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“It’s got to have a real tangible benefit” Jeff Wood, Dan Johnston and Henrietta Mbeah-Bankas on developing digital skills

Our latest panel focused on developing a digital workforce and digital skills, and featured Jeffrey Wood, deputy director of ICT at The Princess Alexandra Hospital NHS Trust; Daniel Johnston, senior clinical workflow specialist at Imprivata and registered staff nurse at Cambridge University Hospitals NHS Foundation Trust; and Henrietta Mbeah-Bankas, head of blended learning and digital learning and development at NHS England.

To begin, our panelists introduced themselves to set the scene. Jeff got us started by sharing information about the different roles within his trust who are involved with digitisation.

The tech team at Princess Alexandra Hospital NFT

Jeff: We don’t have a ‘true’ digital team – like in most places, technology is just one aspect of our digital work. We try to embed digital across the trust as we go.

My technology team is quite large and covers a huge range of areas. We have a service department and an infrastructure team which includes security and technical design, applications support, and design and development. We also have an IT training team, a testing team, project management, transformation and business analysts, along with business partners and customer relationship officers. I also pick up the switchboard team as well as unified comms, which gives me a bit more insight into the communication side.

All of those teams have a specific digital association, whether it’s from the training side, through transformation and business analysis, or business partners connecting with the divisions throughout the trust.

From clinical perspective to health tech supplier

Dan: I’ve been a nurse for over 20 years now. I began my career within the NHS; I’ve worked in acute medicine, emergency care and telemedicine. Throughout that period time, I’ve taken on a variety of roles – clinical, operational and educational. I’ve also worked in research roles. It has all been very patient-focused and I’ve really picked up a passion for service improvement.

It has also given me an interest in clinical research and translational medicine. Over time, my work led to a US career; I’ve practiced out of Harvard ER, where I moved up into leadership and educational roles with a focus on methodologies around quality improvement, lean process design and co-design. At Harvard we had access to a whole range of technologies which we evaluated in the clinical setting. That led to working with things like predictive analytics, hand-held devices which were very innovative at the time, population health tools and decision support. My work focused on validating these tools in the clinical space, looking at how they could be adopted, what they could lead to.

I went onto an NIHR Research Fellowship, and from there onto the Florence Nightingale Global Scholarship.

My varied experiences really help me in challenging industry perceptions of what value is. What does it mean to interact with clinicians? What are clinician priorities? Ultimately, what does it mean to the patient, the healthcare system and our population?

Developing a digital workforce

Henrietta then shared her insights on developing a digital workforce from a national perspective.

Henrietta: From a national perspective, developing the digital skills of our workforce is critical. Along with developing the skills of our existing workforce, we are particularly keen on thinking about how we can support the future workforce. It’s about supporting everyone from those who haven’t yet started on their health and social care careers, to those at the highest level of their careers.

We’ve got various pieces of work underway which focus on developing a digital skills pathway with our further education colleges, universities and technical colleges. We want students on health and social care programmes to start the prerequisite digital skills that they need to either go straight into employment, apprenticeships or higher education. We’re also supporting digital students who might be thinking about careers within health and social care, particularly within the NHS, where we know we’ve got over 30 different digital careers available.

For both sets of students, there is support designed to help them such as the digital health leadership programme or the digital skills assessment tool. There’s plenty on offer from the NHS Digital Academy to really support the development of a digital workforce in the NHS.

How can we prepare people for digital roles?

Jeff: It’s really tough at the moment and there are a few main challenges. One is the fact that a lot of the funding for training is often delivered to clinical staff for healthcare, so it’s often a case of struggling by on the remainder, both for internal ICT staff and for digitally up-skilling other staff.

The NHS has been very slow, generally, to adopt technology, and therefore a lot of clinical staff have not had the opportunity to use cutting-edge tech in their working lives. Some use it at home, some don’t. It’s such a diverse requirement for our staff – we have some staff who are fresh out of university, so keen to use new tech, and can’t understand why it’s not available to them. On the other hand, we have some staff members who haven’t used much tech before and are struggling with the basics. For those people, the culture change can be really difficult.

Alongside, we also have our residents and patients, and we need to ensure that they are not digitally isolated or excluded. Again, there’s a wide variety of skills and attitudes; digitisation can be a boon or a curse.

We have a training team in place to try and train our organisation as best they can when it comes to the applications that we have, but wherever possible we try to use external free resources. There are a lot out there that you can use, and they’re about building the soft skills as well as the technology-specific ones. That helps a lot.

For us to get the best use out of technology and digital, we have to ensure that we procure intuitive systems. There are some systems that you might only use once a month – they have to be easy to use, otherwise people will stop using them.

We’ve invested in something called COPE – corporately owned, personally enabled devices – to encourage staff to take devices home and use them in their home life as well as their work life, because if they’re using them more often they will take more care of them and they will play with them, getting used to them. Then it’s less of a challenge to use them for work. That’s been good for us.

We record sessions where we can to make sure everyone has access to content such as training, because not everyone can join in live. That helps dramatically. It also allows people to return to a session and take it at their own pace.

