Twelve months work in six weeks!
How is that even possible?
It’s astonishing, but these are the words from an NHS Digital Transformation leader.
I interviewed digital and IT managers and directors from 12 different provider trusts, seeking to discover what we could learn from the impressive pace of digital transformation during the Covid crisis.
It wasn’t a one-off comment. Everyone who generously spent time discussing the major change their services had supported – and how to make it sustainable and effective over time - said something similar.
One Chief Information Officer even commented it was like building a house in a week. A fantastic feat and an indication of just how different life has been in the NHS with multiple pressures and an environment most of us have never experienced the like of.
These experiences have highlighted what’s possible. But how can we repeat it when there isn’t a global crisis?! And drive the transformation in patient experience, clinical efficiency and operational performance – such as reduced waiting times – we all know large-scale digital change can deliver.
I know from experience accelerated pace and true sustainability are hard to achieve. As an NHS IT Director many years ago, and in our consultancy work, such as digitalising outpatient appointment and contact processes and moving to virtual and telemedicine clinical consultations, for every rapid result another project can takes months to reach first base.
To better understand what happened, I drew out themes from my conversations and mapped their relationships with each other to understand the dynamics during the Covid crisis, before then identifying what could be learned and replicated.
So what conclusions can we draw? Here are some specific and general – but all strategically significant – learnings I took:
Rapid adoption of technologies
Technologies supporting virtual outpatient appointments and virtual meetings were adopted most rapidly. The rationale to use technology didn’t need explaining - and desire to do something was strongest. Every organisation I spoke to has implemented these via national NHSE agreements for Microsoft Teams and Attend Anywhere.
These technologies had been resisted in the past; indeed, nearly everyone had achieved only small-scale deployments of these technologies pre-Covid, with minimal effective adoption. Interviewees I highlighted that many colleagues who had previously resisted and even actively blocked their use, were now key advocates. For many clinicians and services, these technologies became their only option to help people, to meet and make decisions. So they embraced them fully. Another tactic that accelerated adoption was testing new solutions intensively with those keen to try them out, resolving repeatable barriers and identifying drivers that transformed processes. This cohort became advocates - demonstrating the technology’s benefits to others.
Lesson: Effective adoption is driven by benefits. Find colleagues willing to test new technologies, reduce barriers for them, and help them surface and articulate benefits others can follow.
Implementation approaches changed for the better
Implementation approaches changed radically. NHS clinicians, operational teams and corporate services worked in ways they never had before, helping increase speed of adoption.
Iterative cycles became the norm. ‘Quick and dirty’ implementation and prototyping was followed up with due diligence, optimisation and ‘tidying up.’
Technology project portfolios were reviewed, and most work paused. Organisations’ human and financial resource was focussed high priority projects most needed during the crisis. This prioritisation reduced ‘work in progress’, added clarity, and time wasted switching between many priorities. However, signs are already beginning to emerge that ‘work in progress’ is increasing, and pace of change slowing.
Governance changed significantly. Unhelpful bureaucracy was cut or relaxed more responsibilities were devolved, creating autonomy. Staff at all levels were trusted to define and drive the work, even if it meant senior people felt less ‘in control’.
Leaders went out of their way to be visible, actively humanising staff and recognising what they were doing. Everyone enjoyed having greater autonomy, recognition, feeling part of a team and doing something with a clear purpose - even if they worked longer hours and found switch-off difficult at times.
Genuine cross-functional working became normalised. People felt a real buzz about collaborating, often in new ways and cross-functionally, which had been much more difficult in the past.
These dynamics created a significant shift along the continuum - from bureaucracy towards agility. However, many talked about a return of previous bureaucracy and slowing in the pace of Digital Transformation.
Lesson: Increased organisational agility created a higher pace of Digital Transformation. This was achieved through iterative cycles of change, greater focus, less ‘work in progress’, devolved responsibilities, reduced bureaucracy and cross-functional working.
Operating Models need to change
Many identified a need for their organisations to operate differently to both reinforce progress already made and maximise the benefits from the technologies that had enabled this rapid change.
Almost universal uptake of remote, virtual working was striking. Working from home is recognised as valuable for many reasons and in some form, with flexibility to reflect individuals’ needs becoming more important. Practical opportunities and challenges such as reduced travel, parking capacity, HR policies, supporting technologies, costs and office design are balanced with impacts of new ways of working on mental and physical health, effectively managing performance, and productivity effects in leadership planning for the third phase of NHS response to Covid-19.
Pragmatic questions, with wider cultural issues are emerging. For example, what would an office look like for a mixture of remote and office-based workers?
Entire operating models for service delivery are being questioned, particularly hospital-based outpatients. What would clinic space look like? What are the challenges and benefits to clinical staff working from home? How to manage digital exclusion? How to deliver stronger triage and testing patient readiness for virtual encounters? Even questioning if we should call it outpatients. Changes could be truly radical. Maximising the opportunities could transform patient experience, performance and value
Lesson: Holistic review and end-to-end re-design of operating models is often needed to optimise Covid-driven Digital Transformation into sustainable change.
Easy to use technology
High adoption of new technologies was often related to those which are straightforward, easy to train, and work consistently. Video conferencing is easy to learn, and globally millions are now familiar with it. However, if connectively was poor, then organisations switched to technologies with proven consistency such as tele-conferencing. A small number of organisations were wrongfooted through poor existing infrastructure and architecture, and not being able to increase capacity quickly.
Lesson: Robust, flexible supporting infrastructure is critical, even for easy to adopt/use technologies
IT role in the organisation enhanced
IT departments became new stars during the pandemic. Their reputation and influence grew as their work and rapid deployments became central to decision making and indeed to sustaining operational delivery. The most successful typically had a Chief Information Officer role on the Board.
This increased credibility – and shift from IT as an organisational challenge to driver - will be critical to continued exploiting technology and drive Digital Transformation going forward.
Lesson: IT teams which flourished in lockdown have created a solid basis to accelerate Digital Transformation through delivering results and enjoying a more credible reputation and better internal relationships.
Organisations deploying most innovation had many similar features. This included the ability to flex existing systems and services to meet a broader range of needs
Changing, and sometimes conflicting, pressures and demands on provider Trusts created unique new problems. Organisations with flexible platforms in place, e.g. Microsoft 365, and strong technical capacity and understanding of business needs were most effective. These technologies often changed relationships with supply chains, building dynamic, proactive relationships including with vendors previously regarded as second order, non-strategic partners. These flexible platforms, coupled with agile implementation approaches and adoption dynamics, meant innovation flourished, delivering rapid solutions to urgent problems.
Lesson: Flexible technology – including pre-existing platforms, services and their vendors – supports complex and changing requirements.
The biggest lesson of all was that people were behind this significant progress. Factors including processes, behaviours, and structures were critical to accelerating effective change - a reminder successful Digital Transformation isn’t all about technology.
We can all hope the Covid context that demanded this response is a one-off. There are valuable lessons the NHS’s experience and success which apply to all Digital Transformation, in any sector, at any time. In some ways, the crisis has boosted the opportunity for real change. It has shown what’s possible - and how we can create conditions to support what’s possible.
I’d like to thank the inspirational people I interviewed for this blog, for their time and patience. And of course to wish them continued success in their vital work to modernise the NHS and provide better healthcare for everyone.