After the talks of introducing a new process at the HSJ Digital Transformation Summit, Microsoft’s roundtable of senior digital leaders found four focus areas that can help upscale the automation efforts in the NHS
Spend a day trailing anyone in the NHS – a nurse, a physiotherapist, an operational manager, administration and booking teams – and they’ll show you examples of “wasted” time. Pen-and-paper audits; taking information from one system and putting it into another; chasing people for information. Ten minutes of effort here, 20 minutes of effort there: it adds up to millions of hours which could, in theory, be released for staff to do what they actually want to do, which is serve patients.
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There are also enormous opportunities to further improve procedures which result in better patient quality. But that involves yet more minutes of audits or administration.
The further challenge is that these processes are often specific to the organisation. There’s no off-the-shelf product that can help fill in a bespoke 30-minute form for a referral to palliative care, drawing from the two clinical systems in your trust, or help audit an accident and emergency process which might prevent an error from being missed. Many IT teams are focused on keystone projects, like electronic health record implementations, leaving little time for building bespoke apps.
Low-code platforms enable building apps with minimal coding experience
So how does the NHS find a way to release these millions of hours and help make it even easier to introduce new processes which will help patients, without magnifying the load further?
This was the focus of a roundtable discussion on automation and low-code at the recent HSJ Digital Transformation Summit. Automation involves “robots” trained to perform repetitive work and “supervised” by a staff member or run “unsupervised” when triggered by a particular prompt. For example, at Berkshire Foundation Trust, robotic process automation was used to reduce a 20-minute physiotherapy referrals process to just three minutes, saving 226 days of staff time a year.
Low-code platforms enable building apps with minimal coding experience. The user is able to drag and drop component parts into an application, connect it into existing data flows, define workflows, and create user interfaces. This is then automatically converted into code without any further user involvement: Gartner has estimated the average cost to develop an app is 74 per cent less with Power Platform than with traditional coding methods. NHS trusts are already building apps to improve efficiencies using low-code for e-observations, collecting patient-reported outcome measures, streamlining the new starter experience, and managing compliance with SOPs and policies. These platforms enable a different type of collaboration, building highly bespoke yet affordable apps, ground up, and working with the front-line.
Our roundtable of senior digital leaders – predominantly chief information officers and chief technology officers – identified four focus areas to help scale automation efforts in the NHS:
- Governance: Understandably, one of the biggest concerns of teams is ensuring safe deployment. If “anybody” can build an app or a bot, does that create a risk of deploying unsafe, unsupervised apps into clinical environments? Mature trusts in this area are building a “Centre of Excellence”, providing a range of tools to manage oversight and deployment of technologies – such as dev, user acceptance testing, and test environments, role-based access controls, and oversight of apps being developed and deployed. Microsoft has a set of COE tools to enable governance here, already deployed in a number of NHS trusts.
- Cost: Many platforms require an up-front license fee, which means a business case must be built, not just on a single app or robot, but on a series of such interventions, which then requires staff to build and maintain such products. At one trust, the team has identified 90 processes to automate this year, starting with shared services. Many trusts have started with the tools available through M365 licensing, to begin building capabilities and training staff.
- Scale: As integrated care systems come together, contributors suggested that a COE should exist at a regional level, with staff skilled in low-code platforms and able to support multiple trusts (governance would continue to be held by local IT teams). The other scale benefits come from sharing: currently, trusts are informally sharing code with one another, while NHS England has created the NHSmail Solution Store to share apps across NHS organisations, available through here. Additionally, Microsoft runs a Community Call for NHS trusts to share insights and capabilities; to join, get in touch.
- Engaging the front-line: Automation can be a difficult conversation, particularly if staff are concerned these tools will replace their roles. Bringing staff into the conversation, and framing the question appropriately around supporting them to “work at the top of their license”, is an important challenge. Bringing together teams focused on quality and improvement with automation/low-code teams can help: automation efforts are best linked to a culture of innovating for care. Microsoft also runs free “app in a day” sessions to engage and educate staff.
As with all NHS innovations, a thousand flowers are blooming with automation at present. There is enormous growth in use of low-code platforms – every month, trusts are creating new capabilities to release time to care. Now is the time to share and scale.
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