10 key lessons for embedding digital in your trust

A succinct new guide tells NHS leaders everything they need to know to make digital transformation a success. By Cate McLaurin, director at Public Digital

Three years ago, we partnered with NHS Providers to launch the Digital Boards programme. Commissioned by Health Education England as part of their Digital Academy, and supported by NHS England, it was designed to support boards leading the digital transformation agenda.

This week, we have launched a summary guide for leaders capturing our learnings since the programme launched. Over 2000 leaders from more than 200 trusts have participated in this programme, giving us a unique insight into the state of board digital leadership in the NHS.

We’ve already published several guides for NHS boards on leading digital transformation, but as we come to the end of our third year, we can see that there’s a need for a short but comprehensive version – one that outlines the basics and helps board leaders navigate the information quickly to find what’s relevant to where they are now.

So, what are the 10 key lessons we’ve identified?

1. There must be visible collective responsibility for digital at board level
   Digital is sometimes seen as a separate issue, or an “add-on” to other strategies. However, it is when all leaders recognise and champion digital as a core priority, firmly integrated within clinical, strategic and business considerations that trusts make the most progress.
2. There is (still) a need to build confidence and capability in digital among board leaders
   We’ve been helping boards develop greater assurance of their digital decisions and link digital investment to their quality improvement and patient safety agendas. Many board members recognise the importance of digital, but don’t feel equipped to contribute to the conversation. Trusts benefit when the whole board is confident to engage with digital, so we’ve focused on building that confidence and capability for everyone.
3. Having an EPR in place is the start, not the end of the journey
   Electronic Patient Records (EPRs) are now in place in almost every trust – and there’s a concerted effort to support those that haven’t got one. Having an EPR is a first step to becoming a digital organisation – but implementation is not the end of the journey. Good boards are focused on optimising their EPRs, working to improve the usability and adoption of these systems continuously so that they can better enable more efficient and safer care.
4. Services need to be designed to meet the needs of users
   One of the core messages of the digital boards programme is the importance of really understanding your users – both staff and patients. We’ve seen some fantastic services on our travels, which are a direct result of trusts getting closer to the digital user experience by adopting a user focussed approach to service design.
5. Badly designed services exclude people
   Boards leaders are, rightly, worried about digital inclusion. During Covid-19 we saw that trusts all over the country were able to stand up new digital services quickly. The challenge now is to not revert to older ways of thinking and doing, and instead ensure that we build on that progress by designing for the whole service, and the end-to-end user journey. It is not digital that excludes people; it is badly designed services.
6. There are lots of competing requests for time
   Increasingly, trusts are appointing clinical digital leaders. The momentum continues to build for further professionalisation of digital clinicians. This will start to build much needed capacity and skills in clinical digital leadership, but for as long as digital is seen as an add-on, there will be limited bandwidth across the workforce as a whole, with clinicians struggling to carve out time from their day job.
7. Digital investment is lumpy and unpredictable
   Good digital investment is sustained and focused and enables a trust to deliver against their strategy. But the current funding model means that trusts can end up chasing pots of money for technology or priorities that don’t fit with their wider strategy. More advanced trusts are working to flatten those funding lumps to give stability to digital services and teams. Equally, insufficient funds make it harder to replace core infrastructure or legacy systems, or delay EPR implementation.
8. The big opportunity for digital transformation lies in quality improvement
   Trust leaders are seeing the potential to merge existing expertise in digital and quality improvement to drive the transformation of care delivery, for example with virtual wards that use new technologies to provide more care at home rather than in hospital. We think this is where the opportunity for transformation truly lies.
9. Fixing the basics isn’t sexy, but it’s necessary
   Wifi that works, devices that are usable and removing multiple logins to systems are all fundamental enablers of a successful digital health care organisation. It’s the sort of investment and work that sometimes gets overlooked, but when it’s not there it prevents real valuable change from happening.
10. Digital is the lever for achieving alignment and collaboration
    Alignment and collaboration are the two main organising challenges for integrated care systems. Digital will be the most effective lever in addressing those challenges because technology allows dispersed individuals to come together in a way that was never possible before the internet. However, this also requires a shift in mindset from competition to collaboration. Adopting a digital way of working will enable that shift.

Cate McLaurin, director at Public Digital, has worked at a senior level across local and central government, including as head of delivery at the London Borough of Hackney. She has deep experience of delivering agile, user-centred services and capabilities.