The word “transformation” has become a buzz word in healthcare. According to the Cambridge Dictionary the noun describes “a complete change in the appearance or character of something or someone, especially so that that thing or person is improved.”
The English National Health Service (NHS), which will turn 70 this July, has various attempts of transformation under its belt. The more recent ones were in connection with digitising various aspects of its operation. But to what effect, one might ask? What was improved?
The answer to this question is not so clear cut and is rather dependent on the experiences delivered by the digitised operations.
The more important question, however, is how can this change process be mastered?
“Saving lives costs money, saving money costs lives”
The recent protest rallies in the first months of 2018 had people demonstrating to call for an end to NHS’s budget cuts and constraints. They highlighted a clear sign of discontent within the NHS. Protestors were disgruntled, shouting, “Saving lives costs money, saving money costs lives.” In truth their dissatisfaction was as much to do with frustration with the UK government’s lack of support and investment for the wider healthcare platform as it was a commentary on the transformation progress thus far.
The digital transformation of healthcare delivery has been widely viewed as a major cornerstone in the attempt to use resources more efficiently. However, the NHS’s track record of bringing about such transformation is somewhat tarnished. Most notably, the National Programme for IT (NPfIT), the £12.7 billion attempt to bring the NHS into the digital age by moving towards a single, centrally-mandated electronic health record for patients and to connect 30,000 general practitioners to 300 hospitals, did not work out. Launched in 2002, it was shut down in 2011.
What had gone wrong?
There was a conceptual flaw of imposing a top-down IT system on the local NHS, which did not fit their respective needs. Additionally, the change programme did not have sufficient clinical engagement. With time, the realisation sunk in that digital transformation is not just about implementing technology, but a change management process that requires leadership and the buy-in of all involved. It also became apparent that a successful digital transformation needs executives who are knowledgeable in both worlds, that of medicine and informatics.
Déjà vu – an industry not in isolation
Learnings made in one industry might seem unique, except, of course when there is a common link. Few industries – if any at all – have escaped the touch of digital technologies. The transformation resulting from the impact of these new technologies and the evolving behavioural and engagement practices they engender has succeeded and failed on a number of easily identifiable characteristics – the availability of people with the right cultural mind-set for collaboration, vision and trained skill sets. CIC has long monitored and showcased the experiences of organisations from across the market spectrum in implementing new software and digital technologies and operational processes. We have not been alone. Take a look at agile software development strategies and DevOps application delivery practices adopted in industry sectors such as finance and insurance, retail, automotive, manufacturing etc. and the failure points mirror exactly those highlighted above when we ask ‘What had gone wrong?’.
The metaphorical breadcrumb trail of do’s and don’ts when it comes to leveraging digital technologies has been talked about across the market landscape with case studies of experiences packed to the rafters. NHS Digital, smartly, is starting to recognise that industry specifics aside, it is not alone when it comes to traversing the challenges of digital transformation. In the area of training and education, its approach to addressing the challenge of getting it right is one that would work for other organisations in other industries and markets.
The new NHS Digital Academy: Establishing a cadre of clinical IT leaders
Fast forward to April 2018. The time for the first cohort of 100 executives to resume their one-year-long training at the newly founded NHS Digital Academy. Its CEO, Rachel Dunscombe, describes the programme as a “52-week transformational journey”.
The NHS Digital Academy’s goal is to train and support the next generation of clinical and IT leaders to ensure that they have the skills, expertise and access to the foremost experts in the world. To shape this new cadre of leaders, the academy runs tailored training programmes in informatics and executive/change management, with both national and international partners.
The academy is a virtual organisation that will train altogether 300 executives over the next three-year period to create a cohort of “digital leaders”. This new generation of managers will be recruited from clinical and non-clinical backgrounds. Applicants are required to have five years informatics or digital experience, the support of their Chief Executive, and be able to attend three one-week residential training sessions in-person as the majority of content will be delivered online.
