Interview, NHS trust, NP

Interview: “You need people with broad experiences to lead digital agendas” William Monaghan, University Hospitals of Derby and Burton NFT

Our latest interview features William Monaghan, executive chief digital information officer at University Hospitals of Derby and Burton (UHDB) NHS Foundation Trust. William joined us to chat about the digital projects and priorities at his trust, their emphasis on user-centred design, and his hopes for the future.

Hi William, can you tell me a bit about yourself and your role?

I joined the NHS back in 2008, on the graduate management training scheme. I was a general management trainee and I worked in operations for a large part of my career, from being a general manager for surgery to becoming director of performance and information at University Hospitals of Leicester. I realised that a lot of operational work is just about trying to make the wheel spin faster, trying to push things harder and get them to be marginally better, and I believed there must be a better way to do things.

I went to work for NHS England as the chief data officer’s head of delivery, and then I became NHSX’s director of operations. I was involved in the creation of the Transformation Directorate when NHSE and NHS Digital merged back into NHS England, but then I realised that I really wanted to get back into the acute world. I wanted to spend more time closer to the action. When you work for NHSE, there’s a lot of time between having an idea and seeing something come of it; in the acute setting, there’s a much shorter timeframe for seeing progress.

I think it’s going to increasingly become essential for people in operational management to step into digital – you need people with broad experiences to lead digital agendas.

Bringing the user and the digital voice together

When I look back on what we’ve done with technology over the last 10 to 15 years, I think we’ve spent a lot of time making it harder to be a clinician in the NHS. I’ve seen this when I was working nationally and also at my trust; we’ve often imposed technology on people. It hasn’t been about answering a clear set of user needs, it’s been about deploying what we can afford or what works with our current tech stack. I think it’s made people’s lives harder – for example, there was a report from the one of the royal colleges around what’s making it hard to be an oncologist in the NHS and they specifically referenced technology and the experience of using digital systems.

At UHDB, we’re trying to learn some of the lessons from other public sector transformations. If you think about what Government Digital Service did with, they’ve put the user experience at the heart of everything they do. We’re trying to give our loudest decision-making voice to the users themselves.

For us, that means focusing on those basic but important disciplines, such as being really clear about user needs before we buy any technology and completing a thorough evaluation against them. We also give a major role in our governance to users; we have a digital clinical advisory group bringing together clinicians of all different types, from the most senior clinicians in our organisation to staff nurses and physiotherapists working on wards every single day. It provides them with the opportunity to ‘sign off’ on each stage of delivery within our digital transformation progress. We also give them the chance to chair some of our digital meetings and really put them at the centre of the decision-making progress.

With regards to workforce, we’re trying to make sure that we recognise the importance of those critical roles bridging the gap between users and the digital services team. We’ve appointed a brilliant chief nursing information officer called Stacey Hatton – she’s done an amazing job of working alongside the chief nurse, being part of all the senior nursing meetings across the organisation, and working with the digital team.

We also took the decision to make our chief clinical information officer a joint role, so they are also a deputy chief medical officer. We wanted the position to be very senior so they have a strong voice across the organisation and can talk authoritatively within digital and within medical.

If we’re going to achieve the ambition of making digital a part of everything we do, as the NHS, then we also need to make sure that digital is part of every single team.

What’s working well, and what are the challenges?

I think we’re building a really strong team at UHDB – I genuinely believe we are developing one of the strongest digital teams in the NHS. We’re pulling together some really great people.

There’s also been a step change in engagement in the organisation. People are starting to believe that digital is part of the solution to their problems. That means that they are more willing to come and talk to us, they’re more willing to spend time thinking about how digital can support them.

Part of the challenge is having the capacity and space to do the work required to transform services. We often talk about digital only being an enabler for transformation; often we can have the right resources and people involved to deliver the digital solution, but we can struggle with having enough capacity in the system overall to be able to transform services to take best advantage of that solution. We can digitise an inefficient process, but having the time to step back and review that process to figure out how digital can best support it can be challenging.

Digital priorities 

Digitising is part of tackling the issues that pose the biggest challenges in the organisation on a wider basis.

