For our latest interview, we caught up with Neill Crump, digital strategy director at Dudley Group NHS Foundation Trust, for a chat about the digital methods undertaken by the Dudley Group and what these mean in practice; his belief in collaborative working and professional development; and the importance of personalising the patient journey with the support of digital tools.
On his background and how he got into digital, Neill shared that he has been working in the digital, data and technology world for nearly 30 years, with a background in commercial industries. This included a role in one of the largest cloud business software organisations, working within their centre of excellence and focusing on business transformation.
As time went on, Neill became a father. His little girl was born with additional needs, and Neill came to the conclusion that he could combine his skillset with his passion for making sure he was doing everything he could for her and others in her situation. His move to the public sector saw him take on a role in digital transformation for the local council and a multi-agency role spanning the local authority, NHS, police service, and more. He also gained experience from a role with a national housing association, which he credits with helping him develop his understanding of “how community really works, and how you can connect a community using digital, data and technology”.
Neill joined the Dudley Group NHS Foundation Trust nearly four years ago. He pointed out that whilst the NHS often traditionally likes to recruit internally, the health service can gain valuable insights and benefits when staff bring experiences from other sectors.
Digital methods at the Dudley Group
At Dudley, the portfolio Neill works in and around covers the streams of strategy, transformation, digital, data, technology and improvement practice. “You can see how they interlink, but in my experience, a lot of organisations don’t tend to group all of these things together in one place,” he said. “By doing this, you can set your strategy; get a transformation team to deliver on that; underpin it with digital, data and tech; and ensure a continuous improvement cycle in order to make it sustainable. We have a portfolio team and an informatics team who are there to guide our work.”
Building on that point, Neill reflected on how the Dudley Group has developed its teams from a digital perspective. “We have focused on getting all the basics right first; having clear methods in place, being transparent, and providing the right environment for a high-performing team. We want to attract, grow and retain fantastic digital, data and technology professionals. As such, we have implemented a skills framework called ”Skills for the Information Age”, so that we are very clear on the competencies that we require for each role, and we can look at the performance required to be effective in the role.
“Also, this gives something back to the individual themselves and helps with their progression. We have developed a number of case studies so that we can showcase this to the team; that has helped with building enthusiasm particularly among junior and middle ranking team members, because they can see a clear direction and that we are investing in people. We’re signed up to the Digital Skills Development Network in the Midlands, and we give them training opportunities through our different partners to help them modernise their skills.”
Another key focus for the trust has been ensuring that there is a digital steering group in place that is clinically and operationally-led; Neill himself chairs the group. “We’ve got a “pull” model in place; so it’s not me as a digital strategy director trying to push digital onto people. We take the approach of identifying clinical and operational problems and then looking into opportunities to solve them. It’s not an IT-driven project, and I think that is crucial; we really place the emphasis on clinically-led change.”
Developing digital maturity
Through transformation efforts and with the support of the steering group, the trust has been able to become “largely paper-free”, Neill continued. “We’ve still got pockets of paper which we need to get rid of, and we need to tackle our historic records, because we focused firstly on making ourselves more productive and efficient in the present, rather than going back to that historic problem as priority. But it certainly feels like we’ve made good progress on that journey to becoming paper-free.”
Next, Neill brought up the Digital Maturity Assessment and the national directive around this. “We’ve really embraced this at the Dudley Group,” he shared. “We wanted to understand where we were as an organisation, and the great thing about the DMA in my view is that it touches a lot more than just the EPR. It spans the whole of the organisation across seven different domains. We have spent a lot of time understanding that framework, and then making sure that it is reflected in our organisation, and also speaking to our frontline and operational teams about it so that they are better placed to recognise potential and opportunity.”
The Dudley Group is in the upper quartile within the NHS when it comes to digital maturity. “We’ve reached that place by making the right decisions,” Neill reflected, “and by getting clinical and operational teams engaged. And it’s about having that “pull” method and targeting what our staff want to do, and what they want to change in terms of improving how they operate.”
