In this session, GatenbySanderson shared the trends from their research of public sector leadership. They will draw on evidence-based findings to present the typical profile of NHS leaders, and look at how these compare to wider public sector leadership. They explored how NHS leaders can build on compassionate leadership approaches, enhance collaboration, and drive outcomes to address current challenges, leveraging their strengths and considering areas for growth.
Hello can you all hear what a bizarre um experience uh well welcome uh we’re having a session that’s talking about support supporting the sustainability of the nhf uh and particularly um from our point of view uh thinking about the sustainability of epr implementations uh we’ll um we we’ll let
Jackie and Jane introduce themselves in a minute but just as a beef in uction to us as the sponsor uh we’re Altera we’re a leading provider of um electronic P record uh systems in the UK uh you can see there that across the globe there’s 2,700 hospitals that use
Our software and in the UK uh we support care of about 8 million people uh patients across England and that there are logins by clinicians uh 2 million different logins by CL clinicians uh across uh across England each week the standard approach that many suppliers take to epr implementations requires an enormous
Amount of change uh often changing your paths as well as all of your uh clinical processes uh all at once uh causing yeah uh an enormous uh impact on some really uh some really stretched uh clinical and admin resources in hospitals and really what we’re going to have a conversation
About today is that how we make that process more sustainable how do we get to a point where you don’t have to cause that level of impact and that much change on an organization so we’re going to start by um Jane uh is going to introduce herself
And her organization and then Jackie and then we’re just going to have a chat about um how it is that you using the altia product in these two organizations uh has worked for them and what we might be able to learn from that um oh you can hear me now sorry
They got to change out this again is a really surreal experience with me so hello everybody I’m from the Southeast coast uh down in Kent Maidstone and tumbridge Wales hospitals uh we were extremely challenged about 10 years ago but we’ve completely turned that around and we’re one of the best performing
Organizations in terms VD performance and uh cancer weights and 18 weeks we’ve got no patients waiting over 52 weeks we actually went live with our epr during covid we’ve now been live for two and a half years and I do think a combination of that plus our patient flow system
That we have is one of the major achievements around why we’re doing so well today so I’ll come on to sort of the things that we’ve done and how it’s not always been perfect later on in this kind of discussion so I’ll hand over to Jackie thank very
Much okay thanks very much I’m can you hear me now yeah yeah um I’m Jackie Edwards I’m um Chief clinical digital engagement officer which has been a new role that um the trust has introduced over the last six months and that’s partly because of our journey of um the
Epr that we’ve taken and the real Focus that we’ve put on the importance of clinical engagement I mean unlike Jane and I hope I’m sitting in your space actually in a few years time um is we are a very challenged organization um and I think we’re similar in size to menston and tumbridge
Wales we will we’ve taken a slightly different road map uh that Jane has taken in the our was our very first encounter of that digital transformational Journey um that we took um and it was delayed a number of times and I think that was one of the both opportunities as well as drawbacks
That we had an opportunity in that it really did give us time to get that Frontline clinical understanding and engagement right before we started so that everybody was sort of on the same page with understanding what it would look like what we needed to be doing um
But as you will see as we go through it hasn’t always been that easy particularly with the clinical engagement and some of that is similar to what we’ve heard this morning because actually in the current culture and climate that we’re living in actually you don’t know what’s coming down the
Road at the moment and actually whilst your road map is as it is actually it needs to change because our clinicians have to focus on very different bits I think the bit that I’d like to come back to at the end is the importance that our digital transformation and our epr has
Had in keeping coming back to that taking our clinicians back to that great thank you it’s it’s great to have you both here thank you for your your uh um involvement in this session I’m Mark Hinson I’m here kind of with my altia hat on uh today uh but um we um
Over the last few years have implemented the Ala product at gler where I was the CIO for five years um and we we’ll perhaps also reflect on uh some of the things that we between us learned across all three of those organizations we’re going to start um Jackie with you if
That’s all right to just talk about what do you think’s worked particularly well uh over the period of your um ulterior epr implementation yeah thank you I think first and foremost I would say is about having clinical leadership and and when I say that that’s both at board level in our Chief
Information officer absolutely telling the story at board so keeping our our executive members and at that time I was the chief nursing officer so actually hearing that and understanding how I take that message out to um the professional group that I was leading at the time was really important but
Actually um really vital was actually Ward clinical leadership um and identifying it very early on who were the those leaders that were going to actually really get behind it to start selling the story from peer to peer um and we had started our W accreditation program so actually we knew some of
