For HTN Now, we welcomed a panel of experts for a discussion around digital trusts, focusing on what good looks like from a tech perspective, the best ways of fostering a culture of innovation, building great digital teams, and more.
Making up our panel were Georgie Duncan, associate CCIO at Leeds Teaching Hospitals; Neill Crump, digital strategy director at The Dudley Group; and Andrew Harrison, international principle product manager at Imprivata.
Panellists offered a brief introduction to their role and background, with Georgie sharing details of her background in critical care, and of her current position as assistant CCIO at Leeds Teaching Hospitals, where her portfolio “covers nursing, midwifery, AHPs, and a range of projects incorporating all sorts of services across the trust”.
Working with “an amazing digital team”, Georgie told us about some of the local and regional projects going on at the moment in Leeds, saying, “I’m supporting a lot of discharge-related functions, like electronic discharge advice notes, the recovery care plan, and the integration of our pathology systems across the West Yorkshire Association of Acute Trusts”.
Neill talked about his role as digital strategy director, and some of the projects he oversees at The Dudley Group, making sure the trust has “an effective digital plan in place across all of its services, encompassing digital, data, technology, cyber, and improvement”.
A lot of his focus recently, according to Neill, has been on “making sure the basic elements are in place – doing the frontline digitisation, cloud analytics, putting a new website in, and getting that digital focus around things like digital clinics, e-consent, patient-initiated follow-up”. He has also been working with community teams, he said, “making sure we’re levelling them up and they have the same tools we use in our acute sector”.
In his role with Imprivata, an “identity access management company focusing on simple and secure access in healthcare”, Andrew told us that he’s focused on access in the NHS to SPINE, which he says is “going through an evolution from an existing infrastructure to a new platform known as CIS2”, as well as looking at other countries in Europe “also going through the same transition to look at potentially expanding national single sign-on in other countries”.
In Europe, Andrew said, “the bar is increasing with access regulations, and especially access to patient health information, and we need to think about what that looks like for clinicians”.
Celebrating successes and measuring impact
Our panellists started off the session by talking about some of the recent successes with digital in their region or organisation, with Georgie highlighting the work of LTHT regionally in the setting up of community diagnostic centres, “creating places where patients can come and have things like ultrasounds and x-rays”, adding “the joy of that is that it’s a good patient experience, not having to travel to hospital, and being able to get so many different things done on site”.
The Yorkshire Imaging Collaborative is another project underway at LTHT, “setting up shared reporting across the trust, which means clinicians and radiologists can review scans and things at home – that not only improves their work-life balance, but also means reports get reviewed faster, patients get results faster, and so on”.
In Dudley, Neill shared some successes including integrating a maternity solution into the trust’s EPR, which means “patients can request blood tests, radiology, prescribing drugs, etc, within the maternity solution. Some of the outcomes we’ve achieved there include that women are having c-sections at scheduled times, which is reducing waiting times and improving patient flow. Postnatal documentation has also decreased by 78 percent, so what was previously about three hours is now down to about 40 minutes, releasing time to care.”
Another focus at Dudley has been patient deterioration, Neill continued, “where we’ve been using early warning scores and identifying those at risk earlier, then putting in different actions through tracking boards, so we can do the escalations, senior clinical reviews, etc. Martha’s rule has also been rolled out, and we’ve incorporated feedback from patients and family members within the EPR, and we’ve got a fantastic in-house digital team who are able to keep iterating and improving that product without having to wait for a supplier to release additional functionality.”
Andrew talked about how “good” for digital maturity looks like clinicians moving “outside of the four walls of the traditional hospital”, with access from anywhere to the information needed to do their jobs. “Like Neill said,” he went on, “we need to be looking at analytics and leveraging data for continuous improvement, maximising what you already have”.
At Imprivata in the last six months, Andrew said he’s been working on the new CIS2 platform, visiting customers, and some of the successes he’s seen have been around “the ability to get clinicians into systems in a timely and secure fashion, without the penalty of making it more complicated for clinicians”. Seeing clinicians make the transition from having “millions of usernames and passwords” to “simple and secure authentication” is a sign, for Andrew, of progress. “Then we see providers asking where they can go next, where can they take it from there?”.
Creating a “good” digital team
The discussion progressed to what “good” looks like when building a strong digital team, with Neill talking about there being two main areas of focus for the digital workforce at The Dudley Group: professionalism and the right mix of skills.
