HTN welcomed a panel of experts from across the health sector for a recent HTN Now webinar to discuss scaling health technologies, focusing on digital projects and programmes successfully scaled at Leeds Teaching Hospitals, University Hospitals of Leicester and University Hospitals of Northamptonshire, as well as approaches, challenges, and how to embrace new models of collaboration and leadership.
Panellists included Will Monaghan, group CDIO at University Hospitals of Leicester and University Hospitals of Northamptonshire; David Holland, deputy CCIO for AHPs at Leeds Teaching Hospitals NHS Trust; and Debbie Hale, deputy CNIO for nursing at Leeds Teaching Hospitals NHS Trust.
Introductions and key digital projects
“It’s really useful topic to talk about digital projects and how they’ve gone in a public way,” said Will, “because we’ve all seen instances where somebody has a great idea but it doesn’t get beyond the walls of their own department or team.”
He spoke about his experience at Derby and Burton around single sign-on, noting that this was successful “because it’s genuinely transformational in terms of people’s experience of technology and how they use it every single day”.
At Leicester and Northamptonshire, the trust has been working with Nervecentre on its EPR. “With Leicester as the primary development partner, that has turned into an almost fully-fledged EPR. It’s a good example of how you don’t have to necessarily go with the Big Bang approach, you can work module by module through the digitalisation of your hospital; and in doing that you have lots of opportunity to learn from each of the go-lives and then scale them out accordingly.”
For Debbie, Leeds’ self-built PPM+ EHR has meant flexibility to develop based on the trust’s own specific needs. One of the pieces of work which stands out to her is the work on a VOD (visualise, optimise, and digitise) project to implement digital care plans.
“We ran a paper picnic to help us see what the top documents were that our clinicians were using, which produced about 1,700 pieces of paper,” Debbie shared. “From there the team has done amazing work to visualise what we currently have and the process of documentation to aid us in deciding priorities for our next digital build, like our core care plans and risk assessments that need to be developed to enable more effective documentation.”
Getting engagement with CSUs is integral, Debbie noted, especially when it comes to scaling something across an organisation with 22,000 staff and over 2,000 beds. “That engagement piece is key when you’re thinking about developing something new and rolling it out across a trust of this size.”
David also shared some work at Leeds around engagement, particularly on developing digital advocates across the trust. “We’ve tried to create a core group of staff who are enabled, empowered and educated to digitally take forward the agenda,” he explained. “At the moment we have about 250, and we are looking to increase that number to about 400, looking for those staff who are the early adopters, innovators, and problem solvers to help us drive transformation.”
Having those advocates across every pathway is important, David continued, as it helps the team to understand the opportunities and challenges which might exist in terms of digital. The recent focus has been on Microsoft 365, he went on, “because there’s a huge amount of functionality there, and we’re looking to optimise that and educate our staff to align the usage of the toolkit across the organisation”.
Responding to what service users reported that they wanted to see, David and his team put on an event day including live demonstrations, and will be running another “back to basics” version of this in November. “We’re trying to become an exemplar of MS365 use, ensuring we’re using that effectively and safely. But what really counts is spending time with staff. It’s about having those conversations with nurses, AHPs, midwives, admin staff, sharing our ambitions and seeing how we can support them to support us.”
What works for effective scaling of digital projects
“It’s really interesting to hear what’s going on in Leeds,” Will said, “because there are some good lessons in there about the communication. If I think about the work we’re doing at the moment, there are two key things that make us feel like we’re getting the scaling piece right: creating a sense of excitement around why something is important; and making digital everybody’s business. Instead of a digital programme run by digital leaders, it’s about having an operational, clinical set of changes, run by operational and clinical leaders.”
Spending time with clinicians and “making them feel like they own it” is key, Will said. “Clinically-led, operationally-delivered and digitally-enabled – these are our watchwords when we’re doing digital transformation”.
The other thing to consider, he shared, is ensuring that awareness of the “clunkiness” of the implementation phase. “Transformation at scale can be killed in first few weeks of implementation, when it is painful and bumpy; so being honest and talking about that from the start makes a real difference.”
Debbie agreed with this sentiment, echoing that “working across professional boundaries is important” to make sure that nobody feels left behind, and sharing how in Leeds they put in place regular show and tells with developers and end users to help to ensure that that doesn’t happen.
From her experience rolling out e-observations in Leeds, Debbie emphasised the importance of people feeling competent and confident in using the technology they’re being asked to use. “We were surprised that some people were really concerned and worried about using digital in front of patients,” she said, “and I think getting that key training and education early is absolutely paramount to a successful implementation.” From Leeds’ experience, she suggested that organisations can create “short, snappy videos of two or three minutes to help – we find they hit the sweet spot”.
Sometimes it’s not about thinking what would work better, Debbie considered, but about how we can utilise what we’ve already got. For example, you might get a request for a certain form and already have something very similar that can be slightly moulded to suit. At Leeds, one of the digital commitments is to use all existing digital systems to their full potential before reaching to implement something new.
“There is always a real desire for newness,” Will agreed, “and people can be trying to build adjacent capability to something you already have in your core capability, and then get frustrated when that hasn’t scaled. Debbie’s absolutely right about the opportunity coming from understanding what we have already that can do the job.”
David talked about the need for digital to “understand the challenges associated with the increasing complexity of the workplace”, such as winter pressures and increasing demand. “It’s making sure we create an environment where it’s feasible to successfully launch new tech”, he added, “and about getting that education and training in place, because I feel like when rolling something out you only get one chance to get things right – if you fail that, it’s very hard to relaunch.”
