The ghost in the machine – balancing the human and technology in digital transformation

Digital transformation is a key part of the answer to the NHS’s challenges – but it is not realising its potential

A hospital chief executive officer leans back in his chair and sighs. “We safely implemented the new electronic patient record – which was my main worry – but we just haven’t got the value out of it. We’re still doing things in the same way we were before. Nothing’s really changed.”

A transformation lead talks excitedly on the other end of a Teams call: “We’ve got a really good tool to help triage our waiting list, but after the first push, we just can’t get the doctors to use it.”

The case for transformation in the NHS has never been stronger. The lived reality in the NHS today is one of critical workforce challenges; growing demand and increasing complexity of care; financial and productivity challenges; and a service that too often relies on antiquated, fragmented IT systems.

The NHS has responded by spending nearly £10bn over the past five years on digital transformation – with further investment planned in areas such as the NHS App; the national GP registration; harmonisation of EPRs; as well as very large investments in the NHS federated data platform; and a new electronic staff record system.

And for good reason. The opportunity offered by utilising the NHS’s data, digitising processes, and investing in enabling technologies is huge – allowing the NHS to do more with its finite resources, and ultimately improve care and outcomes for patients.

There have been successes that the NHS can point to:

• The NHS has treated more than half a million patients through digital home care and remote monitoring technologies since the start of 2021.
• AI is starting to have a real impact in driving faster diagnosis in radiology.
• Patients are seeing the benefit of convenience by booking appointments online or ordering prescriptions via the NHS App (around 2 million are ordered via the NHS App each month).

Despite these success stories, however, NHS leaders often find that they struggle to realise the full potential that these systems promise. This isn’t a surprise: across industries, the majority of digital transformations fail to realise the planned benefits – and that figure is typically higher in public sector and healthcare settings.

Delivering value from digital transformation requires a new balance between the technology and human side of change

But why should this be? Boston Consulting Group research has found several common themes in failed digital transformations:

• Staff are left out of initiative design
• Leaders are not leading the change
• Change is not explained well
• Employees lack the required skills to engage with the solution
• Adoption is not well-planned

The failure so often is not that of the technology itself, but it is a failure of engagement and adoption. It is the failure to lead, empower, involve, and support the people – the staff, clinicians or patients – at the heart of the change.

This is of particular importance in the NHS; after all, healthcare is ultimately human – it starts with the person, and it ends with the person. Too often, technology transformations focus on providing a digital overlay to current operating models – seeking incremental efficiency gain – rather than considering how technology can be used to fundamentally change how people care for patients.

The effectiveness and speed of digital transformation depend on the digital literacy and capacity of healthcare workers and patients, as well as their motivation and incentives to switch and embrace digital processes.

Lessons on getting this right

Fortunately, there are examples of successful digital transformation that provide useful lessons – from within the NHS, healthcare and other industries. For example:

Prepare and upskill

• Within the UK public sector, the DVLA has been at the forefront of embracing customer-centric digital services – processing more than a billion interactions a year, with 96 per cent online, whilst reducing costs by more than 20 per cent between 2016 and 2020.
• To deliver this, the service invested in preparing for, and leading, the digital change. The DVLA brought their IT service back in-house, ensuring they had the capabilities and aligned incentives to deliver major change. This was augmented by setting up their Digital Skills Academy and investing in upskilling staff to work within the new digital environment.
• Leadership throughout the digital change programmes was visible and active – getting delivery teams – that brought together operational and IT staff – aligned around relentlessly removing the barriers that derail a technology change project.

Engage the organisation

• One UK government agency has recently introduced a GenAI “co-pilot” tool, to transform how it handles complex legal claims; reducing the time from application to decision of claims by 2.5 months on average, and improving staff efficiency by more than 10 per cent.
• Successfully delivering AI change involved deep people engagement – particularly given scepticism about the risks of AI. The project was set up with sponsors from across the business – including legal, policy and operations staff – with engagement around the risks and guardrails for using AI starting from week one and continuing through working groups and fortnightly show-and-tell sessions.

Develop solutions

• Intermountain Healthcare developed a digital front door solution that consolidated more than 20 different digital products into a single solution that simplified engagement with patients and clinicians – becoming the top-ranked hospital app on Apple’s App Store.
• Key to this success was a people-centric approach, which incorporated more than 100 hours of research with users in the product design, 90 separate prototypes; and a dedicated “digital enablement team” to lead communications, engagement with clinical operations, and resolve issues and ensure engagement across the organisation.

Implement

• Virtual wards have been one of the real success stories of the NHS – with a dramatic rollout of capacity over the past two years. However, utilisation remains a key challenge with massive variation across the NHS.
• When BCG looked at which models were most successful, a key factor was clinical engagement: those services which had worked to engage clinicians in designing suitable pathways, and understood and responded to clinical concerns, had much greater success in utilising virtual ward capacity. This was demonstrated clearly at one trust, where we found three times as much variation in the take-up of virtual wards across consultants within the same specialities.

Towards a solution: digital transformation that balances the tech and human side of change 

There are, therefore, lessons for healthcare leaders who want to reap the benefits of digital transformation. We believe they fall into four areas:

1. Prepare and upskill

• Create an environment that is ready for change – hire the right digital talent; train your workers to improve their digital skills; ensure your leaders are prepared to lead digital change, proactively supporting your teams to tackle the issues that derail change projects; and explicitly look to break down barriers between IT and clinical and operational teams.

2. Engage the organisation

• Ensure that there is as much – if not more – emphasis placed on human change within planning and procurement exercises as the digital change.
• Create explicit structures and teams within a change programme to engage, communicate, understand and involve staff, clinicians and patients throughout the programme life-cycle.
• Understand the risks and concerns of key stakeholders, and address them early and often.

3. Develop solutions

• Adopt the principles of human-centred design: understand and involve users in design and focus on their needs and requirements.
• Develop iteratively, driven by evaluation in realistic scenarios. Progressively improve design and knowledge of users and tasks.

4. Implement

• Plan for adoption from day one. Over-invest in the training, learning, development and support required for healthcare workers and patients.
• Be proactive in communicating the benefits of the transformation, and addressing any concerns and fears proactively.

Digital transformation remains an essential part of the future of the NHS. But without the right focus on people change, the NHS will not reap the potential of the exciting technological advancements we now see. An approach that brings together technology and human change is the answer to bringing about the successful change the NHS needs.