Digital insights: Outcomes are at the heart of patient care, so why not your digital transformation?

Consider the difference between:  

‘Deploy the new Electronic Patient Record (EPR) to all staff by Q2’ 

And

‘Clinicians have more time for patients, less time with screens’
‘Patients tell their story once’ 
‘All operational decisions are based on accurate evidence’
‘Safe handovers - every time’

For an NHS board, this changes what is measured, what assurance looks like and how the organisation is set up to respond to changing environments and priorities. But this is not about dropping one approach completely for the other. It’s about how you as a board prioritise, how you measure and communicate progress and most importantly how you lead and support your workforce.

In a world of competing priorities and rapid change, it’s no surprise that many organisations struggle to deliver their strategies effectively. One of the most powerful - but often overlooked tools to bridge the gap between strategy and execution is deceptively simple: clear, outcome-focused language. A good outcome clearly describes a change in patient, staff or service experience. It is measurable within a defined period of time, creates prioritisation by excluding what won’t be done and stands up regardless of a change in supplier or technology. Whether it’s in your strategy, or communications with staff, the language you use signals what truly matters. 

The NHS Performance Assessment Framework (NPAF) states “the underpinning principle of the NPAF is that over time measures should increasingly focus on outcomes and effectiveness alongside access and value for money.” 

Yet the use of outcomes linked to digital transformations remains limited in our experience of working with over 150 NHS boards on the digital agenda, whilst the value of doing so is clear. 

The most common framing of digital transformation we see can be summarised as 'Deliver software/solution X by date' or 'Transition from solution X to solution Y by date' a framing which doesn’t articulate the problem or inspire teams to solve it. It is perfectly possible to deploy a new digital transformation programme (such as EPR, Robotic Process Automation or Electronic Prescribing) and not achieve any of the quality, effectiveness or productivity outcomes that were hoped for.  This happens when focus has been on the output (the system) and not the real work of changing and transforming processes, practices and behaviours to drive the outcome you want to achieve.

As a board and senior leader, focusing on outputs alone increases the likelihood that you miss or ignore the work needed to meet your outcome. Using and role-modelling the language and behaviours of outcomes can unlock the full potential of teams, enable adaptive delivery, and provide a stable framework for change - even in complex environments.  

This briefing highlights patterns of working for the board which, done right, will mean outcomes can become the trust’s Rosetta Stone: a shared language that helps leaders communicate ambition, and teams deliver with autonomy, purpose and confidence.

When trusts define and use outcomes as a marker of progress, they do more than track performance. They create the conditions for an empowered and adaptable workforce and change how delivery happens:

Outcomes provide autonomy by clarifying intent and not just instructing teams to meet ‘X’ milestone. When your workforce and teams understand the change that is required, and why, they are better placed to adapt and respond appropriately. 

Outcomes enable your experts. By putting decision-making closer to expertise, outcomes free teams and staff to try new ways of working towards a clear goal, reducing failure of projects later on and improving reliability. This is particularly vital in uncertain environments like healthcare, where rigid plans often break down. An outcome-focus allows adaptation without losing direction. 

Outcomes frame purpose. Clear outcomes reduce wasted effort by helping teams focus only on the work that contributes to strategic priorities. They make strategy tangible and meaningful and they are a key to unlocking the strategy execution gap.

Outcomes de-risk delivery. By being clear about the change, rather than the solution, boards can reduce the risk locked into untested assumptions. If teams are instructed to deliver a system by a specific date, they will prioritise that delivery even if it doesn’t deliver the change you need or sought.

Outcomes provide stability. A meaningful outcome, such as improving patient experience or reducing administration time, takes longer to achieve than individual tasks or system deployments. Longer term horizon outcomes provide continuity amid the noise of organisational change. Outputs and milestones still matter, but they should be reported in terms of how they contribute to sustained improvement, not treated as an end in themselves. 

For boards, this translates into greater confidence that digital is supporting productivity, workforce sustainability and consistent quality of patient care, with earlier visibility of delivery risk and stronger assurance that the organisation is making progress against its strategic and financial priorities. 

