Dilshan Arawwawala, CCIO, Mid and South Essex Group

At the recent HETT exhibition HTN asked Dilshan Arawwawala, Chief Clinical Information Officer from Mid and South Essex Group a few questions.

Can you tell me about you and your organisation? 

I am a Consultant in Anaesthetics and Intensive Care and I’ve been doing that for 10 years at Mid-Essex Hospitals NHS Trust. I became the Chief Clinical Information Officer just over two years ago and upon starting that role I realised very quickly that I didn’t necessarily have all the skills and knowledge to work in that role to the best of my ability, and that was my trigger to sign up to the NHS Digital Academy which launched 2 years ago, which was an absolute saviour for me.

The course is split into 6 modules taking it from a macro view, from central policy all the way down to solving micro problems; having that end to end approach really shows you what people are trying to do, why they are doing it and what everyones roles are in digital transformation. We need to build the right structures into health organisations for clinically-led digital transformation if we want house resources wisely and demonstrate the value of the required investment.

Can you talk me through what you discussed in your presentation today and the key themes?

It was a panelled session with five clinical members from the Digital Academy Cohort 1 and it was talking around views from the coal face of culture and implementation of digital transformation.

The key themes based around the questions we were asked from the panel and the audience were around clinical engagement, trust and what are the measures of success.

It’s important that we try to put that into some kind of context, ultimately not all organisations are the same in terms of where they are with digital maturity, financial position; are they a GDE (global digital exemplar) or a cash stricken trust, ultimate without resource, a company will struggle to provide anything.

What was primarily discussed is about having a strong organisational structure which allows for clinical engagement; this includes support staff and healthcare professionals alike, and also a strong governance structure to prevent harm to patients from implementing a digital technology, to not lose trust with the staff who you have asked to use those digital tools, and to some extent the trust of the supplier of that technology. A collaborative approach is the best way to succeed!

There is also an excellent NHS Digital clinical safety course which we promoted; it is a 1-day course where you can train people very quickly around digital clinical safety.

Could you talk me through any technology projects you’ve implemented in the last 12 months and the learnings from them?

We implemented an EPR with DXC Technology and what you really need to understand is what your installed base is- how your organisation works, where clinical pathway variances are, how digitally mature and ready they are, or not as the case may be, and how new implementations fit in with the existing health information infrastructure.

If you spend the time to do that properly, free up your staff to properly engage with the implementation, the long term rewards you get from an empathetic and inclusive approach are massive, and that’s a difficult concept for organisational leaders – they have many operational deadlines to meet and investing resource in potential future benefits is difficult to do.

Currently, we are working on optimising our EPR. If you look at any industry, the only way you really get value out of a digital implementation is by investing in many years of optimisation and pathway transformation. The productivity paradox applies to all industries, including healthcare. Once we have a stable base and robust core pathways, we can start to add additional layers of functionality.

How important is clinical engagement?

Massively, in the US a study showed that 70% of a healthcare professional’s clinic time is punching data into a database; all the while, the healthcare professional is not focusing on clinical care. This only disengages staff and can lead to burnout. Clinical engagement comes in many shapes and forms but fundamentally, in terms of maximising engagement and building a digitally ready workforce, we have to find what that workforce needs to have the biggest impact – the smallest changes can have the biggest impact. For example, if I’m a nurse on a ward, do I know if each of my patients has an up to date venous thrombo-embolism risk assessment? There are digital solutions for VTE risk assessment with clinical dashboards and reporting functionality – these are things that we take for granted but are crucial for patient safety and patient care. Early demonstration of value really helps with clinical engagement and culture change.

As an innovator, what are you working on at the moment?

I am working on the issue of staffing and the current transactional approach to staffing- all nurses being yellow pegs, or all doctors being blue pegs. You can see what’s happening with our staffing where 1 in 10 posts are empty, many doctors and nurses are retiring early or not coming in to the profession at all, and we have to ask, why are healthcare professionals leaving? Many people think the main reason is pay, but actually the number one reason is the working environment and this tells us a lot in that we don’t fully understand what the wants and needs are of the people who actually joined the profession for the simple reason of wanting to care for others.