Combining tactical and strategic healthcare innovation

3 January 2019
By Jim Ritchie
Program Director
Digital Control Center
Consultant Renal Physician and Divisional Chief Clinical Information Officer
Salford Royal Foundation Trust
Combining tactical and strategic healthcare innovation

Innovative technologies, especially digital healthcare solutions, can be presented as a panacea for the NHS. This is an oversimplification that can create a drive towards solutions being defined and delivered with problems fitted only in retrospect. Key to our ability to innovate away from winter pressures, is improving our capability to articulate, define, and measure driving factors. This knowledge can then be used to prototype, pilot and scale solutions that speak to these root causes.

In the short term, technical change should be used to break the negative cycle where we are so busy dealing with immediate problems that we cannot raise our heads and look beyond the horizon. Careful use of tactical solutions can provide breathing space that lets us address this bigger picture. In Salford’s work as a Global Digital Exemplar site we have approached this by focusing on efficacy as well as efficiency. Improving our clinical documentation by applying user centred design to our EPR has made this a more “usable, useful and used” tool. Enabling clinical staff to have a better experience whilst delivering more reliable care and also creating valuable structured data (that supports operational decisions), helps us to capitalise on existing digital investments and infrastructure. The same principles have been applied when leveraging digital communication tools that support specialist services in finding new ways of working that allow them to deliver safe remote management advice. This improves working experiences and supports provision of safer patient care closer to home.

Simple technical changes can support rapid improvements in patient flow by improving communication between teams. Interest in leveraging NHS data sets to predict patient length of stay will only add value if this information can be converted into more timely discharges. In Salford we have piloted a simple task management app to streamline communication between ward flow facilitators and capacity management teams. This has allowed a proactive, responsive approach to addressing discharge barriers. This, in conjunction with clinically sponsored quality improvement work, is bringing discharge times forwards and creating capacity within the system.

The axiom “Prevention is better than the cure” should not only apply to physical and mental health. Strategic investments in technology can enable healthcare organisations to work to this principle and deliver ‘control center’ models. This approach combines technology, analytics and change management to drive improvement. Accurate reporting empowers staff by communicating information throughout an organsiation; predictive modelling supports early decision making, with the combined outcome being improved matching of capacity to demand. Here, we have already seen benefits by matching staffing levels to patient acuity, but this is just the first step towards balancing how the skill mix of our staff is best used to help patients.

Finally, innovations must be rigorously tested and evaluated. To enable this, we have developed the model of a ‘digital factory’. Here, any member of our organsiation can explore their service challenges and problems with a team who are expert in digitally enabled change. Potential solutions can be rapidly identified, tested and (if deemed appropriate) integrated to allow testing in a ‘dummy’ environment. This gives staff ownership of the solution and associated change, and offers protection against the imposition of reactive technical solutions that do not meet long term needs.

In the short term, technical change should be used to break the negative cycle where we are so busy dealing with immediate problems that we cannot raise our heads and look beyond the horizon.