Sharing another example of the trust’s approach, Neill explained that when he worked with cloud business software, he became certified with enterprise architecture. “Following on from that, I have recruited an architect in my team and we have been using that knowledge to help achieve healthcare objectives through stronger decision-making,” he said.
The level of digital maturity that the Dudley Group has built up over the years enables the trust to take an innovative approach now, Neill added. “That gets very exciting. If you think of it like the periodic table, they spent all of that time understanding the foundations of that table and what was in it. Then they brought together lots of elements, and from there, you can put your existing components together and create something new. In our case, that translates to creating impactful changes which don’t always necessitate a nine-month, resource-heavy project.”
As a tangible example, Neill highlighted how rolling out EPR functionality across the trust and providing staff with the means and skills to utilise cloud analytics has meant that the Dudley Group can offer reporting on mobile devices. “It didn’t take an awful lot of effort – all the foundations were already in place. So we have been able to offer this simply by switching on the reporting function, knowing our teams are equipped to use it to plan their time.”
As an example of a data-focused project, Neill raised how the trust has been “undertaking research science on our digital projects, starting with digital health coaching. This saw the introduction of a digital perioperative pathway which features a digital health coach supplied via an app. Patients in perioperative care work with their health coach to understand their health and prepare for surgery.” Participants have reported “various long-term health benefits” as a result of this intervention, Neil explained, and the trust has also seen that the post-operative length of stay is 25 percent lower in those who took part and used the app, compared to those who did not. “We’re currently preparing a research article to publish, and we hope to scale this research science to larger-scale digital projects.”
Patient focus: journeys, engagement and personalisation
In terms of managing the patient journey, Neill noted that the trust tracks and monitors referrals through to treatment, supporting the management of the waiting list with oversight of all aspects including outpatient consultations, diagnostic tests and elective surgeries, as well as the optimisation of resources. This could mean recognising where scheduling could be altered to better fit need, or it could mean increasing capacity in high-demand areas. “It can also mean working with our partners in the Black Country,” Neill commented. “We might be able to take on work that reduces pressure for our partners and vice versa. It all comes back to sharing information.”
A particular focus for the Dudley Group has been personalising the experience for the individual. “We’ve been implementing a deteriorating patient pathway using data from our EPR. We’ve gained insights into the various steps involved in managing a patient, and if their condition deteriorates whilst they are in hospital, we can examine that patient’s journey and look for places where we can improve our care and focus on patient safety. There are various things we have done – one example is the EPR triggering thresholds for early warning scores, allowing us to put a treatment or escalation plan in place, if needed, before the next patient gets to a place where their condition deteriorates too much. Again, this is a case of a clinician-led project where our team worked out where they could make a difference to care using digital tools.”
This pathway has led to an increase in sepsis screenings, Neill added, along with other positive impacts. Red flag triggers are now reported to be “more accurate”, with 86 percent now leading to sepsis treatment; as opposed to 72 percent before the pathway implementation. Sepsis Six, the six medical procedures that can be performed within an hour to reduce risk of death from sepsis, has increased by 12 percent overall, with an increase of five percent within the ‘golden hour’ (the first 60 minutes following a traumatic injury).
Another related example revolves around Martha’s Rule, implemented this year to enable patients, loved ones or staff to request a rapid review of a patient’s condition at any point. “Martha’s Rule comes back to getting information, and ensuring communication between people and their clinicians. We’ve developed a system whereby we collect that information from the family of a patient, for example, and surface it in the EPR so that we can make sure it is seen, understood and acted upon.”
An area that the Dudley Group is beginning to explore lies with patients providing information themselves to the trust. “That’s about patients giving permission for the data they themselves hold to be used for things like long-term condition care – that will help us monitor them, track treatments and so on.”
