For a HTN Now panel discussion, we were joined by expert panellists including Dr Penny Kechagioglou, CCIO and deputy CMO at University Hospitals Coventry and Warwickshire NHS Trust (UHCW); Stuart Dures, digital skills development manager at Greater Manchester Mental Health (GMMH); Dan Chilcott, client enablement director at Patchwork Health; and Sally Mole, senior digital programme manager – digital portfolio delivery team at The Dudley Group.
Our panellists considered some of the key determinants of successful NHS workforce transformation, looking at how best to drive buy-in and support the workforce, and noting challenges and barriers to transformation.
Starting out by offering a brief introduction, Penny shared some details of her background as a consultant clinical oncologist, along with her role as CCIO and deputy CMO at UHCW. Talking about UHCW’s recent EPR deployment, she said: “One of our biggest assets during that programme has been the development of our workforce, and for me, it’s important that workforce development aligns with digital transformation. We’ve focused on building capacity and created a clinical informatics team which oversees that, to make sure we’re not just going live with a clinical system, but we’re also optimising that and thinking about how we automate workflows, embed patient portals, and engage with our patients and citizens better. Without our workforce talent, and training our workforce in digital skills, all of those innovations would never have happened, so we need to keep focusing on how we can evolve that to enable further digital transformation.”
Sally highlighted her role heading-up The Dudley Group’s project management office for the digital portfolio delivery team, as well as her work representing the Clinical Safety Board at ICB level. “My work with the NHS began in pharmacy, before I moved into a digital role about seven years ago,” she said. “Now, I’m responsible for leading our digital portfolio, which has 61 projects in flight, 34 of which are active. The project management office didn’t exist when I started this role in 2022, so we’ve created that from scratch, with a whole new process to implement and a whole new team to onboard. We’ve done a lot in terms of transformation, and then really trying to embed that into our engagement within the organisation.”
Offering a slightly different perspective as a supplier, Dan talked about his experience of working in the NHS as a workforce leader, travelling up and down the country to support different organisations with workforce transformation, and how that has helped him get to grips with his current role as client enablement director with Patchwork Health. “I now support our onboarding of new customers and the ongoing development of our technology suite,” he said, “which is predominantly focused on providing the tools to help organisations deliver workforce transformation projects, ranging from temporary staffing to rostering solutions.” The company’s recent acquisition of L2P has helped incorporate job planning and helped Patchwork create “a seamless journey of workforce delivery”, he added.
Stuart discussed his past work in health records and patient pathway processes, leading a range of projects “on paper”, before following the transformation to digital and EPR, clinical systems and applications. “I’ve trained and led on projects throughout my career,” he shared, “and in my current role I was brought in to start the electronic prescribing process, which we introduced using a gamified approach to training. In general, I help support frontline staff in everything they do, and we’re working on a digital skills self-assessment at the moment to assess staff’s ability across Microsoft products and clinical EPRs, to give us a baseline understanding of where we stand and how to get to where we want to be using targeted training based on where identified gaps are.”
Key factors of successful workforce transformation
Penny kicked us off with some key factors for successful workforce transformation, including having a strong vision in place to help the workforce keep pace with digital transformation. “For me, it’s thinking about the creation of new roles, training, building capacity in existing roles, learning from other organisations and providers, and building not just the technical skills but also the soft skills which cover change management, transforming, challenging the status quo, and improving.”
Success also relies on looking at the ways technology can be used to support staff and support transformation, Penny continued, giving an example of how UHCW has used AI to streamline routine tasks like answering calls and responding to queries for its HR staff. “It’s about how can we ensure that we don’t use highly skilled staff to do mundane tasks.” she said, “so we can ensure our workforce works at the top of their scope of practice.”
Stuart highlighted the importance of “the context that’s used to transform the staff”, saying that engagement should “always be kept contextual to what they’re learning and where they want to get to, what they’re going to get out of it, and the benefits realisation”. The main question staff have relating to transformation is “why?”, he went on, “and they want to know why we’re getting in the way of their current practices to change a system that they believe works perfectly well”.
Sally agreed with Stuart’s point about ensuring the value is outlined within transformation work, adding: “I think the biggest factor in resistance to change is around the communication – as an organisation we need to be clearly communicating why we’re making these changes and how we’re going to do it.” Sometimes the end point can “seem so far away”, she considered, “that you do get a lot of resistance and skepticism around the changes you’re trying to implement”. Changing the communication style to reflect the needs of different audiences is also important, she told us, “so you do need to have that information in lots of different formats”.
Moving on to discuss the skills gap, Sally shared that at Dudley they baseline staff against the SFIA Framework, which she says “helps pinpoint current skill profiles and identify our people’s skills we might not be using”. Talking about the emergence of things like AI and automation, she said: “It’s important to know whether we have the skills in-house to be able to do things like that and transform the workforce, so we can implement these digital solutions effectively, with the right staff.”
