Healthcare digital transformation needs urgent operational surgery

By Mark Lambert, New Business Development Manager - Roq 

A sector under pressure

The Healthcare sector has undertaken some of the largest and most scrutinised digital transformations of recent times, with numerous high-profile headlines referencing disruptions to clinical care due to the failure of various implemented software. As Healthcare organisations attempt to improve patient care in the most cost-effective ways possible, digital transformation will continue apace, with an increasing volume of software releases deployed, in an attempt to increase efficiency, reduce duplication and improve communication.

Digital transformation in a complex environment

Healthcare in the UK is one of the more complex landscapes, with multiple organisations all ultimately aiming to deliver common outcomes. There are various measures to quantify the effectiveness of the current people, processes, and tools. However, in spite of the different ways in which each healthcare organisation performs their digital transformations, and the various software products that they select, they all have common objectives of improving the patient experience and the underlying health of the population. They all also have to operate in an environment where they are under increased pressure to reduce the per capita cost of Healthcare, reduce clinician and staff burn out, and reduce staff attrition rates.

Translating the current processes within Healthcare through digital transformation is no easy task. When we look at successes within the industry, to help learn and accelerate to the future, there are many lessons that can be learnt. A common trait is that increasing the levels of user involvement at early stages in projects typically leads to a greater chance of success, both in terms of delivering the project on time and budget, and the positive adoption of the new systems.  

Healthcare by it’s nature delivers care for people.  However, some complex and expensive healthcare digital transformation projects have resulted in increased costs and greater inefficiencies, rather than the opposite effect that they were trying to achieve. And, of course, as the funding of  UK Healthcare is provided through public taxes, all spending  is forever scrutinised and reapportioned depending on the government of the day, adding further complications.

Where accountability lies

When these large transformations are examined, the greatly varying levels of accountability amongst the software vendors is apparent.

More specifically, the main focus of software vendors is typically not how their systems will operate within their customers’ complex environments, with the result that the integration of the new systems in these environments can be problematic.   And clearly vendors typically won’t produce software which mimics each individual customer’s existing processes, so their software should be configurable and adaptable, reflecting how their healthcare professionals have adapted the use of available technology to deliver the best possible patient care. The digital transformation failures have been detailed many times -stretching from headlines such as back in a Computer Weekly 2010 report on the failures of the NHS  National Programme for IT (NPfit). Equally, inaction can be equally damaging, as starkly illustrated in a recent BMA report where they calculated that 13.5 million hours of doctors’ hours are lost to the NHS every year—the equivalent of 8,000 full time equivalent doctors—owing to IT systems that have failed, are slow, or are not up to date. Both examples show that healthcare organisations continue to wrestle with the digital transformation challenge - is it that organisations haven’t successfully resolved how to adapt and change the delivery to effect a more successful outcome?

What needs to change in these projects to deliver a better adoption and delivery?

The key challenges to deliver a better outcome are categorised in several areas:

·        Planning

·        Integration

·        Data; and  

·        Users.

Planning

Before jumping into an IT project, it’s important to first plan the details. This involves holding meetings and consultations with key stakeholders to develop the requirements and agreeing the criteria for success.

With the NPfIT, it appeared that project managers rushed the Planning step, eager to get the project rolling and to reap its rewards. Too quickly, they were discussing subjects such as policy changes, procurement strategies, and implementation steps, without rigorously agreeing, documenting and establishing solid foundations for the programmes’ success.

As a result, the timeframe was hurried and off-schedule from the very beginning. Some of the preliminary work accomplished was inadequate, and processes were re-designed without sufficient user involvement. This led to additional corner-cutting in an attempt to accelerate and get back on track.

Critically there was also a failure to adequately test the systems, which could in hindsight have alerted stakeholders to core issues before the projects progressed to their next stages. This is a common factor found across multiple organisations, whether quality assurance is not judged as crucial, or it is seen as a restriction to timely “go-live”.

Project planning needs to be thorough to halt the current trend of outcomes, that range from delivering systems that don’t meet the users' requirements, up to and including the complete cancellation of projects in mid-flight. Many issues stem from vendor issues, as reported by the Integration activities. 

Integration

Integration is fundamental to all projects, as typically they will include the introduction of a new system or systems into already complex environments, taking data from multiple sources and with multiple interdependencies.

Many ERP projects are delivered despite their target audience, rather than in collaboration with them, which only builds mistrust and non-acceptance of the changes. Users don’t understand ‘what's in it for them’, or why their knowledge isn't important to the process of the digitisation of their day-to-day work. This mistrust only increases as businesses often sell this internally as ’providing users with a better, securer and more productive method of working’. This is hard for users to accept when they haven’t felt consulted, included, empowered and taken on the transformation journey. This can be very demoralising for the users – as they work in an environment where they are acutely aware that if changes are not designed, implemented and tested correctly and in a timely manner, then there can be damaging and serious consequences to their patients’ health. After all, the Healthcare EPR Transformation is more life-critical than mission-critical.

More often than not, major transformations have some small element of User Acceptance Testing bolted on at the end, and effective communication and training are typically the first elements reduced or even removed when project budgets are over run. These actions, however, are massively counterproductive and  of course greatly increase the risk of failure.

If stakeholders are not involved throughout transformation projects, history tells us that they tend to fail.

Just to bring this up to date - as I hear you say well some of this was in the past - The BMA report of December 2022 has come to the same conclusion, and when you review the recommendations, they have a similar theme

“Recommendation 9: Robust standards for interoperability must be developed by the appropriate UK health service regulatory bodies.

Recommendation 10: Purchasers must be required to enforce these standards, to guarantee that any software meets the required standards. Work must begin to extricate providers from any contracts with suppliers that do not meet the standards as quickly as possible.

Recommendation 11: It is imperative purchasers do not bow to suppliers who have, for years sought to create market dominance with siloed software. Interoperability by default is the only way of achieving this and leveraging the buying power of the NHS a realistic means of doing so.

Recommendation 13: Doctors with an interest and expertise in digital transformation should be encouraged and supported to take up digital leadership roles locally and/or nationally.

Recommendation 14: Users of digital systems should be closely involved with or leading the design and implementation of digital programmes and strategies. Providers must go further to actively consult with doctors at all levels and at all stages of digital procurement and transformation.”

There is an often repeated maxim that “the first sign of madness is doing the same things over again and expecting a different result”.

At Roq we understand the importance of getting it right first time. We also understand how hard that is. Using our expertise and experience, we can work together with that intention in mind.

We even put quality in our name, Roq (Return on quality) from the very first day, and have never looked back. We have built a business that very much focuses on the outcome of our client delivery, the happiness of our clients, and the feedback they give our incredible team. 

I urge you – if  you do one thing in 2023, let’s together look at the immense impact software has on your healthcare organisation, and let’s discuss how you might look at the digital transformation challenge differently.

I’d welcome your thoughts on this and if you’d like to discuss it further, please don’t hesitate to reach out for a chat @ask@roq.co.uk