For a HTN Now discussion on building safer care and embedding clinical safety into digital pathways, we were joined by a panel including Corrina Hulkes, associate CNIO at Health Systems Support Ltd; Peter Hansell, CEO and co-founder at Isla Health; Victoria Mustafa, regional quality, safety and digital lead for London at NHS England; and Ruth North, clinical safety officer at Leicestershire Partnership NHS Trust.
Panellists offered their insights on how digital pathways can be designed with safety at their core, exploring practical strategies, tools, and best practices for embedding clinical safety into digital care models to improve outcomes and build trust.
Corrina started the webinar to share: “I have been a CNIO in NHS trusts for the last seven years, and clinical safety plays a huge part in my role. I worked at an organisation that didn’t have a robust process for capturing clinical photography, people were using personal devices, sharing on WhatsApp, and that came with huge risks, as well as impacting on patient care because images weren’t available at the point of delivery. We improved patient safety and experience by utilising a tool that could capture the data but also share it in an encrypted format and integrate with EPR.”
This meant clinicians could access images safely from a single place, Corrina continued, “which meant they were better able to use those in clinical decision-making”. Results included improved staff and patient experience, and staff appreciated the introduction of the tool as they were able to see the benefits. “I think it also improved patient outcomes, because it meant there were no delays in patient care and decisions were made in a timely way.”
Victoria told us how she began her digital career as a digital midwife, before becoming an ICB digital lead for maternity, leading to her current regional role. “I work across London supporting trusts to improve safety and maternity care, often through digital innovation,” she said. “Although every trust faces different pressures, the goal is always the same: safer care for patients. So for me, building safer care means embedding safety into everyday practice, not just policies, and digital can support that by enabling earlier intervention, clearer communication, and more joined-up care.”
What embedding clinical safety looks like in practice starts with recognising that safety isn’t owned by one team, Victoria went on. “Patient safety, digital, clinical safety, and governance must work together and not in isolation – when we bring those domains together, we move beyond compliance and create digital tools that are co-designed with safety in mind, reflect frontline realities, and genuinely support safer care.” Putting patients at the centre and collaborating are key, supported by digital to spot deterioration earlier, escalate faster, and make safer decisions in real time.
Ruth shared her experience of using Isla, now “well embedded” in Leicestershire Partnership’s community health systems and community nursing areas, where it is used for wound management with images fed into the EHR. “For me, clinical safety starts with looking at what a product does, whether it will enhance what we do, and whether it will make life simpler for our clinicians,” she said. “Getting our clinicians involved in some of the prototype work, understanding what they need from the solution, and checking what risks something might pose for our system, is all part of our process.”
Integration is also important, according to Ruth, “checking whether something works with everything else we’ve got in place, relying on manufacturers sharing their hazard reviews and hazard logs, and looking at how those hazards identified might impact our delivery of care”. The trust’s teams have been working closely with Isla, putting elements of development into areas identified as requiring further attention.
Patient safety and clinical safety are “a massive part” of Isla’s work around building digital technology to support the health system, Peter told us. “I wanted to zoom out a little bit from the way we often think about clinical safety, and get back to safer care as the foundational thing we need to get right. There have been many examples of events that have had negative outcomes for patients that we can learn from, and in an ideal world we would prevent that from happening again.”
In many of these cases, there’s an identifiable communication or information gap that has led to the problem, Peter considered, “and I think digital and building standardised digital pathways is a very powerful way to begin to close those gaps”. From an NHS or system-level perspective, the biggest clinical safety risk is arguably long waiting lists, he continued. “We can have patients deteriorating on waiting lists for months or years, and without the right systems and processes in place to monitor them, there’s a real risk that that deterioration won’t be picked up.”
The role of digital pathways in delivering safer care
Identifying and being really clear about the problem you are trying to solve when implementing digital is essential, Corrina explained. “There are so many digital tools out there, and you always need to consider what hazards introducing them may bring to your organisation – having that clinical hazard workshop with people that are going to be using that tool is a good way of understanding that.” The next step is looking at mitigations and residual risk levels, before moving on to monitoring, going back and reviewing risks, and checking whether any modifications are required.
