Albert Einstein said: ‘In the midst of every crisis lies great opportunity’. COVID-19 is a very human, costly and grand scale crisis. But, in amongst all the darkness, has the virus catalysed any positive changes and advances? And, if positive changes have been made, is it possible to carry these and other advantages forward, or will we return to more traditional ways of working?
A panel of informatics and digital health leaders came together recently to discuss these points and many others too. Our experts were:
- Adrian Byrne, CIO, the University Hospital Southampton NHS Foundation Trust
- Nicki Rayment - Head of IM&T, Cornwall Partnership NHS Foundation Trust
- Phillipa Winter - CIO, Bolton NHS Foundation Trust
- Adam Thilthorpe - Director of Professionalism, BCS
1. Video consultations are booming
‘Over the last six weeks, we’ve seen people screaming for technology. There’s been a real shift change around mental health services,’ says Rayment. Previously, transformation and change may, to a degree, have been a force to be resisted. But, since the outbreak, users and internal customers have been proactively seeking out and embracing digital.
The epicentre of changes has, of course, been video conferencing. Previously very few clinicians - of any stripe - met with their patients online. Indeed, in some places, before COVID-19, there was no video appointment capability at all.
That has all changed. ‘We’ve gone from zero, to last week, just under five hundred video appointments in mental health services,’ says Rayment.
Echoing this sentiment: ‘There’s a level of interest [in digitalisation] that maybe wasn’t there before. We’ve now got the ear of people who would be difficult to get before. That’s been very helpful,’ says Byrne.
2. Working from home in the future?
Cash also helps, Byrne explains. Historically, digital provisioning within the NHS was perceived as being underfunded. ‘Recently there’s been an injection of capital - short term,’ he says. ‘That’s helped with the acceleration of things like working from home.’ Before the outbreak, Byrne says, he might support 100 people working from home on a busy day. ‘We’re now talking about thousands. We’ve ramped things up and rolled out a lot of laptops.’
The rapid shift to home working has created a huge demand for laptops, monitors and webcams - the raw stuff needed to be productive in a remote office. That, though, doesn’t necessarily tell the fullest story: connecting more laptops to a network should just work. The real technical challenges, Byrne says, lay more in converting patient appointments from physical ones into virtual meetings. That required technology but also systems, innovation and pathways. Get it wrong and you’ll end up with cancellations.
With all these changes taking root, Winter feels there is yet more work to be done. Some software licences, for example, were free during lockdown’s initial phase. These may soon become paid-for resources.
Elsewhere in Bolton, Winters’ team has developed an AI system that should aid the identification of COVID-19 from basic x-rays. This, she says, shows that digitalisation during the pandemic hasn’t just been about keeping the lights on.
3. Forces acting on the new normal
COVID-19 has influenced the speed of technology uptake and also catalysed the development and implementation of solutions and pathways. But, as lockdown eases, how Thilthorpe asks, can we still keep doing better for the NHS and for patients?
‘We’re not there yet,’ says Byrne. ‘This unmapped future - a place where people start returning to work - will throw up lots of new challenges that’ll need answering with technology.’ One example, he wonders, might be an embargo on waiting rooms with people waiting in their cars. But, this also throws up new challenges: how, for example, will virtual waiting rooms be managed at the level of process and of communication?
‘Also, will people tolerate working from home indefinitely?’, Byrne asks. ‘Will people carry on, gladly, giving over their homes to their employers? These things need wrapping up in some proper terms and conditions.’
The key to maintaining and even fuelling momentum is, however, is demonstrating value or return on investment. Our experts were all agreed on that point.
COVID-19, Winter says, has created a fluidity. Ideas are realised and actualised much more quickly. But, going forward, there needs to be - as Byrne observed - a real laser focus on chasing concrete gains.
Rayment, in Cornwall, observes: ‘Microsoft Teams… those costs are going to come back… It’s how do we build the case to keep those things going? Teams and Office 365… They are a success story. But, we’ve got people’s ear at the moment. It’s a big figure for Office 365 but nobody wants to see it not happen. But, it is still a big figure for the organisations to find.’
