Digital Transformation AssignmentAnalyzing Issues Encounter by NHS services

Question

Task: Case study: NHS Integrated care (North East of England)

National Context
In 2016, NHS organisations and local councils came together to form sustainability and transformation partnerships (STPs) covering the whole of England and set out their proposals to improve health and care for patients. In some areas, a partnership will evolve to form an integrated care system, a new type of even closer collaboration. In an integrated care system, NHS organisations, in partnership with local councils and others, take collective responsibility for managing resources, delivering NHS standards, and improving the health of the population they serve. Local services can provide better and more joined-up care for patients when different organisations work together in this way. For staff, improved collaboration can help to make it easier to work with colleagues from other organisations. And systems can better understand data about local people’s health, allowing them to provide care that is tailored to individual needs.

By working alongside councils and drawing on the expertise of others such as local charities and community groups, the NHS can help people to live healthier lives for longer, and to stay out of hospital when they do not need to be there.

In return, integrated care system leaders gain greater freedoms to manage the operational and financial performance of services in their area.
More information is available in: Breaking down barriers to better health and care. There are now 18 integrated care systems as shown on the map below:

Local Context: Priorities for the Teesside area
Preventing ill health and increasing self-care. Helping to stop people from becoming poorly and helping to manage their health and any medical problems they already have.
• Supporting people to stay well and independent for as long as possible by improving health and care services within their area.
• Through the Better Health Programme, improving the quality of care in hospital and making sure that people get the best treatment and see the right specialist.
• Using technology in healthcare to improve the ability to diagnose, and develop more convenient treatment options for patients.

Our vision: Meeting our communities’ needs now and for future generations with consistently better health and social care delivered in the best place.

Specific Areas To Explore For North Tees & Hartlepool Trust

The trust has highlighted some key issues (listed below) that they (with your help) are aiming to solve in a relatively short term, medium and long term:

Issue 1:
Some patients who have been discharged from hospital may require continuous assessment to aid their recovery from procedures. This is a particular issue for elderly and vulnerable people living independently in their own homes. If the trust is unable to monitor their recovery, patients could relapse and need re-admission to hospital, or have no choice but to enter the residential care system. These are expensive outcomes. Unfortunately, health and social care providers are overstretched and cannot respond quickly enough to early indicators of a deterioration in health and wellbeing.

The trust believes that being able to track a patient’s patterns of behaviour from the point when they are discharged and through their recovery period would be extremely beneficial and would greatly improve the outcomes from hospital care.

Issue 2:
Training is a vital part of the trust’s activities. As treatments are improved and rolled out, or new equipment is purchased, medical staff need to be trained in new procedures effectively and cost efficiently. Training is often done on the job. See one, do one, teach one is still a common way of cascading knowledge in a high-pressure environment, but mistakes can have real consequences.

The trust believes there are opportunities to harness new technologies to minimise risk and reduce costs. Not every scenario can be taught ‘live’ and there is a need for staff to gain experience through simulated situations. There are also areas where automation might help staff to avoid making the wrong decisions when they are unfamiliar with new procedures or struggling with a high workload, for example in prescribing the right combination of medication.

Issue 3:
Every letter sent by the health services costs £1, said a trust Chief Executive in 2018. Country wide there were 100 million outpatient appointments that year, each requiring at least one letter to be sent. The costs include medical staff time spent dictating letters after patient consultations, administration staff time typing them, paper and envelopes, and postage.

The trust believes that considerable costs can be saved through transformation of routine communication with patients. They would like to develop an end-to-end strategy that addresses the way information is recorded at consultation, how it is then translated into an appropriate and sympathetic message to the patient, and how it is sent. There are also opportunities to improve patient engagement with the letters they receive e.g. booking their appointments.

