In this article, Alister Esam, managing director of eShare, argues that, given the pressure on the NHS to become ever more responsive and agile, attitudes within boardrooms have got to change. The era of ‘minute and forget’ is over. With continuous real-time access to information via a raft of devices, board members have the chance to be constantly engaged, taking decisions on a continual basis, not just at meetings
The monthly board meeting is one of the fundamental aspects of NHS trust and CCG structure. But it is a structure that has remained completely unchanged, still relying, in the majority of cases, on hundreds of pages of paper presented and collated on an almost-continuous basis. Yet, in an era where QIPP targets require consistent attention and decision-making, Digital by Default must become a service standard.
How much time is wasted in board meetings simply verifying the information to hand – rather than actually discussing and taking essential strategic decisions?
With the results of the Francis Report still ringing in our ears, just how effective is this model today? How many critical decisions are shelved ‘for the next meeting’ due to lack of information? And how much time does any member spend considering these critical issues in between meetings?
This ‘minute and forget’ approach is simply no longer acceptable. Not only does the board need to improve its decision-making during meetings, but members need to interact and engage far more effectively throughout the year, and that requires a better way of information sharing than the traditional volumous paper board pack.
Board bottleneck
Over the past decade, trusts have started to invest in clinical technology ranging from Electronic Patient Records (EPR) systems and electronic document management systems, to speech recognition and business intelligence and analytics, with anytime, anywhere access to information in order to meet both national efficiency and cost savings targets as part of the Quality, Innovation, Productivity and Prevention (QIPP) programme.
Employees and healthcare professionals are expected to respond quickly to new opportunities, rapidly flag potential problems and, essentially, take every possible step to enable agility and efficiency. And yet, with an estimated 75% of company boards still reliant on paper-based documentation, it is becoming clear that top-level decision-making still has some way to go in improving its own efficiency and cost savings.
In addition to providing board members with the chance to access information at any time, the key benefit comes from exploiting technology to enhance the way information is presented and shared
So why is it that so many trusts have not yet made attempts to update this model? Paper is inefficient and inconvenient. Managing paper-based resources is time consuming. How much time is wasted in board meetings simply verifying the information to hand – rather than actually discussing and taking essential strategic decisions? Furthermore, how much time is wasted by the secretariat – including the trust secretary, head of governance or director of corporate affairs – undertaking mundane print, copy and collate tasks before each meeting?
This model is not only flawed, it is massively outdated. Whether an organisation operates a Bring Your Own Device (BYOD) or Choose Your Own Device (CYOD) policy, the vast majority of senior workers now routinely use some form of mobile device to access corporate information when travelling, at home and, increasingly, in the office. There is simply no reason – and certainly no justification – for this inefficient approach.
PDF distraction
Of course a few organisations have attempted to remove the paper burden by opting for electronic documents transmission, emailing directors and board members PDFs of the board papers. But this model is actually a retrograde step. Not only is there no version control, creating the risk of more confusion during the meeting, but board members are forced to download various third-party annotative tools in order to make comments on the papers - comments which cannot be easily shared. The result is nothing more than a poor imitation of the traditional paper-based process – and certainly no improvement in decision-making activity.
The ‘Google’ of board packs
Organisations need to exploit targeted meeting tools that provide a fast, consistent way of providing that essential board pack; a way that enables individual board members to access board papers, securely and efficiently from a tablet, at any time and deliver that information in a structured, ordered format. With multiple options that include both on-site and cloud-based models that enable the secretariat to store one version of the board pack securely, in facilities that are compliant with local data regulations and that can be accessed by board members via any device, organisations can achieve significant benefits in line with national QIPP targets. Indeed, evidence reports that one trust that implemented an electronic board meeting management tool achieved cost savings of over £175,000 in print and paper costs alone.
With one-click document distribution, not only can the organisation drastically reduce the essential paper, print and collate costs, it frees up the secretariat to undertake the far more valuable and important day-to-day activity that is typically interrupted by the monthly board
In addition to providing board members with the chance to access information at any time, the key benefit comes from exploiting technology to enhance the way information is presented and shared. For example, documents and links can be easily assigned to particular agenda items, making it easier for members to go directly to specific items of interest. Documents can be annotated using simple tools, and these annotations shared with other board members before the meeting if required. And, critically, board members can search current and historic documents easily at any time, including during the meeting, to create a far more interactive discussion and decision-making process.
Improving decision-making
With one-click document distribution, not only can the organisation drastically reduce the essential paper, print and collate costs, it frees up the secretariat to undertake the far more valuable and important day-to-day activity that is typically interrupted by the monthly board meeting. But that is just the start. This online information approach changes the way board members can make decisions – both within and outside meetings.
For example, during the meeting the board can exploit inbuilt interactive risk assessment and governance tools to provide a top-level view of organisational risks. Rather than trawling though hundreds of pages of paper, members can understand immediately the current risks, the controls that are in place, and identify gaps that need to be addressed. They can use the real-time search to locate relevant information and gain the insight required to make a decision immediately – rather than re-tabling the issue for a subsequent meeting.
Furthermore, while real-time access to information clearly provides a chance to improve the effectiveness of board members during the meeting, the most fundamental change is the way members can interact with the trust between meetings. Combining alerts to information with updates on key topics raised during the meeting, plus decision-making functionality that incorporates discussion and voting tools, and reminds members of outstanding items, can enable boards to take votes and make decisions outside of the board meeting, which can lead to considered conclusions that are less likely to be swayed by more-dominant members of the board. This ensures delays are avoided, and the board meeting can concentrate on the top strategic issues, rather than risked being derailed by minor-yet-pressing concerns.
Conclusion
Those NHS boards that take the step away from paper and look to actively and continuously exploit real-time access to information will not only take yet an additional, significant step in meeting the required cost and efficiency savings, but will also transform both the speed and effectiveness of decision making at every level
Given the pressure on the NHS to become ever more responsive and agile, it is clear attitudes within the board have got to change. The era of ‘minute and forget’ is over. With continuous real-time access to information via a raft of devices, board members have the chance to be constantly engaged, taking decisions on a continual basis, not just at meetings. Those NHS boards that take the step away from paper and look to actively and continuously exploit real-time access to information will not only take yet an additional, significant step in meeting the required cost and efficiency savings, but will also transform both the speed and effectiveness of decision making at every level. And, with pressure from Jeremy Hunt for trusts to go paperless by 2018 to save billions, improve services and help meet the challenges of an ageing population, why not set the trend at board level?
