We caught up with Martin Sadler, executive director of information technology and digital at Sandwell & West Birmingham NHS Trust, for a chat about some of the trust’s recent digital projects and priorities, including considerations for launching a new hospital; how AI is used in radiology at the trust; and how he motivates the IT team.
Martin shared that he has been in the digital healthcare space for six years now; prior to this, he spent time working as an IT consultant, as well as working in local government for seven years. He has also worked in the private sector in finance, retail and utilities, supporting projects such as the launch of the first UK online bank and a cloud-based point-of-sale system.
At Sandwell & West Birmingham, his remit covers all things digital across “one of the poorest regions in the country”, with over 80 different first languages spoken.
“We’re about to open a new hospital in October this year, so a lot of our focus has been on that. We’ve made sure that it is ready in terms of IT, we’ve built the foundations, we’ve got the connectivity and the ability to monitor things immediately and import into patient records through devices. But we’re still trying to understand what a smart hospital looks and feels like, and how it will develop over the next 10 to 20 years.”
Needing to prepare for the vast amounts of data that the new hospital will generate is a key task facing Martin’s team. “From a clinical imaging point of view, one thing we can guarantee as everything gets more sophisticated is that the amount of storage we need for data will go up, especially if we start storing videos rather than single slides.”
As well as the finer details, Martin talked about the work his team has been doing on trying to save time across the organisation and focusing on “how to remove friction from systems”.
He said: “People recover best at home, so when we are building a new hospital and changing the way we work, we need to keep that in mind – how can we get people to the place where they’re going to recover best? It’s an oxymoron to say we’re building the hospital so people don’t have to stay there, but that’s exactly the most effective healthcare.”
Digital projects
We asked Martin whether he could tell us a little bit about his digital team, and some of the digital projects currently underway and recently completed in Sandwell & West Birmingham.
When he arrived at Sandwell & West Birmingham, the trust was facing a number of challenges in terms of digitisation. At the time, he reflected, he thought that it was “nothing like the private sector” and went to his chief executive with plans to see what other trusts were doing and trying to catch up.
“He told me that I didn’t need to go and look at anyone else; I probably had enough experience from elsewhere and I just needed to apply it to the NHS. That prompted me to keep my expectations high, despite the challenges we were facing.”
One of the first projects Martin oversaw involved transferring all images to the cloud so that the trust could increase or decrease the amount of processing power. It also enabled them to train an AI algorithm to see whether it could detect what radiologists detected.
“We looked at between 22,000 and 30,000 lung images for that, and we found that the AI algorithm could do just that – there were very few discrepancies when the algorithm ran against what we’d done, less than two dozen. That really highlighted how amazing our radiologists are, and it proved that there is a benefit to including AI in your clinical workflow like that. 22,000 images is about as many as you’d see in your first ten years as a radiologist, it is a huge number to receive that support with.”
Getting everything signed off is “still a long way off”, Martin acknowledged. Currently, scans are viewed by two people and if there is a disagreement a third person will join. “That’s very time consuming for people who are really good at their jobs – in the future, we’d like to see one person and a computer look at it, and then if they disagree we can bring in a second person. That will still save a lot of time.”
Martin also commented on the launching of an EPR, and the way that it is viewed. “To me, it’s not really a digital project, it’s a clinical project; because it changes the way we work. We’ve put a surgical module on top of the EPR which records activities whilst surgery is happening, so the people doing the surgical work don’t have to keep stopping and making notes. We’ve had some really good feedback on that.”
The most important thing about these projects, Martin continued, is that “it all comes down to saving time – time we can release to our staff, and time we can release for looking after our patients. In many ways, digital has failed at that so far. People put in EPRs and the flow of work slows down, because people struggle to wrap their heads around using the system. The people creating computer programmes can think something is really easy to use, and it’s not.”
