Background
In August 2023, Ethical was contracted by NHS Dorset ICB to undertake a one-month review into its system-wide EHR programme to consider clinical safety requirements associated with current arrangements while the EHR programme was developed.
The need
Ethical was asked to support NHS Dorset ICB with a detailed month-long assessment of clinical safety requirements, leading to recommendations for immediate actions and for an optimal EHR rollout in the future.
Following the delivery of this work, Ethical was asked to provide programme capabilities to support the preparation of NHS Dorset ICB’s EHR readiness activity. Subsequently, NHS Dorset ICB and NHS Somerset ICB were encouraged to consider a combined EHR programme, including a shared Outline Business Case (OBC), Outline Business Specification (OBS), procurement and Full Business Case (FBC). Ethical was retained to support the necessary work to create and submit the OBC and associated documentation to NHS England.
The solution
Ethical provided a blended team of specialists in EHR, clinical leadership, service design and architecture who interviewed stakeholders across the three NHS trusts in Dorset (Dorset HealthCare University NHS Foundation Trust, Dorset County Hospital NHS Foundation Trust and University Hospitals Dorset NHS Foundation Trust) and the ICB to provide a final report. The team was subsequently asked to provide full programme support for the six-month period ahead of the submission of Dorset and Somerset’s joint OBC to NHS England.
To assess what actions were needed to address clinical safety requirements, Ethical interviewed a variety of stakeholders across all three trusts and the ICB over the course of the one-month contract.
At the end of this period, Ethical produced a final report containing recommendations for three major technical changes that could potentially reduce immediate risks, as well as for the culture, behaviour, governance and skills for a successful EHR programme rollout.
Once the expanded team was deployed, it was divided into different workstreams, focused on the following areas and activity:
EHR programme leadership, including transformation
- Confirmed all roles and stakeholders were represented in the appropriate boards, committees and forums
- Affirmed the promotion of a unified vision at Integrated Care System (ICS)-level, encouraging collaborative leadership and shared risk ownership
- Tested and strengthened governance frameworks, fostering improved collective confidence across the digital leadership community
- Ensured emerging ICS programmes aligned with timescales and delivery of EHR procurement
Communications and engagement
- Regular, two-way stakeholder communication sessions and workshops
- Dedicated open communication channels to address concerns and gather valuable input from clinicians, staff and patients
- Comprehensive cross-boundary communications strategy developed
- Collaboration and communication set up between different departments and organisations across the ICS
Clinical leadership support
- Set up clinical and digital communities of practice
- Cultivated shared local ownership of the vision for future healthcare models, including population health, preventative care and targeted outcomes
- Ensured that procurement strategy aligned with potential future requirements
- Identified and engaged future leaders and digital champions to drive EHR adoption
- Promoted engagement, communication and a culture of innovation and shared ownership
Solution architecture
- Carried out technical readiness assessment and non-functional requirements analysis
- Developed target operating model
- Provided technical and digital advice to support pre-market engagement
Challenges
A key challenge of this project was ensuring that all organisations across the ICS had an opportunity to influence and inform the final recommendations, and that the next steps were agreed and embraced by all stakeholders.
Impact
The one-month report was presented to the Senior Responsible Officers (SROs) and Chief
Executives for each trust and NHS Dorset ICB and it positively informed subsequent actions.
This piece of work led to the deployment of a full programme team from Ethical to support the delivery of the joint OBC over the next six-month period. At the end of this, the three trusts in Dorset were working collaboratively, had signed off and submitted a detailed OBC and OBS and were working in partnership with NHS Somerset ICS to plan for the implementation of a joint EHR solution and a major transformation programme.
The team at Ethical brought us an injection of competence, experience and structure to our programme.Stephen Slough, Chief Digital Information Officer, NHS Dorset