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Delivering technology-enabled change in the NHS is far from straightforward. The health service is a vast and complex organisation, with a disparate and disjointed collection of systems and services.
So, how can healthcare CIOs use technology to help transform the NHS for the better?
Computer Weekly spoke with a range of digital leaders at the recent HETT conference in London. From IT infrastructure to leadership culture and onto patient engagement, here’s what six tech chiefs believe are the key issues facing NHS tech chiefs.
Putting the right foundations in place
Tracey Watson, CIO of the Northern Care Alliance NHS Group, says the focus on digital maturity in healthcare so far has been on “those that can”. While maybe 25% of trusts have received funding to be able to mature or transform digitally, other organisations face much more basic challenges.
“It’s about looking at legacy systems and thinking about exactly what’s needed to be done to put the right foundations in place,” she says.
“And it’s bit like a house; you can’t really start decorating a house until you build the right foundations. If you’ve built on land with subsidence, and you’ve got poor foundations, it’s all going to sink at some point.”
Watson believes NHS CIOs must prioritise investment in the IT infrastructure that underlies their organisations, including a fully accessible electronic patient record system. She says CIOs must also concentrate on system interoperability, ensuring they have the right governance and digital leadership in place.
“That underpins exactly what we’re trying to do in terms of liberating data,” she says, referring to developments in her own trust. Watson is focused on building the infrastructural foundations for digital transformation that she hopes will help overcome some of the issues associated to running legacy IT.
“That’s all about empowering clinicians to be able to get involved in what you’re doing as a CIO and how you’re innovating,” she says. “Because unless some of these digital solutions are intuitive, then they’re not going to be used, or at least they’re not going to be used in the right way, or the way in which they were designed or intended to be used, and you’re not going to get the benefits from them.”
Working collectively to deliver benefits for all
Lisa Emery, CIO at Royal Marsden NHS Foundation Trust, recognises that funding is a crucial issue for all trusts, yet it remains just one element of a much bigger challenge when it comes to the implementation of IT. Emery says everyone involved in the digitisation of healthcare must find a way to deliver joined-up services.
“My concern has always been how do we work collectively? How does the centre make sure that everybody’s on at least a level playing field to some extent? If the desire is there that you interoperate across the system and across a patient’s healthcare journey, then everybody needs to be at a basic level, and that requires a basic set of technology elements, such as infrastructure, systems, or services,” she says.
Emery joined the Royal Marsden in August 2018 and is overseeing a digital transformation project. She is working alongside other executives in the organisation to create a business case for refreshing the trust’s enterprise network and applications, including implementing new Wi-Fi connections, updating to Microsoft Windows 10 and introducing Office 365.
“As a healthcare system, we have to invest in that together to ensure we bring everybody up with us,” she says. “So interoperability is really important. But it’s not achievable unless we’re all at least at some sort of standard to allow that to happen. We need to have a bit more whole-system thinking.”
Overcoming communication barriers between healthcare CIOs and CEOs
James Freed, CIO at Health Education England (HEE), says the key issue facing healthcare CIOs now is one of culture. His organisation interviewed 152 chairs and chief executives at healthcare organisations as part of a research project into leadership in the NHS.
“In essence, what they said was, ‘Digital scares us, we don’t really understand it, our board doesn’t really understand it’. We appoint someone, usually a CIO, to understand it on our behalf. But in 66% of cases, we won’t let them sit on the board. So their view comes through an intermediary, often the chief finance officer,” says Freed.
When the CIO does speak, the value of digital isn’t properly articulated. CEOs believe CIOs speak a different language. They talk using terms that CEOs either don’t understand or which scare them, such as cyber security. CIOs also focus on why things can’t be done, instead of what could be achieved.
Freed’s organisation has started an initiative called the Digital-Ready Workforce to help translate the hallmarks of a digitally mature organisation into the sort of language that a board understands. HEE has been using a document called the Well-Led Framework as a medium for that two-way translation. Freed says progress is slowly being made.
