Jane Rendall examines what is needed to make large scale NHS imaging programmes work.
Region-wide NHS procurements for diagnostic imaging are becoming increasingly ambitious in their efforts to support faster diagnoses and better care for millions of patients. They are a means to reduce variation, to enhance equity, to change how healthcare professionals access, analyse and report, and they can facilitate new ways of working collaboratively across large geographies.
But what is the key to making these multi-trust projects successful and what lessons can be shared?
I’m fortunate to have worked alongside several NHS consortia that are doing some extremely impressive things. These are some of the key things, in my opinion, that can drive success.
1. Think multi-ology rather than radiology
As an early discipline to digitise, radiology has traditionally been the home for digital imaging in the NHS. But modern programmes are about realising a vision to bring imaging together from across the whole of healthcare.
An integrated multi-ology approach to imaging means a much richer information resource to augment a report, and much more information at the fingertips of many more professionals, and indeed patients themselves.
Taking what has become known as an “enterprise approach” to imaging strategy isn’t a new idea, but it needs to be recognised and put into practice if large scale programmes being embarked on are to be successful.
2. Enterprise level responsibility and strategy
To move to an enterprise approach effectively, responsibility needs to be taken at the enterprise level. This might mean lifting imaging technology out of the radiology department and entering it as an IT or digital service.
There will probably be a range of internal funding and management complexities to be navigated in the process, but this will mean that imaging can sit at the heart of digital strategy and that information vital to patient care can flow more freely.
It will also mean that radiology imaging system managers will not be burdened with an isolated task of managing data from multiple additional departments.
Sensitivity needs to be shown to people who might be concerned about losing niche functionality, and mechanisms put in place to maintain the tools they need.
A higher-level strategy that has the buy-in from chief executives, chief information officers, chief clinical information officers, finance directors and others, and that is clear on what organisations involved are going to achieve, must also be established.
The same “top brass” must also be willing to provide strategic sponsorship, leadership, and decision making at necessary points. Roadblocks will inevitably be encountered as large-scale programmes are conceived and executed. Strategic decisions will be continually needed along the way to overcome anticipated and unforeseen challenges, and those decisions cannot be taken in the ranks. When authority is provided from the top, a mandate can be given to allow the willing entrepreneurial people delivering great things on the ground to drive forward the initiative.
3. Managing complexity at a regional level
Elevating imaging to the enterprise level of a trust is one thing, but how can this be effectively done across an entire region? Some of the programmes I have worked with have as many as seven, eight, or even nine trusts involved.
One answer is to contract under one participating organisation which in turn has memorandums of understanding in place with all of the others. There are proven mechanisms that can work, but contracting is just one consideration in a programme that involves navigating everything from data sharing to the allocation of human resource.
That is why authority provided by strategic regional board level sponsors is key; if this is a priority for CEOs in a region, then it becomes a priority for others to work through some of these significant challenges.
But equally key is establishing appropriate governance structures, and putting the right people in place to manage delivery. Successful programmes that I have seen are driven by a type of “civil service”: people who do the job, who ensure strategic papers are passed through necessary boards and who can ensure the right things happen at the right time with the right people.
As a supplier, I think we must have faith in our customers and their ability to do this effectively, but again it comes back to having the right strategic objective with appropriate milestones, and a full understanding of how decisions affect different people throughout the organisations involved.
4. Finding the champions – and not just “yes people
Finding champions early is extremely important. For example, artificial intelligence is an area which is of huge interest. But even something as exciting as this will go nowhere without a champion who is really looking to push the idea within the customer organisation; someone who can talk to people and engage, energise and inspire them. Champions must have a level of power to drive the conversation and they need to have aligned goals.
Once the champions have been found, it’s important not to take them for granted and to show them appropriate recognition. This might mean helping to elevate their voice as an influencer or thought leader in the media, for example, or nominating them for awards for which they are deserving.
Successful programmes need more than “yes people” though. You also need champions who are prepared to challenge. That’s when you really start to have useful dialogue. You want people who spot the problems before they happen, people who know the operation and who know their business. We need the people who really understand technologies and what we can do outside of the norm, so that when a problem requires an unconventional solution, the art of the possible can become reality. As a supplier, that sometimes means knowing when to take an anti-sales approach and to bring the technical experts to the table.
5. Work with the exiting supplier
Exiting suppliers have a significant role to play in smooth transitions, especially for areas like data migration.
It can be challenging for a supplier that might be disappointed to be the outgoing party. But it is important for that supplier to consider long-term relationships and their reputation in the market.
Where we have exited in the past, we have made sure we have delivered a professional, timely, responsive approach to that exit. It is a long-term game and a small world in NHS technology. In 5 or 10 years we might well be back there.
Programmes of this scale do not happen overnight. That’s not to say that given the momentum building in the NHS for regional diagnostic approaches that accelerated approaches cannot be developed. But with so many parties involved, things can take longer than a lot of people might predict. Be patient and maintain your determination.
7. An open mind
Customers can often benefit from approaching procurements with a truly open mind. Sometimes people can have a preconceived idea of what the solution needs to look like before they go to market. Sometimes getting real value from the market means allowing competitive suppliers to come up with the innovative solutions to meet the requirement.
Some suppliers in the market have learned lessons from similar projects that have gone before, lessons that they are often more than happy to share. And they may have visibility of new technology coming down the line that the contracting organisation isn’t necessarily aware of.
Intelligent customers know their strategy, they know their organisational needs, the requirements of their people and they know their business inside out. But they also know that there are opportunities to be educated at times. There might be ways of solving problems that they hadn’t previously considered. And in some major procurements we have seen the end solution looking very different to the original requirement.
Establishing and communicating a central vision is crucial throughout all of the above. This must be bought into from the most senior CEO to the user on the ground. Given the pressures faced in NHS diagnostics, and the opportunities for transforming patient care that come from a regional approach to imaging, the vision behind many regional initiatives is extremely powerful.
About Jane Rendall
Sectra UK’s Managing Director, Jane Rendall, joined Sectra in 2010. Located in our UK and Ireland headquarters in Hertfordshire, Jane has a strong clinical background and is on a mission to drive innovation through collaboration and evolve healthcare IT to more cost efficient and adaptable platforms to improve the effectiveness of patient care across the UK and Ireland.