Successful digital transformation starts at the top

Electronic Patient Records (EPRs) are seen as the way forward – crucial to future digitisation of the NHS. And yet, a number of NHS Trusts across the country are currently facing greater challenges, caused or exacerbated by EPR implementation. Jessica Bradshaw, Managing Partner at Channel 3 Consulting, looks at the reasons why the introduction of EPRs is causing some systems to falter, and what can be done about it.

The NHS is awash with talk of digital transformation. Work is going on to identify how Artificial Intelligence can improve patient outcomes, while health systems are increasingly trying to improve the sharing of information through the introduction of EPRs and shared care records. The enthusiasm is to be encouraged; the potential benefits are real. But with any digitisation project, it’s essential that we focus on what we want to achieve.

This is not about buying new kit – technology itself is not the answer. So how do we deliver what we need from new systems to improve clinical safety and patient care?

From tech to transformation

The first step to successful digitisation is to understand the journey you are about to embark on.

Implementing an EPR, for example, is not a technology project, but it is often approached as such. An EPR allows clinicians to access accurate, complete and up-to-date information about patients at the point of care. It should enable better information sharing, greater productivity, consistent coding of information and support electronic prescribing. Essentially, it should provide a safer, more robust system to help Trusts deliver better patient care.

The technology part of this is just the framework – the software, hardware and templates that will facilitate the benefits. It is reliant on the right information being put into the system in the right way for the outcomes to be achieved. To do this successfully requires business transformation, a wholesale review of existing processes and systems, and a planned approach to change.

Those organisations enjoying successful EPR implementation are ones that have embraced the complexity of change from the outset and committed to seeing it through.

Electronic Patient Records implementation provides a huge leap forward in improving patient care, clinical safety and productivity

The role of the Executive Team

Like any other major transformation programme, EPR implementation must be led by the Executive Team, and encompass all staff including clinicians, administrators and managers.

One of the most important roles we play at the start of an EPR project is helping the Trust understand the scale of the task before them. This includes recognising that this new technology will require changes in how people work, acknowledging there will be resistance, and assigning the time and resources that will be needed. In particular, we encourage leaders to commit to driving through the changes, even when it gets hard or when other pressures demand attention. Otherwise organisations risk ending up with a half solution that won’t deliver the expected improvements in patient care and productivity. This requires a deep understanding of where the Trust is and where they are going. Deliberate choices must be made along the way, and the consequences of decisions fully understood.

In our experience, if an executive team fully understands what EPR implementation will mean for their organisation, and commits the resources to see it through, they will be much better placed to realise the benefits and implement the programme successfully. 

Honest questions, thorough analysis

Before embarking on EPR implementation, Trusts should be asking themselves two key questions:

• What is our digital maturity now?

• What is our preparedness to move to digitisation?

This is about separating the theory from reality. It can seem relatively straightforward to build a business case and project plan for EPR based on how an organisation works on paper. But what is often missed is the hundreds of human interventions – the touches that make your existing systems work but which aren’t formally programmed anywhere. One of the benefits of going digital is delivering consistency and clarity – but if you don’t have an accurate view of your starting point, too much will be lost in translation as you move to a fixed system.

This is where detailed engagement is so crucial. Clinicians, admin teams and managers will all need to feed into the transformation process. Transformation teams need to know what actually happens when patients are booked into clinics or consultants discharge patients. When the ‘standard’ process goes awry, how is it fixed? What are the nuances that make the system work, the human elements which bridge gaps in current processes because the flexibility exists to do so? Fully understanding existing and desired processes are crucial in building an accurate picture of how an organisation works and consequently, what it will need from its EPR to keep the wheels turning.

Taking the organisation with you

Telling people they are going to have to do something different is often met with resistance – that’s where leadership comes in. To enable transformation, staff need to understand the rationale and be prepared to change behaviour, which requires:

• Strategic leadership and clarity:

The Executive Team needs a deep understanding of what it’s trying to do. Be clear what the Trust is committing itself to.

• Communications: 
The communications programme needs to articulate the strategic decision and rationale and decide when it is appropriate to inform, engage or consult. Demonstrate listening and help clinicians understand things that will lead you to make choices. Explain those choices clearly, including the factors that have driven the decision and the benefits you are seeking to deliver.

• Governance: 
Be prepared to own and champion decisions, even where they may not be universally popular. Be clear about the need to comply with new ways of working – this isn’t optional.

Alongside this, organisations must be ready to respond to practical barriers. These can include simple but frustrating things – a clinician will soon disengage with digitisation if it takes them 10 minutes to log on to the system.

Clinicians, admin teams and managers all need to feed into the transformation process

Invest upfront to reap rewards

EPR implementation is just one example of a large-scale transformation project – there are many others, all adding to a significant workload and stretched resources. It is no surprise, therefore, that these programmes don’t always get the attention they need.

Unfortunately, when it comes to systems which fundamentally underpin how an organisation works, a comprehensive approach is essential.

EPR implementation is a sizeable investment in time, resources and expertise. There is no question that it is a challenging task, but done correctly, it provides a huge leap forward in improving patient care, clinical safety and productivity.

This article first appeared in Issue 2 of Channel 3's Insight Magazine. To download a copy visit,