When it comes to helping the NHS to modernise, Neil Stevens tells Martin Cooper MBCS why a truly successful product needs to be useful, usable and used.

‘There’s no point digitising a bad process,’ says Neil Stevens. ‘If you take a crap process and digitise it, it’s still a crap process. It’s just digital. You’ve got to redesign and take out the inefficacies - and that’s true whether you’re transforming through digital or through paper-based means. I’ve seen loads of examples where people say: “You could get a computer to do that.” They do, but they still have a clunky process.’

Neil Stevens is now a consultant who works with both NHS trusts and with companies that supply digital solutions to health and social care organisations. Prior to striking out on his own, Stevens enjoyed a career of over 20 years working in informatics and leadership roles across health and social care organisations.

Define your terms

Addressing the concept of ‘digital transformation’ directly, he splits the idea into two words: ‘The digital bit is just using technology. Achieving transformation is done through understanding how we’re doing things currently - how we’re working and understanding things that maybe aren’t working.’

Finishing his point, he says: ‘You won’t achieve a good digital transformation unless you’ve got the cultural and leadership bits in place first. Indeed, I’d argue that the digital bit is the easier element. That’s not trivialising it. If you’ve got good technical teams - if you get the change management and the process workflows right - it’s usually relatively easy to get the digital bit to follow.’

Avoid gloss, deliver benefit

Despite his long career working, often very closely, with technology, Stevens appears refreshingly immune to high-tech marketing, gloss and vogueishness. He began his health and social care career with a psychology degree. The course had elements of computing and this led him to a post-graduate qualification in artificial intelligence. ‘My main focus,’ he recalls, ‘has always been working in a healthcare environment and trying to derive benefits from technology. I’ve not got an interest in technology per-se. It’s what you can do with technology - that’s the interesting bit.’

The drivers for change

‘The NHS has to transform just to survive, I think,’ Stevens observes as he moves to explore the challenges health delivery is experiencing today. By way of proof, he draws up a list: austerity, budget cuts and ever-increasing demand created by an ageing population. Health and social care also face a significant staffing challenge. The NHS has around 100,000 nursing vacancies nationally; GP services are under pressure too and the picture is worsening as doctors leave the profession faster than new practitioners join. In the last four years around 14,000 GPs have exited the service.

Making it easier for everybody

‘All this’, Stevens says, ‘ferments the seemingly endless tide of negative headlines we see about health and social care. You’ve got a situation where healthcare professionals are struggling to deliver the right volume of safe and effective care,’ he says. ‘And technology has got a role in solving that. But, we have to get it right. So, my interest in digital transformation is seeing if we can make it easier for everybody. Easier for patients, first and foremost. Easier for their families, for the doctors, nurses, for social workers, allied health professionals - everybody that works in health and social care.’

Expectation also plays a part in the profession’s need to transform. Staff who work in the NHS today are used to be being able to buy technology that just works. When, for example, was the last time you downloaded an app and had to go on a day’s training course to learn how to use it? Stevens says: ‘That just doesn’t happen. Things need to be useful, usable and used. Products add value by making it quicker and easier to do things.’

Being useful, usable and used

Involving the right people at the right time is a big part of ensuring that transformation delivers benefits. ‘In the NHS that means involving doctors and nurses,’ Stevens advises. ‘You need to remember that [transformation] is also a change management process. In some cases, people have done things in the same way for many years. To change that, you need good leadership and you also need to involve front line people... new products need to be designed well from a usability perspective.’

The concept of user-centric and consultative design is essential, Stevens argues. A solution might be technically excellent but, if people can’t see its merit, it’s unlikely to get used. ‘Nurses become nurses because they want to nurse,’ Stevens observes. ‘And the demand for their time is relentless. This means you’re asking people who are already very busy to join a new [technology] project. To make the project work you’ve got to try and find a way to show people what’s in it for them. This usually translates into: “What’s in it for your patients?”.’

By way of warning, Stevens explains: ‘I’ve seen IT departments come up with great solutions that have been designed and implemented without seeking clinical input. The result is that the solution may be technically very sound but it actually gets in the way of delivering good care.’

For example, in a clinical setting body language is important - carers want to have an open, honest and trusting dialogue, particularly if they’re delivering unwelcome news or complex information. It’s not helpful if the clinician is looking at a laptop. It’s a barrier. But not an insurmountable barrier. User-centric design might find that using voice recognition technology, rather than typing, is a preferable method of capturing a conversation.

Personal experience

This idea of digital services that are useful, usable and used isn’t just theory for Stevens. ‘My dad was ill for a number of years before he died,’ he explains. ‘He was 83 years old and had a range of complex conditions.’ As is common in such cases, he was looked after by a team of carers in different settings: GPs, district nurses, neighbours, carers, family and hospital teams. He also had dementia, so he couldn’t remember all the instances of care he’d received or whether he had taken his medication. This all added up to a constellation of carers, none of whom had access to his complete care record. ‘This meant he didn’t receive optimal care, suffered needlessly and the NHS wasted money.’ Stevens recalls.

‘That could have all been solved by a simple application of the right technology,’ he says. ‘To provide the best care, providers need access to good and timely information. If you get the right information at the right time you can make the right decisions earlier. You can deliver better treatments, make better use of resources, create efficiencies, get better outcomes and give better patient safety.’ By way of a summary he says: ‘That’s an exciting place to work in and to make a positive difference.’

Transforming safely 

Along with helping to alleviate the previously listed pressures on the NHS, transformational processes in a health and social care settings also need to deliver another key imperative: uncompromising levels of safety. In Silicon Valley, failing fast and failing often might be applauded but, when lives are at stake, failure suddenly seems much less a badge of honour.

This puts a great deal of responsibility on the professionals who, in say the NHS, work with technology. They might be career technologists, or they may be clinicians who have moved their careers toward using technology in a healthcare environment. Whatever their background however, the public, quite rightly, should expect that the people using data and building solutions in a healthcare setting are just as qualified as doctors, surgeons, anaesthetists and nurses.

‘Think about other professions,’ Stevens asserts, ‘you wouldn’t get on a plane if the pilot wasn’t trained and experienced. You wouldn’t have somebody working in accounts who isn’t a qualified management accountant. It seems obvious to me that people involved in designing complex processes in a complex and unpredictable environment need to be trained and certified. It ensures the highest levels of safety.’

Finishing his point, he says: ‘In [traditional] healthcare you have great processes in place to ensure that clinical staff have the right qualifications, training, experience and registration. It astounds me that, in informatics, a discipline that plays a significant role in delivering safe and effective care, there is still no requirement for a level of professional registration.’

There is, however, an answer. As part of his work as Non-Executive Director of Bristol Community Health, Stevens has been working with the CIO and they have committed to a corporate membership of BCS and The Federation of Informatics Professionals. This means that all of their informatics staff will become registered informatics professionals and they’ll get the support that comes with that. ‘It’s an exciting and important thing - to raise the recognition and professionalism of this group of staff.’