Hello and welcome to Talking digital health, a podcast by law firm Mills & Reeve, hosted by health and tech lawyers Sophie Burton-Jones and Charlotte Lewis.
Our aim on this podcast is to discuss key topics of interest to those procuring tech in the NHS and also those selling tech to the NHS.
I'm Sophie Burton-Jones.
And I'm Charlotte Lewis, and we're your hosts for this episode.
We're delighted to be joined today by Dr. Temi Akitikori. Temi is a clinician, Chief Medical Officer, and was previously clinical lead for Mid and South Essex NHS Foundation Trust's EPR programme. Temi, do you want to say hi?
Hello.
It's lovely to have you here with us today.
Thank you very much for coming to speak to us.
So, in this episode of Talking digital health, we'll be talking about digital transformation in the NHS and especially the role of the clinical team and the impact a successful digital transformation programme can have on clinicians and clinical teams.
We hear it said, Temi, that digital transformation programmes should be clinically led, of course, but what does that mean in practice?
So I'm going to give an apology in advance for the anecdotes. I'm probably going to bleed out during this.
Go for anecdotes.
It's fine.
We love anecdotes.
But I like to think that in order to change the delivery of healthcare, you need to understand how healthcare is delivered. It's really crucial to get that understanding.
So for me, in practice, would mean embedding yourself or people embedding themselves or innovators within the system to understand what processes are in place, what the unmet needs are, what works well, whether that can be leveraged and expanded or what can or should be improved to improve the system and how things are delivered and whether they can actually be accomplished, I think.
Yeah, I mean, it makes total sense.
The people who understand the processes and what needs what is needed, other people that are actually doing it day-to-day.
So how do you think digital transformation programs can ensure they align with clinical needs and pathways and improve patient care aside from the embedding?
It boils down to intention in my like personal view and I would. ensure that everyone, that both innovators and stakeholders alike, we're all on the same page about the expectations and the goals of what success looks like and what they're trying to achieve.
But if I had my way, I would probably, everyone involved, I'd say, come along, we're going on a long call and it won't be like the nice, bells and whistles and everything clean and everyone's bare below the elbows that is usually done in this day and age.
It would be that we're going in the middle of the night, we're going to be in A&E altogether. You're going to see what happens when everyone turns up to a handover and there's maybe 1/4 of the staff present, not even missing, but 1/4 of the staff needed for minimal staffing levels present and see how decisions get made.
So I'd want them… he who feels it, he knows it. So you need to see the constraints of the service, hear all the difficult decisions that have to be made so that they can feel the consequences of some of the decisions that they're making and what some of the changes could or should look like.
I think that's amazing. And I totally agree. I mean, we take it for granted, I think, that people think that they understand, but nobody could say that they truly understand the pressures facing those clinical teams, unless, as you say, you've put yourself in the most pressure scenario, I suspect.
So I think that's a really powerful thing to do and quite bold, but obvious at the same time.
In a totally different context, it's kind of similar to when they do traffic surveys and things like that and they're doing it in the middle of the day rather than when everybody's actually commuting, the kids are trying to get to school and all that kind of thing.
You're like, well, that's not the right data. That's not showing you what it's actually like. It's kind of equivalent to that.
You almost need to go to, that's kind of the most intense scenario and work back from that because whatever system you implement or embed has got to be able to cope with that crisis point as well as the as well as a sort of maybe slightly less critical or crisis moments.
On that point then, have you got any examples or experiences of where you've seen digital transformation positively impact on clinical outcomes?
Yes, I would.
I was trying to think of instances where the transformation had been done internally or at least like an NHS initiative, but it's mainly been third parties or innovators that have seen a problem or felt a problem and have worked to a solution.
But like wherever the mission has been truly intentional and aimed to serve the needs of all as opposed to just themselves or their own problem or how the problem has impacted them personally. Because innovators can be too proximal to the problem. Approaches have been creative or innovative or just as you said, Sophie, obvious. They've just been really obvious. And I think we're in the NHS, it's all about the low hanging fruit, in my opinion. Quick wins, they're low hanging for reasons because they're obvious and they're easy to implement, easy to embed and easy to be integrated.
So MediShout, they aggregate departments from like a states and operations perspective.
I've seen that, yeah.
Is that, was that one on the clinical entrepreneur program or something like that, one of those accelerator
So that's really, really good. And again, really obvious.
I've had that experience as well, where something really mundane isn't working. Nobody knows whose responsibility it is to get it fixed or addressed. So it just gets left not sorted or not fixed. And you have weeks or days of like theatre lists that get canceled as a result.
And I suppose that is a great example because actually I imagine, and I'm not a clinician, so I'm not going to speak from any degree of experience, only from interaction, and I guess my own personal experience of being somebody who works in buildings and that sort of thing.
