Despite a bumpy ride so far, advances in technology have the potential to improve corporate governance as well as outcomes and patient care. Shreshtha Trivedi reports
In November the National Information Board announced a blueprint to make the NHS fully digital by 2020.
Personalised Health and Care 2020 would be the latest attempt to digitise the health service, aiming to put technology at “the heart of the NHS’s future” and following up on the paperless ambition by 2018, outlined by health secretary Jeremy Hunt.
Not there yet
The NHS cannot be faulted for lacking the vision where technology is concerned. What has gone wrong, though, is the implementation: newer and bolder schemes launched without enough thought given to the logistics, engagement, training and communication, leading to failures and formidable challenges.
‘Paperless software such as BoardPad is very useful, as you can have quite a crunchy discussion’
However, despite the past track record, technology is something we cannot turn our backs on. The NHS needs to embrace innovation and technological advances to improve outcomes and patient care.
To discuss some of these issues BoardPad hosted a fringe session entitled “board leadership and corporate governance: what the NHS boards need to know about investing in new technology” at the HSJ Summit in November.
BoardPad is a meeting and document collaboration solution that helps organisers manage meetings, compile electronic board papers and distribute them instantly to the board.
The fringe session was chaired by Marc Farr, director of information for East Kent Hospitals University Foundation Trust. One of the first points raised was how technology in the boardroom can improve corporate governance.
‘Now you can challenge various divisions on the spot and see if what they have said is correct or not’
Mr Farr said: “Every month at [East Kent’s] executive performance review we use paperless software such as BoardPad, which is very useful as you can have quite a crunchy discussion.
“Previously, we used to have a culture where the data was all in papers and if you haven’t gone through them, you needed to come back again and ask questions.
“Now you can challenge various divisions on the spot and see if what they have said is correct or not. Better than ‘I’ll come back to you on this’,” he added.
He illustrated his point by giving an example of how they once challenged the appraisal rates of midwives in east Kent. Seeing the data live helped them understand that they had not done their appraisal properly.
Mr Farr said the second issue faced by East Kent is a disconnect between staff and senior management, which, according to him, can be solved to a certain extent by “having data and reports in front of us”.
Therefore, not only can technology improve transparency in the boardroom, it can also help staff engagement.
However, Sue Woolley, chair of Lincolnshire Health and Wellbeing Board, expressed her concern about “one more load of data”. She said that “NHS projectile vomits information” and this may lead to data overload.
‘[These tools] encourage staff to raise the level of their game’
She was supported by Annett Gamell, chief clinical officer of Chiltern Clinical Commissioning Group, who added that there could be a “danger of being overwhelmed with data” and “how do we decide what is needed?”
Mr Farr responded by saying the “data needs to be sticky”. He emphasised the importance of picking interesting information and presenting it nicely, such as on phone widgets - one of the simpler ways.
James Harley, business consultant for BoardPad, said it is working with a major acute trust in London that has restricted the information to no more than two or three pages, just like an executive summary. “It would only have absolute important information such as waiting times,” he said.
Raising the bar
Jim O’Donnell, chair of Slough CCG, was of the opinion that these tools “encourage staff to raise the level of their game”.
“We use BoardPad for operation leadership team and quality surveillance programmes. It gives huge access to people who previously had no access to data.
‘Perhaps we should provide BoardPads to GPs to empower them like board members and clinical leads’
“In our quality surveillance we now look at 300-400 parameters every month in addition to individual reports, which gives people a sense of ownership of data. They feel far more motivated and involved in the performance of our providers, which to an extent I don’t think happens at the provider level.”
He said these quality assurance data sets are then provided to Monitor and the Care Quality Commission,
which leads to unannounced inspections, ultimately improving patient care.
“Perhaps we should provide BoardPads to GPs too to empower them like board members and clinical leads,” he suggested.
The second question raised in the session was whether boardrooms should be leaders in implementing paperless technology within the NHS.
Mr Farr said that boardrooms, of course, should lead on implementation. However, they need be careful of politics.
He admitted there is an element of politics between the executive and non-executive teams. “Executive members think [accident and emergency] dashboards and similar tools make them feel exposed,” he said.
“When there is a pack of papers, the chair can ask only so many questions. Similarly, there is politics between our trust and the CCG.”
Keep data secure
Mr Farr stressed that there is a need to be careful of patient confidentiality as well.
On being asked how secure such software was, Mr Harley replied that it is “password protected and 100 times more secure than paper”.
However, a couple of delegates raised the issue of poor broadband and wifi connection, especially in rural areas, which makes them reliant on paper. Mr Harley responded saying that they can “download the software and work in offline mode”. It summed up just how bumpy NHS’s relationship with technology has been.
‘Safe digital record keeping has got to be the heart of the NHS’s future’
At the launch of the NHS national technology strategy in November, Tim Kelsey, NHS England’s national director for patients and information, announced: “Interoperability and safe digital record keeping is no longer a voluntary, amateur sport. It’s got to be the heart of the future of the healthcare system.”
If we want a sustainable health service in the future, it is crucial that the vision is backed up with technological performance, policies and infrastructure across the country.