Hospital Record Digitisation

Our firm has been engaged by a UK NHS Trust – a regional division of the National Health Service – to oversee the transition to a single digital patient record system across all the hospitals under the Trust’s control. These transitions have proved difficult and often chaotic in other trusts across the country – with costly systems not being fully adopted.

The new system is designed to integrate a host of current, disconnected paper and digital systems, so that all data pertaining to a patient will be instantly accessible by all medical staff as that patient moves through the system. As well as improving outcomes for individual patients, this should also save time for hard-pressed medical staff. At a higher level, being able to readily examine patient population data in aggregate will better enable the Trust to notice trends, adjust practices and conduct planning.

The Trust has decided to conduct the transition by a specified date in August, with the rationale that this is well away from the chronically busy winter period and ready for the intake of new junior doctors.

This is an interviewer-led case. As such, the interviewer should be relatively active in helping to guide the candidate through the sequence of questions.

The approach required in this specific case will also be somewhat different from more typical strategy questions.

The case should be conducted in a conversational manner, with gentle prompts and small pieces of information to keep the candidate on the right track.

1. Who are the stakeholders and how would you communicate information about the transition with them?

Stakeholders

• Medical staff, including consultants (senior doctors – “consultants” below will always refer to these medical staff members), junior doctors and nurses and paramedics.
• Support staff such as receptionists and those dealing with administration.

How to communicate with these individuals

• Make use of any existing communication channels already favoured within the hospitals and/or wider Trust
• Recruit change introducers from the various departments, who can conduct group or one-on-one sessions with their colleagues
• Set up a helpdesk and make clear how this can be contacted
• In terms of style, make sure that communication is honest. Admit that there might be some downsides – though emphasise that these will be heavily outweighed by positives.
• Attempt to generate excitement/anticipation/engagement with a sustained and well-considered communications campaign.

2. What other issues might come up and how could you address these?

• How can we be sure in advance of the transition that staff can actually use the system correctly?
• Does this system benefit all the different staff members who will use it?
• How can we be certain that introducing this system is the correct decision?

Some good solutions might be:

• Implement good quality training, potentially including testing, to ensure that all staff are fully competent with the system.
• Where required, design incentives tied to rapid adoption of the system.
• Work with the Trust to devise success metrics based around their key priorities with the system – thus, we will probably assess success as some function of time savings by staff and uptick in patient outcomes.

3. How should the transition’s success be measured and what could you do if senior staff are resistant to the transition?

• How should we measure the success of the transition itself? Over what time period should this assessment be made?
• Senior consultants will often resist the rollout of these kinds of systems and might refuse to operate them within their departments. How would you deal with this possibility?

A good answer might contain the following:

• We should assess the success of the project via goals set at the outset. For example, we might require a minimum of 75% transition to the digital system within six weeks and a 90% transition within 10 weeks.
• Where senior consultants are hesitant to implement the system, the first course of action should be to engage with these individuals to voluntarily bring them on board with the project. A positive case in terms of the benefits of the system should be made. We should be honest about any short term inconvenience in getting to grips in the new system, but demonstrate the net benefits that will eventuate in helping to reduce administrative demands on overworked medical staff whilst simultaneously saving patient lives. Having in place objective success metrics (mentioned in 2. above) in terms of staff time saved and improved patient outcomes should make these arguments more persuasive. Attention could be drawn to how the system addresses any of the department’s current problems, as well as the additional tasks staff now have time to perform.

4. What is your concluding synthesis of the information you have been provided with?

The candidate’s main conclusions should be the following:

• The transition affects staff right across all departments and levels in the hierarchy.
• There should be comprehensive training for all staff involved.
• The transition should be communicated not simply as a top-down imposition, but as an initiative with significant positive benefits for both staff and patients.
• It is important to measure both the progress of the transition, as well as the positive outcomes it brings about for the Trust.