“We’ve partnered with the British Computer Society to give our team the opportunity to get professional accreditation,” Neill said, “so they can become chartered IT professionals and so on, and working with the Midlands Digital Skills Network to offer them the chance to get information security professionalism; we want to make sure our digital teams have got the chance to be professionals, as well”.
On skills for the information age, Neill talked about the structure of the digital department, and the team’s portfolio across digital, data, technology and cyber. “Skills for the information age is a framework which allows us to look at every single role and the digital skills and capabilities it requires, and that helps people look at their career development, I think.”
From Andrew’s perspective as “a product person at heart”, and how “when we talk about the digital maturity of organisations, we’re really talking about the digital maturity of the clinician workforce, as well, because they’re being asked to use all of this new technology and there’s always something they need training on”.
In that regard, Neill shared with us about The Dudley Group’s digital health network, which was set up to “focus on the digital team, but also with a much broader view of the digital team as including all of the clinicians, operational and corporate staff, so almost looking at digital from a clinical perspective, and we’ve got roles such as CCIO, safety officers, nursing information officers, digital pharmacists, digital midwives, and so on”.
Georgie told us a little bit about the digital team at Leeds Teaching Hospitals, saying, “we sit in the office of the CCIO, medical CCIOs, and Sarah Hanbridge, who is our CIO covering nursing, midwifery and AHPs, then there’s myself, and we have some deputies – what was important when planning for that structure was that we had a succession plan and a career pathway for clinicians”.
What’s “great” about that setup, Georgie continued, “is that it’s encompassing all of our professional groups, bringing everybody’s thoughts, ideas, and professional backgrounds into digital”. Nursing students are also invited to come and work alongside the digital team, Georgie said, “to open their eyes about what digital looks like, and what to expect, because they are the people who will hopefully be sitting in my post in the future. It’s how we bring our subject matter experts and things into an informed process.”
The trust’s digital advocate programme has also been pivotal, Georgie highlighted, “and we encourage a wide range of staff to get involved – they don’t have to be digital gurus, just have an interest in digital, and we have a couple of hundred of them now, so that’s been important in that engagement piece”. It’s making sure the whole workforce is prepared and “able to come on the journey”, she says, “and we shouldn’t take for granted what people are able to do, because you have a whole continuum of digital confidence and capability”.
Andrew pointed to the “wave of highly digitally literate workers” soon to be flooding the NHS as younger people begin to work their way in, saying that “they will be the ones demanding the technology, and they’re already savvy with many different types of technology, so there will be a market shift there”.
“I think that’s just going to keep raising and raising the bar over the coming years”, Neill agreed.
Realising the value of digital
When it comes to getting senior decision makers who may not themselves have digital confidence, to see the value of digital, Neill talked about his experiences of attending board meetings, and the “pressures and constraints” that senior leaders face meeting “a lot of different demands” around quality, patient safety, and the best use of resources.
“I think we need to work with our senior leaders to better explain the benefits of digital, and that will give them the confidence to invest more than we currently do – bringing to life real examples and taking people to the frontline to show them exactly how technology is making a difference”, Neill concluded.
Georgie agreed with the challenges around the visibility of digital at board level, and said that in Leeds, the CIO regularly conducts ward walks, supporting digital projects on the frontline. “Last week he was supporting the big discharge collaborative we’ve got going on, and visibility is really important, because that’s about credibility, about understanding – I think the ability to have those discussions with very senior leaders in our organisation is really important.”
Andrew emphasised the importance of doing this, saying, “we might think the frontline looks a certain way, but every time I’ve ever visited a ward or a particular group of clinicians I’ve learned something I didn’t know or expect, and that’s helped shape my view of things and understand their needs better”.
An example of this, Andrew said, was a visit he made to Royal Surrey, and “observed as an outsider that IT was very well known across all of the clinical areas”, which was in contrast to what would at one time have been the norm of “IT here, and clinicians there”. That, he continued, “shows we are converging more closely day by day, and this is exactly what’s needed”.
Neill considered that “we’ve got more to do on that front, not just at Dudley, because we’ve got our tech engineers that are out on the wards every single day, and that’s cut down the amount of service desk tickets, etc., therefore vastly improving the service and getting us a better understanding. However, I think there’s a lot more that we can still do on this, understanding how much time is wasted and where that is – not just in the acute, but out in the community, because that’s where we’re going to have that preventative work.”
We’d like to thank our panellists for taking the time to share their insights on this topic with us.
