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GDEs: Never stop learning

Paul Charnley, director of IT and information at Wirral University Teaching Hospital NHS FT, discusses what his organisation has learnt from being a Global Digital Exemplar (GDE).

In some ways, as an exemplar, we are supposed to be in a position to show others how they should do things. Being on ‘a pedestal’ as a GDE can also feel a bit exposed; we certainly don’t know everything. However, as we enter into the second half of the Digital Wirral programme, it’s a good time to pause and think.

In many ways, Wirral is not extraordinary, and has many things it could learn from other organisations. We do have a long track record, from the late 1980s onwards, of implementing clinical systems. That has given us a great platform, but it also means we may have forgotten some things along the way.

It’s not easy to work out looking back at how we achieved what we have. We’re also yet to be fully tested in terms of replicating what we have done with our ‘fast forwarder’ sister site in the Countess of Chester Hospital.

I think we have learned that:

• These things take time. Striving to achieve a strategy based on a few significant principles (patient-centred, clinician-led, single coherent architecture which is as simple as possible – fewest moving parts, etc.) over a sustained period of time gets better results than changing plans based on prevailing technical trends and short-term shortages of funding. It’s also not helpful to tell other sites that they should have started their Electronic Patient Record programme 20 years ago to get to where we are now. That is not the case, but expecting it to happen in a couple of years is also wrong;
• Ensure the basics get done first. Information governance, record structure and integrity, data quality, training, communication. We get into deeper trouble for longer if we ignore these;
• Don’t let perfect get in the way of good. Whilst we have focused on delivering systems and services to our clinicians, we are not exemplary in everything we do. We can learn a lot from others. It is not possible to be perfect in everything, so it is working out what you have to be very good at that matters. In turn, that works best when it is driven by the clinicians;
• We need to pursue the benefits. We need to get better at understanding the ongoing challenge of releasing benefits from technology, which itself is changing constantly;
• Reflect. As we come to document what we have already done to put into ‘blueprints,’ it is not always easy to remember or to recognise what the key issues were at the time and how they were resolved. A little time reflecting on this and documenting things might have helped. It is also easy to get absorbed in what you are doing locally, and some learning from and comparison with other places (e.g. working with other GDEs) is really helpful too;
• Continuous improvement. It’s worth reflecting on what you have done and recognising (and, if you get the chance, celebrating) the thousands of incremental improvements which you don’t appreciate every day, but that are incredibly powerful over sufficient periods of time. This also means you need patience. 

More recently, being part of a national GDE programme is also a learning exercise:

• Global, national or local? We have created tensions between meeting national aspirations and local ones. Our clinicians want some of the more mundane things already implemented to be tuned rather than pursuing the bright shiny projects that fill out our capabilities against HIMSS7;
• When will we be finished? The level of digitisation that we need to meet needs to be clearly defined: what exactly does ‘HIMSS7 level or equivalent’ mean? Can we agree the ‘definition of done’? We will probably never be done;
• Light-touch programme? There is an overhead to being a GDE in reporting and sharing what we do that we were not specifically set up to do. Should have spotted that coming...

However, we can’t complain: we have had funding to help us move forward and we are more than willing to pass on our learning – but as the question implies, we haven’t stopped learning yet.

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