“Everything mentioned so far rings absolutely true for us,” Dan said, “because when we start working with a new customer these are things we want to address: what is that vision, what are the skill gaps, and what are the outputs we’re trying to achieve.” Understanding the different problems that different stakeholders are going to have is key, he went on, “because the problem that the finance director is going to have, versus the problem the clinician is going to have, might be very different”. Bringing a “full range of those voices” to the table to help make some of those really key decisions is integral, he noted, “because nobody likes having change forced upon them, but when they know there’s a problem that’s going to be resolved, they’re much more likely to come on that change journey with you”.
Overcoming challenges around workforce transformation
Penny cited four challenges around workforce transformation: the change itself, and how that can be “daunting” for some people, along with the fear of failure, and how it’s important to allow people to “fail and retry”; the perception that transformation projects will take people away from their clinical duties, and the need to focus on job planning to “make sure that people have the capacity to devote time to that change”; the lack of trust in technology and its use to replace routine tasks, and having to focus on building that confidence with staff around clinical safety; and digital literacy, with organisations needing to expose staff to digital training to ensure they can use technology effectively.
Dan reflected on his work with NHS organisations across the country, noting that “everyone is different, and everyone’s at a different stage of their digital journey”. For Patchwork, that often means having to integrate with existing solutions or meet differing requirements, with legacy system integration in itself becoming “quite a challenge”, he said. By focusing on that interoperability and integration, Patchwork has managed to help “achieve that flow and minimise duplication of data entry when using technology”, he continued, “and that’s a challenge we need to take on early on, so we can put development work in to meet those needs”.
Another challenge lies with financial constraints, Dan shared, “especially when people are replacing a paper-based system, and there’s no existing line on someone’s budget statement for technology – being able to prove ROI from digitising things can be quite challenging, but when you start to drill out efficiencies these things are possible”. Again, that’s something that Patchwork like to tackle early on, he said, “because then we can move on to the other challenges that Penny mentioned around things like resistance to change”.
Thinking back on her experience in the project management office to date, Sally told us how the biggest learning has probably been around communication and the need to set expectations, “not only for what improvements the digital solution is going to bring, but also for what the clear process is to get us through the delivery”. She also echoed Stuart’s comments on the importance of baselining current position, saying: “You can only understand where those risks and concerns informing resistance to change come from by going on that journey and having that conversation with people.”
At Dudley, there’s a portfolio delivery checklist which “standardises project delivery from end-to-end”, according to Sally. “We’ve also got terms of reference for product owners, so if a request comes through for a digital solution, we have to have clinical buy-in from the top down; a product owner with clear terms of reference about what their role is around engagement; and making sure we have the right subject matter experts involved, so when we come to do things like clinical safety we know we’ve followed the right process.” Quite often, during current state process mapping, “we realise there are lots of other problems we can also solve as part of this transformation”, she went on, “and there are other opportunities for us to improve the services so it’s not just like-for-like”.
Securing buy-in on transformation projects
When considering how best to secure buy-in around transformation projects, Stuart stressed the importance of maintaining that honesty with staff and “keeping the human touch when engaging – don’t do everything by email or SharePoint”. Keeping your communications simple, but ensuring the right level of information so that staff have the details they need is key, he went on, “and it all comes from strong leadership – the engagement practices, the plans, keeping service leads involved at all times so they can cascade and disseminate information, so you get a communication trail flowing”.
Stuart also shared some details about a project using gamified training to help introduce electronic prescribing. “It was a challenge to introduce that at a trust which only used paper because of the safety aspect of it,” he said, “and the trust was also going with a new gamified training methodology provided by a company called Attensi. That wasn’t like the traditional tick-box exercise – it’s a game and a test all of the way through, so you use process steps like you’re using the system in real life, but you answer questions as you’re going.” Depending what the training is, the platform allows users to interact with patients and other members of staff, according to Stuart, “and whilst that’s just for ePMA at the moment, the opportunities there for workforce transformation are endless”.
“Communication is so important for securing buy-in, but it’s doing it at the right time, as well,” said Dan. During the procurement process, he went on, there are going to be people on the panel making decisions, but there are also potentially “thousands of users not on that panel that you still need to take on that journey with you”. An approach that Patchwork recently tried with an NHS organisation was putting in place an open forum for users to ask questions about their temporary staffing solution that was being implemented, and Dan told us how this helped his team understand the problems users were encountering with their paper-based processes, allowing them to demonstrate how the solution would tackle those.
“Having that constant feedback loop in place allows us as an organisation to keep evolving,” Dan said, “and we work to ensure we can really deliver ongoing improvements to our products in a way that encourages people to continue to buy-in, even after the project has been delivered.”
“One size does not fit all in terms of engagement,” Penny considered, “and we need to be able to use different methodologies to deliver the same message.” Agreeing with Dan’s point about engagement and buy-in needing to be continuous, she continued: “We need to be constantly looking at what our goal is, where we are currently, and how we can support each other – I’ve found in my experience that it works best when our engagement is incorporated into existing structures and frameworks, rather than creating new meetings, which can often add more workload.” Examples of what has worked at UHCW include regular workshops, blending the organisation’s staff with industry staff to get different perspectives, and regular check-ins to focus on problems and how tech can be used to solve those, she shared.
