Daniel Johnston MRes, RN, Director Clinical Ops International, ACNIO, NHS CSO Imprivata
Reviewing 2024 and what’s ahead for 2025
It is a great privilege to welcome our panel of leaders as they introduce themselves, their organisation and what stood out over the course of 2024, as well as anything that they're taking forward into 2025.
These conversations follow some insightful customer and health system presentations, where we've seen some of the challenges, successes, complexities and emotional and clinical journeys that have been second nature to the technical implementations.
We focus on the frontline and what it means to patient care and to clinicians attempting to provide that care, against a backdrop of clinical challenges and pressures.
Lucy Weeks - CNIO at Surrey and Sussex Healthcare Trust
Digital care pathways are a catalyst for Imprivata solutions
Surrey and Sussex Healthcare (SASH) Trust is a sizable trust with about 650 inpatient beds and we went live with our EPR in September 2022.
If we look back through 2024 and think of the big achievements that we've made in digital transformation within SASH, the thing that really stands out is that we were an outlier in terms of pressure damage and our system organisation.
We had a new chief nurse that started with us about 18 months ago and there was enormous pressure to improve our figures and our statistics, and we knew there was a digital solution that could help with that. Part of a bigger project for 2025, we looked at changing some of the care plans into care pathways. We created a project team to look at digital care pathways, which was about guided treatment – the EPR was hand holding to do the right thing.
At the time we realised that we didn't have enough of that within the EPR in our nursing assessment and we needed to improve. You fill out an assessment, get the answer and can see the patient is high risk but then what? What's next?
We used the digital system to answer that ‘so what’? for the tissue viability checks which became much more user friendly. It took a lot of resource to roll out the implementation. In the space of around two weeks we trained 500 nurses - an incredible achievement that took a lot of resource.
This went hand in hand with the roll out of the Zebra devices. We had Imprivata enrolment on those separate devices which was a huge success. We wouldn't have been able to achieve the roll out without Imprivata.
The Zebra devices enable our nurses to take photos of patient wounds and upload them straight into the electronic patient record seamlessly, saving an enormous amount of time. In terms of what stood out in 2024 it's definitely pressure care, and statistics have shown that we have got some good results from all the digital work we've done.
In terms of changing any other aspects of care we have been focussing on educating our nurses on the digital processes. In 2025 we plan to be doing a lot more to develop care pathways via digital.
Daniel Johnston
It's kind of back to basics.
Lucy Weeks
Back to basics is the key. We're very focused on not handing out any new equipment or systems. We are going back to basics and we're trying to address some of the challenges we've got in our workforce, post COVID. We have a lot of new nurses coming into our organisation, which is amazing, and we have to make sure we're inclusive in our training and tailoring it to all needs. These are big changes and we are working with our digital training team to develop and deliver the training. Elbow support is clearly much better than e-learning, so we plan to do a lot more of that.
Daniel Johnston
Thank you for sharing that. Workforce skills, education metrics, individual tasks within certain agendas and quality all reflect key basic standards of care, and the digital possibilities ahead.
Louise Clarkson – CNIO Blackpool Teaching Hospitals NHS Foundation Trust
From paper-based to clinically safe sign on
Blackpool is very much a paper-based organisation. We've got about 240 systems that don't talk to each other or feed into one single place and some of the processes were not as clinically safe as we would wish. We are looking at what we can do now with the many disparate systems, working closely with Imprivata.
We've developed such a good relationship with the projects completed so far. We're now rolling out single sign on at Blackpool for the different systems. When I first met the nurses in our community bases, they were having to log on to 19 different systems each day, minimum. And they said the system is slow and frustrating.
Imprivata is supporting our digital transformation. Even though we don't have an EPR yet, we're trying to set some standards and standardisation before we get that EPR and get the workforce more digitally literate.
Richard Cox - CNIO, Manchester University NHS Foundation Trust
Workforce engagement and training
At Manchester we've really managed to transform how our nurses, midwives and allied health professionals (AHP) care and work, and I have had the opportunity to build a talented, knowledgeable and highly skilled digital nursing, midwifery and AHP team.
The Digital NMAHP Team at Manchester have a detailed understanding of our digital system and processes, as well as their clinical experience and understanding. They’re able to work across our large organisation, however they are finite resource. We are asking, how do we scale across the organisation so our entire workforce is digitally confident. That's been a key focus this year and will continue into 2025.
Since we went live in 2022 the expectations of our staff have massively increased. When we started the journey, our teams would tell us they just wanted was a username and password that they used once. Now expectations have changed, and we are having conversations about data quality and AI.
One of my key drivers is how do we make sure that our workforce have got those or are developing those skills and can have those conversations about data and other innovations. We've entered a partnership with University of Salford and Future Nurse who have developed a data-driven leadership course this year, in aid at supporting frontline leaders working with data but linking this with QI and research.
The beauty of this is that not only are we developing data skills across our frontline leaders, we're also building closer relationships with our BI information teams. It has only started a couple of months ago, but it's the start of something exciting and filling a key gap in our workforce that's been highlighted.
David Nelson – Digital Nurse Specialist, University Hospitals of Derby and Burton NHS Foundation Trust
Workflows and staff engagement
Derby and Burton are kind of unique. Burton Hospital had an EPR Meditech in 1996, and they're digitally mature. Derby is paper-based and we have over 100 systems. We introduced Imprivata because there were simply too many passwords, with different formats to remember.