Those wards that were actually really Leading The Way with their quality performance indicators who were very much engaging with staff at that point in time so we identified our pilot areas and I’ll never forget that the one Ward manager who came to me at the time and
It was an elective surgical Ward where I actually said please can you come up front and and be one of our our Pioneers in piloting it and she said why are you choosing me I’m probably the most digital illiterate person there is and I said but that’s not the reason I’m I’m
Choosing you I’m choosing you because of your leadership of your team and I think that was an important message and in fact they did extremely well in in kicking that off so so actually I think that was it is absolutely pivotal is is getting that engagement the second area
That um worked very well was one of our um Frailty WS where I knew that the multidisciplinary team approach was very strong so actually that really helped in those sort of handovers the W DRS the way epr was being used for the very first time to actually be able to actually see how
It was working well but also they gave us really good feedback on on where it wasn’t working so well or where they didn’t understand it excellent thank you uh and Jane from your point of view what worked well at M on uh so again just reiterating Jackie’s Point clinical
Engagement is absolutely key but it’s also following it up with what I would say is quick wins actually promising to do something and then delivering it in a quite short time scale because if you don’t do that they start to lose the trust within the system and I think one
Of the beauties that we’ve had with our particular epr is it’s quite for spokes you can actually make it do things that fit that particular organization so that way that clinici wants to work you can look at developing that documentation to meet that rather than asking them to
Actually conform to a way of working which they might not appreciate and I think that has really enabled us to engage with our clinicians but I think rolling out in phases as well has also made it quite bite-sized chunks so you’re not actually impacting on the whole organization in one go and so
Therefore you have effectively your pilot site started for us in Ed but we were then able to gradually roll that out so we gained the confidence of your Ed Consultants who are quite powerful within our organization and actually were then able to help their medical Consultants embrace it when it came onto
Their Ward areas and and then finally now we’re going into surgery they’ve seen kind of all of their other colleagues so the kind of um challenges that you might have got in much more big bang kind of approach may be much more harder to deal with and it’s enabled us
To optimize and continuously uh change the way that we work to meet what they’re dealing with so with covid we’ve been able to adapt all the time throughout and we’ve been able to come up with very innovative solutions we’re first of tight for um a new clinical
Decision support tool which is around I refer and that’s meant for our Junior doctors it’s really helped them to stop having to order inappropriate tests and so our patients are now getting through the system much quicker and getting um their right test at the right time so
It’s it’s enabled us to do things like that which has really encouraged our clinicians to take it on board great that’s really good and and I think for me somebody ask this question for gler um I think what gler found really useful was being able to sit down
With 58 most senior nurses and M GES nurse across the organization and say Here’s the blueprint here’s the best of the nursy documentation that altia has do you want to take this or do you want to start again and build your own or shall we take this and slightly tailor
It and there’s a a really strong sense of support from the nursing community that if that works in a similar size Hospital in the UK then we just want to make a few changes and that allowed us to go alive in 5 months and as you describe um that doesn’t give people
Time to get weary or or or lose momentum it meant that we could um you know really promise that they’re about to get a system and and five months later we were live on the wards and I think that was a really powerful message to the rest of the organization that as we
Approach this in phases we’re going to be moving really quickly and we’re going to be able to provide something for for your area really soon so Jane what what would you do differently what would I do differently um I definitely would never do an epr roll out during covid because if I had
To go back but we did but that meant actually I learned quite a lot from that about being flexible in your approach but also um when you kind of go into your VPR initially you’re signing up to a contract for a particular length of time with key Milestones that you need
To achieve and one of the things I would love to do if I could go back was actually capture the benefits throughout um we weren’t always as good as I would have liked to have been because you’re on that treadmill of trying to make sure that you’re getting your epr rolled out
In a way that you need to against your digital road map so now it’s quite hard to sometimes go back you know you’ve made a difference and people tell you as soon as the system isn’t available for Planned downtime for example how much of an impact that is to them now not to
Have their electronic system but I can’t put my finger on exactly what that benefit was and also going live with your patient flow at the same time you don’t know whether it is your epr or combination of both so I would really say if you’re embarking on your epr
