The King’s Fund – the role of smarter hospitals within an integrated care landscape

The King’s Fund, a health and care improvement charity in England, recently delivered a virtual panel discussion on the topic of smarter hospitals within integrated care.

The latest session, entitled ‘the journey towards a smarter hospital within a new integrated care landscape’ was sponsored by IBM, hosted by Julia Cream, Policy Fellow at The King’s Fund, and featured high-profile speakers from across the NHS.

The panel of five included: Lisa Hollins, Director of Innovation at NHSX; Dr Mark Davies, Chief Medical Officer (Europe), IBM Corporation and IBM Watson Health; Fiona Edwards, Accountable Officer and Chief Executive, NHS Frimley CCG and Frimley Health and Care Integrated Care System; Professor Kiran Patel, Chief Medical Officer, Deputy Chief Executive and Consultant Cardiologist, University Hospitals Coventry and Warwickshire NHS Trust; and Dr David Selwyn, Medical Director, Sherwood Forest Hospitals NHS Foundation Trust.

What is a ‘smarter hospital?’

Julia launched the discussion by stating “smarter hospitals is a phrase or a concept that many people will have heard of but might find hard to actually define” and asked Mark to outline what a smarter hospital actually is and what it means for patients and staff.

“The concept of a smarter hospital,” he began, “is one that we’ve used to frame the discussion around the current redesign opportunities for our hospitals.”

“At the heart is a consideration of the opportunities technology plays in that but absolutely not in isolation – this is about examining the redesign opportunities that technology opens up; not just digitalising what we’re doing or, indeed, introducing technology for the sake of it. At its heart [it is] a redesigning, rethinking question for the hospitals of the future,” he said.

“In many ways, smarter hospitals is more about digital transformation than just technology deployment…what we’re talking about here, smarter hospitals, is a verb – a process, a journey, rethinking services; it isn’t a thing or concrete destination or, if you will, a noun. If we were to describe what that process is, it is absolutely about thinking about those opportunities, or user-centric design created by bringing together three things: the use of technology, the rethinking of our estates and the opportunities of how we might use our buildings, and the deployment and use of our workforce.”

“The prize here,” he added later, “which I might argue is actually an operational imperative in the current context is more efficient operations, much better designed care pathways, and less impact on the environment…a much deeper embedded relationship with our communities, which makes the walls of our hospitals, if you like, much more porous – in a way that, frankly, our patients always thought they were anyway.”

“In summary, a smarter hospital is what just feels smarter to work in for its staff, it feels smarter and more joined-up for patients and carers who are receiving care, and one that is better enabled to step up and effectively play its part as part of cross-system care design,” Mark concluded.

Julia added, “so it’s very much about not a physical building but a way of working that transforms care across the system”, before going on to introduce the rest of the panel and ask them about where they each are on their journeys towards smarter hospitals.

Lisa of NHSX said: “I think we have huge opportunities to change how we work and improve how we work…the things that I’m interested in [are] how pathways can become digital pathways through the great platforms that we’ve seen for healthcare.”

“Other work that will support hospitals to become smarter hospitals are the changes in shared care records, where people can see and view information along the clinical pathway.”

Fiona then provided her perspective from the Frimley ICS, adding: “Our journey, particularly regarding digital as a whole, is based within our primary function, which is to address health inequalities and improve the health and wellbeing of our population.”

She noted that their system was a complicated one with over 40 public sector partners, including local five local authorities, three community and mental health providers, as well as acute hospital sites, primary care networks and ambulance trusts, plus 11 public sector providers outside their system.

“We are considered to be on the edge of everywhere,” she said, “so boundaries and connections are a core way of working for us…we’ve learnt as a system – we’ve been around now for about five years – that relationships and working in partnerships for the benefit of our communities is our absolute prime consideration.

“Having platforms that connect our organisations and our data are our ways [of] removing walls, removing boundaries and really focusing on the needs and priorities of our population.”

“I view hospital systems, and creating a smarter hospital, as really being all part of a journey of creating smarter health and integrated care,” she concluded.

David, who has a background in critical care, added: “Reflecting back on Mark’s introduction…I think it’s fair to say that I don’t work in a smarter hospital, I’m not sure I actually work in a smart hospital. But we’ve started to try and make change – we have a vision, we have a digital strategy and we’ve embarked on that. So, I hope perhaps I can bring some of the clinical conundrums to the discussion and focus on some of the changes that we all need to make.”