Issue 4:
In the NHS it is important to constantly introduce innovation through research & development on new techniques, medicines and treatments. Currently each hospital has a R&D team that collects patients’ information for those who meet relevant criteria applicable to qualify for medical trials. The team is notified via clinical colleagues when they have specific patients who meet the research study requirements e.g. Patients who present Cardio issues and meet a specific set of criteria such as age and gender would be flagged for the Cardio drug research study. However, this is done on a case by case manually and there is no digital system which allows R&D representatives to see full patient medical details who not only qualify for the specific study but may also qualify for other research studies based on their medical history. The Trust wishes to investigate how the system could be automated in order to flag patients which qualify for the relevant studies.

Your Work
Using the issues mentioned above and what you know of the overall NHS services, you have been hired as a ‘Digital Transformation Consultant’ to investigate how digital transformation could enhance or/and impact on the Trust, its organisation and services to the stakeholders. Your knowledge is very much valued, and your work could greatly influence the Trust’s strategic decisions.

It is expected that you will provide clear ideas of possible technologically driven solutions that could be implemented within the Trust to solve the four issues above. It is imperative that your strategy and critical review demonstrate that you have carefully considered the impact of your strategy on all stakeholders as well as ethical and security issues.

ICA Requirements

Part 1: Digital Transformation Strategy (50%)
This part of the in-course assessment is intended to address Learning Outcomes 2 and 6.

You will be required to create and plan a digital transformation strategy for North Tees &Hartlepool NHS Foundation Trust.

This part of the ICA will be around 1,000 words. You will be assessed on the:

• Coherence and appropriateness of the digital transformation strategy with the organisational aims; consideration of impact of the strategy on stakeholders

• Logic in the prioritisation of the strategy implementation plan; It is suggested that you provide some high-level indications on how and when you would manage the implementation of your digital transformation strategy. Please include a technology implementation road roadmap.

• Clarity of the representation of the overall strategy and plan. Indeed, you are expected to use graphical representations of your strategy instead of it being heavily text-based.

Part 2: Critical Essay (50%)
The aim of the critical essay is to justify the digital transformation strategy and plan that you proposed in Part 1. It is expected that your justifications will be founded upon a thorough and reliable literature review of appropriate subjects matters. You are expected to investigate the following:

• The state of digital transformation of the sector under scrutiny i.e. health care, and in particular literature associated with the four issues provided in the case study above. It is suggested that you use existing case studies if available.
• Technological trends and their possible applications to the sector. You could use application of technologies in different sectors to help you justify applications to healthcare.
• Foreseeable challenges to implement and manage the digital transformation strategy proposed in Part 1.
• Security, ethical and social considerations linked to the digital transformation strategy.

Answer

Chapter 1: Digital Transformation Strategy
1.1 Introduction:
The digital transformation assignment will encompass on topics such as the background of NHS, and will discuss about four different issues of NHS with technological solution and their impact on the stakeholders along with the implementation strategy and implementation roadmap for each solution.

1.2 Background:
The NHS expands from the North West to the South of England with 1.4 million staff working in it (Jonker and Fisher, 2018, pp. 1-6). As of 2016, NHS organizations have blended with the local councils to form sustainability transformation partnerships which have turned out to be in some cases, effective collaboration and help in providing constructive care to the patients as well as aids in gaining freedom for leaders of the care system. The NHS is planning on building 40 new hospitals and more than 50,000 nurses to be employed in the NHS.

1.3 Issue 1 – Lacking post-treatment supervising
1.3.1 Problem statement:
The care system is inadequate with services that assist in monitoring the patients’ pattern behavior after their treatment and discharge from hospitals. Staffs often find it difficult to monitor the medication and other health related data of the discharge patients.

1.3.2 Technology solutions:

1.3.3 Impact of solutions on stakeholders:
Since the solutions are based on the aims of NHS, this is convenient for the patients. However, staff might feel garbled by the new technology incorporation and might require initial training. This solution considers ethical and economic considerations. While facility staffs will have less work since the patients visiting the hospital plummets. Many low level non-clinical staffs might get hit by unemployment. However, researchers would find this easy to gather data to implement it on their research studies. Students will have lesser interactions with patients while working as an intern.

