A spoonful of sugar: Developing the right strategy to enable digital transformation within the NHS

Considering the hugely fragmented and federated nature of the NHS operating entities, few could argue that there is not the potential for millions of pounds of savings and drastic productivity improvements, following successful digital transformation.

Yet, despite a wide variety of successful pilot projects, the question remains: Why has digital transformation success failed to infect the wider NHS?

Firstly, there needs to be a moment of frank honesty.

The NHS is not just a hugely fragmented organisation. Despite the ‘N’ standing for ‘national’ and continual references to the NHS as if it were a uniform, single entity, the NHS is little more than an overarching brand that incorporates hundreds of different organisations operating independently in isolation.

And often, these organisations are even competing.

This fragmented, quasi-competitive market causes health operations to be inefficient and ineffective in providing integrated services to patients.

Against this backdrop, it has been understandably problematic to implement an effective programme of digital transformation.

The benefits of health tech fail because of – instead of an integrated healthcare ecosystem – projects are undertaken in isolation, often driven by the sake of the technology.

However, this can no longer continue. The continually escalating cost and operational ineffectiveness of this fragmentation has forced the discussion of an integrated future, to the very top of the agenda.

This demands the development of a strategy that accepts the current reality but also acts as a prescription for a cohesive, integrated future.

This strategy begins a recognition that it should support the whole healthcare ecosystem, involving all providers and an ‘outside-in’ approach that drives decisions from the two primary perspectives – that of the patient and the practitioners.

Far too often, when it comes to technology implementations, a healthcare trust, strategic authority, or even a smaller entity will become fixated on a single business function solution or the shiny new technology proposed to them and pitched as a panacea.

This is entirely the wrong approach.

Healthcare organisations must focus relentlessly on the two parties that matter most: the patients and the practitioners.

This is directly analogous to a customer-centric and workforce-focused approach in the private sector (and it is indeed a myth that healthcare is any different).

By understanding the patient journey, any implementation of change – and the technology that follows – is put into the correct context.

More specifically, this is based on answering the questions around if that patient is ready and able to access the healthcare they need.

From here the perspective shifts to the practitioners and the provision of that healthcare.

This is a question of operational capability: are the people, equipment, assets, inventory, and facilities available to deliver the healthcare needed?

Both perspectives need to be standardised as far as is possible. Of course, just as with different customer requirements, or varying operational capabilities, there will need to be allowance for individual demands.

However, this is often far less than initially feared, and standardised processes can cover much more than organisations realise – especially when the objective is a cohesive, national framework.

The next element of this strategy is integration.

The multiple organisations and departments within the NHS have created a vast number of silos with differing administrative processes and it is this difference that needs to be overcome.

It is only when we have arrived at a standardised, patient focussed mode of operations that we can then look to enhance and accelerate those processes by the introduction of digital technologies.

The vaccination programme undertook as part of the UK response to the COVID pandemic was a textbook example of this ‘standardisation at speed’ at work.

The apps demanded a standardised entry of data that enabled such a huge vaccination programme to develop smoothly.

If this all sounds very ‘back office’ that is because it is.

Successful digital transformation in the NHS is dependent not on the sexy modern technologies but a radical updating of the legacy technology that spans operational planning and management, patient / customer record and interaction management, data and analytics, and even financial management and settlement.

Only when this backbone is in place can innovative technologies such as augmented or extended reality (AR / XR) can be applied successfully. Artificial intelligence (AI) is a particularly good example.

The paramount consideration behind any AI deployment should be how it is intended to be used, reflected in how it is set-up and the processing rules around it.

At present this is overlooked, and the AI is not sentient, because it must be designed, trained, and directed appropriately.

If managed correctly – driven by a patient focus and guided by practitioner use, AI has immense potential. For example, ophthalmology scanning applied AI can help improve diabetes detection.

It is precisely this kind of innovative, best digital transformation practice that the fragmentation of the NHS prevents.

This maintains an expensive and inefficient status quo as processes and pathways still require manual intervention, and there is huge duplication of both data and effort.

But, with the spoonful of sugar that is a cohesive, integrated strategy, the medicine of change throughout so many organisations can go down.