As part of HTN Digital ICS we welcomed Ideal Health, who offer strategic consultancy, project delivery and specialist resources to support health and social care organisations as they navigate digital transformation, for a session focusing on building the digital workforce.
Senior Digital Transformation Associate Alison Walker joined us, along with Change and Benefits Director Gaelle Fertil from Ideal Health, to share different approaches to the digital challenges in health and social care, along with exploring the strategies and options available for integrated care systems (ICSs).
“2022 has been deemed ‘the year of the digital profession’ by the NHS Transformation Directorate which is fantastic,” began Gaelle, “but I also wanted to balance that with some of the challenges that we have faced over the last couple of years… we know that workforce burnout and resilience is a real issue. We balance that with some of the more recent headlines around driving digital transformation in the NHS and the push for EPR (electronic patient records) convergence, and for nearly all NHS trusts to have an EPR by December 2023. We have here a bit of a challenge in terms of what’s being asked of NHS staff versus what is actually perhaps possible.”
Alison shared survey results from the AWR Intel Digital Skills Survey Europe 2021, which show that 70 percent of organisations feel that they are accelerating their move to the cloud to deliver digital services, but 63 percent say that lack of skills and experience are a barrier for this.
Moving on to UK data, Alison showed figures from the government’s official report ‘Quantifying the UK Data Skills Gap’ from May 2021, which indicates that there are 178 – 234,000 data skills vacancies in the UK, plus 178,000 specialist data roles that require technical or specialist knowledge in the private sector. “This reinforces what we already know,” said Alison, “that it’s difficult to recruit these sorts of capabilities at the moment. For ICSs and the constituent organisations, they’re having to compete against private sector remuneration packages.”
Alison moved on to Ideal Health’s own findings when looking into ICS digital maturity. “We’ve been using the HIMSS Continuity of Care maturity model,” said Alison, “to look at where ICSs have got to, have they got an EPR, have they got a shared care record, are they able to share data, are clinicians able to make decisions with the most recent data in front of them? How is population health management going across the ICS? Is there a HIE (health information exchange), is it being used to plan earlier interventions? We’ve been doing that across 11 ICSs over the last couple of years.”
The main findings from the research showed that there is a twin speed digital maturity across most ICSs; “some ICSs have got their shared care record in place, they’re starting to use the HIE, but others are being held back through no fault of their own because they’ve got a trust or organisation that’s part of the ICS that hasn’t got an EPR, so they’re finding it very hard to move as a system.” Ideal’s research also showed that there are lots of strong plans and high ambitions out there in the realms of clinical, social care, digital and data, but there is also a lot of change fatigue and high workloads forming barriers to people getting involved in digital transformation outside their own everyday roles.
“With the ICSs coming together, personally I think there’s quite an opportunity,” Alison commented, “to look at joint approaches particularly for workforce – pooling of staff, new models of resourcing, and looking at what others have done around the ICS… it’s worth pointing out that a lot of the councils are using RPA (robotic process automation) and AI (artificial intelligence) already, so there’s great learning in pockets around the country. But there are still major skills shortages which will impact not the delivery, ultimately, but maybe the pace of the programme going forward.”
The first question this raises is what can be done, strategically and operationally?
Alison showed the ‘borrow, build, buy’ model; there are different talent strategies that you can follow, from borrow (hiring freelancers with specialised skills to fix immediate skill gaps) to build (expanding internal resources and skillsets to new areas) and buy (buying new talent from external firms or service providers).
Pros of the borrow approach include the injection of expertise, the ability to learn from other projects, ICSs and economic sectors, and ideally transfer of skills through freelancers. On the other hand, borrowing talent is increasingly expensive and risks the loss of organisation knowledge if freelancers do not transfer their skills over to staff.
“We’ve been working with groups of ICSs to take that to the next level,” said Alison. “Could we develop that as more of a managed service for all the projects and programmes that ICSs are doing so that they are not poaching valuable staff from each other?”
Ideal Health have set up a Digital Academy focusing, initially, on EPR skills, to support the approaching December 2023 EPR deadline. “We’ve brought in about a hundred people to train up in the deployment of EPRs,” shared Alison, “and what we’re hoping is that the academy will grow with the people within it, so they’ll start with EPRs and move onto shared care records, we’ll train them as their career progresses… importantly, [the academy will] help them manage the workforce across the ICS rather than compete against each other.”
In terms of the build approach, Alison said, “We’re working with a couple of ICSs about how best to build their digital, data and technology people and professionalise them, bringing their skills up to the next level for the work that’s coming forward over the next couple of years.” The work is based on capabilities and needs identified for future projects and seeks to make use of long-term learning and development plans to develop career pathways for new and existing staff.
Speaking of her own experience, Alison shared, “We were a government department of 2000 people and we put 200 of those into what we called a project pool. Senior managers applied the pool for people to work on short-term projects. This was a way of pooling all the resource so we were able to really quickly flex and be agile in how we moved people around the department.” Alison went on to discuss how this way of working led to people developing their own communities of practice so they could co-manage their own learning and development.
