Why a new culture of innovation must be at the heart of the “digital” NHS.

The pace of change is only increasing. Investment in digital health startups has increased since the beginning of the pandemic, while the number and type of digital innovations available in healthcare is expanding rapidly.

Physical tools (e.g., gloves, needles, etc.) can and do change, but compared to digital tools, the rate of change is slower and functionality is fixed. Patient processes, governance, and pathways have been designed for a healthcare system using physical tools. But digital transformation has its own challenges. And it can often seem like you’re just getting acquainted with a software tool when an update arrives that adds several new features. This means that both healthcare professionals and patients will need to become familiar with digital tools on a regular basis and explore the usefulness of any new features.

Build a leadership culture

How can we successfully offer the abundance of options that digitally driven innovation can offer in a rapidly developing environment? We might automatically think that the solution is to address issues such as poor computing infrastructure: old computers and slow connectivity. But while these issues certainly continue and need to be addressed, I believe that the two critical challenges we now face — culture and leadership — are often overlooked.

First, we need to create an NHS organizational and leadership culture that is more willing to explore new tools and processes. This approach must be cultivated through leaders who model and create more permissive environments to foster innovation; make it clear that digital innovation is part of the core professional responsibilities of NHS staff; and to support digital innovation in care so that it becomes an everyday activity.

Second, we need to support changes in the culture that operates closest to where we care. This is where we need an innovative culture that openly values ​​failure as a learning mechanism; creates support networks that celebrate and help learn from others and share in return; and that makes rapid testing with validation the norm. This requires clinical leaders to support staff to experiment with tools in the open air with patients and the public, failing safely, and capturing learnings to drive improvement. Staff must have a network of partners, governance that fosters innovation, and human resources that foster innovation within roles with a greater emphasis on responsibilities over tasks to give the freedom to shape processes and pathways.

Unfortunately, we are far from realizing this ambition. Areas such as Alder Hey Children’s Hospital, Leeds and York Partnership NHS Foundation Trust and Guy’s and St Thomas’ NHS Trust in the UK are already demonstrating some aspects of this approach. And the introduction of Integrated Care Systems can offer great potential to connect and extend these approaches across local areas if long-term scale barriers are overcome.

Disruption to drive digital innovation

But look at the breadth of the health service and professional roles are largely task-based, clinical pathways are affected by process and governance, while there is a strong reluctance to allow risk or failure. And the shift in healthcare can also follow classic “cascading” project management techniques, in which there are net linear sequential steps with established milestones and deliveries. Although for successful digital innovation we need agile methodologies that use iterative approaches to “test, fail and improve” with established safety nets to use in combination with user-based design (not technology-driven design).

In combination, these factors and the conditions for successful digital innovation are at odds with existing dominant culture and healthcare processes. Effective digital innovation will disrupt the de facto health culture and leadership, and we need to recognize and address the discomfort this can cause.

So how is the NHS prepared to release digital innovation? The recently published Wade-Gery review of how the NHS organizes and supports digital change sets out some useful recommendations that will create some of the conditions for a successful digital transformation, including multi-year funding to support digital change.

The Wade-Gery review also aims to transform the NHS center to have more digital energy, expanding the digital mindset across the NHS in England and through the nine recommendations offered by the review’s ambitious title. “[put] data, digital and technology at the heart of the NHS transformation. And that could be the biggest lasting impact of the review.

But there is a real risk that, without a clear and considered approach to changing culture when merging NHS Digital, NHSX and NHS England, rather than a transformation, it will simply result in the creation of two “digital executives”. “separated in the center who remain divorced from more” major “decisions and policies.

If the NHS adopts the disruptive leadership and culture it needs to unblock the digital transformation, NHS England has a clear opportunity to model the behaviors that the rest of the healthcare system will need to demonstrate. It will be disturbing, but without it digitized care will continue to be a complement and we will be left with a health system that has a foot stuck in the past, so changing culture should be a priority.

Dr Pritesh Mistry, Member of Digital Technology Policy at King’s Fund, UK.

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