https://padlet.com/alisdair_smithi/ip365hcmksb90u02 Do opportunities exist to strengthen your organisation's digital strategy? Are there gaps in the government's vision? What would you wish for? Post your thoughts on the wall here! en-us 2021-11-10 15:05:27 UTC 2023-01-21 09:42:43 UTC hello@padlet.com https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/1916057037 My organisation would benefit from a better strategy for AI and data. We have lots of clinicians with really innovative ideas for using AI for more efficient and effective care but no process for supporting or developing them. Use of data, particularly for quality needs to be improved with a greater level of knowledge for patient-facing staff and a more collaborative approach with more investment in professional data analysis.]]> 2021-11-28 09:40:52 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/1916057037 shanemuk https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/1916653026 We're implementing a region-wide EHR (Epic), but we're faced with restrictions on scope, a forever-need for other systems, issues re migration for decommissioning old stuff. If we had an open standards-based clinical data repository, that would get us some key strategic enablers to help accelerate the overall workpiece.]]> 2021-11-28 21:57:25 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/1916653026 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/1923848470 My organisation will benefit with a Digital Stretgy to start with. I believe our organisation is not an outlier with a lack of one. The attention to the basics and ground reality in the government Stretgy is very appealing to me. We have just completed our Digital maturity assessment and started to stretgise to reach HIMMS level 5. While I am learning the concepts in good time, the only direction we can go is upward from current zero. This document is a good substrate for us in the stage we are in.]]> 2021-12-01 21:50:33 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/1923848470 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/1929809224 Not too many opinions here yet but I can draw from all of them......the sky is blue but there are large shadows cast from overhead.  I would agree there is a lack of strategy and what there is appears to be focussed on the short term.
AI may be of benefit but I am skeptical outside the sort of AI that analyses well defined data (image analysis for example).  Anything else is already showing problems for health where hi fidelity, specificity and lack of bias are essential (and deficiences in which are more acceptable coming from people than machines perhaps). AI depends on good inputs which for clinical data we don't really have in a general sense.
Open (and better constructed) standards are therefore definitely the way to go but sadly what may be called open may not be and I am not sure is built around patient, citizena and healthcare system needs.  I would like to see a truly free from legacy review of data standards so that the idea of a clinical data repository can potentially be realised without manual or pseudo-automated interoperability as I worry the case may be with current approaches.]]> 2021-12-05 18:49:21 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/1929809224 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2383118704 We're implementing the national strategy - there's probably more than one national strategy but ultimately digital has a role to play in improved care, lower costs, and workforce capacity.

I'm not sure the national strategy focuses enough on patient adoption, safety and quality and inclusion.

However, having a strategic direction is important to recognise the need to support the workforce with digital literacy and overcome organisational boundaries to mitigate the instinct to have multiple systems linked to individual preferences. 

The work is complex and slow, but it is a breakthrough and a step change from historical ways of working, which whilst often successful could be uncoordinated and working in the dark!




]]> 2022-11-14 15:34:00 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2383118704 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2383667284 generally well aligned but 2-3 areas of real challenge - data quality challenges interfere with AI aspirations particularly, PFDs is poorly developed and poorly taken up - we need to do far more work on patient cultures/ needs especially to avoid widening inequalities gaps, and the actual capacity in our design and engineering teams to make all the changes we want. ]]> 2022-11-14 21:33:14 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2383667284 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2384973375 I like the strategy - the vision is clear, the aims are broad and the milestones are within the bounds of possibility.  I am pleased that many of the barriers to implementation have been surfaced, although I am less confident that they are easily resolvable. 

The spectre of financial constaint looms large over this agenda, as does a legacy of partnerships with industry on wide scale IT projects which have led to outcomes somewhat short of expectations.

