Ed Hutchison (pictured below), an NHS doctor and clinical solutions specialist at Altera Digital Health, examines the potential ramifications of not utilising junior doctors in decision-making processes and deployment plans when new technology, such as electronic patient records (EPRs), are introduced in NHS organisations
While decisions on new technology adoption are usually made by board members, junior doctors have a key role to play, according to Ed Hutchison
Since the much-anticipated unveiling of the NHS Long Term Workforce Plan in June, many healthcare professionals like myself have been questioning if the commitments are fit for purpose, particularly in reference to digital transformation.
The plan promises long-term change for the NHS workforce and outlines plans to address an estimated shortfall of between 260,000-360,000 staff by 2036/37.
The actions set out within the plan fall into three priority areas: train, retain, and reform.
And, if the plan is successful, it is expected to lead to an extra 60,000 doctors, 170,000 more nurses, and 71,000 more allied health professionals by 2036/37.
However, despite the plan’s ambitious and strategic approach, it falls short in many aspects, especially when it comes to digital initiatives.
Burnout, underappreciation, and uncompetitive pay are among the many reasons junior doctors decide to leave the UK for the likes of Australia, Canada, and New Zealand.
I have seen many of my own colleagues move overseas in search of better working conditions, who are also tired of outdated technology that works against them.
Despite the plan’s ambitious and strategic approach, it falls short in many aspects, especially when it comes to digital initiatives
The recent and ongoing disputes and strikes regarding pay make it somewhat ironic that, as a junior doctor working in an NHS trust, I can read in the BMJ about my colleagues attending picket lines on one page and see an advertisement for well-paying jobs overseas on the adjacent page.
And this is especially true when you consider the state of the technology within the NHS.
Often something as simple as finding a working computer can be a daily struggle.
Exacerbated by the persistence of paper notes or multiple disjointed systems, it is certainly not hard to understand why a third of junior doctors plan to leave NHS to work abroad in the next 12 months.
As a junior doctor, it is not uncommon, and comes as no surprise, that we often feel undervalued while working in the NHS.
Decisions on new technology are usually made by board members and senior leaders, with those that will actually be using the technology most often marginalised from the decision-making process.
The potential ramifications of this are hard to overlook, especially when new technology is introduced, such as EPRs.
These systems are fundamental in the delivery of high-quality patient care, but the same problems with them continue to persist.
Decisions on new technology are usually made by board members and senior leaders, with those that will actually be using the technology most often marginalised from the decision-making process
It is particularly frustrating when you consider that almost 50% of the NHS’s doctor workforce is made up of junior doctors.
Alongside nurses and other AHPs, they will be the ones using the system day to day and have reported poor IT as a major cause of burnout in the past.
An EPR is such a fundamental aspect of caring for a patient and it needs to serve a purpose and function effectively for doctors to be productive and efficient.
It is true that a stethoscope isn’t the most-important tool for a doctor anymore, it’s the EPR.
On the flip side, however, an EPR and/or bad technology is often the major cause of burnout for doctors.
To restore a positive culture with junior doctors, senior leaders need to include them in decisions that affect them the most, like new digital technology and what tools can help them deliver the best care for their patients.
We all know how technology can be a catalyst for change and can significantly improve processes and patient outcomes.
However, it is as though junior doctors have been overlooked as a sustainable resource to encourage much-needed digital transformation, and such an oversight puts our retention at risk.
To restore a positive culture with junior doctors, senior leaders need to include them in decisions that affect them the most, like new digital technology and what tools can help them deliver the best care for their patients
Given the rotational nature of junior doctor training, we work in different hospitals across the country, exposing us to varying degrees of digital maturity and the different EPR solutions available.
This equips us with a unique insight into what works and what (really) doesn’t.
This knowledge should be seen as invaluable to decision-makers who often aren’t afforded such a multifaceted view.
While input from all clinical staff is needed, it is crucial that junior doctors are included and are afforded protected time away from the wards to offer their expertise.
Much like the workforce plan, making heavy-handed decisions about big technology decisions is short sighted, and does little more than plug holes in a broken system.
And, while one of the core aims of the workforce plan is retention, taking the wrong approach to digital transformation will be a fly in the ointment.
Simply investing in glitzy new technology projects isn’t enough. It’s about getting the right people – in other words, frontline clinical staff including junior doctors - behind the projects and taking a different approach to them altogether, so they can use and procure the systems that work for them.
While one of the core aims of the workforce plan is retention, taking the wrong approach to digital transformation will be a fly in the ointment
There is nothing more frustrating than seeing some new piece of niche AI tech be wheeled out, all with marketing extravaganza and fanfare, when the core clinical systems, and hardware, used every day are still found wanting.
‘Quality improvement’ is such a large part of junior doctor training and more often than not becomes a tick-box exercise to pad out the portfolio that dictates your progression.
Instead, trusts need to utilise this training programme requirement and empower junior doctors with allocated time and opportunities to help local digital transformation.
For example, at my current NHS trust, it is the juniors that have successfully facilitated improvements in the digital medical referral process.
By involving junior doctors in these processes, trusts can help to build a health system that works for them, rather than one that is causing them to burn out.
If we do not start to realise the potential of this untapped resource, we will risk losing them altogether.
An effective EPR is the most-important tool you can have.
In an ever-changing policy landscape, and with increasing pressures like the surgical backlog, which will only become more burdensome come winter, having a system that is flexible and can respond to your needs is so important.
There is nothing more frustrating than seeing some new piece of niche AI tech be wheeled out, all with marketing extravaganza and fanfare, when the core clinical systems, and hardware, used every day are still found wanting
With some EPRs, it can take up to three months to make a small change.
But, with a flexible system, configurations can be completed in under 24 hours, enabling trusts to respond to patient safety issues and policy changes literally overnight.
Having an EPR that supports day-to-day activities, improves patient outcomes, streamlines processes, and delivers the right information at the right time can allow healthcare professionals to shift their focus on to what matters – their patients.
Involving junior doctors and other healthcare professionals in the decision-making processes for new technology not only offers a unique insight into what they want for a hospital, but also inspires the next generation.
Getting junior doctors involved in technology early on encourages them to want to use and be involved in the development of new digital health technology, but also provides an opportunity to learn from those using the technology.
Without a shadow of a doubt, digital transformation needs a fresh and grassroots approach, otherwise we will risk losing even more valuable NHS staff.