Like every NHS organisation, we’re constantly looking at ways in which we can improve our productivity and reduce the cost of delivering services. We’re massively focused on automation and using robotic process automation solutions to deliver cost improvement for the organisation.

We’re also doing a lot of work around automation and validation when it comes to our elective care patients. We want all of our admin and clinical teams to be able to focus on the patients who are in need and waiting for care, filtering out that waiting list as much as possible.

We’ve got challenges with cancer at UHDB, so we’re working around voice recognition for clinical correspondence so that we can quickly move patients through the cancer pathways. We want to speed up the process of confirming when people don’t have cancer and provide more certainty and reassurance for patients.

Maternity can be a challenging space – we’re working hard to bring in a maternity electronic patient record so that we can free up maternity staff to focus on delivering the best care they can. We want them to be able to focus their attention on mum and baby as much as possible, without having to think about the system they’re using.

We’re procuring a new core EPR; at the moment we have two, so we have different sites working on different systems. We’re working to bring those together so that we can shore up the services, supporting staff to easily work anywhere across any of the sites. We don’t want that system to require lots of repetitive clicking and data entering; it will be a modern, fully functional EPR, and our clinicians have played a huge part in selecting it.

We’re working with the Federated Data Platform too, linking up patient safety data alongside theatre data to understand clinical variations and outcomes. One of the things that we’ve put a lot of work into, particularly this year, is really understanding where the priorities in our organisation lie. If the things we are working on are not priorities, how quickly can we stop, step back and move onto what really needs our attention, so that we are using our resources on our greatest organisational needs?

Like lots of organisations, we have a lot of digital work that isn’t exciting or glamorous, but it’s essential – sorting out networking, for example, so that people don’t find dead spots in the WiFi, or making sure that the laptops on wards are in decent condition and don’t have buttons hanging off. It comes back to the idea that everything we do should make it as easy as possible for people to do their jobs, so they can deliver the best care for our patients.

Realising benefits

I’ve only been with UHDB for six months, but in that time we’ve managed to roll out Imprivata’s Single Sign On. Any staff member can tap their badge onto a card reader and have all of their usernames and passwords profiled. It’s relatively simple technology, but I think of it as a down-payment on helping people believe in the potential of digital. Our staff can use it every single day and it makes their jobs easier. They’re not having to constantly remember and reset passwords, or resort to writing their passwords down.

It also comes with a stack of other benefits, like information governance with security and traceability. That’s the technology sweet spot that we’re always looking for – how do we make people’s lives better, but also how do we get tangential benefits around that core proposition? Single Sign On is a good example of that.

What are you most excited about for the future of digital health?

Maybe I’m wildly optimistic, but I’m really excited about the future for technology in supporting healthcare. Not least because what’s the alternative to getting digital right in the NHS? Digital is the hope for the future.

We’re involved in a really exciting project with a Scottish university’s artificial intelligence start-up – we’re doing some great work with them around natural language queries for data for operational teams. For example, you could ask ‘can you show me the falls trend data for ward X?’, or ‘I want to understand how many patients were admitted with sepsis last week’, or ‘did emergency admissions go up over the last two months?’ and see the data come through. We can also work with natural language queries for policies and clinical guidance; a member of staff could input a question about a specific patient or specific condition and get recommendations based on that clinical guidance without having to spend time looking it up.

That work is also about developing the AI to function like a clinical assistant – a co-pilot for clinicians of all types. If they needed to order a certain piece of equipment for a particular patient, for example, it can do that for them; it can do the heavy lifting around filling in request forms and provide it back to the clinician in a way that makes it easy for them to sign off on the request. It supports them to do the work that they came to do, which is to look after the patient, rather than having to leave patients to go and complete arduous admin tasks. It would be great if we could get to the place where all of that is taken care of for clinicians – it would be transformative for the NHS, and it feels within reach now. That’s what really excites me.

Like I said earlier, if over the past 10-15 years it’s become more complicated to be a clinician in the NHS, wouldn’t it be amazing as a community if we could spend the next 10-15 years making it a brilliant place to work?

Many thanks to William for taking the time to share his thoughts.