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Applying service design to unlock clinician workload

Reflecting on the RCP’s move to recruit a dedicated clinical director for digital health, Dr James Maguire and Dr Sam Shah from NHSX discuss how best to unlock the clinician workload by applying service design principles. 

Clinicians are experiencing an ever-increasing demand for front line medical services. In addition to delivering hands on clinical care, the amount of associated administrative work has also increased. Clinicians of all disciplines and grades now spend a significant part of their time working through this tidal wave of paperwork. Often this involves having to sacrifice time directly with patients and, for more junior staff, sacrificing training opportunities.

The knock-on consequences of overwhelming our clinicians like this includes burn out, staff exodus and ultimately sub-standard patient care. The problem of administrative work will not go away but there is hope. The ‘gift of time’ is a major theme in the recently published Topol Review, empathising the potential of technology to disrupt existing working practices and to hand back time to staff.

NHS England recently announced the national roll out of its ‘Time For Care’ scheme, in partnership with the Royal College of General Practitioners. This initiative has the ambitious goal of unlocking valuable GP time, using various interventions including digital technology and most importantly changing service design. The results are powerful. The initial pilots reduced the time that patients waited for appointments and also improved clinician workload and their admin burden. If interventions like this can work in primary care, then we need to urgently consider similar initiatives in our hospitals and other clinical settings.

Service design is a method of looking at a whole system by analysing the people involved and the functions that are required. By going back to basics and stripping away the existing processes, it is then possible to work out ways in which the system could function better.  Interventions and tools, such as digital services, can then be identified which meet the requirements and demands of the system.

Clinical informaticians have evolved and now operate at all levels of the health system, spanning policy, commissioning, strategy and healthcare delivery

But how do you start to use service design methodology in a mind-bogglingly complex system such as an acute hospital trust? These organisations have multiple departments, each with countless processes which overtime have been altered, broken or amalgamated. Alongside this, one needs to consider how to juggle the need for innovation with the significant operational demands of already stretched live services. The answer in short is start small and to scale up.

In addition to this, it’s now fairly accepted that culture change is one of the major barriers to adoption of new technology in healthcare.  At the heart of this, there is a rumbling anxiety about the implications of such changes within the workforce.  It’s not uncommon to hear throwaway comments suggesting clinicians could be replaced by artificial intelligence. And whilst these remarks are usually spoken in jest, it’s possible that they shed light on deeper rooted concerns.  The reality is that the true power of digital tools will be their ability to release us from the rising tide of administrative work - as the ‘Time For Care’ scheme demonstrates.  

Clinical informaticians offer a bridge between clinicians, managers, policy makers and technologists. Clinical informaticians have evolved and now operate at all levels of the health system, spanning policy, commissioning, strategy and healthcare delivery. Their skills are increasingly broad and bring together a range of leadership skills to help drive improvements in health and healthcare through the use of digital technology.

The novel post of [RCP] Clinical Director: Digital Health is one of the first of its kind but certainly signals an important moment in the role of the professions supporting the digital development of the health system.

Clinical informatics affects every part of the healthcare delivery in one form or another - everything from the way that services are designed, through to the way we train our future workforce. It’s unlikely that anyone will be able to predict the future of technology or how far it will spread into different components of healthcare but what seems evident is that technology is spreading across the UK health system at pace. It’s essential that both patients and clinicians are involved in the future of a technology enabled health system.

There has been much discussion about everything from artificial intelligence through to the use of online consultations for outpatient clinics. In some parts of the world, advances have been made in the use of technology to assist clinicians in transcribing consultations. A number of global technology providers specialising in natural language processing have initiated projects using voice recognition technology in healthcare.  Clinical decisions support systems which are integrated into electronic medical records may in the future become optimised through the use of real-world evidence. These are all exciting developments and require a constructive dialogue between the profession, industry and policy makers so that the outcomes are of benefit to patients.

The NHS is changing rapidly and initiatives such as the NHS Digital Academy, the NHS Digital Pioneer Fellowships and the NHS Clinical Entrepreneurs Fellowships; and now the Topol Fellowships demonstrate there is no shortage of ambition. The novel post of Clinical Director: Digital Health is one of the first of its kind but certainly signals an important moment in the role of the professions supporting the digital development of the health system.

Dr James Maguire, clinical advisor, digital innovation and artificial intelligence, NHSX 

James is a medical registrar specialising in elderly care in South East London. His clinical interests include liaison geriatrics, palliative care and shared decision-making. He recently worked on implementing an electronic record system at his hospital, which sparked an interest in clinical informatics and he subsequently became a clinical fellow at NHS England. In his role in the Digital Development Team at NHSX, James works across a wide range of digital transformation projects and is keen to engage with suppliers and innovators to stimulate change throughout the system. You can follow him on Twitter at @jamesma9uire

Dr Sam Shah, director of digital development, NHSX

Sam is a clinician and director for digital development at the newly-formed NHSX. He has a background in primary healthcare, public health and research. Sam’s main focus is using digital technology to improve access to health services and to optimise the citizen experience, while improving system efficiency. Sam has overseen the development of NHS 111 Online in England and currently leads on a number of initiatives that are designed to help patients connect to care, and where possible take a digital first approach. Sam and his team lead a number of programmes and projects that span the NHS, as well as a number of partnerships with industry and academia. You can follow him on Twitter at @healthyopinion