Why is Digital Transformation so Slow in the Health Sector?
The NHS is unquestionably feeling the strain this winter. On a quick scroll through the BBC health homepage last week, hysterical headlines range from generalisations such as “10 charts that show why the NHS is in trouble“, to the heart tugging clickbait “NHS 'failed' spinal cancer death woman” through to the editorials such as “Growing waiting times threat to NHS” offering historical analysis but no insight as to a solution.
With budgets shrinking in real terms, an ageing population and a click obsessed media ever more desperate to find fault in a highly emotive topic, is it any surprise that barely a day goes by without a report coming out about targets being missed here and delays happening there?
Therefore, the question I shall muse upon today is why, oh why, in an industry crying out for the efficiencies that can be gleaned from digital transformation, is the NHS finding it so hard to adopt widespread digital practices.
Doubtless, this analysis will merely scratch the surface of the issues at hand, will miss important points and has a vested interest in promoting the solutions proposed but, if there’s a possibility to “Uberise” the NHS, surely it’s worthy of debate.
What is Digital Transformation?
Digital transformation is very much a tech industry buzz word at the moment and therefore, I’m loathed to use it. In essence, it means using digital technology ranging from mobile hardware, to innovative apps, onto emerging artificial intelligence platforms to drive efficiencies in the workplace and improve processes.
The chances are it’s a phrase you are familiar with, hence my using it to get you to click on this article, however I shall now use the far more colloquial BERT (Burden Ease and Reduction Technology) as it sums the idea up far better.
How Does it Work?
At its core, BERT is all about making people’s lives easier. You could fill a library writing about how Uber, Deliveroo, and Airbnb are influencing people’s lives but when it comes down to it, every single one of them takes an existing process and makes it faster and more convenient.
We’re all humans after all, when you had the choice of tapping an app and making a pizza burger appear in front of you, why would you cook?
(Maybe this has something to do with the strain on the NHS?)
There are thousands of Digital Transformation experts out there who will advocate many different systems to optimise processes through digital technology but, in order to achieve widespread adoption, BERT’s principle of making the end user’s life easier is where the policy has to start from.
Why has BERT Worked in Other Industries?
Interestingly, in industries where we have seen widespread digital transformation / digital disruption / BERT has very rarely been led by the current incumbents in the sector. If we look at any multitude of case studies; Uber, Amazon, Deliveroo, Airbnb, to name but a few, these competitors all came from outside the sector they were disrupting with a new approach that revolutionised the market.
There’s a multitude of reasons why we see this; including agility, a culture of innovation and capacity for risk but, a less often cited perspective, is that of the motivation for the desire for change.
When a large corporation, such as the NHS, looks at bringing in innovative technologies, the motivation is always inwards facing:
“We need to improve OUR processes to stay in budget”
“We need to find efficiencies to meet OUR targets”
Without question, the ultimate motivation here is to improve the experience of the customer but, it is limited by a degree of separation. This means the benefit to the customer has to be explained and “sold” to them, instead of them instinctively grasping it.
Alternatively, when we look at all of BERT’s successful friends we see a common theme. The idea initiates as a solution to an end user’s pain point, Uber was founded off Travis Kalanick and Garett Camp’s frustration at the state of taxis in San Francisco and Deliveroo was founded off the back of William Shu’s inability to get a decent takeaway, this motivational shift is the key.
This idea isn’t revolutionary. Since Dale Carniege’s beautiful articulation of influence in 1936’s “How to Win Friends and Influence People” it’s been widely understood that to get people to do what you want, you have to give them a reason to do it.
So why is this approach not taken to organisational change? Digital transformation can have massive procedural and bottom line impacts, however, these have to be a by-product of improving the life of the end user, not the motivation for change.
At the end of the day, in the present age, BERT isn’t a technological challenge, it’s a people problem.
When Can We Start For the NHS?
I’m glad you asked internet.
Realistically, a thorough analysis of end user’s pain points before a process of mapping the potential solutions and ranking them by their impacts on organisational processes would be the best place to start. Unfortunately, that is beyond the scope of this article.
Instead, to provide an example I’ll zero in on one of the major problems of the day, A&E waiting time. At the time of writing, A&E waiting times in January 2017 are the worst since targets were established in 2004 exemplified by the following statistics:
- 82% of patients in A&E - rather than the target 95% - were transferred, admitted or discharged within four hours
- More than than 60,000 people waited between four and 12 hours in A&E for a hospital bed, after a decision to admit, known as a "trolley wait"
- More than 780 people waited for more than 12 hours for a bed
There are two typical approaches to this problem - increase the supply of A&E resources or try to reduce the demand on those resources through education and hence reduce demand.
However, both approaches are experiencing diminishing returns, financial resources are stretched to breaking as are the human resources being asked to cover the gap through hard work. As to affecting demand side, this doesn’t consider the motivations of the end user, with only a few exceptions, the end user is in pain and simply wants help as fast as possible.
The innovation required to completely solve this problem is beyond me right now… I haven’t had my second coffee, but instinctively I ask why not digitally begin the triage process?
If through a video app the patient could have an initial prognosis performed they could be told not to come into A&E, thus reducing the pressure on resources. Alternatively, they could be placed in a digital waiting room so their travel time counts against the wait.
Of course, there are endless nuances to this example but, in the absence of any other ways to turn, maybe an embrace of the future is how to save a great institution from the past.