1.3.4 Implementation strategy:

1.3.5 Technology implementation roadmap:

1.4 Issue 2 – A greater need for staff training and automation

1.4.1 Problem statement:

To conduct effective training for the staff to effectively incorporate new technologies. Still, the training would not be sufficient to eschew medical errors, so the need for automation in medication proliferates.

1.4.2 Technology solutions:

1.4.3 Impact of solutions on stakeholders:
I would say it has a positive impact on both the staff as well as patients since staff can concentrate further on taxing issues than billing and any such rudimentary actions, and patients get an effective response and can be diagnosed from home considering their age and treatment impacts on their physical and mental health.

1.4.4 Implementation strategy:

1.4.5 Technology implementation roadmap:

1.5 Issue 3 – Extravagant spending on communicating patients

1.5.1 Problem statement:

The healthcare industry found it preposterous to send millions of pounds in reaching the patients through letters along with the time spent by the staff members in drafting them rather than concentrating on other importunate issues.

1.5.2 Technology solutions:

Mobile medical apps Applications such as “Medicall” helps the patient to maintain their appointments and notify them of their medications. With the help of AI, the reports after consultation can directly be sent to the digital devices of patients (Peek, Sujan, and Scott, 2020).

1.5.3 Impact of solutions on stakeholders:
It provides a positive impact on both patients and staff members. But shadows negativity in facility managers, since the digitalization will truncate the requirement of such job titles in the healthcare industry. It provides an opportunity for researchers to further enhance their research and bring out innovation.

1.5.4 Implementation strategy:

1.5.5 Technology Implementation roadmap:

1.6 Issue 4 – Lack of digital perusal technique of patient records for research studies
1.6.1 Problem statement:
The R&D department in hospitals finds it is strenuous to read patient data and flag them for particular study and diagnosis. This engenders concern among the researchers as to gather and collaborate similarly affected/diagnosed pati

1.6.2 Technology Solution:

1.6.3 Impact of solutions on stakeholders:
Positive impact for the researchers, students, and practitioners as they would gain easy access to old patient’s history and diagnosis techniques and medications easily which will alleviate the painful process of doing same thing again. No impacts on patients and staff members.

1.6.4 Implementation strategy:

1.6.5 Technology implementation roadmap:

1.7 Digital Transformation roadmap

Chapter two: Critical review

2.1 Introduction
The essay reviews on the history to the future plans of NHS’s digital transformation in a timeline format. The National Health Service (NHS) is a public organization developed to fortify the healthcare system in England (Atkins et al., 2019, pp. 11-17). In 2016, this organization coupled with the local councils to form sustainability and transformation partnerships (STPs) to enhance the health of the citizens of England. This coupled organization can also be mutated into much more effective collaboration. The primary purpose of such collaborations would be to manage the resources, deliver the NHS standards, and ameliorate the health of the patients they serve. This integrated system provides multitudes of benefits to both patients as well as leaders in the healthcare system (Allsop, 2018). However, in the local context, these systems assist in obliterating the people from exacerbating their health conditions with imprudent negligence of proper medication. The essay also emphasizes on the 4 different issues faced by NHS and provided a viable solution for each one of them. The vision of the organization is to meet the present as well as future health needs of the community. In this critical review, we are to discuss the history of digital transformation and its incorporation in NHS along with the general trends in the technology and solutions for certain issues faced by North Tees &Hartlepool Trust. And finally, by discussing the impediments and challenges faced in successful transformation is discussed explicitly with security, ethical and social considerations in transforming the NHS service digitally.

