The art of the possible: shared learning from the GDE programme

Dermot Ryan describes how the findings of an independent evaluation of the GDE programme align with ongoing support for frontline digitisation.

As a number of NHS trusts reach the milestone of completing their commitments as part of the Global Digital Exemplar (GDE) programme, an independent evaluation of the programme has been published by Edinburgh University. The findings of the report highlight approaches, insights and outcomes that are underpinning NHSX’s ongoing work to support the digitisation of our health and care system. This work includes our Digital Aspirant programme and ongoing investment in frontline digitisation, alongside the What Good Looks Like guidance for good digital practice and access to support, and other guidance including the GDE blueprints.

The ethos behind the GDE programme was to demonstrate the art of the possible - that the NHS could do digital, and do it well - by investing in organisations already pushing the boundaries in terms of digital capabilities and helping them to do even better. The 51 provider organisations who joined the programme in 2016 to 2017 have generated invaluable learning through their digital transformation journeys. Those lessons have been made available to other organisations through an evolving learning ecosystem, and are the foundations of our ongoing work to level up digital capabilities across the NHS.

The lessons learned from the GDE programme have been carried forward into Frontline Digitisation and the associated Digital Aspirant programme. The principle of a national initiative designed to optimise local ownership and accountability by allowing provider organisations flexibility on routes to digital maturity, within a structured framework of accountability, continues.

Similarly, the value of broadening the traditional conception of technology programmes from merely IT deployment towards digitally enabled transformation, changing care and work practices to efficiently deliver safe, high quality care is at the core of NHSX’s mission.

The promotion of an ethos of learning and sharing through an adaptive programme strategy, facilitated by a range of knowledge sharing mechanisms including blueprinting and partnership working, will persist.

Other key features of the programme are now embedded in how we ensure organisations are ready to make best use of the central funding provided, including:

• high level ownership at board and divisional levels and clinical ownership across the organisation
• the necessity of digital transformation expertise being in place (exemplified by the appointment of chief information officers, chief clinical information officers and chief nursing information officers)
• the insistence on organisations having an internal vision and strategy for digitally enabled transformation and associated signed off business cases
• the maintenance of a dynamic plan with milestones and benefits delivery linked to funding flows
• strengthened engagements between adopters and vendors collectively

The provision of dedicated multi-year external funding, subject to Spending Review constraints, is also something that continues to be the goal of Frontline Digitisation.

Impact

Through their digital transformation journeys, the GDEs have demonstrated how they have unlocked efficiencies and savings through their work:

Improved user interfaces, including single sign-on, have reduced the time spent by staff logging into multiple clinical and non-clinical systems and reduced ICT helpdesk calls. This is estimated to have resulted in £15.84 million non-cash releasing time savings across 12 trusts over 36 months.

EPR systems and clinical noting have reduced clinical and administrative time spent capturing and managing paper records with 14 trusts reporting non-cash releasing savings of £23.86 million over 39 months.

Seven trusts reported interoperability improvements resulting in increased electronic sharing of information and swifter access to clinical information with estimated non-cash releasing savings of £4.26 million over 42 months. Three trusts reported cost efficiency savings of £4.65 million over 33 months, by reducing the costs of out of area beds, optimising shift patterns and increasing income from outpatient activity.

Online consultation and treatment tools and the resulting reduction in multi-disciplinary team meetings, "did not attends" and follow up appointment visits with associated travel cost saved three trusts £2.26 million over 30 months.

Most tangible amongst the outcomes of the GDE programme are the clear benefits of digital transformation in health and care, and their impact on patients and staff. During recent visits to GDE trusts I and other members of the NHSX executive team have seen this first hand:

At Alder Hey Children's Hospital, virtual reality headsets are being used as distraction therapy for young people undergoing treatment. Films tailored to individual patients include roller coasters, dinosaurs and games.

Patients at Clatterbridge Cancer Centre can now quickly and easily check in for appointments using digital check-in kiosks, and consultants can use their time more effectively through virtual ward rounds and digital dictation for clinic notes.

Cutting edge work at North Tees and Hartlepool includes the implementation of a pharmaceutical robot for drug dispensing, and an electronic prescribing administration module (EPMA) that allows clinicians to digitally track and prescribe patient medication.

Using Sunderland Royal Hospital’s GDE blueprint, South Tyneside District Hospital has successfully rolled out their Electronic Patient Record (EPR) in record time and despite the pressures of a global pandemic. Whether a patient is in the Emergency Department, an inpatient ward, a diagnostic area, or attending a therapy or outpatient appointment, the EPR provides live, up-to-date information without the need to access paper records.

Insights and learning

In terms of investment, one of the findings of the report underlined the value of dedicated, multi-year funding with a requirement for local matched funding. For participating trusts, this helped drive the organisation’s progress along its digital roadmap, with additional funding accelerating the adoption of innovation through supplier relationships and staff training and support. This model has been taken forward with how funding is allocated to trusts participating in the Digital Aspirant programme.

The GDEs also demonstrated the critical importance of executive commitment to digital transformation, and digital transformation expertise in the organisation. GDE success has been shown to be linked to executive ownership of the programme. Progress through the programme was driven by the development of roles such as chief information officer (CIO), chief clinical information officer (CCIO) and chief nursing information officer (CNIO).

This learning underpins work we've already taken forward to build trust board understanding of the potential and implications of the digital agenda, and increase the confidence and capability of boards to harness the opportunities it provides. Through the Digital Boards programme, supported and funded by NHSX and Health Education England, NHS Providers is partnering with Public Digital to deliver a range of events and resources including bespoke board development sessions. The Digital Boards programme has already engaged over 840 NHS board leaders over the course of the last year.

The report also cites the creation of the foundations of a learning ecosystem as a key outcome of the GDE programme. Knowledge transfer through formal and informal learning networks, and the creation of resources such as blueprints, has established a lasting legacy of collaboration between organisations. The blueprints generated by the GDEs provide step-by-step guides - covering care settings, care pathways and digital capabilities - to help other organisations in their own implementation. Many trusts have already fed back on how the blueprints have saved them time and money, including Digital Aspirant trusts who are required through the programme to produce blueprints of their own.

Collaboration between GDE Imperial College Healthcare NHS Trust and Fast Follower Chelsea and Westminster Hospital NHS Foundation Trust enabled Chelsea and Westminster to deliver their EPR programme in 14 months, resulting in cost savings of approximately £2 million. Training materials only took four months for Chelsea and Westminster to prepare compared to 18 months for Imperial College Healthcare. This learning ecosystem is integral to ongoing support to trusts.

According to the findings of the report, stakeholders in the GDE programme recognised the value of digital maturity measures as they helped them map the journey towards digital excellence. The What Good Looks Like guidance which was published this summer does exactly this, as it sets out a common vision for good digital practice to support frontline leaders to accelerate their digital transformation. The guidance identifies seven success measures for good digital practice for organisations and ICSs. Going forward, we will continue to develop What Good Looks Like including through the development of detailed assessment criteria and tools to help organisations understand where they are against the baseline.

The publication of Edinburgh University’s report both informs and confirms our approach to ongoing support for the levelling up of digitisation of health and care. I look forward to seeing further programme participants reach their accreditation status and continue to share invaluable learning with our cohort of Digital Aspirants.