Fixing the digitisation process in the National Health Service: Three steps at a time

Responding to popular demand

Nearly three-quarters of NHS staff believe that digitisation could transform patient services and have urged their trusts to invest in new technologies and software (Thornton et al., 2024; Chipman, 2023).

In recent announcements, Prime Minster Kier Starmer and Health Secretary Wes Streeting outlined a renewed focus on modernising the NHS through digitisation. The Labour government plans to prioritise the use of artificial intelligence (AI) in hospitals and expand the NHS App as part of broader efforts to enhance frontline care (Department of Health and Social Care, 2024; The King’s Fund, 2023).

These measures aim to address existing inefficiencies and support the NHS's transition into the digital age, with the expectation of improving service delivery and contributing to long-term productivity gains (Lord Darzi Review, 2024; National Audit Office, 2023).

It remains uncertain whether this announcement will provide the boost the 75-year-old institution needs, especially following the previous cuts to frontline digitisation funds earlier this year to offset the costs of strike actions.

Playing catch-up

Yet, despite the promises of digital transformation by successive governments, the real issues remain unsolved. While technology and AI are driving productivity in other sectors (Yang, 2022; Magd et al., 2022) the NHS continues to lag behind in implementing even basic digital tools to properly support frontline staff (King’s Fund, 2022; Health Foundation, 2023).

Discussion of new technology and the use of AI for our public health services should be viewed sceptically, given the previous failures of digitisation attempts within the NHS (Cresswell et al., 2024; Sheikh et al., 2021). The National Project for Information Technology (NPfIT), initiated under Tony Blair, was shut down and cost UK taxpayers £13 billion.

Following that, the then-Health Secretary pledged for the NHS to go paperless by 2018, but this plan also fell through. The plan was later renewed to ensure that all NHS hospital trusts would have electronic patient records by the end of 2025, but even the government's own Infrastructure & Project Authority deemed this goal unachievable (Freedman and Wolf, 2023).

In the face of such high-level rhetoric and a real struggle for public funds at every level, the disjointed digitisation strategy for an institution with over 1.6 million patient interactions a day is at a genuine risk of falling behind in terms of efficiency and effectiveness (NHS Confederation, 2023).

The missing link

Our previous research, 'The digital transformation conundrum: negotiating complexity through interactive framing', suggests that frontline digitisation efforts are not just about the technology, but also about the workforce. NHS staff, as the end-users, have a direct stake in the successful adoption or non-adoption of technology.

Despite the focus on technological innovation and digitisation within the NHS, macro-strategies have often overlooked a critical element: investing in the workforce. The existing workforce shortages, coupled with the challenge of recruiting and retaining staff, exacerbate the impact of any operational changes.

The lack of emphasis on workforce development has led to a "subjective rejection" of digitisation initiatives, as NHS staff face increasing demands without the support or training to effectively integrate new technologies into their workflows.

This institutional rejection is compounded by "cognitive fatigue," where overworked staff are unable to engage with new digital tools, leading to decreased morale and increased turnover.

The challenge of recruiting and retaining skilled healthcare professionals only amplifies this issue. Reports have highlighted that vacancies across the NHS have reached over 110,000, with shortages in nursing and frontline care role (NHS Confederation, 2023). As a result, NHS staff are often too stretched to focus on mastering new technologies, which further entrenches resistance to change.

Bridging the gap

Addressing these dual challenges of institutional rejection and cognitive fatigue requires an "interactive approach to digitisation." This means focusing not only on introducing new technologies but also on engaging the workforce at every level, providing adequate training, and addressing the broader issues of recruitment and retention.

A digitisation strategy that acknowledges the human element – through workforce support, adequate staffing levels, and interactive training – can help mitigate these challenges and foster long-term engagement with digital transformation efforts.

By positioning technology adoption as part of a broader workforce strategy, the NHS can address both the operational and human aspects of transformation, ensuring that digitisation enhances rather than hinders patient care.

The concept of an interactive approach to digitisation has mainly been discussed in academic theories and texts, but it offers a vital lens to address the challenges of digitisation in the NHS. This approach involves:

a) Building a roadmap that considers the complexity of the digitisation process and promotes enhanced engagement by end-users.

b) Addressing biases at different stages of digitisation to improve acceptance by end-users.

A threefold approach

Based on our research (Zaman et al., 2023; Zaman et al., 2020), we have identified three dimensions of a comprehensive strategy as part of our interactive approach to digitisation:

1. Dual strands of digitisation (people and technology)
Equity of recognition is crucial for successful digitisation. Both end-users and technology must work in sync. Transformative digitisation projects should have a clear roadmap and operational identity for both entities.

2. Reduction of technological bias
In complex institutions like the NHS, technological bias can lead to disillusionment among the workforce and hinder the successful adoption of novel technology. Plans must consider a holistic viewpoint where the workforce remains central to the solution offered by digital artefacts.

3. Upskilling the workforce
Amidst the excitement of multimillion economic spend and novelty of digitisation plans, the localised needs of the workforce are often overlooked. The institution must prioritise understanding the workforce and its needs in relation to the operational capacity of the technology. Sufficient investment must be made at both pre- and post-implementation stages to ensure the success of digital efforts in the diverse workforce of the NHS.

The dimensions outlined above call for policymakers, practitioners, and politicians to adopt a more decentralized approach while still maintaining a strong local voice for effectiveness.

During times of urgent need to improve patient outcomes, our approach to digitisation must be more deliberate, coherent, and, most importantly, built on past rectifying historical misdemeanours of the decision-makers. Our research shows that digitisation is most effective when healthcare professionals are involved in decision-making about technology.

A bottom-up approach, where staff help shape digital tools like electronic patient records, ensures better adoption and usability. This co-design process aligns technology with clinical workflows, enhancing both patient care and workforce engagement, allowing the NHS to fully leverage the benefits of digital transformation.