Victoria considered how digital pathways are making the biggest impact on clinical safety by improving access to real time data, as well as enhancing communication, citing digital early warning systems and electronic referrals. “We’ve recently done in-utero transfer platforms to help frontline teams respond faster in critical situations, finding co-designing with clinicians helps get things embedded in daily workflows. These systems reduce variation, support timely escalation, and ultimately improve outcomes for patients.”
Ruth shared that the most important thing to bear in mind when embedding safety into a digital pathway is whether it works as you need it to, and if it saves time for clinicians. Training and getting feedback from staff is also key to understanding what areas they might be struggling with and what can be done to make improvements. “We’ve got some rural areas with poor Wi-Fi and telephone signal, so we’ve got an offline element now, where we can still capture photos, but they will be uploaded once the connection is restored. Ease of use is another thing, especially if we’re asking our patients to use it, and Isla is very easy to use – they receive a link, click it, take their picture, and then it’s submitted for review.”
Offering some more details of Isla’s digital pathway platform, Peter told us how Isla’s aim is to work closely with clinical teams to standardise patient care and the decision points along a patient’s care journey, from primary care through to secondary, hopefully to out-of-hospital monitoring. “We can start to iron out some of the delays that happen in the health system, because often what we’re waiting for is an information gap to be filled, and very often we can fill that without having to bring patients back into hospital to collect that information.”
The team at Isla work closely with each different trust it deploys with, as well as the GIRFT team at NHS England. “The aim is to build standardised digital pathways whereby every patient that comes into the health system is at all times flowing in an optimal way through to the next treatment or intervention that’s right for them,” Peter said. “We’re working on a project with London North West to support them in implementing Martha’s Rule, which gives patients and families the right to request a second opinion, and that’s a good way to show how we can improve safety for patients through quite a simple intervention.”
In the last six months Isla has received 2,500 submissions from patients and family members who are monitoring a patient’s symptoms, and the platform then helps triage that data and highlights for clinical teams where those symptoms might be trending strongly. “That’s helped the team have a much more data-driven conversation with patients on the ward when it comes to implementing Martha’s rule, and when it’s appropriate to seek a second opinion. That’s now been done in three wards at London North West, with further rollouts expected over the next few months.”
Another example is Isla’s work with the GIRFT team to try to establish a more standardised way of monitoring men with prostate cancer. “The safety net we should provide there is quite clear,” Peter said, “so for people who are on an active surveillance pathway, we should be taking a blood test and checking the PSA level every three months, and doing an MRI or physical examination every 12 months.” In practice, that can be inconsistent, according to Peter, “and that’s a great example of where the safe pathway is well understood, and much more of a systems challenge, whereas if we had something that integrated into EPR and deployable nationally, we could very quickly get everyone to that same standard of care”.
Adoption and compliance
Ruth noted Leicestershire Partnership’s approach to checking GDPR compliance with digital tools. “We look at whether anything is being stored or routed externally, where the server is being held, and so on. If it’s not compliant with our standards, then it’s not something we’ll use. When you’re looking at any product, you’re looking for what patient identifiable information it will use, where that will be held, and we go through screening with our cybersecurity and IT teams.”
“We went on quite a steep learning curve when we started six years ago,” Peter shared. “It can be difficult, as a start-up, to begin working with the NHS, but I do think that the standards you need to comply with are clear in terms of sensitive data and processes to minimise risk.” With that said, approaches may differ from trust to trust, he continued, “and it’d be great to move further toward a once-for-the-NHS approach”. Rather than seeing clinical safety as a blocker, it should be seen as a core responsibility of running a company that is going to support health systems, he added.