Virtual wards: key to success
Speaking of monitoring and tracking patient treatment, Neill turned next to the Dudley Group’s paediatrics virtual ward.
When it comes to a successful virtual ward, Neill shared the view that virtual wards should not be seen as a digital programme in themselves, or run by the digital team with technology as the key success factor. “It’s about the collaboration between the paediatricians, the nurses and the community teams, in my eyes,” he said. “Really, we are talking about a change in how they operate and a change in the care pathway. As a digital team, I wouldn’t want to take recognition away from the work that they have put into that.”
The role of digital here is to provide an underlying, supportive foundation, he said. “That is a success factor, of course – but it absolutely doesn’t happen without frontline adoption and engagement. Those clinical and community teams put in so many design hours upfront to make our virtual ward work, figuring out how their standard operating procedures were going to be different and working out how they could safely deliver high-quality care. So actually, as a digital leader, I think it is about stepping back a little bit, and letting the clinical and operational teams own it.”
Advice for planning frontline digitisation
The Dudley Group will have delivered on almost all of the capabilities of frontline digitisation by next March. Would Neill have any advice or learnings to share with other trusts looking to complete related projects?
“We feel confident that we have used the funding effectively to tackle all of the mandated areas, and I think it comes back to collaboration with clinicians and operational staff,” Neill reflected. “Engaging a wide range of different people and roles is really key so that you can understand how to form the plan.”
Collaboration is also necessary with finance colleagues, Neill pointed out. “You need to work out where the benefits are. Even though you get national funding, there is always a revenue consequence. You still need to make sure there is a return on investment. We managed to develop a business case which our trust board signed off that really shows where the benefits are; and then we have been able to track those benefits through to fruition.”
Priorities for the year ahead
With regards to the next 12 months, the priority for the Dudley Group will lay in finalising the work tied to the frontline digitisation programme, including upgrading and moving the trust’s EPR out to the cloud.
“We’re doing much more work on our data warehouse, making sure that we are using the information captured in the EPR, making it easily accessible as digestible insights for our frontline. We’re also going to be extending our patient portal so that we’ve got patient-initiated follow-up, and expanding the form functionality to gain a more immediate, targeted response between our clinical and operational teams and patients. We hope that this will improve communication and help with elective recovery targets.”
The Dudley Group has been rolling out e-consent to general surgery, with plans in place to roll the functionality out to other areas such as cardiology and dermatology. Neill also shared how the trust has partnered with a health tech supplier to work on “modern clinical communications”. This will support improved communication with numerous different roles within the frontline, Neill explained, and it will also support task management.
Clinical decision support is in the Dudley Group’s pipeline, with a focus on how services connect to primary care. The aim here is for primary care staff, when making referrals, to gain support around radiology decisions in line with established guidelines. “When staff are clicking through the referral process, the guidelines will be built in to help prompt them and suggest courses of action. So that will be great for the patient, I think, as they are more likely to get the right treatment in the first instance.”
Looking to longer-term plans across the next five years, Neill shared that the existing trust strategy runs up to 2024; and the digital plan runs until March 2025. A new three-year digital plan will be put in place to follow on from this.
“It’s important to note that we no longer need a digital strategy,” Neill observed. “We’ve done enough work and we have strong enough foundations in place to make a strategy redundant. A plan, however, is more action-based. It will be led by our clinical and operational staff, and we have used ten anchor points based on the What Good Looks Like framework to build around.” These include building confidence and trust in digital tools and processes among patients; supporting digital literacy and empowerment among staff; reducing costs and environmental impacts through digital means; and making best use of tech and data in order to improve and coordinate care pathways across the region.
“I’ve deliberately kept the plan simple,” Neill added. “I’ve not filled it with tech-talk. Ultimately, when it comes down to it all this work around digital is about highlighting the ways in which we can use technology to support staff, empower citizens and improve patient outcomes.”
Many thanks to Neill for taking the time to share his insights.
