Comment: Why the NHS needs more transformation expertise

By Tas Hind, director of technology at Essentia Trading, explores what needs to happen before the NHS can reep the benefits of technology transformation projects

Tas Hind

There are some major critical success factors that need to be satisfied around any large technology transformation project.

There is potentially a lack of understanding among some health and care organisations about the value that experienced transformation directors or change agents can bring

And this is no more apparent than in the initiatives that are currently underway within health and care.

This is particularly at the Accountable Care System (ACS)/Sustainability and Transformation Partnerships (STP)/Integrated Care System (ICS) level.

Unlike the commercial world, there is potentially a lack of understanding among some health and care organisations about the value that experienced transformation directors or change agents can bring.

But, without this expertise, organisations are opening themselves up to more risk.

IT programmes are likely to fall down due to lack of integration with changes planned at a business level. This would be combined with unrealistic expectations about the scale of the change and difficulties around engaging large numbers of stakeholders.

The reality is that it requires skilled individuals to facilitate change, bring large groups of people together, and make it stick

The latter is likely to include multiple organisations, not to mention the public and patient communities.

And all of this is likely to result in IT systems that are not being used or exploited to their full potential and or delivering their real value.

There are currently 44 large-scale transformation health and care projects planned across ACS/STPs/ICS organisations in England. All of these involve significant changes in processes - who is doing them, where and how? And all will require some level of new and updated applications, information flows, and supporting infrastructure.

The size and scale of such change has never been attempted before and the expectation is that a great deal of this work will be achieved through limited resources and probably completed as part of people’s daily workload.

But the reality is that it requires skilled individuals to facilitate change, bring large groups of people together, and make it stick.

Moreover, there will be a requirement for vast amounts of engagement, education and training both within organisations and among the public.

However, most people assigned to these types of projects are not necessarily experienced or skilled at implementing such large-scale changes.

We may instead end up with siloed initiatives that do not necessarily come together or support each other in a timely manner.

If we fail to exploit the great opportunities that technology can bring then we will fail to deliver the much-needed new ways of working

If we fail to exploit the great opportunities that technology can bring then we will fail to deliver the much-needed new ways of working. We will waste money and fail to exploit the window of opportunity to make changes to the NHS and the wider health and care system will continue to struggle. And local people and patients will continue to receive a poor service.

For example, the establishment of urgent care centres and better integration with mental health services will require a transition away from old practices and the adoption of new ones. This will require a clear understanding and blueprint of the new processes: who does what where, information flows, applications that will be used, and the underpinning technology interfaces with other organisations incoming and outgoing and continuity of care.

It will also require substantial engagement, communication, training and education of everyone who will be impacted, including the public, to create a stable and sustainable environment. Without that the upheaval is likely to be significant and the impact negative. More money will be wasted, and the best outcomes will not be achieved.

Another example is in the current drive to implement community-based care. This, again, will result in significant changes in current practices, information flows, access to applications, technical infrastructure, and who does what where and continuity of care.

Unless all of these are considered along with adequate engagement, communication, education, training and business change support; the solution will be badly implemented. It will mean resources will be wasted, there will be a lack of confidence in the new ways of working, and the desired outcomes will not be achieved, resulting in pressure to move back to old and unsustainable ways of working.

So what can be done?

We need top-down sponsorship and leadership to deliver these changes. These should be supported by adequate funding and teams that are skilled at implementation and change management.

We need top-down sponsorship and leadership to deliver these changes. These should be supported by adequate funding and teams that are skilled at implementation and change management.

We need to ensure there is robust and high-quality engagement, education and training of staff and local people in the new ways of working and supporting solutions.

And there needs to be close collaboration and integrated working between organisations and new IT solutions that is facilitated and led by heads of transformation who can transcend both domains.

If all of this is put in place, the outcome would be a good use of scarce money and resources. It would improve the day-to-day lives of the health and care workers, patients and the wider public. And it would result in changes that deliver real benefits and have the much-needed impact.

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