Learning from experience, sharing learning, and engaging with staff in a meaningful way are all key factors in success, David told us, “but the other key element is setting the right expectation, because you can roll things out successfully, but if you set the wrong expectation, the outcome is often suboptimal.” He also highlighted the need to “understanding where tech is adding value”, in order to better understand the journey and the way forward.
Scaling across organisational and regional boundaries
Our panellists shared some examples of effective scaling across organisational and regional boundaries. Will talked about how in the Midlands a decision has been made by a group of CIOs, CCIOs and CNIOs to largely select Nervecentre as the EPR in the region, and to work on implementing this same technology.
“We looked at what opportunities using the same technology gave us,” he said, citing examples such as doctors in training being able to train using the same systems, and the increased ease of movement between hospitals or trusts as a result of being familiar with those systems. “If we’re all going to be on the same EPR, why couldn’t we give our universities, our nursing schools and our medical schools training on those? That would allow doctors in training and nurses coming out on placements to feel entirely comfortable with the technology they’re going to be using from the very first day.”
Will also noted the opportunities that arise from working at this wider regional or cross-border level. “We’re in active conversations with suppliers about these types of opportunities. For example, if I buy 20,000 mobile devices across UHL and UHN, that will attract a certain amount of discount; but if I can buy 70,000 mobile devices across the entire region, that’s next level in terms of what we can achieve for price and efficiency.”
Meeting once a week face-to-face ensures everyone is on the same page, Will said. “We also share money – some years you’ve got capital and some years you haven’t got enough capital, and a different organisation will be in the reverse position.” The group has also looked at sharing staff and expertise where possible, and trying to recruit people as a region rather than as individual trusts.
“We recognise that the decisions we are making are bigger than individual, organisational self-interest. There have been times where we’ve had to take decisions that might be as good for us individually; but which are really good for the region. It’s about the velocity of decision making, which matters when you’re collaborating at scale. If you’re waiting for everybody to agree, you’re never going to get there.”
Using cloud as the “direction of travel” is integral to opening up opportunities for future collaboration, Will concluded, “because although the technology comes second to the kind of outcomes we want to achieve, we need to be able to allow that role-based access for referrals and patient care across organisational borders.”
David and Debbie also shared their perspective on sharing across organisational and regional boundaries in Leeds, with Debbie highlighting the Leeds Care Record, which she described as “basically the community view of PPM+, which gives our community services a read-only view of things like documentation and observations”. This also works in reverse, so if a patient is known to community services, they will have a tab on their PPM+ record providing key information.
One of the major benefits is having access to GP data, with GP Connect bringing information together from across the country, Debbie added. “This is absolutely paramount if somebody comes in late at night, or they don’t know what medications they’re taking, their past medical history, or so on.”
Debbie also described a new document dashboard called Recovery Care Plan, a collaborative piece of work between Leeds Teaching Hospitals and the community teams in Leeds. “This is going to be the first document that community teams can actually write into PPM+,” she continued, “and it’s just rolling out across the trust now after we’ve piloted it for a number of months.”
“We also work on the Yorkshire & Humber Care Record,” David put in, “to try and make everyone’s EPR visible to each other. In Leeds we have three providers with different EPRs, so it’s about working together to try and optimise the view.”
On a wider level, he said: “We’re trying to make it so that although we’re three separate organisations, from a service user standpoint it feels like one.”
Leeds Teaching Hospitals has also linked in with Leeds Community Healthcare and Leeds City Council, “who have a big digital programme called 100% Digital Leeds, and a large digital champion programme supporting staff and service users. There is potential there for sharing of resources, sharing of learning and training as a wider city, to ensure the health economy goes forward.”
David also highlighted how he and his team are looking at undertaking their MS365 work across Leeds. “There’s a real opportunity here to standardise learning, to align practice, and to make sure that we are thinking regionally or citywide.”
Implications and outlook for digital leadership
Looking to how digital leadership may evolve over the coming years alongside these new modes of collaboration and models of working on a wider scale, Will referred back to his earlier comments about “digital being everybody’s business” and said: “Whilst that’s something that is said, I don’t think we’ve yet translated that into the expectations of leaders across our organisation.”
People taking the view that digital ‘isn’t for them is “increasingly becoming an unacceptable position”, Will reflected, “especially if you want the privilege of leading people in the NHS. Digital is all of our business and we need people to own that change.”
With this in mind, the role of the digital leader in future “will be far more about coordinating and far less about delivery moving forward”, he summarised.
“I totally agree,” said Debbie. “All of our roles now include using technology. For me it’s thinking about how we capture the interest of those digital leaders of the future – we’ve started to offer some digital clinical placements, and next week we’ll be lecturing for the first time at the University of Leeds for a module around digital.”
Working with universities like this is “a great opportunity”, Debbie emphasised. “We want them to see what we’re actually using in the trust, to encourage those future digital leaders, and introduce students to that world of digital and what is possible.”
This also gets students on board as digital advocates, David noted, and “they are the workforce of our future”.
Whereas once digital would be all about EPRs, “it’s now about the potential, about the scope, and about the engagement” he concluded, “we have so much talent now within the trust in terms of digital. It’s about how we engage with and nurture that to create a genuinely digital future where people are engaged and educated to achieve that wider ambition.”
We’d like to thank our panellists for sharing their insights with us on this topic.