Making digital a bigger part of the curriculum and promoting continual learning is key. “We allow people to use computers with very little training, but we don’t allow them to operate or take temperatures without training. I think we need to get digital up to those same standards of training. It’s an essential part of people’s jobs. We also need to get better systems, which talk to each other, and to be better at holding software suppliers to account and saying, ‘the health system deserves better technology’.”
Using digital to improve patient experience
One of the areas Martin has been focusing on at Sandwell and Birmingham is customer service and patient experience. He shared with us a few of the ways that his department has been working to improve their customer service across the board, including putting in an e-consent solution and patient barcodes to help track the patient journey.
Additionally, he shared that “50 percent of my staff are female – we’re really keen on getting that diversity of thought, because then we believe we can deliver our services to our diverse customers.”
Describing the NHS app is “one of the best things the NHS has ever done digitally”, Martin said: “We really need to embrace it across the whole of the NHS. If the app can see a patient’s medical records wherever they are, why can’t I see the medical records of someone who lives outside the area? I think it’s a great cornerstone; don’t allow any more IT solutions into the NHS that don’t have a connection to the app, and don’t upgrade or renew them until they’ve got a connection.”
A key project at the present time sees the trust launching its patient portal. “That’s interesting again, because that’s not IT, that’s communications. I think there can be confusion for in-house IT departments because they have a captive audience and they start thinking of the portal as ‘their’ product. But it’s not about them, it’s about the patient.”
Martin expanded on the concept of the ‘captive audience’, saying: “That gives us a couple of options. Either I can be as mediocre as I like – you could ask me for an update and I could make you wait three weeks for it because you can’t go anywhere else. Or, it can incentivise us to be the best we can possibly be.”
Martin’s team are determined to choose the latter; he told us how he incentivised his team by getting them to pretend there was a competition, starting by looking at what “the best IT department” would look like, and then considering how that would be measured.
“We ask people who leave our organisation what it is like where they’ve moved to, and when people join us from other NHS organisations we ask them what we could do better, and whether we’re any good from their perspective. We also looked at the traditional measure of an IT service desk, which is first-time fix; how quickly we answered calls and so on. But we decided that wasn’t a good enough measure.” Setting a target of 95 percent for measuring first-time fixes, for example, “could mean that I’m changing everyone’s passwords every morning, and then everyone will ring up and I’ll give them their new passwords. My first-time fix rate would be amazing, but it doesn’t really mean anything!”
What Martin’s team decided to measure, instead, was how much time IT “wastes” across the organisation. He referenced the concept of “combined weight”, which he compared to being on the motorway when a couple of cars slow down ahead of you, having a knock-on effect with traffic moving slowly for the rest of the day. It can be difficult to record or measure this, Martin acknowledged, but after looking into how much time was getting wasted as a result of phone calls taking up time and blocking the phone lines, they found that the IT service was “collectively wasting eight people per day”.
To resolve this, Martin’s team decided to train people so that they could be put on the front line for IT support and “experiment with how many people it takes to make sure there is no queue”. The answer, according to this trial, was 14. That number “meant everybody was answered in less than a minute”.
The knock-on effect of this was even wider, Martin shared. “By the time it got to 10am, we no longer needed 14 people to manage the queue; we needed three people. Those extra staff could go on and do other things, like further training and development, which means they can do more things and resolve issues faster.”
Priorities for the next 12 months
When it comes to his priorities for the next 12 months, Martin shared that his focus will mainly be on the opening of the new hospital, but that his team will also be looking at some training in machine learning. His team has started to develop more competitions in this area and has launched a league with the aim of “making it more fun”.
Martin said: “We want to keep improving our digital skills and expanding that across the network, especially with the new hospital coming up, and the transferring of everything across. We really do have a problem with the amount of digital training we give our teams, so we want to give people the skills to do their jobs with digital support, and make systems easier to use, whilst also continuing to develop ourselves and starting to develop the skills we’ll need in five year’s time.”
Martin’s book, ‘Aspirationally Idle: A Fresh Approach to Digital Leadership’ is available here.
We’d like to thank Martin for his time, and for sharing these insights with us.