2.2 Digital transformation
The digital transformation can be defined as the successful integration of digital technology in every aspect of the organization for its betterment and to change the business operation techniques and strategies to develop the company into a propitious one (Ebert and Duarte, 2018). On an organizational basis, the digital transformation would bring out changes in how the organization operates and how they provide value for their stakeholders (Fletcher and Griffiths, 2020, p. 102185). For instance, if the manufacturing company incorporates the technology into the process, then much manual labor would be losing their positions and be replaced by the technology changing the work atmosphere and the operation by waxing the efficiency of the industry. While in case of the cultural change, the organization has to constantly tax the cachet of the company, should be stolid about the failures, and finally must be tested and observe the results and ramifications of the transformation process (Hartl and Hess, 2017). For instance, some technological incorporation may not be as constructive as it was anticipated, in such cases the operation would be a complete failure and might affect the surrounding actions as well. The company must prepare for such consequences while executing digital transformation in the company. A new strategy inside the company requires many employee groups to change their working methodology and approach being so, transforming the complete organization operation would require a lot of changes and effective acceptance from every working people inside the organization (Kutzschenbach and Bronn, 2016). For instance, involving technologies in people’s workplace would be new to many workers which would slow down the progress. In such cases, the companies have to execute training programs for the workers to get accustomed to the technology being incorporated.

2.2.1 History of Digital Transformation
The hotspot for the digital transformation (DX) would be when there was an internet boom in the market in the 2000s. However, digitization begins in the 1940s with Claude Shannon’s work on “A Mathematical Theory of Communication”. The invention of the microchip in the 1950s made analog computing to go digital for effective usage the starting point for the conversion of physical clusters to digital clusters. In the 1960s, the first message was sent over ARPANET, the basement for the modern day’s internet broadband (Crocker, 2019, pp. 14-23). In the 1970s, home and personalized computers are introduced, and data entry jobs are introduced to aid the ventures to convert analog records to digital data. The 1980s is considered commemorating era for the automation as world wide web is first invented. By the 2000s, over half of the American houses owned a personal computer, the inception of the digital revolution (Cosmulese et al., 2019). However, it took almost 10 years in 2014 to show success in pioneer digital transformation processes. By 2015, MIT and Deloitte articles fortified those strategies are crucial for digital transformation, not the technology (Menear, 2020). In 2017, the virtual budgets proliferate and enhanced the solutions made through software. By 2018, the DX continues in hegemonizing the business strategies and initiatives have begun on mobile technology, IoT devices and so (Hossain, 2017, pp. 61-65). In 2020, more than 50% of the companies in the world have engendered a DX strategy on their venture as to the predicaments caused by the COVID – 19. In 2021, the continuation of the predicaments further dynamized the digital revolution in various industries and started influencing different quotidian activities from banking to entertainment. It is estimated that by 2022, the budget allocated for DX would reach $2 trillion (Dmitrievskiy, Eremin, and Stolyarov, 2019).

2.2.2 NHS Digital Transformation

For lucid understanding of NHS digital transformation, the answer for “what?” is clearly expressed with the help of a timeline. Now, the answer for “So what?” will be the effectiveness of NSH and its implementation. Since the inception of NSH, it has been proven to be effective in transforming burdensome activities into easy ones. It has been effective in enhancing the health problems among the people of England. It has improved the health factors of the population for the past years from its initiation of digital transformation in NSH. It mitigates the patients' struggles in acquiring effective healthcare and instantaneous diagnosis. Now with the struggles installed by the pandemic, the digital platforms in NSH will be an added benefit in curtailing the detrimental health effects among people.

2.3 Technological Trends
What are the technology trends in recent times? Computer and the internet have been key elements for the recent trends in technology such as IoT, Artificial Intelligence, Machine Learning, Augmented Reality, Digital Marketing and so (Mohri, Rostamizadeh and Talwalkar, 2018). So, what are the effects of these trends? These trends have been anticipated as the future of the industrial world. Now, what is the future for trends? These trends have shown that the scope of these technologies is rigid and inflexible.

