Patrick Mitchell, Director of Innovation, Digital and Transformation at Health Education England shares insight into digital transformation in healthcare, ahead of The Future of Hospitals 2021.

The public clapped for our NHS during the darkest moments of the Covid pandemic. In surveys of “what makes us British” the top three usually places the NHS in number one spot followed by the Royal family and BBC. Our strength of feeling and bond for the institution has brought about a very strong sense of paternalism between us as citizens and our healthcare system. Any suggestion of a local change whether that be a A&E or hospital closure leads to mass protest and vehement public support – what politician would argue with the electorate on that?

Our reliance and trust in the system go unwavering at a time when our other behaviours and values have changed quite markedly because of our engagement with the digital revolution. Most of us have now shaped a very new relationship with our Bank, insurer, travel agent and variety of retail needs.

The desire to transact “interactively” has grown even stronger by necessity for consumer need and access.

Services have removed barriers to customers at many levels through digital transformation, giving customers, not only control but increasing opportunities to, shape and test products and services – either consciously or unconsciously. Business and commerce use data in varying ways, but in particular to build their products and services around need and want, driving improvements as well as customer satisfaction and, of course, profit margins.

Cleverly they have saved cost by bringing their service more conveniently to our fingertips (or thumbs!) and have given us ownership of what data we share. We have traded providing all our personal data for speed of service.

So why hasn’t this happened so quickly yet in the NHS? What barriers exist to making this now happen. Covid has certainly brought about a notable change in attitude towards the customer (patients) engaging with service more by necessity than choice but now the genie is out of the bottle how many would go back to how it was? Now we have been pulled away the paternal bond the relationship has moved on– like students leaving home for the first time, that freedom, once experienced, means there is no rush to go back and rebuild like it was. Why would you now spend half a day getting to the 10-minute GP or hospital appointment when you can transact through an online consultation, phone or AI driven clinical chatbot? My own personal experience with my practice’s online, AI-driven tool was great and I have no desire to go back to wasted time travelling to the surgery and then sitting in a crowded waiting room, feeling guilty I wasn’t as ill as those around me who looked more in need.

So, if we have accepted that change is not an option and the barriers to engagement have been built what do we do now? There is clearly some immediate retrospective redesign required so the administrative burden to those running online services can be fixed. We rushed to online through necessity so there are inevitably systems and processes needing change. Importantly, we also must ensure we have not moved forward at the expense of those least able to adapt or connect.

The NHS now needs to learn from those ahead in putting their customer at the centre of any digital transformation. It is a skill in itself and rather than designing around the healthcare professional as we have far so often done to date, we need to refocus around the our customer – the patient... At Health Education England, in very close partnership with NHSX, we are working on NHS and care workforce engagement in the digital world through the Digital Readiness Programme.

Digital transformation is about cultural change in an organisation using digital technologies to act as both a catalyst and enabler for change. Culture is about how behaviours – the mindset – are positive and lasting and skills are deployed to the greatest effect. At the same time leaders must own, nurture and endorse what is necessary to bring about transformational change including areas such as understanding user’s needs when delivering change and avoiding failure or experimenting safely and moving on.

With that, HEE’s offer is a model for digital development and awareness for boards and senior leaders. The intention is to help boards understand how digital can transform their organisation which is particularly prominent following the COVID-19 period where digital has come even more to the fore, in fact a necessity. Board sessions are being delivered by NHS Providers who have been commissioned to lead this work. Despite Covid, 24 Boards have gone through the process with a growing waiting list, a good sign in this case.

Additionally, we are embedding digital content into existing leadership learning programmes, as a ‘bolt-on’ learning resource and we see importance in linking digital capabilities with emerging talent management initiatives in the system so we can better identify our digital leaders of the future.

A digitally negative culture eats strategy for breakfast, and this is often fuelled simply by lack of understanding, fear and low digital literacy. This creates a major barrier to real engagement that in turn is toxic for digital transformation. Boards and the wider NHS leadership is quickly learning that this is not about the technology alone but is more importantly about leading [cultural] change, improving digital skills, opening new ways of working to be the norm and providing the resource. With that, we are more likely to get commitment and effective buy-in and bring about sustainable change for the NHS.

About the author

Patrick Mitchell is Health Education England's (HEE) Director of Innovation, Transformation and Digital. He joined HEE in 2013 moving from joint senior roles as Director of Medical and Dental Education at the Department of Health and Director of the Better Training Better Care programme at Medical Education England. Patrick chairs eIntegrity, a private enterprise jointly governed between HEE and the royal colleges, selling learning materials internationally and reinvesting the profits into NHS e-learning materials. Patrick is also a Board member of a large homeless charity covering the east midlands. 

Patrick will Chair Day 2 of the Institute of Government & Public Policy's The Future of Hospitals 2021 online conference, taking place 23rd - 25th March.

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