We undoubtedly live in an age where health is starting to experience an unprecedented influence from digital technologies.
Tony Young, National Clinical Lead for Innovation, is driving a vision for innovation in healthcare. The new Health Secretary, Matt Hancock, has pledged £475m for investment in technologies that increase efficiency and reduce risk to patients. There are a plethora of Digital Health companies and start-ups with great ideas on how they can ‘fix’ healthcare and the NHS.
With all this will, money and motivation, it’s hard to see why we haven’t succeeded already. Whilst there are obvious barriers to devising solutions for everyday problems felt by frontline staff and then integrating these solutions NHS-wide. The answer to overcoming these barriers may be obvious too.
What are the barriers to innovation and integration of technology?
- Supply-driven and top-down
- “Not my day job”
- “It’s just too big!”
- Budget silos
- Purchasers work on a ‘Least-cost’ basis
- Expectation == Rapid return
- “What is the route to uptake?”
- Viewed as a Luxury
There is a common message amongst the people in charge of leading innovation and integration in trusts throughout the UK. A message of ‘getting the foundations right first’ before pushing forwards with truly innovative technology. A massive project for many hospitals and other organisations is the digitisation of paper-based services. I have no doubt that £475m could quite easily be spent on this particular project. The problem, as an aim this is too safe and too short-sighted.
The key is to look at the organisations that have already digitised their service and see what they are doing now. That is the goal to strive for. Not following the exact path that they took, but the direct route. The route that has insight of all the obstacles, all the hold-ups and problems along the way.
Whenever there is an innovative idea in the NHS, almost without fail there is a part of the NHS that has already instigated something similar, but nobody else seems to know about it. This is compounded by the structure of the UK Health Service and the streak of financial competitiveness running through it, which hinders true collaboration. As an example, if a trust has invested large sums of money into an innovation, have found their way through the problems and now have a better service, why should they provide that information and experience for free to other trusts.
It’s a difficult situation if you are effectively penalising those areas willing to push forwards with innovation. If an organisation in the NHS wants to innovate it takes the financial risk and operational disruption without guarantee of success, surely it’s easier to sit back and let someone else take the risk.
It takes 17 years for innovations to be adopted throughout the NHS. 17 years! Something has to change.
What is the solution?
There is a solution to integrating innovation and technology within the NHS and it’s not actually dependent on the technology. The solution transcends the technology and actually creates a positive feedback loop, encouraging more innovation and more uptake of technological solutions.
Frontline staff hold the key to overcoming many of the barriers. Experiencing problems firsthand, identifying possible answers and championing their ideas. Pushing forwards their solutions and driving integration back to the frontline.
Innovation and technology in healthcare should be driven by need not want. Whilst a difficult concept to embrace, those with the power to make decisions on purchasing new technologies or implementing new innovations, should defer to their experts. Their experts are their frontline staff. Those with the power to make decisions should support those in their charge to make decisions.
Why would this work?
When Jack Cochran, paediatric plastic surgeon and executive medical director at Kaiser Permanente, defined the role of his clinicians as “healer, leader and partner”, he emphasised the importance of ‘clinicians as leaders’ in improving patient care. This change in emphasis changed the culture within his organisation and improved patient care.
Change the message, change the culture
There is clear evidence that involving clinicians in shaping clinical services results in clear improvements in patient care. This is not achieved through one-off, toy-projects, nor is it achieved by giving someone a new job title. It is achieved by the clinicians change in vision, their change in identity, the very fabric of who they are and their understanding of the contribution they could make to healthcare.
When you have person who truly believes in what they do, who is excited about what they do and feel they are making the world a better place, their attitude becomes infectious. They influence those around them. You develop a common vision with those around you, the culture of the organisation starts to change.
However, merely giving a clinician a new job title and asking them what the think about how services should be reconfigured is not enough. It takes true leaders, with authenticity, with passion and a drive to improve that which is around them. The clinicians view must align with the view of wanting to improve services. When they do, the clinician brings a vast knowledge of the implications and trade-offs when changing services, adopting new practices and integrating new technologies.
Certain areas of the NHS are aware of the importance of clinicians in improvement, those with strong clinical leadership being the highest-performing compared to those without. Many organisations, both within healthcare and outside, have demonstrated the benefits of distributed leadership models. Treating all employees as potential leaders within their domain allows for effective local decision making, guided by the overall principles of the organisation and without the need for excessive micromanagement.
Where are the leaders?
There is an ingrained skepticism among clinicians regarding the value of spending time on leadership when balanced against the value of treating patients. And often there are financial disincentives for doctors taking on leadership roles, with salaries often lower for managers than doctors.
There are some important questions to answer with regards the kind of leaders we need to drive innovation and integration of technology within the NHS. How do we realise the task of finding, inspiring, and stretching those clinicians who possess the greatest potential as leaders? How do we train clinicians with leadership skills that are relevant to their roles? What skills and attitudes do we hope to encourage? Are there differences across professions or roles? Which area requires the greatest development in leadership?
The path to leadership
Finding the leaders we need is not, necessarily, an easy process. There is a clear need for role models and those first few leaders will likely be the most important. Paving the way to create a robust and credible evidence base to show the importance of innovation and technology to others within their clinical domain. It is important for organisations to track measures of improvement and correlate them with their impact on quality of care, safety and costs.
Training must be focused on what the organisation needs from that specific leader. It must address the practical issues that will be experienced by that leader and be truly centred on ‘learning by doing’, support integration of concepts within their clinical domain and emphasise the importance of immediate feedback and the encouragement from observing tangible impact.
There is a need to pool findings from innovation within healthcare, to create a repository that can be used by all organisations, to identify changes and innovations that work, the problems experienced whilst introducing them, the knock-on effects on other health domains and the ultimate costs and timings that will be incurred.
My thought for this would be a website, where organisations could trade or purchase the blueprints for implementing new innovations, with clear calculators based on location factors and patient population. Watch this space.
Starting with isolated pockets of excellence and innovation, healthcare still has a long road to travel. But this is an essential journey for healthcare organisations, clinicians and patients. The deep commitment to patient care and to traditional clinical skills will always be at the core of a clinician’s identity. To achieve truly innovative transformation, however, with adoption of new ways of working and new technologies we need to look to those who face the problems every day and know what is needed to improve them. More than that we need to ask them to lead us to a cultural revolution.
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