Sometimes we focus on the very clinical side of it, but actually there's the operational stuff that's going to impact your ability to deliver a clinical service that's going to generate a lot of frustration. And actually, you may have, as a clinician, less ability to impact or influence change in that.
So for example, the light bulb, unless you're going to go down to B&Q or wherever and buy a new light bulb, you can't do that. If it's a clinical thing, you might actually be able to make a quick fix and change that because that's your job. But if it's an estates thing, you've got to log it with the right team and wait for somebody to come.
And if it doesn't get logged properly or they don't come or it doesn't get picked, but that can prevent you from delivering the service and performing your role, which must be hugely, hugely frustrating to not be able to do your job because of something that's beyond your personal control. So that's where something like MediShout becomes just, like you say, obvious, but super useful.
And I think sometimes we do think about the big stuff, the big digital transformation, but actually there's, like you say, there's a lot of low hanging fruit, obvious things that could have a huge, huge impact.
Why do you think that we're still in a situation where some of the obvious stuff hasn't been sorted within the NHS?
I think it's just a lack of accountability and ownership.
Yeah.
And that's one side, but the other side is a lot of people are probably really quite tired.
Yeah.
A lot of people are just going to work just to survive the day.
If I haven't eaten for my entire shift or I haven't had like gone for pee for the last 13 hours, the last thing I want to do is be groundbreaking and transformative and innovative. That is the last thing. I just want to go home, sleep, and then have to do it all over again.
Yeah, it's very rinse and repeat.
So I think those are two quite the big reasons why I don't think the obvious gets addressed because so many things in the system as they are today have been normalised. So people either don't think it's their responsibility to fix it or even if they had some responsibility, they just don't have the bandwidth and maybe like they don't even know it can be fixed.
A lot of the time, even if I wanted to go down to B&Q, got the light bulb, wanted to change it, I could be like slapped on the wrist and said, well, it needs to go through the governance process. And I would ask, okay, well, what is the governance process? I don't know.
Yeah, yeah, yeah, yeah.
Too many times it's happened, too far too many.
I can well imagine.
Yeah, yeah.
Brilliant.
So, as we said, you're a clinician yourself. What have been some of the key challenges that you've faced when integrated digital tools into your daily clinical practice?
Again, multifaceted, and everyone will have different reasons as to why something, a challenge has arisen or why something hasn't been utilised or adopted.
But I was at the Royal Society of Medicine's Women's Health Summit, I think it was last week, and one of the speakers said, to be trusted, you need to be trustworthy. And that was really, really, really powerful because it goes back to intention and understanding of what it is and you're trying to fix and why are you trying to fix it? Is there something that needs to be fixed?
And too often, there's lack of utility, there's lack of integration, and it boils down to a lack of understanding on the part of many different individuals. So, for example, on the part of innovators or people who are going to be procuring the solution, quote unquote solution, maybe that perhaps they don't understand the system within the service. And the system goes beyond just IT. It's the people, the processes, the culture, and how those solutions will fit in within those systems.
And on the part of frontline staff, so that could be like clinical staff and non-clinical staff or whoever is going to be using it, it's a lack of understanding of what the offering is and what the offering means to them their day-to-day and whether or not AI will replace them, no.
I think it's just a case of it's instead of you doing three people's job, you'll now be doing the job that you're meant to be doing, but you'll be able to do it well this time.
Yeah, I mean, that's something that in any kind of product or service offering, what you should really be doing is how does it impact you, the user? What is it doing for you? Not just we've got this great product, it does this. Well, what does that mean for you? That doesn't always come across in any area, not specifically the NHS, but any type of product or service.
I guess following on from that theme then, are you aware of any strategies that are in place to engage and train clinical teams in adopting new technology? And actually, from the sort of innovator supplier perspective, is there anything that they can do to support that and make that easier for clinicians?
There are two that spring to mind. So, the first one, there is a company called C2AI and they use precision analytics to pretty much stratify risk and give suggestions as to how to properly mitigate them and meaningfully.
Because a lot of the time you get a system that shows you all the risks and you look at it like, okay, so what can I do with that with the tools and resources I have to hand?
So this actually provides suggestions and solutions based on not only resources, but according to the cohorts of patients and resources within a region.
But also, so that was one.
And then the next one is some work that was being done between Get It Right and the Time programme and I think IBM, they're doing some process mining and understanding what workflows, what they actually look like, what are the driving factors? What influences decisions? And I think they mapped it all out and it was huge. And I think at a basic level, it also goes back to the point that you said earlier, which is provide or supply stuff that actually fixes a problem or does something, makes my life as a clinician better, easier, makes my job easier, and then also make that easy to use as well.