Within our procurements, we’ve started to include support training. It’s not just about getting these applications in and supporting their use within the business, it’s about training the people that will be supporting others. That might mean our own technical support team or super users, for example. We ensure that training is included for them in a variety of ways, such as computer-based training or documentation, so that there’s different options available.

Trying to free staff up to attend training has been difficult for us. We always have to highlight a compelling reason as to why you need to be more digital, why it’s important that you come along to training sessions and engage. Having our business partners and transformation teams helping to digitise processes and not forgetting that process change before they digitise it is really important.

We’ve also worked closely with our chief clinical information officer. It helps to have someone there who can talk to clinicians on their level and explain the benefits. In a similar way we’ve got a head of digital nursing who is helping us.

I think the real key is keeping in mind that everything that we do in terms of digitisation has to be the right product. It has to give the clinicians more time to spend with their patients instead of in front of a PC. Everything we do is about saving time, making something easy to use, making it fit for purpose, so that we can show the benefits and give clinicians the time back that they need. That’s when they really invest in the technology.

Dan: For digital in the future, I think staff involvement is key when it comes to design. I would say that there’s also a role for industry to have more clinicians in the trade, so that they can help translate and make things accessible.

As Jeff said, digital needs to be accessible and intuitive. We should have the same principles for health tech that we have in our personal lives – you don’t pick up a training manual to use an iPhone, and the same should be said for our systems.

We should also make sure that systems really make sense to the workflow of what people are trying to accomplish. I’ve had to use quite a lot of systems both from a clinical perspective and an industry perspective, and a lot of systems aren’t necessarily intuitive and communication around them is not always clear. There should be training, but that training has to be done closer to the frontline than we currently see.

The industry really is moving fast, and I think it’s about making sure that the products we get are consumable at the point of care. I think that’s something that is a challenge at the moment.

Learnings from national programmes

Henrietta: Culture is a huge issue, and there’s no one-size-fits-all solution. Jeff and Dan have already raised a lot of the learnings that we’ve found from national programmes around the need for accessible, intuitive systems.

Another learning is around how we can start to make digital part of people’s everyday language, rather than ‘the other thing’ that they don’t always want to engage with. It almost needs to be socialised into our professionals and our roles until we make digital the thing that enables people to effectively do what they need to do within their role. If we don’t do that, it will carry on becoming ‘the other thing’. That’s why, for us, it’s really important that we start investing in our future workforce, to embed this from the start.

There’s an assumption that young people are automatically digitally literate – we’ve found from our learnings that this is not always the case. They will have strong digital skills in some areas, for example, in communication and connecting; this tends to be around social media use. But there are other areas within our digital capability framework where we see young people with digital knowledge gaps. That said, their attitude to digital is positive.

On the topic of digital skills, there’s also something to be said for examining overall digital readiness. That looks at attitude as much as skills. Attitudes will only change if we make it a lot easier for people to access digital tools, for people to have training for the skills they need. That’s why our support is very much targeted at the person’s level of expertise or their level of skills, to ensure that we do not lose people who do not feel digitally confident.

The final point I’d make brings us back to the use of digital champions. We have found that this is one of the most effective ways of supporting staff who do not feel digitally confident to start developing their skills. As our medics often say: see one, do one, teach one. If people can see how something works and they learn to do it, in time they develop the confidence to teach others how to do it.

Measuring digital skills

Henrietta: There are a number of ways in which we can measure people’s digital skills. The digital skills assessment is an obvious one – it was developed by Health Education England, now under NHS England, and it provides opportunities for you to baseline staff. The data is owned by the DLS Learning Solution Centre. You can get your people to complete the assessment and from that data you can understand where your staff are at in terms of their digital abilities. You can look at it from a number of perspectives, from groups to whole departments, depending on how the registration has been handled. You can also repeat it periodically to see whether there has been a shift in people’s abilities and track progress in that way.

The move towards integrated care

Jeff: The key word is collaboration. We need to be talking to each other a lot more as we progress, and the way to do that is the use of technology. Within the trust we are doing a lot of work in terms of our training needs analysis going forward, to understand where our staff are, but ultimately the patient is at the heart of everything we do. Therefore everything we look at should be improving the lives of patients, whether that’s within the hospital or at home.

It’s key that all of the digitisation we put in place is accessible to the patients and also accessible to everybody that needs to be treating those patients. Integrated care systems are starting to bring those things in together – we’re procuring more systems that have joint use and we’re looking at ways in which services, people and roles can be shared across many organisations.

Dan: There needs to be a vision. If you’re going to make any of these technologies accessible, having a vision of what you’re looking to accomplish is key. It sounds basic, but because of the complexity I often find that the vision is either changed or it isn’t clearly defined or it’s sometimes even absent. In order for the technology to be available and consumable to staff, it’s got to have a real tangible benefit to it.

Digital identity

Dan: If you’re going to have digital systems, you need to be able to say who you are and what role you are – who, what, when, where and how, just the same as if you were documenting on paper. All of that is only really enabled if we are able to prove who we are within systems. It’s not acceptable in the analog world to complete note and orders and records using somebody else’s signature. So from a professional point of view, and in terms of security, there’s the accountability and clinical governance aspects to take into consideration.

