Thomas Webb outlines why successful digital transformation is about more than just the choice of system – it’s about preparing the entire organisation for change.
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There’s some chastening stuff out there at the moment about electronic patient records (EPRs) and what happens when they go wrong. So, it’s really important the NHS gets better at EPRs; our track record is pretty poor to date.
First, some evidence. Our partner KLAS Research has a huge database of research on what makes EPR programmes successful (and safe). The data is unequivocal: your own organisation’s readiness is twice as important as your choice of supplier. If we are to get better at EPRs, we need to focus on organisational readiness more than anything else.
It’s worth just sitting back and taking that to consider whether EPR practice in the UK reflects this fact. Speaking from experience of every EPR programme I’ve been involved in or witnessed, I have categorically never seen an organisation apply twice as much focus on their own organisation as they have on the whole process from procurement to implementation of the software itself. This is perhaps understandable, given that the process of developing a specification, procurement and evaluation, contract negotiations and configuration of the system itself are all really time consuming and resource intensive activities. And of course, this process is a lot more definitive than looking at your own organisation. The technology side is a defined process, a series of steps that you follow with a clear definition of ‘done’ when you implement your new software.
The organisational readiness side is much more complex, with no clear definition of what ‘done’ looks like. It’s much more natural for us humans to focus on the clear and less complex actions than the murky world of trying to change an organisation’s culture, for example. And yet the hard stuff yields the most value.
We should definitely spend much more time on organisational readiness. But what does that even mean?
Preparing for change
Organisational readiness is not just about the readiness of your organisation, oddly enough. It’s not just getting ready for a one-off event (usually your go-live). It’s also about your capacity and capability to continue to evolve, optimise and support your EPR after your go-live. It’s about how ready your organisation is to have an EPR as part of its DNA, from go-live onwards. How ready is your organisation to move to a place where an EPR isn’t special but is an intrinsic part of what your organisation is and does.
Organisational readiness isn’t just technology and infrastructure. And it’s not just about having a team of people in place to implement your system. These are all things you need in place for a successful go-live but the things you need for sustainable transformation are more important. Things like culture, leadership, insights from data, organisational structure and governance, commercial nous.
Ethical’s 7-Step Organisational Readiness Framework provides a comprehensive appraisal of an organisation’s readiness for transformational change. It covers:
- Leadership and collaboration – getting your board prepared and engaged with an equity of understanding and knowledge.
- People and change – making sure you have sufficient change and transformation capacity and capability.
- Future-proofing – strategic technical readiness to support your system at go-live and into the future.
- Optimising how care is delivered – rethinking clinical processes for a digitally enabled service.
- Learning and inclusivity- training your staff appropriately, focusing on digital inclusivity and diversity of workforce.
- Communications and engagement – reaching people with communications that penetrates through your organisation and identifying and engaging key stakeholders.
- Benefits management – baselining and building the right capacity, capability and governance to track benefits the right way.
Each of these steps is interlinked and provides a route to understanding how and where your organisational needs to focus its efforts when preparing for digital change. Walt Disney once said “progress is impossible without change” and we need to embrace that mindset when it comes to improving services and care in the NHS.
A fundamental prerequisite to improving things with your EPR (improvement shouldn’t be assumed; there is a wealth of evidence of poorly done EPRs making things worse, including the recent BBC investigation), is that your organisation has the tools, capacity and capability to change.
What we are talking about here is service design. Redesigning clinical services with the advantages and improvements that digital can offer. But redesigning services for whom? User-centred design (UCD) enables organisations to redesign services with the needs of patients and practitioners in mind – things that need to be fully investigated and understood before embarking on an EPR implementation.
But UCD isn’t just following best practice; it has to be a shift in mindset and culture and driven by an authentically inquisitive interest in the experience of service users. We need to move away from working in siloes that, although very real to those working in them, are completely invisible and irrelevant to those using the service. People must care about the whole, not just their bit.
That is very easy to write, and very hard to do in real life. Change is painful and there is huge organisational inertia with these things. But that is why step 1: leadership and collaboration is so important. The phrases ‘our EPR programme is a clinical programme not a technical one’ or ‘clinically led, digitally enabled’ are so ubiquitous they have become meaningless. It’s just a thing you say to sound like everyone else. In reality, most EPR programmes don’t even attempt service design or go anywhere near it. A system gets put in, and some processes get forced to align with whatever processes have been baked into the system; the same ones that every other customer gets.
This is ‘discontinuous improvement’, where small and disjointed elements of a process get changed independently, with little regard to the overall service being provided.
Building long-term capabilities
What people should be doing to get ready for their EPR is, ideally years ahead of any procurement, building service design capabilities into their organisation, and begin changing cultures and improving services. When an EPR comes along, it merely becomes another tool in the change arsenal that gives new and enhanced options to those looking to improve care and experience within the NHS. Of course, many NHS organisations won’t have this in place, but it is never too late. Service design and improvement are continual, they never end, so any time you start on the journey is a good time to start. You want to be building capabilities for the next 10 years, not just for your EPR implementation.
In summary, getting your EPR wrong is disastrous. It is not an ephemeral risk – it can kill people as well as bringing an organisation to its knees, operationally and financially. The biggest factor in getting your EPR right is getting your own house in order. That’s twice as important as the choice of system so we need to put the equivalent effort into preparing an organisation for change.
If you want benefits, then you’ll need to enact change. The more change, the more benefit. And really you can’t make meaningful change without leadership and culture working in concert. So, what is the biggest thing you can do to get your organisation ready for a decade of continuous service improvement, helped by an EPR? A culture of UCD and service design.
And it’s not just getting service designers in but turning your whole team into service believers. Everyone needs to shift to a user-centred mindset – clinicians and digital folk, alike. It genuinely is about clinical service change, not about conforming with a system. I’m hopeful that in coming years things will begin to change and NHS organisations will start being brave enough to look at EPR readiness as a service design opportunity rather than simply being ready to put a system in.
Get in touch
Learn more about our organisational readiness service here or contact Matthew Roberts at matthew@ethicalhealthcare.org to discuss how we can prepare your organisation for digital transformation.