Journey is make sure you get one of your team the role is just to capture benefits both before and after so that you can demonstrate to all of your clinicians your managers your Finance directors exactly what that benefit is bringing to this organization I I’d have to Echo that actually and
We’re really experiencing that at the moment because it feels a little bit like we’re on catchup because part of that is then how you can celebrate the successes and I’m not sure we’ve celebrated our successes with our clinical teams um in the way that would really still keep them engaged because
That’s one of the biggest challenges certainly um as I said at the start as as you know we’re entering winter or and we’re entering a different phase of our rollag how do you keep people um still with you when actually they’re very distracted but actually taking them back to saying
But this is the fundamental element that will help you actually through that phase because they just can’t see it people go back to what is familiar and comforting and certainly I’ve gone on to some of the wards who have just said oh oh I’m just too busy today I can’t do
That I want to go back to paper and our staff really have been challenged with we’ve got a mixed model so it is all El electronic and patient record some of the wards because of the phased roll lag particularly the nursing documentation hasn’t come online um and
One of the things that actually has really helped is getting peer-to-peer advice so what one Ward is doing and how they’ve said you know on the computers uh that they they use actually there’s a list just by the side of what what nursing documentation is and what isn’t because actually when they’re really
Busy it’s very hard it it’s creating a network among the peers I’ve bagged is really helpful to share that information the other key bit that um certainly I know my digital team members would say please tell people this is managing expectations because I’m not sure we put enough effort into explaining actually
Whilst it looks like this and this is your your educational program to to get you to use it actually there is so much more that goes on behind it so if I give you an example of our shared care record that we brought online we we’re still trying to engage with people because
They don’t really know it’s there CU they’re just too busy so our um our our team that we had that wore orange t-shirts that they called the Orange team were invaluable to us of going around and just accompanying a clinician on a wardr and saying have you seen this
Button cuz actually whilst you may have been taught it or you you’re familiar with it from the teaching package actually they’re not using it and they’re not using it because they’re just too busy to click into it so I think investing a lot more time in teaching and education um would be the
Other big element because then that helps you manage their expectations our team were inundated with requests of can I have this changed can I have that changed because actually actually it was there already but it’s letting them know that yeah understanding what’s there and how it worked um
And how many people have been engaged in in that initial design is obviously really important um from a gluster point of you it was um uh I think we had the lowest ever score of um digital maturity when I got there I think we hads level 0.18 or something slightly mad that came
Out of the system and that meant that we were trying to address a lot of things in parallel so it would have been great to be able to do order com sooner but we needed a new pathology system first it would been great to do electronic prescribing sooner but we needed a
Pharmacy Stock control system first so think it was great having the flexibility as you say of being able to implement the alterior product in a modular way because it meant we could fit around all those things and it was great that we got from you know that
Level of digital maturity to him’s level five in less than two years um it just would have been easier if there been a different starting point um the last question before we ask people for um you know they’ve got any questions from was what do you think the
Future looks like what’s uh kind of what’s your vision of of what happens next and what hospitals and organizations can can do with this and other technology Jackie um certainly for me it’s about how we get systems across the system really working or integrating um from a
Digital perspective and you know I I feel at the moment um patients coming in on pathways through Ed having sight of of their sort of records from primary care and throughout into social care will be the thing that really will help revolutionalize that that experience for the patient and ultimately then the
Experience that the staff are having um It’s hard out there at the moment and it feels very disjointed from that perspective and certainly hearing this morning about you know how can we make a difference in in you know bringing down those waiting lists but really improving that patient experience I think the
Digital infrastructure and transformational piece for me is definitely where we are in Worcester share that element that we just need to work to and join together and so that may not be that it’s the same epr but the infrastructure elements so that you know things such as virtual Wards things
Such as you know outpatient appointments people have particularly as a patient you know they’ve got their their ownership of it it’s bringing that all together thank you I think for me it’s about giving our staff the time to think outside of the box and really use digital in an
Innovative way of changing care Pathways I think I heard today somebody talk about uh digital care module um they just don’t get the time to think about what digital could actually do for them we have road maps we kind of prescribe to them exactly you know virtual W is