Improving this has really transformed the care. Staff can get into the systems and are less frustrated, they are simply just engaging with the patient, which is one of the key changes that we've seen.
We have a PFI hospital and a non-PFI hospital. The PFI is great, but it isn't that spacious, so if you want to change things and put more computers in, it's another hurdle. Instead, we have introduced a lot of shared devices and with tap on, tap off, the big difference is that people can share computers much quicker.
In 2024 we rolled Imprivata out across 5 sites, division by division. I was tasked to come in from a clinical point of view, having 22 years in ICU. My job was to go out into the clinical area to engage with the staff when the team encountered resistance – such as “I'm too busy. I've got too much to do”.
I work with the staff to get them on board and get everybody to work together. We concurrently launched Badgernet, in our maternity unit and we're going forward with new voice services in cloud. And while doing that, we're also going through a major procurement process for a new EPR system.
We are bringing clinical staff into the discussions about how the new system is going to work. We are working with Leicester/Nottingham/Mansfield/Peterborough to create a single record, so that when doctors move, they can just almost seamlessly move between trusts while they're training and that's our big challenge for 2025. We are really proud of what has been achieved in 2024.
Daniel Johnston
Today’s challenges - workflows/workforce development, optimisation and technology
Today’s challenges are workforce/workflows development, optimisation and technology. The agendas we are seeing are to get back to basics, delivering standards and care. We are trying to create these transformative workflows and turn them into business as usual and advocating for the patient.
What stands out? What do you need? What is in short supply? What are the reflections in terms of bringing the operational, clinical and technical aspects together?
Louise Clarkson
Education of staff and Digital Academy
Education is the key. For the Digital Academy this year, there were 350 to 400 that applied for just 100 places. And that's just the Academy.
In a nursing career, you go to degree masters, but there's only the Digital Academy route that gives you the digital skills. The question is how we make sure our workforce is educated, since everyone on the team, not just me, but my ward matron and senior nurse, want to understand what digital transformation is and how to do it properly.
Daniel Johnston
Digital transformation and resource
Digital transformation delivers the real value of the EPR, so that medications can be administered quicker to a patient with sepsis, or IV antibiotics can be given. Or a patient’s allergy status can be checked quickly in the case of an anaphylactic shock. This is what we are looking for in transformation projects.
Lucy Weeks
The other side of that is the resource element, in terms of being able to build these new workflows and the technical expertise that is involved.
In our digital transformation team at SASH we are super keen. We've got lots of things that we want to do and aligning them with the wider organisation objective is easy in one respect. However, we can't always move as quickly as we would want to with the workflows that we want to develop, because we don't have the resources to build. The training team is quite small, so we go back to education and how important it is.
Again, it's back to basics. Getting the staff away from the ward to do some training can be challenging, especially in some of the working environments. But it is possible. We managed to train 500 nurses in two weeks away from the ward. It was driven by the organisation’s leadership that made it very clear with everyone that they had to undergo the training, which really helped.
Richard Cox
Partnership working with academia and industry suppliers
On that point, having our chief nurse by our side was integral to our success, working with them to understand the benefits of going digital. As CNIO's we need to look at how we can work with other academic partners, suppliers and industry, to see how they can support building knowledge across our workforce. Whether that's training, innovation or development of tech.
David Nelson
In Derby, as an example, we work in partnership to bring clinical people in to work with IT, so you can understand both sides, see what the obstacles are and come up with creative solutions.
Another area that we're really keen on in Derby is to encourage and enable the clinicians to release time to come and support us. We've got a large clinical community that's helping us with the new EPR build. Understanding what their needs are as we're building the EPR, getting their involvement and making sure that they're engaged so that they're pushing forward the change for us.
We're now rapidly expanding our IT team and it's been about having the resources from the National bodies to bring those people up to speed quickly. We've got a lot of really engaged clinicians. We have over 1000 health allied health professionals and we have them represented in our digital team, and we are also engaging the patient groups.
Daniel Johnston
It’s key to include all these groups. The link that I can see is having a vision, having a strategy and having the transformation and the clinical and patient focus.
The key questions to ask are: Where are we heading? What is the benefit to the patient? Is there anything that really strikes out in terms of vision, strategy, transformation. Is it leadership that helps link all that, so that projects deliver?
Louise Clarkson
Leadership buy-in and support
In my experience the leadership in each organisation has been completely different. It can transform an organisation with the right people, because they understand the qualities that they need to achieve a large scale transformation.
We've got a service to the community, and by changing into these systems and pathways and getting things right, we will get the population health data right, which will then transform. We've got a duty of care to do that in digital and in clinical roles.
Lucy Weeks
Building on that point, it's crucial for Senior Nursing Leadership and the Chief Nurse to have a clear understanding of what digital transformation means for the organisation. While digital initiatives are a top priority for many Chief Nurses, they may not be fully familiar with the specifics of the EPR system, often relying on staff feedback. The key challenge is to better understand the experiences of our frontline staff, particularly when it comes to navigating multiple sign-ons, and to explore practical solutions to improve this process.
Louise Clarkson
The importance of the role of CNIO
We are starting to see recognition about the importance of the CNIO role for the organisation. You need a CNIO to manage the digital process and to bring the nursing team in when they can't always get off the ward. Having that voice is so powerful.
Daniel Johnston
There is no doubt that the journey that's taken place within nursing and allied healthcare professionals and the medical establishments aren't too dissimilar.
Each group shares more in common than divides them across the clinical, technical and operational teams. We're making these technologies work and seeing what this transformation looks like to really benefit patients.
