Digital innovation and the future of doctors’ workBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1368 (Published 27 March 2017) Cite this as: BMJ 2017;356:j1368
Digitisation could reduce administrative workloads, alleviate stressful staffing situations, and help doctors become better clinicians. Tom Moberly reports
Over the next decade digital innovation has the potential to transform the way doctors work.
Automated data collection could free doctors from having to manually input and manipulate data. Real time information on individual doctors’ performance could provide continuous feedback to help improve patients’ outcomes. And data on the needs of individual patients will help inform decisions about the skill mix of staff needed throughout a trust at any given time.
Keith McNeil, chief clinical information officer at NHS England, believes that digital innovation can create a virtuous circle by “giving people, in real time, access to data that they could use across the whole of their practice.”
Speaking to BMJ Careers at the Health Foundation’s conference in January this year, McNeil said that clinicians should be provided with their own personal dashboard, including details of the cumulative outcomes for all their patients. He argues that being able to access data on cumulative outcomes means that doctors can start to compare themselves with their peers. “We want people to discipline themselves across all levels of the NHS,” he says. “We don’t want people to come from outside and ask, ‘Why are you different?’ but for people themselves to say, ‘Hang on, why aren’t my results as good as this guy’s? What’s the difference?’
“It’s that continuous data feedback and the ability for us to be able to analyse the data and feed it back in a sensible way that enables people to do that. It’s a continuous virtuous cycle. And it can be at an individual level, a unit level, or a whole hospital level.”
Collecting clinical data routinely in a standardised fashion also means that the same data can automatically act as an input into a wide range of processes. McNeil says, “Imagine a world where, if we’re collecting data correctly, in a standardised accurate way, it automatically feeds your revalidation cycle, it automatically populates your clinical audit cycle, and it automatically populates national datasets, so that people aren’t having to spend time redoing spreadsheets, recutting bits of information for different places.”
But McNeil believes that these sorts of benefits will be achieved only if staff on the ground are on board with the proposed changes. “You cannot do this without engaging that part of the workforce and without getting their buy in and co-creating it with them,” he says. “The start of the conversation is talking to the people who are going to use the systems and asking, ‘What is it that you need, and what is it that you want?’ We have to provide what people need, and we will have either a limited or a high capacity to give them what they want.”
One of the key challenges in implementing digital innovation in the NHS at the moment is the workload demands facing staff, McNeil believes. “It is really difficult at the moment, when the operational pressures are such that it’s hard for people to pull their head out of the weeds and really think about it,” he says. “I would absolutely argue that time is more important than money in many respects. When it comes to innovation, it is time that is most valuable.”
To help overcome these sorts of challenge, and to encourage the uptake of digital innovation in the health service, NHS England has named 12 acute care trusts as “digital exemplars” that will seek to develop new ways of using digital technology to improve patient care. Each of these trusts will receive up to £10m from NHS England.
One of the digital exemplars is Salford Royal NHS Foundation Trust. Raj Jain, its executive director of corporate strategy, believes that better use of data has the potential to make doctors’ working lives less stressful.
Also speaking to BMJ Careers at the Health Foundation conference, Jain said that better use of data will allow trusts to be more precise in determining the care needs of individual patients. That in turn will allow them to align staffing needs with patients’ needs, allow information to flow better through the system, and allow doctors and other healthcare staff to work more intelligently, with fewer handovers between individual staff members.
Salford Royal is trialling software that will allow the trust to predict how many hours of nursing care each patient will require over 36 hours. Ward managers can then use that information as the basis for intelligent rostering. The system is being tested on five wards and has so far led to improvements in the quality of care and cost savings, Jain says.
Jain believes that similar systems—and the clarity they could bring in likely demand and staffing levels required in different areas—could be used to manage the flow of patients much more intelligently. He says, “Once you have an organisational level of transparency about workload and staff skills, what’s to stop staff moving to support the front end? What’s to stop us? In the mornings when the emergency services are generally quieter, what’s to stop us altering the staffing levels in a way that’s much more sophisticated than the crude averages that we use now to manage staff?”
But trusts will need to have honest conversations with staff and clearly articulate how the better use of data will change their working lives. “We tinker around, and we’re reluctant to say that there is going to be a major workforce change, even when staff know this is needed,” Jain says.
“All the staff know this is going to happen, but we’re not clear enough in our vision or our methodology about how we’re going to achieve the workforce change that enables us to achieve improved quality, reduced costs, and happier staff.
“Staff want to see different ways of doing things that enable their working life to be much better and less stressful than it is. They want a better, more productive working environment, and they can see how change is going to happen.”