The next new thing but actually is it is it really what your local population needs actually as a challenge to me as a digital leader I need to know what they would like to deliver and it’s my um kind of remit to go away and see what I
Can do to facilitate that yes there’s a financial envelope that we need to look at but it’s about how I can support those clinicians to deliver better care that is sustainable for the future thank you I think very often um clinicians um appreciate kind of being led and
Directed through those first phases of an epr program because not everybody can imagine work in a different way but some way of cycling backr and being able to really take advantage of everything that they’ve learned and once they’ve realized what’s possible then um you know the other Advantage I guess to
Still having the system that you can configure and that you can develop in a modular way is that you can go back around can’t you and say now you’ve been using this for a year what all the things what are all the things you wish
You told us and and how can we you know optimize and take advantage of what we’ve got um and I think also echoed Jackie points that it’s great isn’t it that there are patient flaw modules that Al and other people sell that can really help to address flow in the hospital but
But then we need to reach out to and work out how do you deal with flow across an IC footprint how do we engage um you know the third sector how do we engage adult social care families everybody uh in the challenge of getting people you know out of the hospital be
Down into uh a place that that kind of Best Suits them that’s safest and and best for them um we’ve not talked about it I suspect it will come up in almost every other digital conference or session anywhere so I I’ll do it uh which is you the potential for AI so you
Know the the projects at the front door at bloster um there’s a bit of AI that can identify just on the basis of information we’ve got already about them if there’s a patient who’s likely to stay in the hospital for more than 21 days we know that for every day that
Somebody over 70 spends in a hospital bed they use a Year’s worth of lose a year worth of muscle mass and flexibility and have your life changing loss of Mobility if they get stuck in a hospital bed so what can we do in the first 21 minutes or the first 21 hours
That could help avoid those patients ending up in a hospital bed keep them mobile get them back home as soon as possible uh and avoid that that loss of mobility and I think there’s a whole ton of things that we can do um um that would um you that would really impact
Patients for the better and help to free up you know some of the challenges we’ve got around the bed so there’s a roving microphone uh if you um if you’re happy to ask a question or have a question like to ask if you could raise your hand Chris wins that
Particular um race uh and we’ll uh we’ll deal with that Chris right wow this is extremely surreal isn’t it now I can empathize with the panel um Chris Fleming I’m from public digital it’s a digital transformation consultancy um I’m really curious about the um getting the right balance between Bes spoking and
Standardizing qu with quite a customizable sort of arrangement what have you how did you how did you find that balance uh do do you think you got it right and what governance what did you what was the effective governance around that to kind of manage it
Um because we’ve been live for two and a half years I would say initially we didn’t get it right we went for a subject matter expert and asked them to tell us exactly how they felt that it should work um but subsequently what we’ve done is we’ve engaged much more
About the clinicians and designing their whole clinical pathway before You’ actually then introduced the digital solution to them and that enables them to hopefully then have the conversations about how do we standardize our practice across maybe one organization we’ve got two sites and even two sites can be very
Different um so we’ve now become a bit more mature as an epr team and we challenge back and say Well when you’re ready to tell us how you want your clinical Pathway to look then we can support that because otherwise we put a lot of effort and time into designing
Documents flow sheets Pathways that they then go live with and they go I don’t like this I want to change it so I think over time you kind of of um evolve that maturity but also it is a slight responsibility I think of an epr team to
Look outside and make sure that we are also reflecting best practice too coming to conferences like this or other kind of clinical conferences you can help channel that at the same time um I think one of the key key elements of learning certainly from a a board level perspective is getting the
Governance right around it and I think that that is evolving for us rather than it has evolved at the moment and at the and as it stands it sits almost in two camps and certainly making the the transition from the role I was into this role actually the key learning for me is
Actually the governance for digital and changes Etc is sitting here and the patient patient safety element is sitting here how can we bring the two together so actually the board and C our quality and safety committees our non-executives are aware of what that is because it feels like it sits too
Separately yet it isn’t because one is impacting on the safety of the other and that then goes back as you are saying to are we are we involving the right people in the in the the spoking nature because that is absolutely the right way to go
And I know certainly talking to some of our our clinicians that’s the way they want it to go I think in our journey unlike yourself we’re still at a point where they don’t know what they don’t know at the moment so they know they want it to look like this and they want
