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Why NHS digitisation will fail without clinician ownership
As the profile of the NHS digitisation agenda continues to rise, we must learn lessons from past failures and place clinicians at the heart of transformation argues MV’s Matt Carter.
We are witnessing seismic shifts in the NHS towards integrated care systems and population health management. One of the foundations of the proposed system redesign is the increased use of technology to transform practice and improve outcomes for patients.
The Secretary of State for Health and Social Care is evangelical about the potential of digital technology. He recently confirmed that new national standards will be mandated, focusing first on infrastructure and interoperability. This is a direct consequence of previous attempts to progress the NHS digitisation agenda failing to achieve their objectives.
Design focus – learning from the past
Probably the most well-known of the failed digital health initiatives is the National Programme for Information Technology (NPfIT), established in 2002. After over a decade, and billions of pounds, we were no closer to standardisation and the project was abandoned.
In 2016, the National Advisory Group on Health Information Technology published a report setting out lessons learned from failed initiatives, such as the NPfIT. Entitled ‘Making IT Work’, the findings highlighted a failure to engage with providers and healthcare professionals. As the Group’s Chair, Professor Bob Wachter argued ‘IT systems must be designed with the input of end- users… Poorly designed and implemented systems can create opportunities for errors, and can result in frustrated healthcare professionals and patients.’
Clinicians are the key to successful digitisation
Clinicians are the most critical component of delivering high quality services to patients. It is they that have the understanding of how services can best support patients, and they that know what care is needed. They can provide critical insight to guide digital reconﬁguration in the most appropriate way, whilst ensuring any technological change remains safe for patients.
From my personal experience, clinical inclusion at the development stage of digital initiatives is essential. Clinicians must feel a sense of ownership. This not only reduces the risk of designing counterintuitive user-interfaces, which will inevitably lead to staff reverting to historical processes, but it also helps to accurately identify needs of patients, as opposed to those assumed by non-clinical IT developers.
Equally important is clinicians establishing an understanding of, and faith in, the benefits that any digital solution can offer. The workforce has become understandably sceptical, following repeatedly overstated claims regarding the ‘life-changing’ implications of technology – whether it is electronic ward rota planning, automated signposting, flow management or shared care records.
If the workforce has doubts that a new digital solution will improve outcomes or working practices, they are likely to resist it and actively seek ways of working around it. For example, I have observed Community Nurses refusing to use data systems they found confusing in favour of moving back to a paper-based approach.
Conversely, working alongside clinicians that have embraced new digital systems, I have witnessed them become advocates for new solutions, going on to support their peers as deployment continues. Nobody can convert a clinician as effectively as another clinician, particularly a clinician claiming that a new technology is ‘life-changing’.
Clinical engagement needs to become a core element of digital health transformation. We must move away from where clinicians feel they are ‘done to’, towards a model where it is ‘done with’. Without this, we risk repeating the costly failures of the past.
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