The keys for me are as follows:

- Establish usability through continuous engagement with users and refinement - hard to do at scale, so roll out needs to be tempered by the experience of delivery.
- Ensure interoperability / open standards so that data generated can be exchanged between systems and consumed upstream. This also protects against the failure of any single supplier.
- Demonstrate and socialise benefits to stimulate engagement and ensure takeup

We are currently going through an organisational transformation resulting from the merger of Arm's Length Bodies - as upstream consumers of the outputs of these future operational systems, we have a stake in the success of this strategy. Our own digital function is likely to change as a result of both the merge and this strategy, but I suspect that coalescing of these strands may be some way off yet. 

We must prepare for the arrival of new data sources and maintain our agility in order to adapt and avoid acting as a potential handbrake. Early engagement with the programme will ensure that any upstream needs are considered at design time and incorporated.

]]> 2022-11-15 15:05:50 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2384973375 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2385342641 My programmes strategy aligns well with the governments vision. Accordingly, our is much more details and less 'big picture'. 

I would argue that I have found in general the government strategy is largely not reflected at individual programme / project level. Especially when you look at regions / local delivery. There can be a huge mismatch between the aims and strategies of the NHS organisations which ultimately hinders a cohesive delivery of the national governments. ]]> 2022-11-15 18:40:03 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2385342641 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2385391277 we have a strategy, but I am not sure how or if we are measured against it. It seems a paper exercise to me. The last one that was written was never mentioned again until it came to the refresh. It seems to me having one is more important that it actually being used !!!]]> 2022-11-15 19:11:08 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2385391277 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2385542685 When I was preparing to interview for my current post, I reviewed several digital strategies for mental health trusts across the region.  Of the 6 trusts I identified, I was unable to identify a strategy for two.  For the remainder, I was struck by the fact the various strategies were so similar as to be virtually interchangeable.  In addition, each strategy could have been ported over to an acute trust with minimal alterations.

In each case, the aims were laudable but somewhat generic and appeared to represent a desire to meet expectations rather than deliver excellence.  I'd agree with a comment made elsewhere for this activity that *having* a strategy is an end in itself rather than the strategy being a means to achieve a particular set of ends.  Looking at the model from a previous lesson, they're generally focussed on the question of "where do we want to be?", rather than "where are we now?" or "how do we get there?"

The government's plan represents a significant improvement.  It proves a clear set of preferred, generally SMART, outcomes and sets out a clear set of approaches to achieving them.  Whether this is feasible or not is a different question.  The document's genesis preceded the current economic challenges and the goals seem to presuppose a degree of homogeneity which is inconsistent with the fragmentation which arose from the late 20th century and culminated in the HSCA 2012, and has only partly been reversed by the Health and Care Act 2022.  

Hopefully, the plan will act as a model to promote the development of more meaningful, though perhaps-sadly-also more realistic local or ICB level plans.]]> 2022-11-15 21:10:37 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2385542685 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2385666069 There are several new ideas from within NHS organisations and coming from outside of them, however for any strategy to even lift off from a board paper or even reach the boardroom, the leaders need to be receptive, open minded and in the mental phase to be explorative. Many boards aren't brave enough or are willing to invest in fireproofing rather than investing in fire extinguishers. The forever chasing of targets and focus on recovery and waits does not allow them to take a step back and invest in the time and energy to find long term solutions. 

Therefore in my opinion, no matter how wonderful and robust new ideas are, the traditional manner in which they are viewed by the Boards, looking at conventional short term return on investments as the deciding factors for seriously considering innovations and out-of-the-box solutions, will always render these ideas to the archive folders.  

The NHS national plans and visions remain partially delivered due to the focus on constant firefighthing instead of taking the time for Boards to approve building fireproof platforms. ]]> 2022-11-15 23:52:13 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2385666069 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2387233635 Our Digital ambition has been revised by another strategy document to take into account the digital acceleration following th epnademic and also to bring it in line with our Trust Mission, vision and strategic objectives and to underpin the national and system level digital ambitions. There is a clear intent to engage and consult stakeholders in defining the strategy.

