Why a new culture of innovation needs to be at the heart of the ‘digital’ NHS

The pace of change is only increasing. Investment in digital health startup investment has exploded since the onset of the pandemic, while the number and type of digitally enabled innovations available in healthcare is rapidly expanding.

Physical tools (e.g. gloves, needles etc) can, and do, change but compared to digital the rate of change is slower and the functionality is fixed. Processes, governance and patient pathways have been designed for a healthcare system using physical tools. But digital transformation brings its own challenges. And it can often feel like you’ve just got familiar with a software tool when an update arrives adding several new functions. This means that both healthcare staff and patients will need to regularly re-familiarise themselves with digital tools and explore the utility of any new functions.

Building a leadership culture

How can we successfully deliver on the abundance of options digitally-led innovation can provide in a fast-moving development environment? We might automatically think tackling problems like poor IT infrastructure – old computers and slow connectivity is the solution. But while those issues undoubtedly remain, and need addressing, I believe the two critical challenges facing us now are often overlooked, namely culture and leadership.

First, we need to create an NHS organisational and leadership culture that is more willing to explore new tools and processes. This approach must be cultivated through leaders who model and create more permissive environments to foster innovation; making it clear that digital innovation is part of the core professional responsibilities of NHS staff; and support digitally-enabled innovation in care to become an everyday activity.

Second, we must support changes to the culture that operates closest to where care is delivered. Here is where we need an innovative culture which values openly failing as a learning mechanism; builds support networks that celebrate and assist learning from others and sharing in return; and which makes rapid testing with validation the norm. This requires clinical leaders to support staff to experiment with tools in the open with patients and the public, failing safely and capturing learnings to drive improvements. Staff need to have a network of peers, governance that encourages innovation and HR that encourages innovation within roles by placing more emphasis on responsibilities over tasks to give the freedom to shape processes and pathways.

Unfortunately, we remain far away from realising this ambition. Some areas such as Alder Hey’s Children’s Hospital, Leeds and York Partnership NHS Foundation Trust and Guy’s and St Thomas’ NHS Trust in the UK are already demonstrating some aspects of this approach. And the introduction of Integrated Care Systems may provide huge potential to network and spread these approaches throughout local areas if long standing scaling barriers are overcome. 

Disrupt to drive digital innovation

But look across the breadth of the health service and professional roles are largely task based, clinical pathways become encumbered with process and governance while there’s a strong reluctance to permit risk or failure. And change in healthcare can also follow classic ‘waterfall’ project management techniques, in which there are neat linear sequential steps with set milestones and deliverables. While for successful digital innovation we need agile methodologies using iterative ‘test, fail and improve’ approaches with established safety nets to fall back upon combined with user-based design (not technology led design).

In combination these factors and the conditions for successful digital innovation feel contradictory to the existing dominant health care culture and processes. Effective digital innovation will mean a disruption in the de facto healthcare culture and leadership, and we must recognise and deal with the discomfort this may create.

So how prepared is the NHS for unleashing digital innovation? The recently published Wade-Gery review into how the NHS organises and supports digital change sets out some helpful recommendations that will create some of the conditions required for successful digital transformation, including multi-year funding to support digital change.

The Wade-Gery review also sets out to transform the centre of the NHS to be more digitally powered, by expanding the digital mindset throughout NHS England and through the nine recommendations delivering on the review’s ambitious title to ‘[put] data, digital and tech at the heart of transforming the NHS’. And this might prove to be the review’s greatest lasting impact.

But there is a real risk that without a clear and considered approach to culture change when merging NHS Digital, NHSX and NHS England, instead of transformation it will simply result in the creation of two siloed ‘digital directorates’ at the centre that remain divorced from more ‘mainstream’ decisions and policies.

If the NHS is going to embrace the disruptive leadership and culture it needs to unlock digital transformation, NHS England has a clear opportunity to model the behaviours the rest of the healthcare system will need to demonstrate. It will be disruptive, but without it digitally-enabled care will remain an add on and we will be left with a healthcare system that has one foot stuck in the past – and so culture change should be a priority.

Dr Pritesh Mistry, Policy Fellow for Digital Technologies at the King’s Fund, UK.