29th May, 2019

Marcus Pradhan is a Project Manager on the Outpatient Transformation Programme at Homerton University Hospital NHS Foundation Trust, and one of DigitalHealth.London’s NHS Digital Pioneer Fellows.  He is responsible for identifying areas of outpatient improvement, and implementing digital solutions to cut waste and ensure the right care is offered, at the right place and time.

Marcus is working on a project to prevent unnecessary referrals and hospital outpatient attendances, ensuring only the most clinically appropriate patients are able to access timely specialist care. He is also working on improving pathways and clinical communications and patient-centred care. Here, he writes about what he has learnt about a human approach in digitising a solution to an NHS problem.

Mrs P wanted to raise a complaint, not for an apology or for compensation, but to make sure that no other patient had to go through her experience. The polite 85 year old lady had a debilitating eye condition and was now registered blind, having recently lost her eyesight in her remaining eye due to her surgery being cancelled. Not only did we delay rebooking her surgery, but cancelled her subsequent appointments until four months later when a registrar informed her that she had lost her sight.  

Mrs P is not alone in this. According to HES Data (NHS Digital), 84,825 elective surgeries were cancelled by the hospital in 2017/18 in England, of which 44% was down to admin issues. Similarly, 7 million outpatient appointments were cancelled in the same year excluding allowances for planned leave, emergencies, and sicknesses. The most common complaint that a patient makes about their outpatient appointment is either how long they had to wait to see a doctor or how many times they’ve had their appointments cancelled and rescheduled.

When I started my fellowship programme with DigitalHealth.London, I wanted to pursue a digital solution for this problem with all my heart. Through my personal experiences, I’ve always felt that a simple tech solution could be an answer. The only thing that I am beginning to realise there is a lot more to this. It might not be so simple after all. The key lesson that I have learnt is that not everyone will share the same view, no matter how great you think your idea is – unless you’re clearly able to define and articulate what your problem is.

As an operations manager, a particular issue might clearly be a problem. A clinician might only realise a problem when an incident report attributes a delay in treatment to an appointment that was cancelled, for example due to staff leave (that the clinician was fully entitled to). But we are used to work arounds and manual checks, and we might be able to control this to a certain degree. But as we rely on humans with manual processes, we must accept that to err is human. So when errors do happen, who is responsible? Can we digitise a solution to one of the NHS’ most common administrative problem?

Having attended my first two learning days on the NHS Digital Pioneer Fellowship, my eyes are opening up to a plethora of problems no less complex or difficult that my own. Systematic prescription errors, inequality in access, increased demand, and dwindling capacity for services, caring for acute patients with real time stats – all equally complicated problems. The two things common were that most of these problems were down to communication in one form or the other, and the proposed solutions were to save time. Time means money, and let’s be honest we need to be more efficient with spending in NHS. The challenge is how we achieve financial efficiency, when we’re dealing with human lives and emotions.

Applying a digital solution to healthcare problems, and dealing with complicated issues involving human emotion will take a lot more than a few hundred lines of code. How many assumptions do we make around our problems or purported digital solutions? How do we measure and evaluate what we think is a problem? Is the problem really the problem? How accepting are we that others may have a better idea than you? How much do we need from others as much as they need from you? And most importantly how does this affect the patient?

It does feel overwhelming when I start thinking of what needs to be done, but feel more supported to head in the right direction. Getting to know one another, sharing perspectives and most importantly understanding the common themes in our own complicated problems, with fellow Pioneers has allowed me to challenge my own understanding of how to deal with problems. I sincerely look forward to the next few months working together in a way that seems to the most human approach in digitising a solution to an NHS problem.

Do you think you have a solution to address hospital cancellations in the NHS as a patient or a clinician? Get in touch.

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