Comment: Think big, but stay practical: Achieving a paperless NHS by 2018

Published: 14-Aug-2013

Richard Jones of Moorhouse argues that change management and transformation within NHS trusts will be vital to achieving the goal of creating a paperless NHS

In this article, RICHARD JONES, client director at Moorhouse and an expert on managing change within the healthcare system, speaks about the Government’s drive to create a paperless NHS

Health Secretary, Jeremy Hunt’s desire for the NHS to be paperless by 2018 is exactly the kind of genuinely transformational and innovative change that the NHS needs to be driving through to help cut costs, and improve performance, efficiency and quality.

With the huge pressure the service is facing to do more for less, the time has passed for small tweaks to operations and the damaging salami-slicing approach to cost cutting

With the huge pressure the service is facing to do more for less, the time has passed for small tweaks to operations and the damaging salami-slicing approach to cost cutting. It is time for ambitious projects such as this to be embraced. But, of course, with larger projects come more challenges.

The key to successful transformational change is to understand the feasibility of the goal. Is the ambition deliverable? Critics argue that the NHS National Programme for IT, led by Connecting for Health, fell victim to biting off more than it could chew. At its most basic level, there was too much focus on an overly ambitious technology solution, with insufficient consideration of the many, multiple stakeholders involved, encouraging them all to ‘row in the same direction’ proved impossible.

By being realistic about what can be feasibly achieved, huge failures like this can be avoided. For example, is the ambition of having detailed patient records accessible on a national scale absolutely necessary, or could 80% of patient and clinician needs be met by working on a regional, or even local, basis?

The NHS has been through huge change over recent years with the implementation of the Health & Social Care Act structures and systems. It is therefore understandable if staff and organisations are suffering from change fatigue. However, changes in the NHS are by no means complete; in fact change has to become a constant, both in the NHS and the wider business world if the providers of services are to keep up with changing demands and financial pressures. From the bedding in of the new structures to the potential hospital closures, the NHS still has a lot to be done.

Delivering more for less can only be achieved through transformational change – and technology is often key. The technology the NHS requires to become paperless is already there and used across many industries; just think of the technology we now routinely expect when managing our bank accounts, organising our time, or researching and purchasing anything from cars to fridges. Naturally, this raises patients’ expectations, particularly with the smartphone generation becoming an increasingly dominant and influential segment of society.

The technology the NHS requires to become paperless is already there and used across many industries; just think of the technology we now routinely expect when managing our bank accounts, organising our time, or researching and purchasing anything from cars to fridges

However, it is important for leaders not to get hung up on having the best and most up-to-date technology. Of course patient security and privacy should not be compromised, but as banks and online retailers have shown, the technology exists to keep information secure. NHS bosses do not need to reinvent the wheel in the quest to make the NHS paperless.

The technological aspect is just one part of this kind of project; what can be much more challenging is the cultural change aspect. How can you get people out of the habit of printing screeds of documents for an hour-long meeting? One example is printers that tell you how much that printing has cost the NHS, a very direct way of showing the financial consequences of actions.

By building a common vision and taking workers with them on the journey to a paperless NHS, senior leaders can make sure that the project stands much more chance of success

Similarly, with pressure on A&E at an all-time high, and with much of that pressure resulting from medical problems that don’t necessarily require expensive A&E resource to address them, could technology help? Work is underway to assess whether a smartphone app could show how long a wait people are likely to face in A&E, enabling them to exercise more judgement before clogging up A&E with minor sport injuries, cuts and bruises.

These kinds of tactical moves are a small part of what needs to happen. Our recent Barometer on Change 2013 found that while culture change was cited by 31% of organisations as a key challenge, just 13% have programmes in place to tackle this. By building a common vision and taking workers with them on the journey to a paperless NHS, senior leaders can make sure that the project stands much more chance of success.

It is tempting when trying to fix big problems to propose big solutions. However, by setting unachievable objectives, organisations are simply setting themselves up to fail. In a perfect world it would be possible to make sweeping changes immediately and everything would run smoothly. However, that is not the way things work. When dealing with a huge and complex structure, such as the NHS, the key is to set a programme up for success by setting achievable goals. Once these are met, and the behaviours embedded, the next stage of the programme can be tackled.

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