Ensuring sustainable workforce transformation
Responding to a question from our live audience about how we can be sure that workforce transformation projects are sustainable and do not simply end up “landing in someone’s lap” or creating extra work going forward, Stuart highlighted that “the BAU (business as usual) teams, who run everything as the project gets going, sometimes end up on the back end of it, because the funding dries up, the staffing that was supposed to remain in place to allow a project to continue falls flat, and that leaves them to have to deal with it”. That’s why the sustainability of a project should be seen as “the main aspect” of the project moving forward, he said, “and it’s important to look at that when it comes to funding, and to get everyone involved with those conversations about how this is going to keep performing for a long time, not just for now”.
Sally picked up on the topic of financial and staffing challenges, pointing out issues around managing starters and leavers, and “achieving that consistency across services” as the project continues. “As part of our BAU service desk, we look at issues that might arise as the project moves forward,” she said, “as well as scalability and shared services – we should be looking to procure at an ICB level to get better value”. What often happens, she considered, is that interoperability and integration takes a lot of time and resource, “and if you can buy something where those services are already shared, and you are rolling out on a much wider scale, that’s much more financially sustainable”.
From the perspective of a supplier, Dan noted how these financial challenges make it all the more important that the solutions being delivered enable NHS organisations to achieve a return on their investment. “Whenever we support customers, we’re always looking at what the savings to come out of the project will be,” he said, “and over the past few years, we’ve saved the NHS millions of pounds in agency avoidance by enabling these systems to run.” Building in features like rate controls within temporary staffing solutions also allows for further savings, he said, “and we’re constantly committed to driving workforce costs down where possible, whilst still maintaining that ability for organisations to deliver safe and effective care”.
“For me, it’s about how we can leverage big transformation programmes to ensure maintenance training for our staff is right,” Penny said. “Stuart is right – you get a number of agency staff, and then when they leave you’ve got a gap, and you’re left with a couple of people to deliver a big change.” Looking at ongoing training and how that is delivered in order to keep up with that is key, she went on, “and there are lots of online courses we can use to support that as well”. Then there’s how technology can support productivity, she continued, “and what the outcomes are when it comes to saving time for our staff to improve productivity”. Aligning workforce transformation strategy with digital transformation strategy would be an area to focus on for the future, she considered, “because there might be roles that are now redundant as a result of new technology, and there might be new needs that need to be met by workforce to keep pace with that technology”.
Sally told us how her team at The Dudley Group have been doing “a lot of sharing” around roadmaps and lessons learned, as well as sharing their build for the maternity department with Bolton. “We spent nearly two years doing that, and they’ve been able to implement it within a four-month period,” she said, “so I think there’s something to be said there for canvassing the area and where we’ve got the same demographics and the same standardised build, looking to share the digital innovation work we’re doing, so we’re not reinventing the wheel all the time.”
Going into more detail about what the maternity build involved, Sally talked about how Dudley took a blueprint “which equated to roughly 40 line items”. The scale of the implementation from getting that blueprint to working in all of the necessary regulations around maternity care, and “making the solution fit for purpose across the whole pathway”, meant that this increased to 160 line items. “We employed a digital midwife specifically for that project,” Sally told us, “and a lot of that work was going on on the floor, with the midwives, consultants, obstetricians; to go through their processes, because there was lots of paper, lots of risk – labour and delivery was probably the biggest eye-opener for me – and from a digital perspective we wanted to try and stop people having to put things into the EPR which had already been captured.” Midwives were spending “about four hours” after a delivery writing up their notes, Sally continued, “which was instantaneous at the point of the episode, so they saved a lot of time”.
“We’ve already got an excellent workforce with a very high level of skills,” Stuart said, “and I think it’s important to focus on the upskilling of those people in a proactive sense, rather than just on demand.” That approach would save money for future projects as a whole, he noted. Stuart also mentioned consistent underspending of apprenticeship levies, adding: “They offer so many courses on things like data, digital, AI; we should be looking to actively use those, because we just lose them in April, every time.” What good would look like for the future would be promoting self-learning, he continued, “so part of our staff’s objectives is to upskill themselves, and we’re giving them the digital tools to support that”.
As a supplier, Dan shared how his team go about looking at the capacity that’s available to NHS organisations from within their digital teams before looking at how they can support that. “Some have got resource available to them,” he said, “and it’s whether you can tap into that, but also where you can scale your implementation offer to support smaller organisations who perhaps don’t have those skills or that capacity available to them.” Going back to Stuart’s point about self-learning, Dan also told us that Patchwork Health has “invested heavily” in online learning and some elements of gamification to help make their solutions accessible and easy-to-use, so people are engaged. “That also helps us communicate with users about any new updates to our system or new features which may be available, and we’ve done that in a really innovative way, too.”
The direction of workforce transformation away from a single organisation out to the ICB, has meant Patchwork Health is increasingly spending time on “helping organisations find a safer and more effective way to deploy staff to multiple organisations, like by using digital passporting and relevant credentials,” Dan shared. “That’s a really interesting concept we’re looking to explore with our customer base”. Another area of focus is on smarter staff scheduling, he said, “so we can look at activity and see how many staff members we need to have on a certain day to ensure safety for patients”.
We’d like to thank our panellists for taking the time to share these insights with us.