The promise of outcomes is real, but it’s not automatic. Getting them right requires both discipline and a willingness to change how you lead – and how you work. This is primarily a governance shift, not a strategy re-write. Something that can feel tough, especially given the constraints and pressure that boards operate under, but you can do it by starting small and focusing on the patterns we’ve set out below. In each area we’ve provided an anti-pattern, the actions and behaviours which limit an outcome focus and a pattern to follow which will encourage an outcome focus. Do more of the patterns and less of the anti-patterns and you are on your way to unlocking the value of outcomes. 

Characteristics of an outcomes-focused board leader:

Spend time building real trust and show that you mean it.

One of the biggest challenges is that outcomes demand trust. Moving away from rigid milestone tracking of outputs and activities towards test and learn delivery means that leaders must give up some control. It also means shifting the role of leadership from monitoring assurance to enabling collective confidence and creating the conditions for team success.  

Instead of asking 'are we on track for go-live?', ask: 'are we learning?' 'are we on track to make the change we said we would?', 'are our teams confident in what they’re doing?', 'does what we do really matter to our patients, staff and service users?' These questions prove you care about the outcome and will build trust with your teams. 

Trust anti-pattern: You demand a fixed go-live date (output) for a new system before clinical workflows have been validated with frontline staff. Forcing teams to deliver the plan, not the desired change.

Trust pattern: You focus your conversations and challenge on the key clinical/operational outcome metric (e.g., 'reduction in inpatient wait times') and trust the digital team to adapt the technical solutions (outputs) to achieve it safely. You provide clear guardrails to teams to help them make decisions within a framework and make governance meetings more valuable by asking how you can support and remove obstacles or blockers to delivery. 

Lead through uncertainty

Transitioning to an outcome-based model requires leaders to engage with uncertainty, challenge existing false certainty and understand the benefits of doing so. For many leaders, their identity is tied to being the one with all the answers who directs the work. To step back and empower the team to find their own solutions is a courageous act of humility and a demonstration of true leadership.

It also takes courage to stand by the principles of this model, especially when faced with setbacks. There will be times when the team's chosen path doesn't lead to the expected results. In these moments, a courageous leader doesn't revert to old habits of dictating solutions. Instead, they foster a learning environment where failures are seen as opportunities for growth and refinement, reinforcing the team's autonomy and strengthening their problem-solving capabilities for the future.

Courage anti-pattern: You are continuously funding or focusing conversations on IT ‘solutions’ over new, outcome-driven digital capabilities. Technology teams are only engaged when new software needs to be implemented, not when solutions are being considered or designed. 

Courage pattern: You prioritise a cross-departmental outcome (e.g., improving staff experience), even if it has an uncertain delivery path that crosses your organisational boundaries. You identify early milestones as key learning points to build confidence in your long-term approach and align clinical, operational digital leaders together. 

Even in a time of pressure, you give it time

Working in this way can be met with resistance from individuals who are accustomed to more traditional ways of working. Some fellow leaders or workforce colleagues may be uncomfortable with the level of autonomy and accountability that comes with this model. 

You must be prepared to navigate this, provide support and coaching, and build a culture where the new way of working flourishes. It's a change that, as well as trust, requires patience and persistence. As a board, you will need to iterate and work together too, you’ll not get this right the first time. Talking about that openly will be important to prove to teams across the organisation your commitment to outcomes. 

Time anti-pattern: In the interest of pace, you task the departments across the trust to come up with a handful of outcomes (which are a rapid re-writing of the current outputs) which are then prioritised and agreed and set in stone. At the first quarterly review of progress towards them, priorities have changed or it is found that outcomes haven’t been adopted as expected so completely new outcomes are written or outcomes are abandoned. 

Time pattern: You invest in crafting outcomes in partnership and ensure buy-in before you commit. Once working towards an outcome you review progress towards the outcome with equal interest in the outputs, the approaches taken to work towards the outcome, new learnings and overall progress. You iterate the outcome where necessary and you support teams by unblocking them when challenges arise. 