2.3.1 Technologies for solution 1
The technology that could resolve the issue of maintaining an effective surveillance system for monitoring the patients after their discharge would be through mobile applications such as Banner Health iCare, Mercy Virtual Care Center, and many more, as well as by telehealth and video conferencing. I have chosen these technologies since they are cheap, reliable, and easily accessible by both the customers as well as staff. The mobiles are now an inevitable device that is inseparable from our quotidian lifestyle (O’Bannon et al., 2017, pp. 125-141). Being so, handling one by the staff or patient would be easy and could truncate the time wasted for the training session in understanding and contemplating the new technology in action. Similarly, the video conferencing option lets the patients be in their homes and consult their doctors through video conferencing. This helps the patients to get the diagnosis immediately, and patients are in no need to travel to the hospitals to get the consultation. Telehealth is another distant healthcare service that helps the staff members to monitor the health of a patient from the hospital itself. Through telehealth, the nurses or caretakers will provide instructions o medications. This kind of technology is used in many business firms and schools recently with the quandaries of coronavirus. And it has been effective with the evolution of the internet. Other technologies that could be used in place of the mentioned ones will be the AI incorporated medication monitor where the predefined comments and remembering notifications would be provided however this is difficult to use as most of the patients are elderly age group and would be expensive to install such high-end technologies.

2.3.2 Technologies for solution 2
The technology that could resolve the problem of providing effective training to the staff members is robot process automation, AI applications, and Augmented reality. Human errors are unavoidable being so, even with effective train sessions ad education staff tend to make mistakes that could end up in serious issues since we are speaking of healthcare industries, it might even lead to serious fatality (Mulac et al., 2017). So, to truncate all such issues, automation is the best option. Automation could effectively replace human actions and could be conducive to obtaining fruitful outcomes. Recently the healthcare has incorporated automation in various fields, such as robotic process automation is used in handling administrative tasks such as billing, maintaining cash flow, drafting patient’s care plan, scheduling the appointments for the patients according to the availability of the doctors, and amount of free spaces available in the hospital to intake further patients by the hospital to maintain an amicable environment (Ratia, Myllarniemi, and Helander, 2018, pp. 222-227). The next one is AI applications which would be assisting in the collection of surveys and examining the responses provided by the patients and finally the augmented reality in the surgeries and other diagnostic practices. This incorporation is primarily beneficial since it pacifies the mentality of the staff working in healthcare to concentrate their mind on more taxing issues. Many customer service providers and manufacturing plants have already implemented Augmented reality for effectively designing and simulating the process (Lai, et al., 2020, pp. 69-81). Other technologies would be surgeries handled by robots and AI-incorporated machine parts; however, these are untested and are probably dangerous to the health of the patients (Seto, Mori and Aikou, 2017, pp. 193-198). So, partial automation while handling the patients and complete automation in handling the medications and coordinating plans will be constructive.

2.3.3 Technologies for solution 3
The effective solution for overcoming issues related to truncating the communicating cost for delivering the report after consultation would be through telemedicine, patient portals, and mobile medical apps. Telemedicine as discussed before will let the patients interact with the doctors virtually ad so the reports can be delivered through mail or SMS or even could directly be delivered from the doctor (Alshammari, 2019). Second would be the patient portals that could be developed by the hospital institutions which could help the patients to check the status of the medication and any recent updates on the medication provided or even for obtaining the reports after the consultation. These patient portals will help the patients to download the reports whenever they require them (Cronin, et al., 2017, pp. 110-120). And finally, the mobile medical applications, such as Medicall which uses the SMS or the mobile networks to share the reports of the patients after the consultations as well as will help in setting an appointment with the doctor according to the availability of the doctors (Verissimo, 2018, pp. 442-447). Mobile applications have been proven to be much effective and reliable as they can handle more sensitive cases as banking (Baabdullah, 2019, pp. 38-52). Mobile banking is one of the most revolutionizing trends of the modern era. The primary importance of the deliverance system is the safety of the report. Since mobile could swiftly handle banks and other transactions, mobile medical apps are the most suitable form of communication for North Tees &Hartlepool Trust to save 1 pound in every mail order.