The initial focus will be on chief information officers (CIO) and their clinical counterparts, chief clinical information officers (CCIO) from NHS trusts across the country. The goal is to equip them with a set of skills so needed for managing the digital transformation successfully.
The Institute of Global Health Innovation (IGHI) will lead a consortium that includes the University of Edinburgh and Imperial College Healthcare NHS Trust (ICHNT). The consortium will also obtain international strategic input from Harvard Medical School, a partner with a high level of expertise in blended learning, health informatics, leadership development and transformation programmes. This endeavour represents the first nationally funded program of IT training. There is a fund of £4 million to run the academy programme. At the end of the contract, IGHI has a clear strategy to ensure it will be sustainable by moving to a fee-based model with industry sponsorships and international fellowships. The alumni will receive ongoing support and will be part of a network of internationally based digital leaders.
The English patient
The digital academy was set up mainly in response to Professor Bob Wachter’s review of NHS IT that was published in September 2016. In his independent report, “Making IT work: Harnessing the power of health information technology to improve care in England,” he stresses that it was vital to the NHS’s future to create a fully digitised NHS. However, Wachter pointed out – “just installing computers” would not suffice. “It is not just about the technology, it is about the people too”, says his report. It is a good point that is reiterated across industries.
Wachter identified as the crux “a lack of professionals – namely CCIOs and CIOs – that can drive forward the transformation agenda enabled by informatics and technology.” He observed a lack of digital know-how in the NHS as one of the barriers to the digital transformation. As a remedy, the report called for placing well-qualified executives who are trained in both clinical care and informatics in every trust. But those are hard to find.
The Wachter report concluded that a significant new investment was required to develop those CCIOs who are vital to the success of digitising the NHS. Announced in September 2016 by Jeremy Hunt, Secretary of State of Health, the NHS Digital Academy was launched a year later, on 11 September 2017.
A smart move that resonates, but don’t stop there
NHS Digital is now specifically engaged in addressing one of the main barriers to successful transformation – training and equipping key stakeholder leaders from across the various clinical and operational domains of the NHS with the technical and practical skills of working in the digital landscape. That they are doing so is both a welcomed step and a confidence boost to the success of future transformation projects.
Other learnings must be made though. Insights that will work just as well for the NHS as it looks to operate more effectively digitally are there in plain sight and easily accessible. Not only can they be found in CIC’s sizeable research vault and on our website, but also elsewhere. As an example, there is a common unifying success factor that CIC found when interviewing leading organisations from other industries on the foundations that underpin their transformational initiatives. Of the many nuggets of insights discovered, a leading one was: Bringing together the right mix of people equipped with the right technical skills, creative vision and practical knowledge set. Doing so can help NHS Digital to reimagine processes that will deliver a step change in operations and provide for more effective patient engagement and outcomes to be achieved.
After all, a notable step change in improvement is at the heart of what is required of a vital service that must be fit for future purpose – financially and operationally.
Training leaders isn’t just a UK topic
The perceived need to improve leadership skills is not just a UK phenomenon. In its Q3/2017 Annual European eHealth Survey, HIMSS Analytics found that this was also true throughout more than 14 other European countries. The answers of 467 respondents from health institutions, IT software vendors, governmental health authorities and other professional organisations as to how important it was to be able to develop their leadership skills within their roles respectively their organisations were fairly unambiguous: The average score across all types of organisations stood at 4.2, with 1 being “not important” and 5 “very important”. The score among healthcare organisations only was even slightly higher at 4.3.
Although this survey did not investigate the particular training needs required, it is a clear appeal that healthcare organisations (and others) need to develop crucial leadership skills, without them, it will be much harder to master the path of the digital transformation in the best possible manner.
“The birth of professional profession”
The NHS has experienced major setbacks en route to its digital transformation. It has finally sunk in that a digital transformation is a change management process that needs leaders that are skilled in both worlds, the realms of medicine and medical informatics. It is, as Dunscombe rightly said, the “birth of a professional profession” with a more structured set of skills to be learned. This is an important move for improvement.