Why do we need the Digital Academy?

James Freed, our Deputy Director of the Digital Academy observes 'Digital doesn’t work yet, but we know why and we can fix it.'

If you go to any conference with 'Digital' anywhere near the title you will listen to many speakers telling you about the wonderful power of these products and technologies and how our life will be so much better.

Half of me strongly agrees. Moore’s law is alive and well, the power digital technologies have to change our lives for the better is exponentially increasing and, at least in someways, sometimes for some people, those benefits are felt. But it is far from the norm.

It is my privilege working in a national body on a niche area, to consume, and conduct research. Earlier this year we conducted a Learning Needs Analysis (LNA) of the NHS with regards to digital skills in collaboration with South, Central and West CSU. One of the things we asked about was people’s perception of digital technologies in the NHS.

6 out of 10

Not bad, but definitely a net detractor score. On average people talk more negatively about their experience of NHS digital technologies than positively. What’s worse is the impact of this dissatisfaction. Data from the Arch Collaborative indicates that staff satisfaction with their Electronic Patient Record (EPR) correlates strongly with the proportion of staff suffering from burn-out. In fact, lowest scoring trusts for EPR user satisfaction have more than twice the burnout rate of the highest performing organisations. Digital doesn’t work. Yet.

There is a body of research that explores failures in digital transformation initiatives and reasons for that. A number of studies put the failure rate of digital transformation at 70%, but my favourite data looked at almost 900 digital transformations and broke down that 70% of failures into minor failures (44%) and major failures (26%) this last category failing to realise more than 50% of expected benefits. Research from Gartner and KLAS that indicate a significant majority (maybe as many as 63%) of those failures are caused by cultural and workforce issues – things that could, conceivably, be addressed by educational interventions.

Incidentally, this is why I love my job – this data means that, if we do our job well in the NHS Digital Academy, if we convert those digital transformation failures caused by mindset and capability deficits from failures into successes, we will be saving the NHS more than £350m every year. And that’s before we’ve taken into account the retention benefits and staff productivity improvements associated with just being happier at work. How’s that for a purposeful job!

Through our Learning Needs Analysis we asked people what their biggest issues with digital technologies were. In some ways the results were depressing – the same lists of the same problems that litter similar studies conducted over the last two decades. However, we took the opportunity to ask who needed to behave differently to fix those problems. We asked those questions in order to develop our own theories of change, what we call our logic model. We wanted to create a series of hypotheses to help us prioritise our educational efforts to make the biggest difference in the shortest time.

It turns out that all of those problems boil down to two core issues:

1. Our staff report to us that they lack the confidence and competence to use the digital technologies we ask them to use on a daily basis
2. The digital technologies we ask people to use on a daily basis are neither usable nor available

To address our first issue of digital confidence and competence, we have hypothesised that were we to support all our workforce with the targeted and personalised support they need to do their job with the technologies they need to use, this issue would be addressed. We also uncovered an unexpected goldmine in 1,200 people who work for the NHS and consider it their job to support the digital upskilling of the NHS workforce. Unfortunately these educators also reported feeling ‘in the dark’ and ‘at sea’ as to how to do it.

To address our second issue, what may be considered the 'root cause' of our digital woes, we need to look at those buying and building technology in the NHS. Clearly this means supporting the professional development and education of our 41,000 strong Digital and Data professional workforce, but our learning needs analysis also identified a second, much bigger group of people.

Service owners, managers, clinical leads and project managers – people with a budget and a mandate to lead change, who simply don’t understand how to buy, build and implement technologies. Collectively these people are responsible for the hidden costs of poorly implemented digital products, the eleven different systems clinicians say they have to log on to in a typical day, each taking 20 minutes, resulting in stress, burnout, retention issues and, ultimately patient harm.

Finally, our analysis identified a group of people who, by dint of their senior organisation-wide position, have the potential to impact on both problem areas. These senior digital and non-digital leaders, Chief Officers and Board members, clearly have a role to play in the context of creating a culture where innovation, within the guardrails of resource bandwidth and safety, can thrive.

I am pleased to say we have some learning products to offer to address some parts of all of these needs, though the offer is not yet fully comprehensive. Our analysis however, helped us work out where we need to prioritise our efforts.

The strength of opinion from the NHS workforce is clear and remarkably consistent. You want us to try and help all our workforce develop confidence and competence in the tools they are asked to use first. Although this is not the root cause of our problem, it is the area where we can make the most difference in the shortest period of time, so that’s exactly where we’ll start.

This year we will start to deeply research the needs of staff to help them become fully confident and competent, we’ll also explore the role digital educators have in this space and what we can do to support them. At the end of the first year of this initiative, we’ll have a collection of minimally-viable learning products aimed at the whole workforce and educators to make a real and measurable difference.

If you or your organisation would like to be involved in our research, please look out for opportunities to participate as there will be interviews and surveys to get involved in.

Digital may not work for us yet, but if we get this right, it will do.