2.3.4 Technologies for solution 4
The final issue is the difficulty faced by the R&Ds of the hospital institutions to gather and categorize different patients’ records into a criterion-based arrangement. For instance, under the column of cancer patients, age above 40, gender male, our handpicked guy must be placed if his records strike all of them out. If not, then a new column would create starting with that record. For a long, this has been done manually. People would collect the details of the records from the pile of patient records and categorize them one after the other. However, with the recent developments in technology and internet platforms, hospitals could now use a Clinical decision support system (CDSS) that reads the record and contemplates them, then with the construed results these records will be categorized under different criteria. This form of segregation is used in food production industries, however, there are only two options to categorize – either good or faulty (Asioli et al., 2017, pp. 58-71). This is a rudimentary form of what can be used in the healthcare industry. CDSS will categorize the records effectively with the margin of failure extensively less when compared to the human categorization. These segregated records are used for research purposes in further enhancing the treatment techniques and caretaking operations, also this categorization is useful in quickly determining what type of diagnosis and medical intervention is needed for the patients and which one will be effective and which one will not be effective by comparing to the previously stored records.

2.4 Challenges/Impediments to successful Digital Transformation
There are four primary issues faced while effectively incorporating the digital transformation in the hospitals and healthcare systems:

i. Inadequacy in interoperability platforms – all the NHS trusts depends on the workforce solution platforms to handle and organize their staff member either permanent or contingent. The integration inside these solutions is less and ineffective which makes the NHS trust to lend some help from the outside source this loots a big sum of money from the budget. This impediment hampers the effective incorporation of telemedicine and telehealth services and exacerbates the digital transformation (Kouroubali and Katehakis, 2019, p. 103166).
ii. Forgetting the importance of the human workforce – implementing fully technological practices ad automation will be effective in some cases, however, in other sensitive cases, there will be a need for the human factors to operate. This is a manifestation when avoiding human factors in important processes such as surgeries and so. Plummeting human workforce will curtail the number of staffs to operate telemedicine or data grouping technologies (Adeola and Evans, 2018, pp. 66-83).
iii. Inexperienced staff members – this would be the most crucial issue impeding the successful incorporation of digital transformation. If there are no staff to operate the cutting-edge technologies in healthcare then there would be no use for implementing them firsthand. This will affect monitoring post-treatment patients, extravagant spending on communications, and digital categorizing techniques.
iv. Ineffectual government standards – Many services and solutions do not provide the fortification of the government. This lack of government support could affect the incorporation of high-end technologies such as Artificial intelligence or telehealth to gain the credibility of the patients with its government assured authenticity. “The main barrier to adopting high-end technologies in low- and middle-income governments is the cost and maintenance” (Syzdykova et al, 2017).

2.5 Security, Ethical and Social Considerations
Security issues in digital platforms have been a growing concern in recent technological enhancements. Being so, it is important being a security analyst to develop the skills and equally grow with the technology and transform regularly to keep in touch with the changing firewalls and other components supporting the security of the digital platforms (Mendhurwar and Mishra, 2019, pp. 565-584). As a security analyst I have found from researches that AI technologiescould build millions of variations of antibodies to obliterate the threats. The core ethical values to be followed by the organization is to:

i. design for the privacy, security, and integrity
ii. promote trust
iii. beware of the differences
iv. assuring the presence of accountability

While considering the social aspects of the organization I have hired to analyze, the digital transformation could help in managing the environmental impact of the business by helping the companies to become eco-friendly (Hanlet, Busse and Kolbe, 2016, pp. 463-502), and will help the organization to abide by the legislation and regulations. As a security analyst I have found digital transformation as an effective tool for capturing the internet frauds, and unauthentic medical records.

2.6 Conclusion
This critical essay has encompassed various issues and suitable solutions for those issues and why those solutions are more suitable than any other prevailing techniques are well discussed in the essay. Also, the essay successfully discusses the impediments that are holding back healthcare from incorporating digital transformation into the system. What are major issues and impediments are discussed? So, what will be the solutions for those issues is also discussed. And finally, now what could be done to prevent those issues is discussed by considering various factors such as social, ethical, and security. So, if the NHS focuses on eschewing these hampering factors, then it could succeed in digital transformation.

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