Reading through this document I get the impression that some work is yet required to impress that digital evolution and hence transformation is fundamental to all of the Trust's strategic ambitions. It is included as a key enabler alongside leadership, new estates, CQI, Research and provider collaborative. 

While there is clear evidence to work within the system and collaborate with system level partners, there is a distinct lack of positioning and identifying USP areas that can be leveraged.

The delivery plans are realistic. The details on use of innovative technology is brief. There is no mention of standards and ambition to achieve level 6/7 on EMRAM.]]> 2022-11-16 19:56:34 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2387233635 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2388588716 When I read this plan I felt that there were a lot of themes which I felt that our trust alligned with!

So thinking about different parts:
Equipping the system digitally for better care
I can see here that we are doing some work on AI around WNB rates and looking at validating wiaiting lists with RPA. My concern on this part is education is left out and they are such a vital part of the system that I think this could cause challenges.
Supporting independent health lifestyles
Platforms we are developing align with this one. Particualrly around accessibility. We are also looking at digital mental health approaches for CYP.
Accelerating
Again a big link to our innovation team and how they test things and put things into practice. However, I do have concerns on this part of the national stategy around possible monopolies. 
Aligning oversight with accelerating digital transformation
Think this one will be the biggest challenge. Do have some unique opportunities being a peadiatric trust to link with social care in that way. 


]]> 2022-11-17 16:26:07 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2388588716 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2390267690 It would be amazing to get alignment between provider, ICS and London strategies to leverage the benefits and opportunities of a pan-London programme. It would also be helpful if national programmes did the same! As an example - it is a strategic priority to make the NHS App to digital gateway to NHS services, however the reality is that the service does not have the capacity to do this to support regional initiatives. ]]> 2022-11-18 17:50:02 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2390267690 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2390532383 Having read through the plan for digital health and social care, the What Good Looks Like Framework definitely resonates for nurses and our Trust.
The strategy to Digitise, Connect and Transform is clear and provides organisations and the Integrated Care System the guidance and support it needs to drive change and meet our local digital transformation strategy.
Advances in technology and understanding the need for a safe and secure, easy to access patient information at the tip of the fingertips, our Trust has been able to obtain information coming from the GP services through the East London Patient Record.
Our ICS is also looking at new technology and programmes to better equip the community with how they can take better care of their health through the Patient Knows Best programme. 
On a more local level, having a group leadership model approach, and a digital nurse leader, we have a good structure and excellent skilled informatics team to support our goals of digitising EPR within our 5 hospitals.
Getting the clinical staff involved from planning and designing the system all the way to its implementation is a good foundation.
Enabling clinical safety for delivering patient-centred care. With support available for nurses to access training and development to empower them to identify, address and manage risks.
With nursing involvement from ward to board level, and having a safe system to inform practice and improve care, nurses would be at the forefront of innovation that would help transform health and care for the population.

]]> 2022-11-18 22:26:16 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2390532383 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2391019992 I read our Welsh strategy, because the NHS one posted does not apply to me or my work.
The WG is admittedly old, but it forms one piece of strategic guidance that other pieces of guidance have been built on, with digital threads throughout.
https://gov.wales/sites/default/files/publications/2019-03/informed-health-and-care-a-digital-health-and-social-care-strategy-for-wales.pdf]]> 2022-11-19 17:07:47 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2391019992 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2391404935 Our trust digital strategy was published in early 2021 and feels quite dated.  While talking about innovation the ideas expressed are not particularly innovative as they remain constrained within the old school IT services type of approach; automating processes, ensuring staff have the right hardware, software and training etc.

In terms of inspiring a digital vision for transformation, it's not really happening.

The strategy chimes in some respects with the national vision, published much more recently.  This gave me cause to reflect on the rapidity of change within this field and how the challenge of creating realistic strategies with stable ambitions at the same time as responding to change.

What I would wish for and which is largely absent from our strategy is a vision for how digital can enable and empower patients as partners in their own care: this is critical to systems of better care and supporting independent healthy lives.