Winter also points to a potentially worrying, yet untold story: the number of people attending A&E has dipped dramatically. Is this because she and her team have created a remote appointment infrastructure that simply functions brilliantly? Or, is there are darker truth: are people just staying away. This needs to be unpicked and understood.
4. More conversation with the CIO
These costs, will, of course, need to be presented to and, hopefully, signed off by governance. This begs the question: ‘how have conversations with senior leadership changed?’ Is IT seen as a positive agent of change?’ asks Thilthorpe.
‘I think what’s interesting,’ Byrne says, ‘is that I’m sitting in on discussion and meetings that I wouldn’t previously have been invited to. People are now asking “what is the IT impact of this?” That’s a very good thing. Everybody from the CFO to COO and the CEO… The chairman… They all love meetings on Teams. I’ve got a whole bunch of people who are surprised [by technology]. But that overlooks the fact that we have a huge issue with digital literacy across the workforce - it’s like the virus. It doesn’t discriminate.’
5. The need for digital literacy
Continuing, Byrne says: ‘Digital literacy is a bit like real literacy. It’s like reading and writing was thirty years ago - where people used to hide… Then there was a [successful] campaign to make it less of a stigma. But, we do have a situation where people aren’t digitally literate… they may have been hiding. We’ve got to do something about that. We’re spending too long on the phone sorting out people’s home broadband - connecting their thing to their other thing. That should be business as usual for anyone in their normal life. There’s a lot of people who don’t do their banking online. And, there’s a lot of people who can’t plug a cable into a computer. They think that is “techy”.’
Picking up the conversation, Rayment agrees ‘But,‘ he says, ‘I’ve also seen the opposite. I’ve seen a lot of people who would have been quite needy before, doing a lot of self-help and peer help.’
‘I think [digital literacy] is important,’ says Thilthorpe. ‘If we are going to move to AI and make use of these technologies in clinical practice… to make use of some of these advances, we’ve got to be able to do this “keeping the lights on” stuff. I’m reminded that the average reading age of the population across the world is 12 years old. The same, I think, is true of digital literacy. There are super-users who form clusters. But really, there’s a lot of [people] with digital knowledge that isn’t quite so advanced.’
Winter pointed to user-centric design as possible mitigation or at least a means of not placing such an emphasis on users understanding tech. IT users in a practice are, after all, practicing clinicians first and foremost. If helping a patient becomes a matter of digital literacy first and clinical literacy second, it would seem that the digital product hasn’t been built well. And building well, of course, requires clinicians and people in practice to be included in design decisions.
6. No more silos
‘We’re all dealing with the same people. Social care call them citizens. We call them patients. They’re all the same people and there’s only a certain amount of public services money. We need to stop working in silos,’ Winter says. ‘It has to stop. At the end of the day, it’s about the patient. We’re not helping [care] teams because of our organisational structure and our posturing. COVID’ has cut some of that. But the question is: “how do we keep the momentum?” That’s down to senior leaders in the NHS and in other organisations… We need to understand why we’re here.’
As a way forward for leaders, Winter points to John Kotter’s 8 steps of change. She says: ‘[Kotter is] key because it talks about the big opportunity. And, I know it sounds really awful, but COVID’ is a big opportunity. And, if you look at those eight steps of change… you get the workforce onboard and they become involved - you’ve all got the [same vision]. It’s often under crisis… You can bring that workforce forward because you’ve all got the same values and beliefs about what you want to achieve.’
Continuing she says: ‘For us to be successful… we need to go back to those sorts of methodologies. We need a vision; it needs to be embraced… People need to be engaged… I keep coming back to the citizen. That’s so key. We need to keep telling those stories.’
As a closing note, Winter asks: ‘What makes the big difference to engagement? Here [in Bolton] it’s higher levels of temporary staff. If we roll out and there’s an area of high turn-over, or lots of bank and agency staff, I know they’ll need far more investment. Those are the sorts of things we need to pick out across such a massive organisation.’
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