Transformation Directorate

What does good look like?

The What Good Looks Like framework published by NHSX sets out a common vision for good digital practice and outlines seven success measures for digital transformation. Chief Clinical Information Officer, Ayesha Rahim, describes how some of these elements are already evident in the digital transformation journey undertaken by Lancashire and South Cumbria NHS Foundation Trust.

The new What Good Looks Like (WGLL) framework published this week represents a golden opportunity for NHS organisations to draw a line in the sand about what we consider to be acceptable standards in our field. It represents a yardstick by which we can measure our own progress and also benchmark against others. But any guidance of this nature needs to tread a line between being aspirational enough, while also being something that is realistically achievable. Aim too low and we miss a chance to drive up standards. Aim too high and the guidance becomes irrelevant.

The WGLL framework seems to strike a balance between these two positions, but the acid test is whether organisations on the ground can visualise their current position and also see an attainable roadmap for themselves.

The foundations for success

In Lancashire and South Cumbria NHS Foundation Trust, a mental health and community trust in the north west of England, we can pick out some key areas where we have already made good progress, as well as areas for future development.

As a jobbing clinician, as well as CCIO, I am delighted to see that in success measure 2, Ensure smart foundations, the first domain is ‘people’. We all need systems to deliver care, but systems are only as good as the humans that are empowered to use them. So by emphasising the workforce it feels as though we are starting off on the right note.

We know from Health Education England’s digital workforce modelling report that we will need a considerable increase in clinical informaticians over the next 10 years if we are to be able to sustain the pace of digital transformation in the NHS. In our trust, we have been lucky to have a board that really understands the importance of clinicians working in this space. As a result, rather than acting alone as a CCIO, I lead a multidisciplinary team of doctors, nurses and pharmacy professionals, with more expansion to come.

As clinicians, we are not just there to be consulted with, but to be co-producers of our digital future alongside our technical colleagues. Clinical informatics can no longer be seen as a one-person job, tagged on to an already busy professional’s existing portfolio. It is a specialism within its own right, and deserves adequately resourced time to deliver the goods. As well as the time resource, we must also recognise the richness of experience and expertise that a diverse clinical team can bring to the role – none of us can be a subject matter expert in all professional domains.

Delivering excellent, safe care

Similarly, success measure 5, Safe practice, makes explicit mention of the importance of clinical safety standards. Digital health, more so than any other field in healthcare delivery perhaps, is a rapidly evolving space. As such, evaluation of interventions cannot always keep pace with the need for us to transform our ways of working. We do not have the luxury of conducting lengthy randomised controlled trials in the same way that we would do for most pharmaceutical advances (though even that field has had to adapt in light of the COVID-19 pandemic).

What we cannot compromise on however is the safety of our practice, which is why it is fundamental for us to hold ourselves accountable in this area. As before, we cannot pay lip service to this function which is why not only are most of our clinical informaticians trained in this area, but our team has put on training to other members of the digital directorate, led by our chief nursing information officer. Clinical safety should be everyone’s business, so by training our project managers on the basic principles and procedures we have embedded a culture of safety in the department. Now the clinical safety processes that we adhere to are a fundamental part of the project planning for every piece of clinically-relevant digital work we undertake. This also helps to keep in everyone’s consciousness why we do what we do – delivering excellent care for patients.

Patients as partners

This brings me on to the final area: Success measure 7, Empower citizens. Through the last 12 to 18 months pretty much all organisations have mobilised remote consultations, in order to provide care to those unable to engage through traditional channels. The hope is that we can maintain and build on this progress to fully exploit the advantages that this brings, whilst paying close attention to patient choice, clinically-appropriate usage, and digital exclusion.

However, the aspect of this success measure that really caught my eye was the steer to include patients as partners in digital transformation. It is encouraging to see that the old-fashioned model of consultation and engagement is being discarded in favour of co-design. Professionals may be experts in care delivery, but our patients are the experts in themselves, and in their lived experience of receiving care.

In Lancashire and South Cumbria Trust, we have worked hard to move towards this model with patient representatives on our patient portal project board. There is no greater authentic voice than that of a person who has had to navigate the complex landscape that is our modern NHS – and we would ignore this at our peril. As a result, it is incumbent upon us to actively seek out “experts by experience” to partner with us in delivering transformation that works. Where patient councils or equivalents don’t exist, there will be plenty of voluntary sector patient organisations we can link in with to seek support. None of this of course is a substitute for doing wider patient engagement, but without patients’ voices being present in the decision-making spaces, we are only doing half the job.

Overall, the WGLL framework is a huge step in a positive direction for us to hold a mirror up to ourselves, and ask the difficult questions about whether we are delivering the best for our communities.