The challenge is, with all of these checks and balances, it still needs to be accessible, consumable and fast. In addition, the focus needs to remain on the patient, as Jeff was saying.

When you’re looking at it from an ICS perspective, you’re obviously taking numerous organisations into account; and the power of digital means that more people have digital touch points and can access more data than ever before. It underlines the fact that it is paramount that we can evidence who we are. We would expect it if it was our own care or a loved one’s care – we’d want to know who did what, where, and why. It is the basis of a learning healthcare system.

I see digital identity as a cornerstone within a myriad of technologies that enable progression and digital maturity.

Culture change

Jeff: Everybody knows by now that COVID brought a big change in focus for everybody in the NHS. It’s been said that technology advances in leaps and bounds during war, and actually we were at war with COVID. It brought a massive change in terms of how NHS trusts looked at technology and what it could do. I also think that the funding available during that time and afterwards has helped significantly both in terms of being able to invest in the technology but also being able to demonstrate what it can do. There have been a lot of proof of concepts that have gone out, a lot of different hospitals have tried different things.

When I first joined the NHS about five years ago and we wanted to change a system, one of the first things I suggested was finding out what other people in our region were doing and going to talk to them about it to learn. Now, we’re all starting to talk to each other a lot more. We’re starting to run alongside each other and re-use what others have done to make improvements, and I think that has been a big culture change.

Henrietta: On the other hand, we have also got organisations that are not open to learning from failure. If people don’t feel confident with digital, they often don’t want to touch the tech because they think that if it goes wrong, it may have implications for their employment. For the culture to change, we need to foster openness for learning. It needs to be okay to learn, to not know something from the start.

Fostering change and innovation

Dan: It’s about being people-centric. As I mentioned before, you need a clearly defined vision; you need to know where you’re going. You’ve got to be really close to the frontline and understand the work that is being completed or the processes that are being used and the value within that.

Co-design is a must. I think we’re on the cusp of change in this area and COVID probably accelerated it, but there’s still a long way to go to make sure that the people who are going to be delivering innovation are part of the process of innovating. We’ve still got a long way to go though.

In terms of existing projects, I think there is further innovation that is yet to be realised, and there’s a lot of excitement about that.

Looking particularly at benchmarking within healthcare IT; if you’re going to innovate, you need to understand what your current state is and where you are going to. Sometimes, some of the best ideas come from those who aren’t especially digitally literate, because they’re more focused on their current state and where they would like to go. We’ll probably look back on this era and see it as health tech in the dark ages, and it’s only through benchmarking right now that we can understand where we can go. All too often, it’s not present and is still not a big enough topic of conversation.

Henrietta: People are already busy doing their day-to-day jobs. As a starting point, it’s always useful to highlight what people need, but also what’s in it for them. Why do I need to engage with this digital solution or gain digital skills? The conversation needs to change.

Advice for developing digital skills in an organisation

Henrietta: We need to utilise those champions to make the most of peer-to-peer learning. We have a user group who say ‘we don’t do digital’ – how do we target our interventions to engage them?

We’ve got our digitally positive group who embrace tech; we need to support them to develop their digital leadership skills so that they can support us in implementing strategies and interventions within organisations.

The third group are those who sit in the middle. They think digital is fine, they’ll try to use it, but they’re not really bothered. Based on our interventions, we can move this group to be either positive or negative towards tech, which is why it is so important that our interventions are targeted and considered.

The fourth group to consider includes people who are digitally excluded, irrespective of their digital skills. If they haven’t got access to the tech or access to connectivity, it’s highly unlikely that they will be able to utilise the skills they have developed.

In any organisation, to fully implement digital skills or digital strategies, you really need to think about the needs of these four groups independently, but also in terms of bringing them together to support each other.

Jeff: I’d agree with Henrietta. It’s key to make sure that you recognise each staff group and handle them in a different way.

It gives us a lot of benefits when we give our champions access to the new tech and let them play with it, and share proof of concepts with them. When others see these people using them, it creates a sense of ‘you’ve got that, I want it too’. It’s about trying to foster that want in people before you deliver it out. The worst thing you can do is just hand someone a device and tell them to use it because it will help their job. People are resistant to that. By building that want within the business, people are more likely to come to you and ask for a device because they’ve noticed a colleague using it and they want to try it.

It’s also important to be clear about evidencing the needs and requirements across the whole organisation, not just at exec level. We need to show people the art of the possible, because that then encourages them to want to try these things. It’s amazing what people come up with when they try tech as well – ways to use the device that we never would have thought of. If you can get that information out to the rest of the trust and it’s come from somebody outside the technology team, that’s really important.

Dan: In my own opinion, we need a bit less digital and a lot more focus on how we can use our digital systems to deliver benefits to patients or organisations. If we can be more outcome-driven, then I’d hope that digital will just become part of the overall healthcare matrix – one mode in which care is delivered or recorded. That would be welcome, because I think the word ‘digital’ can create boundaries in itself. We have to move past that word and focus on making these technologies available and understanding the barriers to their adoption.

Many thanks to Jeff, Dan and Henrietta for their time.