I would also like to see a strategy that looks forward to new technologies such as AI to support clinical and operational delivery.  

The strategy recognises the digital maturity of the trust but fails to inspire in a way that will help move us forward to a brighter future.]]> 2022-11-20 13:11:21 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2391404935 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2391719710 I was involved in reviewing an early version of the DHCP and bringing in others to review the commitments being laid out for the National Digital Channels (NHS App, nhs.uk and NHS Login). We were not ready to fully commit , due to ongoing work required to build out our positioning of the channels in the wider market and evaluating our capabilities against what was possible. We were also going through a merger that changed the leadership of our area. This is why appendix B mentions that we will change depending on an emerging review of the future role of the National Digital Channels.

We are now progressing by researching user needs, analytical insights and technical capability reviews , although the major organisational changes and reduction in staff numbers will continue for some time. We are still developing against the roadmap and Transformation Directorate priorities mapped against a Prioritisation Framework process for 2022/23. This will be evolved as we move forward our strategy, but not as a document . It will be a set of principles and a decision making framework, alongside processes for empowered product teams to adapt to grow their products aligned to our objectives and KPIs. 

I would like more focus on the development of cultural elements of strategy delivery and very senior level buy in to proposed changes across our organisation and the wider NHS.]]> 2022-11-20 22:22:08 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2391719710 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2394699166 Reading some of the comments here I think I am starting to appreciate my Trust more and more. (sorry). Our Trust strategy aligns well with the Plan for Digital Health. We have a well developed Digital Strategy. Progress towards the Digital Strategy is reported on every month/2 months to our Corporate Programme Board and all of our digital projects and programmes align to part of the Digital Strategy. Our Digital Leadership is much more robust than it was a few years ago, and we now have ambitions of leading the way in innovation and are starting to realise some of these ambitions now - VR is being used for Major Incident training, Smart Stations, Smart Vehicles, making best use of data and integrating and sharing across organisations. I am optimistic for the future and the impetus provided by COVID is not wished away.]]> 2022-11-22 20:55:13 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2394699166 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2399124156 I read the national strategy when it was published. It says all of the right things and I think that the strategic development in the Black Country reflects this well. We will not agree on all details but that is because we have our own population and needs will vary however the strategy and programme we are delivering has similar foundations. We underpin our governance with sub-groups which are both collegiate in supporting delivery of our strategic aims and hold autonomy to drive systematic improvements. We recognise organisational strategies whilst promoting organisational synergies. Where we can work together, we do. Where we can't (due to contractual or other reasons) we strive to align and cooperate.]]> 2022-11-27 15:26:01 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2399124156 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2399254887 Our organisation strategy has been created through extensive stakeholder engagement. Our digital strategy needs updating but certainly fits in with the organisational ambitions and government plans, what good looks like framework etc. We are in the process of EPR implementation and a lot of the strategic plans rely on the successful implementation and consistent adoption of the EPR system. Things like advanced analytics for operational decision-making within our system or TRE development, require structured data and the end-users being engaged and making efforts to complete medical records digitally.]]> 2022-11-27 19:15:01 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2399254887 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2400960912 2022-11-28 21:53:14 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2400960912 https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2402054135 Our first Digital strategy was written in 2019, and despite COVID and like Imperial, much of what we have delivered in the past 3-4 years has been aligned to that strategy and we can see clear line of sight between this and the government Plan for Digital Health and Social Care.
One key benefit from our early ICS digital strategy was that of culture and board focus - like Kevin Jarrold's reflections from Imperial, digital is now seen in our ICS as a key driver to enable change and transformation which is really key to next steps. This will help us in our current digital strategy refresh which will also seek to align further to the national strategy. Our strategy also helped to focus on securing funding, investment and effort via consensus on a set of agreed common goals and objectives which has been a huge help to drive the changes needed.

]]> 2022-11-29 15:01:54 UTC https://padlet.com/alisdair_smithi/ip365hcmksb90u02/wish/2402054135