“I think that group approach can work incredibly well, and it’s actually very low cost apart from the management of the group itself.”
The final strategy from the talent model is the buy approach. Benefits include making use of skilled consulting or interim resource, the fact that it exports delivery risk to the provider, and the ability to change providers if there is an issue. Disadvantages are the increasing expense and “IR35 and the 2 year rule” – there is not unlimited flexibility here, as if you continue to buy the same talent from external service providers for two years, they become an employee.
Another option for outsourcing talent within ICSs is shared services. Shared services “can suffer from a poor reputation” within the NHS, but Alison commented, “I think we do have to look at that because there is huge scope, particularly with the ICSs, to share some of our HR and finance functions now that they are becoming one organisation. We took that approach in government and it’s still there… maybe that’s something we need to think about in terms of ICSs too.”
When it comes to working out the best approach, “it depends very much on where you’re starting from,” Alison said. “If you’re in an ICS or a trust or a council which is really digitally mature, you’re probably going to be looking at more of a buy approach to bring in those rare skillsets. However, if you’re less mature, then probably a borrow approach is more appropriate because you’re bringing in people on more of a short-term project basis maybe to implement an EPR. For both of those, build is probably going to be equally important – whatever you do in terms of bringing in short-term skillsets, you’ve got to continually, professionally develop your staff or they’re going to be poached.”
At this point, Change and Benefits Director Gaelle took over to discuss the digital workforce in terms of clinical and operational staff.
“I wanted to bring it back a little to the challenge we have here, which is the need for additional skills in our workforce,” said Gaelle, “and the increasing drive for digital transformation, and all of those things colliding together on top of an already overworked workforce. So what are we going to do about managing that as an impact?”
Gaelle showed samples from the What Good Looks Like success measures, noting that they include the necessity to support staff and develop leadership and board-level accountability for digital transformation.
“The digital skills that we need to focus on are really across many different levels,” Gaelle continued. “That’s where it can get very unwieldy. We’ve talked about digital leadership, it’s about increasing digital knowledge and awareness at board level positions, we’ve talked a lot over the last few years about the rise of (roles such as) CCIO (Chief Clinical Information Officer)… but what we are perhaps not talking about enough is the remaining board level positions, what is their digital knowledge?”
Supporting the digital leadership positions are the specialist health informatics workforce, the roles that Alison discussed the difficulties in sourcing, and corporate digital workforce who support the implementation of digital changes such as project managers and HR. “You then have the digital workforce at large,” said Gaelle, “which is a huge set of people, but actually without increasing digital skills and knowledge within the workforce, none of these projects will be successful. So how do we do that, how do we identify the pockets of good practice, the peer networks, and really promote digital transformation.”
It’s important to keep the public in mind, too, Gaelle noted; with more digital solutions, the public are handed more responsibility to self-serve. Additionally, within the ICS at large, there will be different levels of digital maturity, so there will be a need to identify areas needing support and increase digital skills there too.
“It’s multifaceted,” Gaelle explained, “and in some ways it helps to think of it in different chunks to see where we need to focus.”
Next Gaelle shared research which identifies the top nine skills a digital leader must have, “they must be able to communicate personally, encourage digital literacy, keep up with technology, allow errors, provide support, facilitate change, prioritise others, manage ambiguity and be innovative. These are actually change leadership skills, there is very little of it which is about digital context… really good digital change leadership is good change leadership,” Gaelle commented.
Gaelle recommended referring to the Person-Centred Digital Literacy framework for supporting wider digital staff. “It has fantastic advice about where to focus the different skill levels,” she said, “and how we are going to look at using digital in the workforce.”
The techniques Ideal Health suggest to support people through transformation are similar to the ones they recommend for pooling staff skills, such as peer networking, mentoring, training and empathetic leadership.
“If we want to approach this as a proper digital transformation, I recommend leveraging the Kotter eight phases of change,” said Gaelle. The phases are establishing a sense of urgency, building the team, defining the vision, sharing the vision, encouraging action, planning and creating short-term wins, tracking progress and strengthening change. “It is probably one of the best used approaches when it comes to thinking through the various steps of how a change may be implemented, but really one of the things that I love about it is that it makes a big deal out of explaining that it’s going to take time…. we may not be able to go as fast as we want to with some of these digital transformations, the key is to focus on where we can get the real value add and support staff through the change.”
Gaelle goes on to recommend the implementation of a Change Management Office (CMO). “I think for a transformation of this size, it’s potentially a really good idea… it takes care of all of the organisation’s change management plans… it looks ahead from now to wherever you want to be in three, four, five years time. What are the different changes that your organisation will go through, what challenges will you face in terms of digital transformation? It really scopes them and understands them in terms of who is impacted by what.”
Many thanks to Alison and Gaelle for sharing their time and experiences with us. You can watch the webinar in full below.