So I know a lot of people sort of liken the fact that technology has that user experience built into it so that's intuition is going to be far better than something that you need to be trained to specifically to use actually if it just kind of makes sense and flows through. I think a lot of suppliers are aware of that. But I feel like that consumer experience is better served, or that experience is better served, in the consumer market than it is in necessarily other kind of other areas.
So, you know, the iPhone is always the classic example, isn't it, of how it makes sense to work because they've really spent a lot of time thinking about how people would use that technology as opposed to forcing people to understand how to make it work, if that makes any sense.
Oh, absolutely. There have been multiple times where a change has happened seemingly overnight, sometimes even in the middle of a shift. And you just think, whose bright idea was that?
We think that sometimes as well about changes that we see that aren't in that high pressure environment.
That's what I had in my mind as I said my point actually was, yeah.
Sometimes we get told, you know, it's only an extra couple of clicks and it's like, but that extra couple of clicks every hour or every half hour over every day of the year adds up to quite a lot.
So looking ahead now, in terms of final question for you, how do you see the role of clinicians evolving as digital becomes more and more embedded in clinical practice, NHS?
Well, we hope it does, given that's the drive and the strategy going forward.
Yeah, I think if done right, it has huge, huge potential to support frontline staff and not to replace them. Not to replace them, to support them.
A lot of stuff has become very, very bogged down in mundane or rudimentary processes that are very, very, very manual. For example, like a fax machine, you still have those. I'm always quite shocked by the amount of people that don't know that we still have fax machines. We do; lots of them.
And if done right, it has digitalised the potential to support and alleviate some of those processes, but I think it should start small.
And I think there needs to be a concerted effort to ensure that we're not setting setting up digital or staff to fail simply due to a lack of understanding or a lack of like the language surrounding digital because very easily staff can get their backs up.
So back to intentionality really, it's all, it's going to be collaborative, it should be intentional and it should be a concerted effort.
I think I see digital being a tool that in the right hands can be very beneficial to people's day-to-day for staff as well as for patients. But I think it should boil down to starting off small, I think.
Yeah, well it's going back to what you said at the start is the what is the day-to-day low-hanging fruit that we can tackle first to make people's lives easier rather than big fancy things that might need to come later.
You've got to have the base there to start with.
Yeah, everybody's going to have a Da Vinci.
It'd be nice, but I think that with some of the rhetoric that I've heard in terms of doing more with less, that already is a worry because that doesn't seem like it's going to be digital. It doesn't sound like digital will be used to really support staff to be their best. It sounds like we're using digital to meet the bare minimum and that's not what we want either for like ourselves for our day-to-day nor for our patients.
I think it reminds me a little bit of, you hear it quite frequently, where, in relation to a digital transformation programme, a digital solution or technology comes along and it is put in place to replicate the current system. So, they just take the current pathway or however it looks, and they just turn that from analog to digital. And actually, the thing that is transformational, the thing that's actually going to make people, clinicians and patients' life easier, service better, is to make that pathway, that service better.
So not just flipping it from one to the other, but actually looking at it holistically and thinking, how can we use all of this amazing technology that exists to make this process better than it currently is, to strip out a lot of the admin, to make it more responsive to clinicians and to patients, to transform it and free up resource and time and space in the system to allow people to get on with what they need to get on with so that they're not burnt out, they're not doing a 13-hour shift without having time to go to the toilet, that sort of thing?
And I think that's what you're saying really about the role of the clinician in terms of and embedding it into clinical practice is that it's got to be done right, not wrong. And actually, if you get it wrong, I think that potentially causes more harm than good further down the line.
We'll lose a lot of trust and faith, I think, from the clinical staff.
Exactly.
And I think when a lot of people come in with very blue sky thinking and ideas of what digital is going to achieve, when you have lived and breathed certain pinnacle scenarios during your working day, even non-clinical as well, because we've got admin staff.
Innovators can very quickly lose credibility because staff will turn around and say, well, I don't know who you've spoken to, but that's not what my day-to-day looks like, and that's not what my data is going to look like because I know and feel the constraints of the system.
So I think it's getting to a point allowing digital to get people to a point where they can catch their breath first.
Yeah.
And then we can be the pioneers.
Great.
Well, thank you so much for your time today, Temi.
And if you'd like to hear more from Temi, then you can contact her directly via LinkedIn.
And at Mills & Reeve, we're very happy to discuss any legal queries you might have around NHS digital transformation, including on planning for and running a digital or IT procurement. And our individual contact details are available on our website at mills-reeve.com.
So thanks for joining this episode of Talking digital health by law firm Mills & Reeve.