Corrina mentioned some of the barriers to adoption, including poor usability, a requirement for hours and hours of training, and resources for that. “You need to get the balance right so people have enough training to go off and use something, and also the at-the-elbow support for them once they’re using it,” she said. “At London North West we recently employed some digital clinical educators to go around to all of the clinical areas and check whether they need more support.”
Agreeing with Corrina’s points on training and support, Victoria added: “A lot of it is just being visible – when I was a digital midwife I would walk around the shop floor every Friday, and it’s amazing what you pick up that people have never mentioned. That might be that they can’t open something like a form, and showing them once is all that’s needed to change that for them.” Doing that comes back to understanding whether you have the right digital skills and digital systems in place to support people with their day-to-day roles.
“At regional level we work with trusts and clinical leaders by focusing on learning and not just assurance,” Victoria explained. That involves embedding safety into everyday practice to support MDT reviews, sharing insights across different systems, and co-developing tools. “We’ve just developed the Patient Safety Review Framework, and we saw that everyone was doing something differently, so we came up with a system to help with that. We’ve got the terminology of “do once for London”, and although that’s not mandatory, it’s about creating a culture where safety is seen as part of good care and not just a checklist.”
Reflecting on her own experience, Corrina talked about the need to get the right people on board at the start of a project. “We implemented Isla quickly at London North West, and I think it’s because we had the right people in the room – we worked with the information governance and cyber leads, made sure we had all of the documentation from Isla on compliance, and went from there.”
“Engaging early and moving away from clinical safety as a blocker is key,” Peter said. “Clinical safety workshops are a really valuable way of thinking about how we go about deploying a tool, and they can help get away from that tendency to leave it to the last minute or to do the minimum in terms of documentation to try and get things signed off.”
How Isla can help with patient safety
Ruth considered the importance of ensuring that using the Isla platform isn’t creating more data siloes, highlighting its integration into the EHR. “There are a couple of gaps on some of the pathways, but we’re working on that so hopefully as much as possible of the data collected will be stored in our EHR, to help give clinicians an overall view rather than having to access on different platforms.”
“If you go to most community trusts around the country, there will be pockets of clinicians who don’t have any other option than to capture videos, photos, or sound recordings on their phones,” Peter said, “so sometimes these data siloes exist and they might be invisible.” The question then becomes whether using a platform like Isla is better than having data stored on hundreds of devices around the country, he went on, “so it’s not necessarily that data needs to be stored on the same server, but it’s getting as much of it in one place as possible to give users visibility”.
Looking ahead
Considering what might be the most immediate opportunity to strengthen patient safety over the next 12 months, Victoria mentioned the rollout of the single patient record as set out in the 10 Year Plan. “I’m excited because that started in maternity services, and it could significantly improve interoperability across community, clinic, and acute settings. I’m hoping it will help teams identify risks earlier, and mean we can escalate more effectively, communicate more effectively, and deliver more joined up care overall.” Ambient voice technology is also being explored in London in both community and clinic settings, to reduce documentation burden and support early risk detection, she added, “and I think together these innovations could transform how we deliver safe and responsive care moving forward”.
Ruth’s team has recently reviewed its Isla safety case file, identifying that an area for improvement is allowing staff to see previous edits made to a patient’s information or submission. “That will help with our ability to see where we are with that particular patient, what’s been submitted, who has dealt with it, and give a much clearer picture to anyone who picks up that record,” she stated.
For Corrina, it’s important to bring clinical safety back to being hand-in-hand with patient safety, as well as to ensure that whilst clinical safety is done properly, it isn’t a blocker for innovation. “It’s about making sure you’ve got the right processes in place so that you can do it efficiently and it doesn’t delay innovation,” she said.
“My key takeaway for this session would be to keep a very strong sense of perspective on risks and make sure if we’re setting out to solve something that is a known and significant risk, we’re not getting too waylaid by the smaller risks,” Peter shared. “That’s in no way to diminish the importance of very thorough clinical safety reviews, but we just need to make sure we keep all of the improvements in priority order so we can move forward as fast as possible.”
We’d like to thank our panellists for taking the time to share these insights with us.
