The digitisation of healthcare systems and processes is more than simply replacing paper with computers. Done well, it presents the opportunity to transform the way health services are delivered; quality, safety and patient outcomes are improved; and patient and clinician experiences are enhanced. But the digital transformation road is long, winding, and full of unexpected obstacles.
Michael Walsh, Powerhouse Partners
Digital transformation in healthcare is more about the people, clinical engagement, leadership, and process changes than the technical ICT aspects. Clinician leadership is the beating heart of a successful digital program, particularly in hospitals. It is not just about convincing clinicians, it is about empowering them to lead and seize the opportunity to create a system that delivers better outcomes and experiences for patients, even though the digital transformation journey will be challenging for them. Genuine CEO and senior leadership engagement with clinical leaders is essential to agreeing priorities, managing risks, and ultimately achieving a successful transformation.
In large, multiple hospital systems (such as Queensland, NSW, Victoria, and other states and territories in Australia), the challenge is even greater as many clinical practices are unique to each hospital or health care site, and agreeing a common approach takes time and a willingness to change historical practices. Reaching agreement on how a digital health record will operate depends on the early engagement of clinicians and the establishment of system-wide structures for consultation and decision making.
Although we regularly hear about electronic medical records (EMR) or integrated electronic medical records (iEMR), we need to progress beyond these models where a hospital is placed at the centre, or a particular health profession is placed at the centre of a person’s care, and truly move to a digital, real-time, multidisciplinary, patient-centric digital health record (DHR).
Given that we are on a journey to a true DHR, we need to take every step deliberately and with great care. When dealing with the health of an individual, we need to make sure we minimise risk and maximise the safety and quality of care.
Currently, in public hospitals across Australia, digital transformation does not occur in green field environments. Embarking on a large multiple hospital digital transformation that results in the use of a common set of digital patient-care applications means that some locations will be required to stop using home-grown applications or locally implemented solutions. These home-grown or locally implemented applications are usually highly regarded and strongly supported by the clinicians who use them and may have been involved in their development. As no two applications are the same, there will be some functionality that clinicians will lose when moving from the locally implemented applications to a system wide application platform across multiple hospitals. It is essential that this is acknowledged and that there is an open discussion of the differences including the benefit of an integrated system wide view, the ability to do advanced analytics, the opportunity for improved clinician feedback, and the potential for patient portals to allow the patient more involvement in their care.
Engaging clinicians in digital transformation needs to take the same approach as the companies who are leading the digital transformation in our personal lives. Apple, Microsoft and Samsung don’t sell products, they sell lifestyles, experiences, and visions of the future that we believe will improve our lives. We need to think the same way about digital health transformation. To be successful, clinicians need to believe that their lives and the lives of their patients will be improved as a result of the digital transformation. We are in the early phases of digital health transformation and the applications and systems are not as intuitive, seamless and personalised as those we use in our personal lives. But we are getting closer and clinical engagement will drive the improvements needed.
To ensure that clinicians are fully engaged and leading the transformation at each hospital, it is important that CEOs and senior leaders engage directly with clinicians during the digital transformation journey. This means that Directors-General and Secretaries of departments and ministries; CEOs of local health network; and other senior leaders need to meet with clinicians and discuss the issues, challenges, and benefits of digital transformation.
When I was Director-General of Queensland Health, I met with all the medical, nursing and allied health directors, at least twice, ahead of every major go-live. These meetings provided an opportunity to have an open discussion between the local clinical leaders and the Chief Executive of the health system. The discussion was always wide ranging and covered any issues the clinicians wished to discuss. However, I always brought the discussion to a conclusion by focusing on the following seven questions:
- Are all the staff in your area trained and confident in using the digital health record?
- Have the workflows using the digital health record been developed and practised in your clinical area?
- Are you confident that your staff have embraced the new way of working with the digital health record and that you have strategies ready to address issues that may arise?
- Are all the computers and devices in place, tested and working quickly and reliably?
- Do you have arrangements in place to operate if the digital health record is not available?
- Are you ready to respond to internal or public criticism of the digital health record?
- Are you confident that the go-live in your area is clinically safe?
Clinicians always had the authority at these meetings to delay the go-live if they thought that any of the seven areas covered by the above questions would cause problems during, or post go-live. Providing this level of accountability and authority supports the full engagement of the clinical leaders and their dialogue with their clinical colleagues.
Early, genuine, and ongoing engagement of clinicians by CEOs and senior leaders is the key to a successful digital transformation that improves the way health services are delivered and improves patient outcomes and experiences.