Key components to delivering successful regional imaging programmes

Jane Rendall examines what is needed to make large scale NHS imaging programmes work.

Jane Rendall

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.

6. Patience

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.

8. Vision

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.

Is the NHS failing to leverage transformation from technology?

Adam Hill.2jpgThe NHS spends a great deal on IT but rarely embraces the service redesign opportunities this offers. Dr Adam Hill, Chief Medical Officer at Sectra, explores how this could change.

The NHS spends significant sums on its valuable IT infrastructure. But despite this investment, our health service often fails to embrace the service redesign opportunities this technology presents, with major deployments still often layered onto existing services.

Redesigning services can dramatically improve care and save substantial amounts of money. Yet missed opportunities mean that we have under-utilised assets, and all this in an era of more for less.

The real opportunity to reshape the delivery of clinical services hand in hand with the deployment of IT programmes can be seen by taking a glance at the recent history of diagnostic services within the NHS. Radiology and pathology are both service delivery specialities within modern day medicine. Consultants from neither speciality have their name above a patient’s bed, but both are mission critical diagnostic specialities, and the bedrock upon which modern day healthcare is based.

One of these specialities has already managed to embrace technology at a remarkable pace. The other has very effectively embarked on service redesign. Yet neither has achieved both—something that must happen in future in order to maximise benefits for patients, enabling a shift to a new era in which cost-effective health outcomes are commissioned.

Radiology and pathology: two sides of the diagnostic coin
Radiology has shifted to digital very rapidly in the NHS. The National Programme for IT (NPfIT) accelerated coverage of picture archiving and communication systems (PACS) to in excess of 95% within 18 months. Despite widely publicised criticism, NPfIT revolutionised the delivery of imaging diagnostic services in the UK. However, the potential to reduce inequality of care provision and improve cost-effective outcomes have been less successfully realised, ultimately impacting upon professional working conditions.

Not only does service redesign impact the health of our population at risk, but it can have any number of indirect benefits. As just one example, it could mean freeing up and consolidating vastly under-utilised real estate in the NHS. Clinicians providing a diagnostic service with a digital workflow can arguably report from an office, a hot-desk reporting hub, from home or whilst on the move with equal fidelity. But radiology is yet to really harness this opportunity.

Pathology, in contrast, has undergone a significant service redesign following the Carter Review in 2008, focused on reducing costs by 20%. However, this diagnostic service has failed to realise the impact upon equality of outcomes and cost reduction that come with implementing a digital workflow, despite the widely held anticipation that pathology will soon be the next big digitisation in healthcare.

IT infrastructure deployment can re-vision service delivery
Embracing IT infrastructure at the same time as the service redesign opportunities that new deployments offer can unlock the potential to transition clinical care provision from centralised environments, through to decentralised models and distributed networks of care.

In diagnostic services, this would mean the ability to balance workloads across a region. It would give hospitals anywhere in a region the ability to access clinicians with the right skillsets to prepare a specimen, perform an examination or report a finding.

Modern PACS systems are cross-enterprise document sharing, or XDS , enabled. They can allow federation of workflow across a region, something that has previously been balkanised by different PACS vendors. This workload balancing can allow hospitals to meet ever stringent service level agreements, whilst improving specialist job satisfaction.

Joining up tasks to join up care
Put simply the tasks of IT implementation and service redesign are currently decoupled. It is very infrequent that a hospital looks for IT to support a service transformation programme. It is equally rare that hospitals will use the deployment of an IT infrastructure project as an opportunity for service redesign to unlock efficiency savings.

We must now move away from a situation where IT is simply layered onto the existing healthcare service as a result of analysing current workflow to inform IT architecture.

The focus must now be on the use of IT to support hospitals and the people within them, whether that is the clinician, the radiology service manager, the CEO, the chief financial officer or the patient.

Innovators will embrace the opportunity to use IT to redesign healthcare, achieving affordable health outcomes today; the risk of being a late adopter is that cost efficiencies are not realised until much later, failing patients that can’t wait for our health system to meet their needs tomorrow.

*Radiology Information System/Picture Archiving and Communication System

About Dr Adam Hill

Adam is a dual-qualified Clinician and Mechanical Engineer, previously having co-founded and led a successful university-based research centre at the interface of both disciplines. Adam’s expertise is in the research, development and optimisation of medical technologies and healthcare services, with over 100 publications and 8 academic awards in the last 15 years.

Having learnt the fundamentals of his clinical trade in the NHS, Adam passed through the Royal Military Academy, Sandhurst, before serving as the doctor to the Household Cavalry Mounted Regiment. Upon retiring his commission, Adam held technical and commercial leadership positions within start-up companies spanning service delivery, skills development and, most recently, technology incubation, before working as a Management Consultant with international clients in the Lifescience and Healthcare industries. During the term of our most recent coalition Government, Adam has provided thought-leadership, advice and content to a handful of its initiatives and programmes.

Adam’s current interests include unlocking the value of networked services, believing that the whole is greater than the sum of its parts; the primacy of imaging in the realisation of personalised medicine; and powering efficiencies in care delivery through standardisation.

Sectra has a rapidly growing share of the RIS/PACS* market the UK, a powerful product portfolio, and a world-class research and development centre at the University of Linköping; these are our foundation, our building blocks and our brain trust with which we can design, develop and deploy solutions to the most complex of problems challenging our NHS customers today.