The University Hospitals Birmingham NHS Foundation Trust was named as a centre of digital excellence, by Health Secretary
Jeremy Hunt. Ian Halstead discovers more.
In our digital era, organisations which can devise and deliver new platforms and operational models are the ones who lead where others can only follow, and for both innovation and sheer consistency, the trust which runs Queen Elizabeth Hospital Birmingham is something special.
Its reputation for digital excellence is based on a long-term track record of successful collaboration with partners here and overseas, and a demonstrable willingness to deliver new solutions within the primary and community care sectors.
No surprise that NHS England awarded the QEHB trust ‘centre of excellence’ status, and considers an exemplar to help it achieve its own ambitious digital aspirations.
Mark Garrick, director of medical directors’ services, makes a passionate advocate for his organisation’s expertise, as he discusses its work with Deborah McKee, the trust’s head of clinical systems development. “Many of the systems we use now were originally developed here, and then evolved, over the last 15 to 20 years,” he says - with understandable pride.
“The University of Birmingham’s school of computer science has an excellent reputation, for breakthroughs in the theory and practice of new systems and applications, and has become a magnet for talent.”
“Our USP is that we create digital innovations for the benefit of patients, and that all our programmes are clinically-led,” says McKee. “We’re all working very closely with doctors, consultants and research nurses, to ensure that technology is being used to deliver benefits for patients and to help healthcare staff who are in the front-line work more effectively and productively.”
Each QEHB ward has multiple hand-held devices and laptops, plus digital ‘dashboards’ detailing every aspect of a patient’s care, condition and treatment.
“Healthcare IT is an enabler, allowing hospitals to meet their operational priorities, and make the very best use of their resources,” says McKee. “We have, for example, a big focus on missed drug doses to understand why they happened, and to build in more effective systems so that the number of such doses is driven steadily downward, and we’re also using IT to drive down the length of patient stays.”
Inevitably though, any trust which acquires such digital expertise discovers that its staff become potential recruitment targets, for employers in the public and private sectors.
“Some people will always move on, but we’ve focused on creating clear career pathways for individuals, so there are always opportunities for people to progress,” says Garrick. “We regularly bring our clinicians and IT people together, so they realise just how valuable each other’s insights can be. We moved our informatics team off-site, but we bring them back for half-a-day every week to make sure they’re always fully attuned to the healthcare environment.
“We also encourage them to engage in less formal ways, to share ideas and experiences, because it’s surprising what benefits can ultimately result from the simplest conversation. One crucial area of activity was about how risk assessments were being carried out.
”Setting up interactions between junior doctors and members of our team, perhaps in the Institute of Translational Medicine, allowed us to identify what we might call ‘aberrant’ ways of working.
“We found, for example, that some doctors were waiting for test results to come back from the labs, rather than contacting the labs directly, and that some were waiting for other doctors to do something, rather than taking action themselves.
“Once we put all the data together, and adjusted how the system worked, we were able to implement a much more efficient system which improved patient care, and also helped the junior doctors.
“Once they understood that the IT teams were there to help them, the feedback was tremendously positive because they were getting real-time feedback, and they understood more about how everything worked.”
There’s so much enthusiasm in the room that the two almost collide, as they lean forward to outline the many ways in which IT and Big Data come together to deliver better outcomes for patients and hospital staff.
“We do take a multi-disciplinary approach to all issues and challenges, because it’s only once everyone starts to interact and interpret what is happening that solutions start to appear,” says McKee. “As an example, the coders need to understand the requirements of the healthcare teams, the clinicians then start to see new ways of working, and we’ve also developed business analyst roles, for people who understand the business model and the systems.”
“Exactly, and when everyone gets together, it’s remarkable what can be achieved,” adds Garrick. “Just as one example, I remember when one of the leads from an intensive therapy unit outlined one change he’d like to see, and the programmers said it couldn’t be done.
“Six weeks later, they came back with a solution which was even better than the consultant had hoped for. Once you’ve got teams which are genuinely integrated in their approach to challenges, the benefits just start to flow.
“Change can’t be driven from the top, and the most rewarding aspect is often when people come to us with ideas which no-one else has considered.”
Innovation comes in many forms, of course, and such new ways of working also require new structures, and the recruitment of people with different skill-sets from those traditionally employed within the NHS.
“We have created a new role, quality development leaders, and we now have around 80 of them, as a conduit between the clinicians and the data teams,” says Garrick. “You also need a framework in which to work effectively, which usually didn’t happen in the past, and also a very good ‘governance’ model. At the moment, the digital/data department employs almost 270 people, so structures must be in place to make sure you create the best outcomes.”
Given the enormous pressures throughout the NHS - to gain maximum benefit from scarce resources, and to ensure that productivity increases are achieved - Garrick, McKee and their colleagues must also constantly deliver both new solutions and complete ongoing projects.
“We’ve made excellent progress on storing all our in-patient records digitally, so we can continue to take more paper out of the system,” says McKee. “In the coming year, we’re also focusing on the creation of virtual health clinics so patients can be assessed and monitored without needing to travel to hospitals, and continuing to develop the MyHealth@QEHB portal which at the moment allows something like 13,000 patients to securely access their records online.”