The more time I spend working with the NHS (seven years and counting) the clearer it becomes how closely the twin agendas of digital and improvement are linked. At Public Digital, we often refer to our definition of digital as using the "culture, process, operating models and technologies of the internet era" to improve outcomes for users. Squint a little and you could arguably define improvement the same way.
At their core, both represent long term behavioural shifts in how people, processes and technology come together. To successfully effect change, both require organisations to hold a mirror up to their existing orthodoxies and practices, and make best use of the levers they have at their disposal.
On 31 January I had the pleasure of joining a panel with Maxine Power (director of quality, innovation and improvement, North West Ambulance Service NHS Trust) and Matt Graham (director of strategy, Harrogate and District NHS Foundation Trust) as part of the NHS Providers Trust-wide Improvement programme. The conversation revealed a strong consensus that there are powerful levers trust leaders can use to deliver digitally enabled quality improvement. Here are some of the levers that were mentioned:
Prioritisation
You will not be able to do everything, everywhere, all at once. There will always be competing pressures. As leaders, being methodical enough to identify the most important problems to solve will yield the best results, and in doing so win you the most friends. Think about scale: where are the highest volume and highest value transactions that can be made better for the most people? It's worth noting that the panel unanimously agreed you need to fix the basics – devices, network, Wi-Fi – before you do anything else.
Evidence
Ask for evidence and measurement to establish whether you are achieving outcomes. Naturally, given the pivotal role and philosophy of evidence based medicine, this approach is pretty ingrained in the NHS. But it's important to extend this to your digital efforts. For instance, what does the data (from your website, help desk, or incident log) indicate is your top user need? "When can I go home?" is the question that patients in a care setting probably ask the most. So focus on this question (and others like it) as a starting point for your service design. Success is not won by simply buying and deploying: the solution actually has to be used and useful, with evidence to prove it.
Teaming
"Change is a multidisciplinary team sport". Leaders can create the space for change by enabling different disciplines to come together to figure out answers. For me, the magic ingredients of a team like this are operational, clinical, digital, and design. This kind of interdisciplinary thinking is the key to driving effective change: in reality, innovation isn't shiny technology. It is finding new and better ways of doing the basic stuff to solve users' biggest challenges.
Governance
It's striking how often governance is equated to "project and programme board meetings" in the NHS. Of course, the rhythm of meetings around a project is important, but endless project updates will not give you anything like the same understanding of its progress as going to see it for yourself, by visiting the team, and letting them show you what they've accomplished. Done well, governance should be empowering and enabling. It should invest teams with the ability to make decisions for themselves, but set the guardrails that ensure those decisions take account of a wider ecosystem of dependencies.
Patterns
As you deliver change on a particular service, department, or pathway, you will learn an enormous amount. This might be a smart approach to information sharing, a strong business case argument, the way you should ask a user a particular question, or a helpful dashboard layout. Capturing what you're learning, and making tools, documentation, and content related to the problems you've solved available to the wider organisation teams will enable you to scale the change more quickly.
NHS trust leaders are increasingly seeing how the sum of the parts of digital, quality, and transformation can be greater than the whole. Long-term culture change is hard. So using all the levers you have at your disposal will give you the best chance of success.
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