Drawing on his own experiences in the US, Dr Harpreet Sood, Senior Fellow to the NHS England Chief Executive, argues that digital health care initiatives must bring the workforce along with them if they are to succeed:
Ron Heifetz, Professor of Public Leadership at Harvard, describes two types of change: technical change, which provides solutions to problems we can already answer; and adaptive change, which addresses problems we cannot yet answer.
Adaptive change requires changing people’s hearts and minds. It’s harder than technical change, but when it’s successful it can result in huge improvements. Those embarking on technological change tend to forget this more human, adaptive side.
The Nuffield Trust report, Delivering the benefits of digital health care, is timely, as it sheds light on the adaptive nature of health information technology. It sets out seven opportunities to drive improvements and transform health care offered by digital technologies.
The NHS is increasingly using technology to provide services, which should help drive the integration of physical and mental health, health and social care, as well as primary and specialist care, as set out in the Five Year Forward View.
Having been closely involved in the Wachter Review, which is looking at implementation of electronic health records in secondary care, I recently visited a few hospital trusts. Our group witnessed substantial progress, but also saw large variations in the way that technology was being used – some of them quite concerning.
I spent over two years in the US, where I became impressed by the growing importance of technology in delivering health care. Boston, where I was based, is now a leading hub for digital health. A key observation has stayed with me from my time working there: the importance of engaging the workforce in technology developments.
While working at Brigham and Women’s Hospital, a 769-bed teaching and research hospital in Boston, I was in the thick of an electronic health record (EHR) system implementation. Colleagues initially thought the system would resolve all the inefficient and silo ways of working. However, contrary to this belief, this exercise turned out to be much more than a simple installation of technology and the hospital took several steps to ensure this was the case.
First, the leaders had to convince the workforce this was not just a health technology installation but more a large-scale transformation project. The Chief Medical Informatics Officer and a Chief Information Officer deployed dedicated teams and clinical champions throughout the organisation to engage the workforce and build usable solutions that made sense for individual departments. There was constant communication, with regular updates and engagement events with clinical and managerial staff, making them feel part of the process.
Second, the hospital saw this is an opportunity to redesign service delivery and develop new workflows to gain longer-term benefits from the deployment. Moving from a paper-based to an electronic health record is not just a change in how information is recorded. The real value comes from using the electronic health record as a trigger for redesigning care and making use of data.
Many opportunities for improvement were identified, including improving the quality and safety of care, automating tasks such as medication reconciliation and review, promoting shared decision-making, and achieving financial savings by avoiding duplication of laboratory and radiology testing. Concerns remained over the usability of the EHR and the possibility that it was supporting hospital billing rather than improving care. However, a basic infrastructure was being deployed that could be built on further down the line.
Finally, the hospital ensured support from the chief executive and board, and made the implementation a priority for the organisation. Commitment from the top was shown by substantial investment and dedicated resources for training and development. The board and leadership were regularly updated on progress, ensuring accountability and fit with the timeline and budget.
The complexity of technological change in different industries has been captured by Erik Brynjolfsson with the concept of the Productivity Paradox. This concept refers to the near‐universal experiences of industries implementing information technology tools expecting to see rapid improvements in quality, safety, reliability and productivity.
The initial experience tends to be disappointing (hence the ‘paradox’) but it tends to resolve, often after a period of five or 10 years. However, an important ingredient for this to take place is leaders and staff to reimagine how they can deliver care and bringing together organisations to make a big improvement – something needed in the NHS.
NHS trusts are now developing plans for implementing EHRs, and leaders are encouragingly making it a priority. But local providers must recognise this as a continuing journey rather than a one-off event.
Additionally, as demonstrated with the CCIO network, the NHS needs more informatics professionals to drive this change. The journey will take time, and winning the hearts and minds of the people will be crucial for the change that is to benefit both patients and the workforce.