Are we doing digital right?

James Freed, Deputy Director, The NHS Digital Academy

After the publication of Lord Darzi’s rapid review of the health service in September, PM Keir Starmer pledged to move “from an analogue to a digital NHS” to address a service in disrepair, with outdated IT and low productivity. But will an increased focus and larger investment in digital transformation guarantee the improvements we desperately need? Or do we first need to ask searching questions? In his recent keynote at the Imprivata User Conference James Freed,

Deputy Director of The NHS Digital Academy, dared to raise the fundamental issue – are we doing digital right? 

The ‘unlimited potential’ of digital

In the 1960s Gordon Moore, who co-founded chip maker Intel, observed that the number of transistors on a single chip would double every two years with minimal cost increases. This doubling of computing power became known as Moore’s Law and came to stand for the wider idea that the power of computing would continue to grow exponentially. 

The expectation is that digital solutions will be able to do more and more for us, fixing a plethora of problems and opening up an ever expanding range of new possibilities. The press has been in thrall to this idea, always happy to move on and talk about the ‘next best thing’. Today’s hype around AI is the latest manifestation of this phenomenon. Often we feel as if we are continually playing catch up or being left behind.

Why don’t we feel better about digital?

The opportunity digital has for health and care seems to continue to expand. It’s a great story but one where our real world experience doesn’t seem to bear this out. Things should be continuously improving but something doesn’t feel quite right. 

The NHS Digital Academy’s research from April 2024 found that on average people working in the NHS rate their experience of digital as 6 out of 10, with some variations either side based on their job role. Similarly 6 out of 10 was also given for how well technology did what staff needed it to do. Why are we in this situation of the experience being underwhelming to many? 

How does healthcare measure up?

It seems healthcare isn’t an outlier in its response to digital. By combining surveys from respected sources HBR, Forbes and McKinsey, analyst firm Gartner found that across all sectors 70% of digital transformations fail. Research from Boston Consulting Group showed just 30% of projects met or exceeded targets and created sustainable change. 44% created less than expected value with limited long term change. 26% delivered less than half of what was expected and provided no sustainable change.

More specifically Gartner found that in the public sector technology and budget were not the major challenges for digital transformation success. 63% of failures were driven by cultural or skills deficit reasons. These included issues such as siloed decision making, insufficient depth or breadth of digital skills, and lack of digital leadership.

Is selecting the wrong solution our main problem?

The Arch Collaborative, a group of healthcare organisations committed to improving the experience of EPR, conducts regular extensive research across different organisations and countries. Their study on whether healthcare providers were satisfied with their EPR showed from almost 41 thousand respondents in over 200 organisations, that there was a wide range of satisfaction with the digital solutions chosen. 

Surprisingly the actual solution implemented was not the major indicator of success and satisfaction. It showed that providers with highly rated solutions also had poor ratings for the same technology when it was implemented at other organisations.

It seems that the choice of technology is not the main factor in whether a digital transformation was deemed a success. In the UK it appears that the problem is significantly worse. We put far too much time and resources in selecting the ‘right’ product and less in implementing it successfully to make sure it does what clinicians need in practice. There is little measurement of impacts and outcomes of digital transformations built into projects from the outset.

How can we improve?

When we do things which aren't successful they can actually cause harm. Digital failures have huge opportunity costs in effort expended; benefits unprovided; and efficiency not delivered, but it can be the impact on day-to-day workloads and morale which are the biggest issues.

Real problems about technology reported to us include multiple IT systems not integrated so that an overall view of the patient is not possible; huge amounts of time spent logging in and out of systems; poor response times; instability of IT causing crashes and loss of data. These issues impact performance and efficiency. They also sap satisfaction and morale leading to the above average staff burnout rates in the UK when compared to other countries.

Given the weak correlation between EPR technology selected and the staff satisfaction and success of the project, we could turn around perceived failures if people behaved differently. These behaviour changes, brought about in part by education that can change capability and mindset, are what we define as ‘digital skills’. Our analysis shows that 26% of digital activity could be changed from perceived failure to success by changing culture and education. Current NHS spend suggests that this could save around £368m per year.

How can we start to change?

We can make rapid improvements by looking at culture and education whatever the digital solutions we have selected and implemented. Start with an assessment and education for staff to help them use the data and technologies they are given.

Provide support for educators to enable them to contextualise and deliver learning about digital. Introduce education to help leaders and influencers create the right digital culture and make the right digital decisions. Create training and career structures for DDaT (Digital, Data and Technology) professionals. Educate managers and budget holders on how to make changes to their services so that they better meet users’ needs.

The outcomes of these steps will be that digital technologies and data are available, usable and designed to meet the needs of both users and the organisation. NHS staff will have the confidence and competence to use digital technologies and data as they need to perform their roles.

We all share the challenge to change

Often day-to-day pressures obscure what’s really important to drive the change that’s needed and meet the responsibilities we all have. We all have a part to play. If you work in healthcare, it’s your duty to continue to learn. If you are an educator, it’s your duty to teach what’s relevant to drive improvement and change. If you run a service, get the help you need to make the right decisions. If you are a digital professional, it’s your duty to make the right decisions around digital. If you are a leader it’s your duty to help as many people as possible to be enabled to make as many of the right improvements they can.

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