Making digital work on hospital wards

August 2017

Human head with gears inside

Ian Woodburn, chair of BCS Nursing Group, explains how technology can help both patients and nurses have better lives - if that tech is designed and deployed correctly.

Can you tell us a bit about yourself and your career?
I’ve been a nurse for 36 years in the NHS. I’ve worked in various areas. Predominantly, I’ve spent a lot of time in the community. I like to push boundaries, particularly for nursing, and open doors for colleagues so we can move the profession forward in the UK.

Can you paint us a picture of how technology and informatics might change the role of nurses?
Ideally we nurses want to admit a patient and to have all the right information in the right place and at the right time. Nurses are the people who are with the patients 24/7 and they are using IT systems all the time. This means, as a nurse, we often plug gaps. If things don’t work, we make them work. In hospitals we have disparate technical systems that don’t necessarily work for us. If they don’t, we end up plugging gaps. Many systems have been designed around a doctor, or around an admin process, and they don’t speak to each other. Nurses need to be involved in procurement and in the early stages of these systems’ development. We need them to work for us on our wards.

Doesn’t user involvement happen as a matter of course in, say, the air industry?
That’s a good analogy. That’s absolutely what happens. If we use that example, in hospitals, there are systems that have been built around consultants. The consultants maybe don’t use the systems, or use them for 10 minutes a day, whereas the nurses are stuck with the systems twenty four seven. If we use the analogy of building a plane, the systems are build it around the pilot, but what about the cabin crew?

How important is digital transformation to the NHS?
It’s crucial. We need to reduce duplication, and we need to have the right information in the right place and at the right time. Processes could be accelerated with the right equipment and the right systems. It will help with the background stuff. It would free up more quality time for the patients too.

I’ll give you an example: think about an ambulance crew and what happens when you call 999 and the team sets off. When they arrive, they’ll ask for your medical history, they ask how the accident happened and they’ll record it all electronically. Because they are the ambulance service they do not link directly to the hospital. You then get asked the same details again in A&E. You then go up to the ward, and because you have been seen in A&E, and the record hasn’t caught up with you quickly enough, they’ll ask you again. This is what we need to address.

You would think in today’s day and age everything should be digital. Why is this stuff not electronic? Why are clinicians repeatedly asking you the same things? It is because we have different silos of paperwork. And for me it’s simple: just make the records standard and mandatory, and then we will all fill them in the same way. As the ambulance crews put your name and address in, we just feed it through the system instead of asking you again. If we could get rid of all that it could save hours for a nurse every day. You replicate that across the hospital, that is really a lot of time to spend with the patients.

How do you think patients perceive NHS digitisation?
Patients are usually quite gobsmacked that we don’t have all this information to hand. If we use the example of a GP referring you to A&E, the patient might find that A&E doesn’t know their current meds. They are very surprised that we don’t share this information. And you will still get examples of patients moving from ward to ward, or ward to a radiologist somewhere else, and all those details are asked for again and again. That’s because we have very siloed systems, and systems that we don’t trust. To safeguard ourselves we just repeat things over and over again.

What does patient-centred care mean on the ward?
Being patient-centred is about empowering the patients to take more ownership of their lives and their care. We need the patient to be heavily involved in their care. They should know about their diagnosis, they want to understand the tablets they are taking and why they take them. This all happens in hospital, but, for example, the minute they leave hospital, or they have a long-term condition, some of that falls by the wayside. And then if they don’t have close links to their GPs or other professionals, it’s often then that you find that things go wrong.

What are the key steps in the journey towards a digital future?
The IT needs to work. We need to reduce duplication and we need to make IT mobile. By that I mean we need the ability to walk around the wards, and of course if you are in the community, the ability to use IT across the community.

If I had a magic wand, the ideal future would be to have cloud based products that don’t link us to organisations as such. That’s because, for example, if I am a specialised nurse I might see a patient on the ward and I might then go to their house. I might then see people in a residential home or a nursing home, I might go into a school, I might meet a social worker. I want to access my records anywhere and I want to do it safely.

At the moment, the barriers are that we are linked to organisations. Even if we do have fantastic WiFi, it’s still linked to your organisation. It is very difficult to move into social care with patients because we can’t pick the WiFi up.

We talked about the importance of getting nurses involved in the testing and designing of products. How can we actually do that?
At my last organisation, we set up a model ward where we introduced equipment, worked through the processes and how the systems worked. And then we worked on improving all of that. Then once we got that model right we rolled it out across the organisation.

We need to involve nurses at the beginning. If you use the example of buying a new product, if it involves the clinicians, I think we should have them involved as a group. This means involving doctors, nurses, and allied health professionals together, float ideas by them and see what their views are as a group. Don’t split them off into doctors, AHPS and nurses because it just doesn’t work. You’ve got to think of the consequences of putting equipment on a ward.

What advice would you give to someone starting in a nursing career?
If I used my personal experience, it’s the best thing I ever did. It’s a totally rewarding job. I love every minute of it. The ability to swap and change, and take different avenues, and still be involved with patient care, it’s just awesome. The NHS is such a fantastic organisation. It does have its problems though. In NHS England alone, there are 40,000 vacancies that they can’t fill because we haven’t got enough qualified nurses.

Image: istock/Pogonici

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