“There’s been a systemic breakdown in communication between chief executives and CIOs – and that’s not just a health-and-care-specific issue, but it is something that I see in health and care,” he says. “Our best CIOs get that they need to change how they communicate with the board, but plenty don’t yet.”
Looking beyond the IT department and into the ward
Like Freed, Toby Avery, chief digital and information officer at Surrey and Borders NHS Partnership Foundation Trust, believes that IT leaders across the NHS still have a lot to learn when it comes to pursuing new avenues of digital leadership.
Avery completed the NHS Leadership Academy’s master’s in healthcare leadership programme seven years ago. He was the only IT specialist among a cohort of clinicians. That experience, says Avery, reset his view on the role of IT professionals in the NHS.
He says the biggest impact was on how he believes technology should be delivered – that digitisation must be focused on the needs of the patient. He says all NHS CIOs must go beyond the IT department and learn from the experiences of on-the-ground clinicians.
“If we’re not keeping our eyes on them, in whatever tech we deliver, then we’re missing a trick,” he says. “As a digital leader, I now look outwards a lot more. I engage much more broadly than I ever did before. And when you look out, you recognise that sometimes some of the inward stuff isn’t quite where it needs to be.”
Finding the right balance in an era of constant change
Bill Fawcett, CIO at Leeds and York NHS Partnership Foundation Trust, says it’s tough to pick one challenge above all others. The NHS faces multiple challenges and those concerns vary from one day to the next. However, he says the most critical issue for CIOs is to ensure they find a blend between maintaining operational systems and delivering innovative services.
“It’s about finding the plan that allows you, as a CIO, to stand up in front of an executive board and show them that you are making a difference,” says Fawcett.
“You want to be showing them that you’re setting a pace and that you’re doing something really wonderful, but equally that you’re a safe pair of hands and things are secure. You want them to know that if IT goes wrong – and things do go wrong – that they have the right person who’s going to put it right.”
Fawcett joined the trust as CIO in June 2015, after spending his career leading technological change in the private sector. He’s taken an outcomes-based approach to IT delivery at the trust, giving healthcare workers access to reliable devices and platforms. His experiences lead him to suggest that healthcare IT leaders should take nothing for granted.
“The challenge for CIOs is always being on that tightrope where you’re only two minutes away from the next disaster. So, it’s a balance – and you’ve got to get that right. You’re always going to have part of your environment that needs attention,” says Fawcett.
“CIOs might think they have the Holy Grail, where everyone’s got a new laptop, you’ve got a brilliant network, everybody’s connected, and it’s all working perfectly. But a new challenge is always going to come up. There’ll be a new organisation that joins your trust, or a contract will come to a close, or some system will just fail.”
Making sure that everyone is engaged
Allison Nation, associate director of digital strategy at NHS Somerset Clinical Commissioning Group, says engagement is the key issue for healthcare IT leaders. She says everyone in the UK is a user of healthcare services in one form or another. Explaining in plain English how digital can help change the provision of services for the better is critical.
“We need to inform people,” she says. “We often talk about digital literacy – and that needs to be about patients and their digital literacy, and about staff and their digital literacy. How are patients using tools at home? How are staff using tools at work? Any tools we use in healthcare should be intuitive – you should pick it up and use it, with no manual required.”
Nation is running a broad sweep of digital projects across Somerset, including an artificial intelligence (AI) pilot that is being run by Bering Research and GPs at Axbridge Surgery in Somerset. The project uses an algorithm in Bering’s Brave AI system to analyse the complexity of patient health. Nation says these pioneering initiatives prove the importance of engagement.
“Get everybody involved as soon as you can,” she says. “Look for co-design. Get technology rolled out and used, and find those advocates for what you’re looking to do. That’s really helpful. Also, challenge the most challenging person – and if you can encourage them to use new technology, then you’ve probably cracked it.”
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