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Scepticism of NHS IT and the digital transformation

14th January 2020

Have we seen it all before? Is there hope?

As advocates of technology and innovation, we are very excited about the bright future of the NHS and we’re encouraged by the statements, policies and recent mission statements of the government, the NHS and NHSX. The NHS Long-Term Plan (LTP), as covered in a previous post, represents a positive change that will benefit many people in the UK.

Our enthusiasm for the future of the NHS, and the digital transformation at its heart, is shared by many but not by all. We decided to take a look at what concerns are being expressed.

The Vision

The digital transformation initiative seeks to standardise business processes within the NHS and allow different departments across health and social care to work more closely. Customer experience and outcomes are at the heart of the business model and the vision includes openness to artificial intelligence and machine learning.

The Department of Health and Social Care generated the Long-Term Plan and NHS England (including NHSX) is driving its implementation.

In June 2019, a few days before he took up the post, the now Chief Executive Officer of NHSX made a keynote speech that outlined the digital transformation strategy. The full speech can be seen here on YouTube

During the speech, Matthew Gould took time to acknowledge the scepticism from those within the NHS and that there is a general feeling of having “seen this movie before…”

Mr. Gould’s astute observation on this point would appear to be correct and probably stemmed from the time he spent in the weeks leading up to this speech touring the various medical institutions of the NHS up and down the country during which he spoke directly with the staff on the frontline.

That NHS staff form the main voice of concern shouldn’t really come as a surprise, and from what we have seen it is not just overworked A+E staff venting their frustration, there are many at a senior level who have raised an eyebrow and expressed concern in a blog or commented on the blogs of others.

What are the concerns?

In a blog for the independent charity The King’s Fund, a Senior Consultant for Leadership and Organisational Development, Mandip Randhawa, writes about the importance of ‘transformation’ being necessary at the level of the individual and not left to a particular project team for example.

In critiquing the movie we have all seen before, Mandip gives a warning for the directors of the sequel – namely, change attitudes, beliefs and behaviours of the individual and consider whether the existing architecture of the NHS is suitable for this purpose.

The point of view in the article seems to have struck a chord with many readers including current and retired MDs, senior nurses and academics who have all left comments of broad agreement.

When considering Mandip’s article, it is easy to appreciate the position of scepticism amongst staff:

Consider for a moment that working in the NHS is a difficult job that carries a high level of risk – decisions can be life or death and in any case affect the health and wellbeing of patients and their families. Jobs in healthcare take a significant amount of time and effort to learn and then yet more time and effort to master the right operating procedures particular to any institution.

Therefore, when a ‘transformation team’ comes in and starts changing the way things are done, often with little understanding of the knock-on effects, there is bound to be resistance.

Bear in mind that staff retention in the NHS is a major issue that threatens the very existence of the organisation. Enforcing change is dangerous, experienced and efficient staff members can feel they have been reset to rookie status, having to learn processes that were second nature before the change. Individuals dislike demotion, be it real or imagined, it erodes professional pride and self-esteem. It also affects the quality of care that is delivered to patients.

Staff in the NHS have experienced transformation many times before. They have been reset to ‘rookie’ each time and for little or no benefit that they can perceive.

Solutions Going Forward

You may have noticed that some of the problems that the digital transformation is trying to correct are actually part of the cause of the resistance from staff. Such as changing the particular working practices of an individual department in order to standardise processes across the entire hospital or trust. Is there an answer?

A digital system that does not replace the existing IT infrastructure, but overlays it and brings everything together in one place on one intuitive interface achieves modernisation, future-proofing, and accessibility while retaining familiar working practices.

With a system that unites desktop and mobile with digital interconnectivity that includes patient access, hospitals can produce real, tangible transformation. Practices identified as sub-optimal can then be addressed gradually so the effects can be monitored and harmful changes reversed or amended.

Example of traditional business decision versus the innovation of digital overlay:

Consider a hospital department that runs three different computer programmes to function effectively. Staff within the department are now used to the software and work efficiently with the foibles of each system.

The department is reviewed and identified as a candidate for improvement. Efficiencies can be made, costs saved and patient experience improved – says the reviewing team.

A single computer programme is found on the market that promises to be able to handle all the functions of the existing three systems. There is an initial cost upfront but the projected savings and improvements to service are judged as worth the expenditure.

Here we have an ostensibly sound business decision. Decisions like this are taken every day in every type of industry and it is hard to pick fault in the rationale. However, this type of call is purely business and ignores the fundamental human element that we discussed earlier in this blog and the main point that Mandip made in her article too. Pure business decisions do not tend to work well in the NHS.

The overlay solution works differently. Sitting on top of the existing system it unites them with single sign-on and a single interface. The working practices that are familiar to the staff remain the same initially so there is no upheaval.

Real efficiencies are felt rapidly by staff and patients. Single sign-on alone improves the access staff have to their vital computer systems, which in turn promotes patient experience. In the Gould speech (linked above) he talked about the nurse who tried to show him something on the computer system she used but was unable to log in to it, even after half an hour. Imagine being a patient in that hospital.

Overlay solutions do not cement in the systems they rest upon, far from it. They provide a continuity structure that enables older software to be removed and new systems to be installed without noticeable disruption to staff or the need for them to have to retrain in basic computerised procedures.

myday uses API connectors to overly existing IT infrastructure, presenting the full functionality of all programmes to users via a single intuitive interface requiring a single sign-on. If you would like to know more about myday, please contact us for information or to arrange a demonstration.


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