You craft your outcomes and don’t settle for the first draft which will be ‘alright’ 

Working effectively in this way relies on defining meaningful outcomes. It's a demanding task to articulate what success looks like in a way that is both specific and measurable, without being overly prescriptive about the process. 

There's also the inherent challenge of balancing short-term results with long-term strategic goals, ensuring that the pursuit of immediate wins doesn't compromise the organization's future.

Well crafted anti-pattern: Your outcomes are so broad or ambitious that it is hard for teams and staff to understand how they contribute to its success. A ‘healthier population’ is a great aspiration, but everything the trust does can contribute to that. The outcome must exclude some things otherwise there will be no prioritisation. 

Well crafted pattern: You have real priorities behind your outcomes, they are informed and data-driven. They are short, clear and memorable for staff. For example, instead of 'implement electronic observations', say 'deteriorating patients are escalated within 15 minutes - every time'. They are something that teams and leaders recognise as valuable within a timeframe of two to three years.

The trust’s digital strategy is centred around six priorities that clearly communicate outcomes that will benefit staff, patient and service users. These include:

1. Improving core clinical systems 
   Enabling staff to work better with improved clinical systems
2. Empowering patients 
   Technology and support to enable patients to be more digitally active in their care
3. Advancing the use of information
   Turning data into actionable information to improve care and outcomes
4. Seamless system-wide working 
   Working closer with partners across organisational boundaries
5. Improving efficiency
   Releasing time to care through better systems and technology
6. Safe, secure and stable systems 
   Equipping our staff with the technology they need and keeping systems secure.

By framing the strategy around priorities that resonate with users, this increases buy-in and engagement.

The former digital health strategy is based on a model where outcomes are identified that will create the greatest possible value and impact, technology is then agreed and once thoroughly tested, made available for implementation across the wider health system. Example outcomes include:

• Patients have more options of taking responsibility for managing their own health.
• Patients interact with healthcare professionals who have prior insight into the patient’s pathway.
• Healthcare professionals will spend less time obtaining relevant information about the patients to whom they are providing treatment and care. 

The real problem that focusing on outcomes helps you with is the notion that a big, complex change by date X can work only if we do enough planning and then stick to that plan. This false certainty limits innovation and problem solving. Outcomes encourage iteration towards the end state you are trying to reach and your outputs become navigation points to help you course correct as you go, stopping what doesn’t work and supporting what does. 

For the board, embracing an outcome-focus is not about adopting a new strategy; it is adopting the approach required to successfully execute your existing strategy. By using a shared language of outcomes, you directly connect every digital investment and delivery activity to the priorities and the financial sustainability of the trust.

To make this real the board must ensure their behaviours reflect what they are saying. In practice, that looks like: 

1. Identifying an outcome where your clinical, operations and digital teams can work together and craft that outcome collaboratively so that everyone is bought in.
2. Create your measures of success or indicators that will help you understand how you are progressing - include things you want to learn as well as outputs you want to deliver.
3. Create space for the team to work together, ensure they have time rather than slices of 'the slots that doctors have but I have forgotten what they are called' which never overlap.
4. Change the board papers for this work, instead of just a RAG status against milestones, ensure the team shares progress against overall outcome, what might have changed, risks to achieving outcome and the help needed from the board.
5. Ask assurance questions on the direction of travel rather than the here and now. Do we have evidence to show the work to meet this outcome is improving care? If we deprioritised X piece of work, what outcome would fail? What have we learnt that means our desired outcome might not be possible?
6. Ensure updates on finance and risk track the financial benefits linked to outcomes not only outputs, create a distinction between risk to meeting delivery date and risk to achieving the outcome.

Successful digital transformation is not achieved when a system goes live, it is achieved when patient care is safer or when productivity increases through better use of staff time. An outcome-focused board ensures that every digital investment can be translated into measurable impact whether that be quality, safety or productivity.