Advice for leaders on driving productivity through technology

A solid digital infrastructure is the bedrock for any meaningful productivity gains. For the NHS, this means moving beyond paper-based systems and fragmented data. Think about the inefficiencies of manual patient record keeping – data can be lost, misfiled, or difficult to access across different departments. Implementing a unified electronic patient record (EPR) system eliminates re-keying, reduces duplicates, and ensures a single, accurate source of truth. Solving the everyday basics like reducing login times or avoiding the need for multiple sign-ins can’t be forgotten among the search for shiny baubles.

Advice: The board should champion investments in core digital infrastructure, including robust networks, secure data storage, and integrated systems. They need to ensure that the trust has a clear strategy for data governance, ensuring data is clean, accessible, and auditable. Without this foundational layer, more advanced technologies will struggle to deliver their full potential.

Staff in the NHS are increasingly encountering and often using AI-based personal productivity tools like Microsoft Copilot or large language models such as ChatGPT. Instead of banning or ignoring their use, boards should recognise this trend and provide clear guidance. For instance, staff might use these tools to draft routine patient correspondence or to summarise medical literature for research purposes. The incentive to do so given time pressures on staff will be extremely strong.

Advice: The board should establish clear policies and training on the safe and ethical use of AI tools, particularly concerning patient data confidentiality and clinical decision-making. This guidance should focus on using AI as an augmentation tool, not a replacement for professional judgment. Trusts could implement internal AI secure testing environment or provide approved, secure versions of these tools to prevent shadow IT and ensure compliance.

Technology is merely an enabler: true productivity gains come from fundamental shifts in culture, processes, and operating models. Consider the implementation of Robotic Process Automation (RPA) in an NHS finance department. While RPA can automate repetitive tasks like invoice processing or claims management, simply deploying the software won't yield benefits if the underlying processes are still convoluted or if staff resist the change. It’s important to encourage a culture where the board and leadership constantly challenge existing processes. If new technology promises a tenfold improvement, but current workflows only allow for a minimal gain, demand a radical rethink of those workflows to unlock the full potential.

Advice: Boards should mandate a whole-service approach to technology adoption, and look at whether sufficient resources are allocated to re-designing workflows, training staff, and managing change. This includes investing in change management expertise and ensuring clinical and operational leaders are actively involved in designing new processes around the technology. The 'cost' of cultural and process transformation needs to be fully integrated into project budgets.

Productivity benefits are directly tied to the actual adoption and effective use of technology. If systems are clunky, difficult to navigate, or don't meet user needs, they will be bypassed or underused, negating any potential gains. For example, an Electronic Prescribing and Medicines Administration system needs to be intuitively designed for nurses and doctors to use at the point of care, ensuring safety and efficiency. If it's cumbersome, it could lead to workarounds or errors.

Advice: Boards should champion user-centred design principles. This means ensuring multidisciplinary teams – including clinicians, operational staff, digital and design specialists, and even patients where appropriate – are involved from the outset in designing and testing new systems. Regular feedback loops and iterative development should be encouraged to ensure systems are truly viable, safe, and desirable for their end-users.

Technology implementations often highlight existing departmental silos, which can hinder successful adoption and benefit realisation. An integrated electronic health record system aiming to provide a comprehensive view of a patient's journey, requires seamless collaboration between different specialties, administrative teams, and even primary care. Without this, the system might become just another siloed data repository.

Advice: The board must actively promote and incentivise cross-departmental collaboration and multidisciplinary working by creating the space for truly multidisciplinary teams to come together. This can involve setting shared objectives for transformation initiatives, establishing cross-functional governance structures, and recognising teams that successfully work together. Boards should also establish governance of digital transformation that trusts and empowers, giving decision-making authority to teams so they can focus on delivering while providing guardrails to keep them focussed on the right outcomes.

It's crucial to acknowledge that the location of investment in digitally enabled transformation and the location of the productivity benefit may not always align. Investing in a digital referral platform for GPs might see the direct costs borne by primary care, but the significant benefits – such as reduced administrative burden, faster patient pathways, and improved specialist resource allocation – could accrue within the secondary care setting (e.g., reduced outpatient no-shows, more appropriate referrals).

Advice: Boards should foster an environment of honest and transparent dialogue about where benefits are expected to materialise, even if they are outside their immediate trust boundaries. This necessitates strong system-wide partnerships and shared governance models, for example, within an integrated care system, to ensure that the broader benefits are captured and incentivised. This might involve joint business cases and pooled funding.

The most effective way to ensure technology delivers productivity benefits is to adopt an agile, iterative approach. This means being clear on the desired outcomes but flexible on the precise path to get there. For instance, when implementing an AI-powered diagnostic tool for radiology, a trust might start with a trial in a specific area, collect data on its impact on report turnaround times and diagnostic accuracy, and then refine its implementation strategy based on those learnings. This not only reduces risks but also improves the chances of productivity benefits as lessons are learned on implementation approach, staff behaviours, opportunities to save time as well as the efficacy of any tool itself.

Advice: Boards should encourage a 'test and learn' mentality, moving away from rigid, waterfall project management. This involves establishing robust data collection and analysis mechanisms to track key metrics related to the desired change. Beyond financial return on investment, metrics should include time saved, errors reduced, patient outcomes, and user satisfaction. Regular reviews of these metrics should inform ongoing adjustments to implementation strategies. Boards should be bold enough to stop things that aren’t working.

Significant productivity benefits from technology in a complex ecosystem in the NHS are rarely immediate 'quick wins', despite what vendors may claim. They often take months, or even years, to fully materialise as staff adapt to new systems, processes are refined, and the full capabilities of the technology are leveraged. For example, the full benefits of a comprehensive EPR system in a large NHS trust might not be seen for several years post-implementation as adoption matures and data analytics capabilities are fully exploited.

Advice: Boards need to set realistic expectations for timelines and communicate these clearly to stakeholders. This involves planning for sustained effort, ongoing training, and continuous optimisation post-implementation supported by skilled teams. They should avoid the temptation to declare victory too early and instead focus on long-term commitment to digital maturity and continuous improvement.