The ownership and the empowerment and and the that’s our vision is for it to be very clinically designed and led but at the moment the digital is is very is very much needed to take that leadership function our aim is to try and get that to
Shift I think there’s a balance isn’t it you know I think starting with a a blueprint which is the best of what all the kind of alterior clients in the UK use but then being able to tailor it to help your clinical teams is great I think after that exactly as you describe
It’s involved with as many people as possible but the the worst outcome is that you go live on on a Monday and everybody in in a clinical area is delighted but then you get loads of requests for change on a Thursday and it turns out that that’s the member of the
Team who wasn’t involved and then they’re not on shift the following Wednesday and everybody’s happy again and then they’re upset on the Friday and so involving everybody from the team uh as with any change is really important are there are there any other questions thanks very much uh emyn Jones
I’m a non-executive director at donc cast Ambassador Foundation trust F Hospital trust it disappoints me and this isn’t the first time that I’ve heard it that there’s not been any proper measurable quantifiable benefits evaluation uh to implement an epr like this in an acute trust is an expensive
And time consuming and people consuming uh exercise as a non-executive member of a board if there’s any investment of public money being made I would have thought that it was absolutely essential that right from the start there should be a process of benefits realization and value for return for investment built
Into the process and indeed I’ll put this over to the suppliers of the software and say that you ought to have as part of your advice to the trust that’s implementing that there should be quantifiable measurable benefits and disbenefits um measurement built in how can we stand up in front of the public
And say we’ve spent so many hundreds of thousands of pounds of your money and we don’t know what benefits we realize yes Dr so and so thinks it’s good but apart from that nothing else so just a plea pleas for more measurable quantifiable benefit evaluation yeah I don’t know if
Anybody’s going Jackie wants to speak I’ve got a view but I’ll like Express yeah um I I think certainly one of the things that we’ve learned and we’ve now got a role that’s Absol absolutely dedicated so we’re 6 months into our journey and whilst it is there so to to
Be honest there is a framework that’s there that really looks at I would say as you say quantifiable I’d also like to add in we need the qualit qualitative elements to it as well um is that that’s there one of our learning is that we didn’t put the investment in for having
That Workforce to capture that because our clinical Workforce at the moment is is not able to do do that so actually the thing one of the things that we we’ve put in and are working together much more now is to to gather that data in re much more real time because as I
Said feeding that back to a ward as well as the board is invaluable because that’s the celebration of success you know driven by that value based approach and as you say then we’re capturing the the the value for money elements um if I take you know quality um priorities
Which you know we report to the board on a very regular basis we have seen and we’re now capturing it from a case study and then obviously onto the um quantifiable elements a real marked improvement in our pressur on in the Ws because actually the staff have got the
Documentation and it’s they’re being driven to do that from an accountability fashion to document and they can’t go forward if they don’t document it so we are starting to see some of that going through but I think it’s bite-size and you know I I I I really support that
Challenge from the board’s perspective that you need to keep driving this bit not just from a financial point of view but really importantly the patient outcome perspective I all I would I you agree with all that and we’ve got some really interesting stats from different sites including releasing 25% of a nurse’s
Time to care just as a result of taking the chaos and the telephone calls and the looking for paper out of the system there’s all sorts of stories of patients deteriorating overnight on One hospital site which was observed at the other site by the acute care response team because the electronic observations were
Being recorded and you know the the triggering was happening in a way that could never happen on paper I I guess the only thing I would say is you know the organization you’re a non-exec of is a sort of size of a footsy 250 company um none of which think it’s right to
Work on paper anymore um and it’s a bit like electricity um there were loads of things I assume that came out of electricity being everywhere uh the person whose job it used to be to knock on the windows to wake people up was put out of business cu the alarm block
Worked and the person whose job it was to light the gas lights was put out of business and people weren’t falling over at night because the electric lights run all night there’s there’s countless benefits from having electricity and sometimes it’s less about making the case up front and more about afterwards
Making sure that you’ve gathered up all those benefits as a way of explaining to a board that this is a continual investment you need to continue to spend a decent proportion of your revenue and your Capital to keep up today and keep progressing keep making care safer keep
Making care more reliable so I think a bit before but but loads after as well are there any other questions Perfect Look at that right on time thank you very much for your time thank you J Jackie it’s really you very much [Applause] appreciate