Interview, Secondary Care

Interview Series: Bruno Botelho, Director of Digital Operations at Chelsea and Westminster Hospital 

Bruno Botelho, Deputy Chief Operating Officer and Director of Digital Operations at Chelsea and Westminster Hospital NHS Foundation Trust took time out to chat to HTN about his role, current projects and vision for the future.

As well as opening new digitally-enhanced critical care units, the trust and its charity CW+ have had a busy year in which they’ve stood out for innovation. This has included initiatives such as introducing a wayfinder app for patients, joining the NHS Clinical Entrepreneur Programme, rolling out new thermal imaging and screening technologies, developing apps to help patients manage conditions such as diabetes and HIV, and even running an innovation funding final.

But what else has the trust been up to? And what else is in the digital pipeline? HTN finds out…

Hi Bruno, tell us how you came to be in your present role

Where do I start? I’m trained as a nurse and started in the NHS as a qualified RN [registered nurse]. Over time, I got very interested in efficiency, productivity and patient pathway management, as well as the cost side of running the business. That led me to a couple of roles within Operations – as Efficiency Lead, General Manager, and then to more senior roles within the NHS.

At Chelsea and Westminster, I’m embarking on my fifth year. I joined in 2017 as Divisional Director of Operations. I was in this role for almost three years but, having always been interested in digital, I moved into a new role that was primarily focused on leading the deployment of an Electronic Patient Record (EPR) system. I’ve been Director of Digital Operations for over a year now and, as Deputy Chief Operating Officer, I also support the current Deputy CEO and Chief Operating Officer role on a range of activities, mainly related to operational performance and delivering the national standards.

What are you working on at the moment?

The deployment of the EPR is the single biggest piece of transformation the trust will go through, at least within the next 15 to 20 years. We’ve replaced an old system across two hospital sites and introduced a Patient Administration System (PAS), as well as an EPR system – with the aim of going paperless in the transition. Today, all of the patient pathway is now managed without requiring access to paper, and all the patient records are accessible via a computer.

As a result of the deployment of the EPR, my team and I are responsible for identifying inefficiencies and driving optimisation of the system. This means adjusting functionalities, developing new workflows or supporting staff with training material. We have a significant number of projects related to EPR alone; this ranges from simple workflows within the outpatient pathway to more complex work within anaesthetics and intensive care units.

In addition, we’ve a portfolio of other digital and innovation projects as part of our CW Innovation programme – run jointly with CW+ – with partners like Sensyne Health and General Electric (GE). Our initiatives drive improvements in patient care and experience through state-of-the-art equipment and new models of care and patient pathways.

As an example, the Sensyne piece of work in ICU has helped clinicians manage COVID-19 patients in real-time – which is fascinating and has truly tested some of our new digital capabilities. The teams were able to forecast how the disease would progress, using machine learning algorithms and clinical information obtained during the first few hours of arriving to the hospital. Clinicians are now able to predict the need for an intensive care bed and for mechanical ventilation. It’s an excellent effort all-round from clinical and non-clinical staff. It shows that data and the way we use it at the moment really adds value.

We recently brought in ISLA – a video and photo system which links back to the main EPR, ensuring images taken by patients are readily available for clinicians to manage specific pathways. This also avoids patients having to travel to the hospital for their consultations – it’s very helpful for patients and staff and is already proving to be a success.

The trust has always ‘pushed’ for innovation and digital to improve the delivery of care within the population we serve. As an example, a few years ago we introduced a provider called DrDoctor as part of a project called Test Bed. They were contracted to handle our patient text messages and patient correspondence.

We have worked over the past year to improve and expand some of the functionalities. Through DrDoctor we now send c.114,000 text messages per month for appointments, allow patients to reschedule consultations by pressing the keypad on their phones, ask patients to complete online questionnaires, and run video consultations. It also enables patients to access their patient letters online – 71% of our patient population is choosing not to print, which helps to reduce our costs and helps the environment. In addition, we have used DrDoctor to manage the booking of our staff COVID-19 vaccine.

We have also been working with our partners to significantly improve the management of the patient pathway, from referral to discharging the patient back into the community – this is called the End to End Patient Pathway project. The aim is to surface the correct data from our systems and empower clinicians to easily manage the pathways. We have developed a tool as proof of concept and are currently trialling sections of that tool across the trust. This could be a game changer in the way patients are managed within the hospital and across the sector.

What’s your vision for the hospital and trust going forward?

That’s the million-dollar question at the moment – if only I had a crystal ball. The last 12 months have been extremely challenging for staff and patients. However, there has been an overall recognition of the importance of having data and real-time, accurate information.

Going forward, there’s probably three areas that are strategically important: one is around the network and infrastructure – we need to make sure that whatever we’ve got is resilient, fast and can be accessed from anywhere; second it’s about having a smarter capability function within the hospital, relying on the data points that we’ve created, equipping staff with better tools to manage the patient pathway which will then open up conversations about the power of analytics and forecasting tools to inform decision makers; third, we’ve seen a boom in wearables – your sensory type devices that are enabling patients to have remote monitoring. This became so important during the pandemic and is an area that will grow.

I think the future is very exciting. It’s about us now agreeing to the roadmap and continuing to support the workforce that’s been battered about during the pandemic. We must not forget the need to continue to focus on efficiencies and make better use of the resources. Often investment required to support digital, innovation and frontline staff is made possible thanks to the success of cost improvement programmes.

How did the wayfinder app come about?

It was an initiative led by the charity, CW+, and some of my clinical colleagues. The mobile app will help patients and their families navigate their way around the hospital more easily, reduce staff time spent giving directions, help ensure patients arrive on time for appointments, reduce stress, and minimise traffic in the corridors.

What have your learnings been over the past year?

Lessons learned? The army of people from across operational teams, clinical teams, and informatics all working to keep the show on the road – often overnight.

Now, it’s about keeping that momentum. How do we continue with the same drive? I’m saying this because people are tired. So, how do we work with our workforce and keep them innovating?  Up until now, it has been about COVID response and now it’s about the recovery and restoring of NHS services. We know we have patients who have had their surgeries postponed. They need us, so we need to keep the same energy and motivation.

What’s the most impactful thing you’ve worked on at Chelsea and Westminster?

The implementation of the EPR was huge. It affected everyone. But, since then, there have been other challenges.

Through the digital boom, we acknowledge that there is more that can be done in terms of understanding what clinical systems are telling us. How do we create a single version of the truth that sits on top of multiple systems and supports clinical and non-clinical decisions? The End to End project we are currently running can positively impact patients and our staff.

We are trying to develop data driven tools, which clinicians can easily access for information about patients and to help them make decisions. Those decisions are captured and are enacted in real-time, keeping both clinical teams, managers and patients informed. That’s going to be the biggest challenge, as we no longer work as a standalone organisation – with integrated care systems and patients navigating within the sector, we need to be more agile, and we need to support by creating those single points of access that anyone can tap into and manage.

Find out more about the innovations at the trust, through CW+.