Kiran, a cardiologist by background and formerly of NHS England, rounded off this section by saying of his organisation, “we’re on a journey and it is a journey without an end in sight, which I think is the right way to see digital journeys – it’s not about establishing a product but, actually, an enabler.”

After highlighting his trust’s achievements around digital pathology, he said: “Although we often see hospitals as very visible…organisations, I would describe care as the converse; care has to be tangible and not visible, and our ambition is that we need to deliver care which is not confined within geographical boundaries or any time constraints either, we need to deliver care 24/7.”

“In terms of our digital journey, I’m quite keen to see a digital journey that brings integration across the entire population, as well as organisation, because we all know that architecture within the NHS comes and goes, and it changes relentlessly – but our citizens are here to stay,” he said.

The panel then went on to discuss the idea of hospitals without walls, electronic MDTs, how remote technology and dashboards are changing patterns of care, and how to engage those that may be resistant to change and transformation, by acknowledging people’s legitimate concerns, which are often based on years of experience regarding infrastructure.

Kiran said of the challenges: “When you ask about challenges and leadership, Julia, I think it’s important not to underestimate the challenges that our clinicians and managers face – it’s been a really busy year. I wouldn’t see embracing digital healthcare as a way to save time. Don’t underestimate the time it takes to deliver care and prepare care for something simple, like an outpatient appointment.

“We need to make sure that we provide the resources that individuals need – and be very open and honest when things don’t work and deliver as they propose to do. And then make sure that we create time to generate the skillset that people require. I always remember a phrase ‘you’re only as good as your worst team member’ – that may be for very many reasons, one of which is that they just don’t have the skills and capability. We have a workforce that spans multiple digital decades and we’ve got to cater for all of that, so it is challenging.”

“Don’t forget passion,” he advised, “nobody comes to work to do a bad job but people have different drivers, and health inequalities is a real passion that I have, personally. But we’ve appointed a public health consultant that reminds me everyday about healthcare inequalities and digital inclusion is something we must absolutely embrace.”

As an example of this he cited, the COVID-19 vaccination programme and a QR code developed by staff from the trust as an online tool to help access. Their public health consultant made sure this was available in different languages, with iPads and staff provided to take people through the algorithm if they weren’t digitally enabled, to ensure equity of access.

Experiences of transforming care

Julia also asked the panel for their real-world experiences of transforming care.

Kiran focused on EPRs as the biggest transformation he expects his organisation to have over the next five years, which he said implementing and realising the benefits of, while delivering healthcare at the same time, felt somewhat like “redesigning the aircraft as we’re flying.”

Mark commented: “We have tended to start with the technology, we tended to start with the answer, and actually, if you look at the experience of digital transformation in most other industries, that’s not how it happens….it tends to be design-led.”

“You create the technology roadmap, understanding the pain points,” he said, “then you can plan in a flexible and modular way…at its very heart it’s all about people…it’s about users and people, it is less about boxes and wires.”

Lisa, meanwhile, highlighted how transformation could change and improve the retention of the workforce. “Some of the developments we’ve spoken about…offers some opportunities for people who aren’t able to work the many hours full-time staff work; if they want to work part-time, if they want to work virtually, if they have to be at home at certain times and have caring responsibilities…some of the different remote types of pathways open up different types of roles for people within the NHS – it might help us to retain some of the staff that we sadly lost over the last 10 years, or so,” she said.

Fiona, who has been a chief exec for 20 years, added some insight from past implementation ‘failures’, saying: “My learning over the years has been looking for the perfect, robust solution and grounding out benefits realisations and thinking you can deliver them in a linear way, you’re doomed to failure with that. You have to almost build the capability…in terms of digital competence of your organisation, at every level.

“Latterly, in my chief exec career, I’ve really invested in making sure you have digital leadership in boards, digital competence and [ensuring] the digital team in any organisational system sees themselves as part of the clinical transformation…and that we make judgements about going where the energy is.”

The session was rounded off by Julia asking the panel about plans and hopes for the future.

Fiona focused on keeping people at the centre, and the importance of enthusiasm, risk taking and experimentation, while Lisa pinpointed opportunities to impact working lives through technology.

David said: “Digital not a thing, it’s not a something in a box that you get out. I see it as an enabler, as a cultural change vehicle, if you like…if we don’t stretch ourselves…if we truly aren’t bold then we’re really going to struggle to realise the true potential of all of this.”

Kiran added that he hopes to take clinicians with him on his digital transformation journey and summarised by saying, “we all know that healthcare is a business, but we know that delivering it is an art.”