Not able to see the wood for the trees
The NHS is under an ever-increasing pressure to balance rising demand and limited resources, while improving outcomes. Recent initiatives such as Sustainability and Transformation Partnerships (STPs) have embarked on planning journeys to tackle themes such as reduction in variation, more integrated working, workforce and stronger leadership. However, the level of confidence and commitment to these plans has been patchy and has led to further revalidation work or expensive transformation based on intuition. The gap between planning and reality is widening.
Why is this happening given the vast amount of available data and investments in digital, particularly at the organisation level? A major driver is the lack of connection between data science and decision-making. From our research, we see important decisions being made by boards with varying levels of knowledge of the organisation. There are several drivers impacting this:
- Focus: use of data for optimising organisations and resource management is inconsistent and trails digital health investment in personalised care and pathway redesign.
- Contagion: the need to ride the AI, big data and population health wave means investment is being made in large scale data projects without fully understanding the benefits and how they can help deliver large scale transformation.
- Data safari: focus is on collecting historical data and disproportionate time and resource are spent on reporting, rather than making sense of the data to enable objective decision-making.
- Perspective: siloed focus on transactional data and benchmarking, failing to connect the dots between different data dimensions and understanding cause-effect to give a single version of truth.
- Capability: manual and cumbersome data gathering, processing, analysis and reporting further compounded by lack of skills, experience and capacity.
Consequently, decision-makers are taking an isolated view of the world based on their beliefs and cognitive biases. This creates different versions of the truth. The result is overlapping investments, transformation inertia, political challenges, reinvention, promotion of a heroic culture and shifting the burden from one year to the next.
For example, within one calendar year, a provider organisation spent around £3.5m on external analysis over several projects supporting the planning of clinical improvement, the winter beds programme, bed flow optimisation, productivity, capacity and demand, and feeding into transformation and business case development. This is in addition to the opportunity cost of making the wrong calls.
We need to humanise the data
Working with NHS Providers for almost a decade, we have developed an alternative approach. As an example, we supported an Acute Trust in developing their road map. They had reached a cross roads and wanted to reduce their financial deficit while considering collaboration opportunities within the wider local health and social care system.
Being an early adopter of electronic patient records, the Trust had amassed enormous amounts of data. However, as with many NHS organisations, there was little intelligence and insight informing the decision-making at all levels. Furthermore, the information was viewed in silos i.e. from either a quality, finance, performance or operational perspective.
Wanting to take a different approach, the organisation went on a journey of discovery and design fuelled by a multi-platform digital solution. A team of economists, clinicians, anthropologists and data scientists conducted advanced qualitative and quantitative analysis and modelling to:
- Determine who are their cohort of patients, how well they are served, their future needs and the burden of care
- Understand how current services are consumed, the cost to serve and how these need to change to meet future demand
- Determine the causal links between quality, finance and performance in delivering patient outcomes
- Link insight to the boardroom and regulator’s agenda.
A key element of this was humanising the data and telling patient and staff stories – making it real. This helped unlock the value from their existing data and gave a much better understanding of the organisation, clarity on areas for improvement and most importantly a shift in focus from data to individuals and their needs. This led to the development of a complete system transformation and the establishment of an integrated care alliance.
Lessons from the field
We have been supporting NHS providers to develop innovative strategies, effective plans and disruptive innovation in service redesign, fuelled by humanised data. Along this journey we have learned some key lessons:
- You do not need large and expensive programmes to develop actionable insight
- Perception of needs and priorities differs between clinicians and patient
- Small changes can have big impact, but you have to take a different perspective
- Data for decision-making is already there but we need to go beyond the current descriptive and benchmarking approach to analysis
- Avoid the herd mentality. Every organisation is unique and to get most value you must create the human context
- You have to bring the staff along on the journey and contextualise the data to help them connect with the insight and build confidence
- A good test of insight led decisions is if an organisation can simplify its transformation agenda.
Tomorrow's solutions, today
A key myth is that this requires quality data and large investment. We took on the challenge and developed JinKo.
A complete data analytics and modelling solution, JinKo humanises and creates a golden thread through an organisations’ dataset, to create a single version of the truth. Developed over 5 years with a number of NHS providers, it provides deep analytics on the population and service users. The tool explores their needs, wants, health profiles, demographic and socioeconomic characteristics, health behaviour, resource consumption, cost to serve and future burden of care. It provides a single source for informing the multiple strands of work within an organisation from strategic planning, service redesign, productivity improvement, through to contract designs and managing patient flows.
Building on our experience, organisations can be up and running within a period of six weeks at a fraction of the cost and significant financial savings. This enables leadership to refocus from analysis to action and improving patient care. Organisations will also become members of the Strasys Digital Health Academy (SDHA) to access continuous support, peer-to-peer learning, capability development and leveraging the latest data science developments to enable organisations to move up the digital maturity curve.