating unintended consequences for systems, staff and patients. Successfully implementing technology means embracing a new kind of leadership.