While the coronavirus pandemic has seen a surge in virtual GP appointments, Rory Tanner from Health Tech Partners explores why not all tech has lived up to its expectations.
Let’s be honest, Covid-19 has not quite been the catalyst for digital transformation in the NHS that we had all hoped for. Sure, reports that 48% of GP appointments happened virtually in May and that 85% of primary care prescriptions are electronically processed point to positive progress. But the lingering concern is that these are isolated incidents rather than the wholesale digital transformation originally envisioned. The initial panic about capacity, the urgency for novel solutions and the promise of technological panaceas have slipped away as the immediate threat of the virus has subsided.
Perhaps the best symbol of this is the NHS Contact Tracing app. Arguably the most public technological tool the NHS has ever produced, it went from being the most promising pathway out of the pandemic to being permanently shelved in favour of the Apple and Google solution. This was an incredible opportunity for the NHS to prove that it could effectively harness technology, but it was unsuccessful, both practically and in the court of public opinion.
There is a danger that this will fuel fresh scepticism about the NHS’ capabilities to adopt digital solutions. Yet the need to free up clinicians’ time, to provide services remotely and to reduce waiting lists all remain. Digital transformation is therefore as important as ever, but the NHS is currently losing the battle to prove that it can create, adopt and implement technology. So, where do we go from here?
Better to try and fail, than fail to try
Yes, this is the sort of quote you expect to hear from annoying LinkedIn motivators, but stay with me. The NHS needs to change its perception of failure with technology. Here, it can seek inspiration from the tech sector, where ‘failure’ is viewed with a completely different lens. Talk to any tech founder and they would be happy to explain how many failed attempts it took to finally perfect their solution.
History is littered with examples of this, like when James Dyson went through 5,127 prototypes of cyclonic vacuums to get the design right. There are two morals of this story. First, if you fail 5,127 times and succeed once, you can become a billionaire. Second, and more importantly, is the need to embrace failure in order to succeed with technological integration.
Here lies the challenge with the NHS. Its institutional memory of past failures means it is wary of any innovations that promise to solve everything the last tech solution tried and failed to address. Especially amongst senior leaders, the potential for failure is generally seen as a reason to not try or try again.
It is understandable why this aversion exists in the NHS when failure has a direct impact on patients. Getting it right first time is a celebrated ambition in the NHS, but with tech this rarely happens. NHS leaders should therefore embrace the tech sector’s perception of failure. This means adopting a risk appetite that accepts the possibility of failure and a steely determination to keep trying. It is not just down to Digital Transformation Leaders to embody this, but also Chief Executives and other senior leaders. NHS Providers state that every Trust’s leadership should take collective responsibility for the digital agenda. This means that the vision for digital-enabled healthcare should not be discarded, even if it doesn’t work the first, second or 5,127th time.
Stairway to adoption
If the NHS Contact tracing app proved one thing however, it is that the NHS is probably better off by letting industry come up with the innovations. NHSX clearly thought this when they scrapped their own technology for the Apple and Google API.
So if the focus is on identifying and adopting technologies instead of creating them, then the immediate priority must be to create adequate pathways to do this. Currently, no formal pathways exist for digital technologies to enter the NHS. The Techforce-19 challenge was a huge success, as the speed and efficiency in which digital solutions were identified and integrated was as surprising as it was encouraging. The entire process seemed to operate more like an innovation accelerator than a traditional pathway, and if it ain’t broke, then the NHS should look to replicate it elsewhere. Here we can once more look to other sectors for best practice.
Take Lloyd’s of London for instance, a 330-year-old institution that is both the birthplace and beating heart of the UK insurance industry. Like the NHS, its long-term viability was threatened by its size, resistance to change and glacial speeds of innovation. So in 2018, it created the Lloyd’s Lab. The premise is simple; the Lab identifies some of the current and future challenges facing the Lloyd’s Market, and then cohorts of tech businesses are brought in to collaborate with key stakeholders in the Market to find solutions to these challenges. Those with the best solutions are invited to work with Lloyd’s permanently.
Where is the impetus for an NHS Lab? The costs of running such a scheme are marginal compared to the potential upsides these innovations could bring. The Techforce-19 challenge proved that with enough political motivation, a scheme like this can be executed successfully. But this should not be a one-off. There now needs to be similar impetus to make an innovation accelerator a permanent part of the NHS’ own digital transformation.
All roads lead to funding
It is important to conclude that digital transformation in the NHS can only be possible if these technologies are funded. At present, there are several pots of money scattered across the entire health and social care system to the point where they make a Jackson Pollock painting look orderly.
Initiatives such as the MedTech Funding Mandate sought to alleviate this by incentivising adoption through the mandatory funding of approved technologies. But this has been indefinitely paused because of COVID-19. It is important for the NHS to consider how it can effectively fund innovative technologies if the MedTech Funding Mandate is not going to be resumed. Digital transformation cannot take place without these avenues for funding and adoption.
The NHS’ vision for digital transformation is still possible. COVID-19 and its provocation of an NHS-wide open-mindedness to tech solutions provided a radical window to accelerate technological integration, but the barriers highlighted here must be addressed. Changing the NHS’ perception of failure, creating new pathways for digital technologies and properly funding them are essential to make this vision a reality.
6 August 2020 @ 20:59
This article is rather vitriolic and written by people (?) who apparently do not understand what DT (digital transformation) is. The article is written as if DT is the application of the best technology to whatever one is doing, whether the underlying process it is bolted onto is effective or not.
DT to the rest of the of the world is the development or enhancement of methods, processes – call then what you will – which move the business forward. That, when compete, is underpinned with the appropriate technology; DT done.
There are many examples of organisations which fail in their DT efforts – 70% of them fail – for various reasons, one of which is bolting new technology on inefficient ways of working because they misunderstand the ethos and raison d’etre of DT.
The Covid tracing application was cited and implemented successfully using technology, so I am wrong? No, the process was already defined and understood but implemented differently by the NHS and Apple etc. What DT means in the NHS is a review of its objectives (keeping us alive and well) and redesigning its processes to achieve this.
I maintain that the biggest issue facing it in the NHS are the communications processes which need redesign to be a closed loop from initiation to completion, implemented using technology with a suitable logging mechanism for backtracking in case of issues which may arise, such as an unexplained death.
The NHS can buy as much technology as it wants but they will fail to achieve anything without designing these processes and some enhancing technology plus the rigorous methods of project definition, deliverables, milestones, review points and all the other paraphernalia of a project. Top class project management will not help a poorly defined project, just as technology will not help poor processes – just make the inevitable happen faster.
The other thing I would add it follow the 4 Es – examine, evaluate, emulate and exceed (the originator) – of a proven, working system’ wherever it originates. This has been mooted for the tracking system but little else has.