INNOVATION AND THE NHS. DOES IT REALLY WORK?

We look at the progress of Great Ormond Street hospital, London, and ask – was COVID the driver of their reach-out; and can other hospitals learn from this?

I’m sitting at my office desk and the good people at HIMSS media have sent me a long link so I can easily register. The details of my credentials are already known to them and already pre-filled when I click the link. I am on auto-pilot, I click “yes”. Many times. I am going to the HIMSS20 Conference in Helsinki, except that it is no longer in Helsinki. It is staged in a TV recording studio somewhere in west London.

Instead of trains and planes and hotels – I click on this virtual panorama and I could be walking around the Convention Center at Orange County Orlando – I feel sucked in, I pass by the names of the well known vendors, who have their Announcements, and Booths, and I almost miss it. Hidden on Day One, is the modest title:

“Lessons learnt from COVID-19: Supporting and protecting the front line”.

It is redolent of my own far distant days at Uni, the modesty of a non-engaging title that we all know hides far greater truths:

“Some new thoughts on Mozart’s Figaro”.

I pick up the phone, and get through the wait on reception at Great Ormond Street, and get connected. Catherine answers the phone. She is a nice lady.

“Do you want a Soundbite?” She laughs.

I laugh, in my turn. No. I want everything. I want to know how you do it.

What is obvious about this Presentation by Sarah Newcombe and Catherine Peters – is that – despite the turbulence of today’s times, and the recognition that everything has changed – in reality, nothing has changed. As Catherine says in her notes below – Great Ormond Street hospital started on this Innovation journey some four years ago. And HIMSS itself has always been the byword of digital tech reach-out. Speaking at HIMSS has always been a sign that you have made it.

Except that there are of course differences, Innovation itself does not necessarily mean tech. It may simply be a change in the way you approach things. There is no mention of technology in Steve Job’s mantra “think different”. And this is the point of convergence with Catherine’s thoughts; her standout advice is – if you want to get it right, then – “have a Plan; and do it now.”

You can argue that anyone can have “technology”. And anyone can have buzzwords. Just a few years ago it was “interoperability”. Today it is “digital”. I am not sure I know what “digital” actually means, but that does not matter. This discussion and presentation , is the journey that every hospital should be taking but that few have the courage or expertise to do, without a RoadMap.

The notes below, are the RoadMap. This is what Catherine says:

RB; “Innovation” is supposed to be the flavour of 2020.  If COVID had not happened, would you have gone down the innovation route that you discussed at HIMSS?

CP; GOSH has been on a digital maturation pathway for the last four years. The implementation of an enterprise wide electronic patient record (EPR) platform in April 2019 helped us leap forward on this journey. Having a fully digital and paperless health record meant that our staff were able to adapt to COVID rapidly and to continue to work remotely if needed.

The patient portal was included as a key element of our EPR from the outset, and we had actively encouraged patients and families to sign up prior to COVID. However, as the pandemic started, we could see the power of integrating video visits into the portal. Through concentrated power of will and the benefit of a highly functional team, we were able to work with our telehealth and EPR partners at a pace that was breath-taking and skilful. From a completely standing-start, we were able to deliver video meeting capability for 5000 staff and establish fully embedded video-visits capability within our EPR within eight days.

Our vision at GOSH has been to use technology, data and analytics to provide safer, better and kinder treatments and care. This has required strategy, focus and a plan. For us, true digital innovation needed to be a living, breathing entity underpinned by an empowered and enthusiastic workforce where continuous improvement is part of our culture. Innovation that is not nurtured or a fad does not thrive and become a reality.

We are very fortunate to already work within a highly functional and motivated team and for us, COVID has been an accelerating agent; COVID helped focus the minds of those around us to really move at a pace that is difficult to achieve in more normal times. In effect the COVID pandemic forced us to fast forward our plans

RB; Did you have to change your way of dealing with patients?

CP: Our patients are complex, and we have high numbers of face-to-face outpatient visits. This had to change, and we reversed the ratio of face-to-face and virtual appointments within a couple of weeks

The interactions between clinical staff and patients required both groups to adapt to new ways of working (environments, communication and medical assessment itself)
We also had to promote and actively sign up patients to the patient portal in order to schedule video visits. This in turn has opened up the possibilities of the patient portal to many patients and families. Messaging, lab results release and access to letters have been the most popular features of the portal. In turn this means we have improved engagement and communication with our patient groups.

This has fostered our patients being greater partners in their own help. Surely, the patient and their family are the most important members of the care team? We have developed bespoke functionality (“heads-up”) whereby patients are encouraged to ask their doctor or nurse any questions on their mind before each clinic visit. We feel this is a powerful tool to enhance the connection between patients and their clinical team. We are really happy to share any of our news ways of working and ultimately feel this type of capability would strengthen any outpatient consultation.

RB; The impression we had, was that although you have changed how you cope with things – actually you are still restricted by existing processes, i.e., protocols, policies, etc – that in themselves become a substitute for actual new things. How much did you have to throw the rule book out, so to say, or actually – you have never been restricted – there is an inherent flexible mindset?

CP; There are many ways in which our staff and patients have had to be flexible and change working patterns and environments. At the onset of the pandemic, team meetings, patient discussions, and operational meetings moved to telehealth and video conferencing platforms. Patient safety, clinical governance and safeguarding of course remain of paramount importance.

As a specialist children’s hospital, it is vital that our governance, while done in a timely manner, is done to the highest standards. Our approach to using technology and data successfully has been to incorporate it into the workflow of clinicians and we ensure it supports care delivery. This approach itself acts as a built-in parity check.

We also wanted to help the system and all paediatric patients across the country during the pandemic. Working closely with our colleagues in North Central London, we opened up GOSH to take patients with general paediatric conditions.

Our hospital is centred geographically between many other large hospitals. We were able to support patients and staff in these other locations by opening new ward environments and transferred general paediatric patients to our site. This in turn meant beds in other hospital units were available for adult COVID patients. We onboarded over 200 paediatric staff from other sites within weeks. The need for adaptability and flexibility has been required and achieved in so many areas of clinical care and we are really proud of our staff and patients.

Our greatest asset has been our staff and we are very fortunate to have full executive backing at Board Level in the Trust to leverage digital tools and capability to make a difference and enhance the care we delivery.