Transformation in healthcare

REMI ERIKSEN

Welcome to Trust and transformations - leaders navigating change, a DNV podcast. I'm Rémi Eriksen, DNV’s group president and CEO.

In this series, myself and our business area CEOs sit down with other global leaders to talk about how they tackle transformations, build trust in their business and people, and what they think is coming next for their industry. Right now, they are experiencing a series of historically significant transformations, making trust more important than ever.

This episode is hosted by Liv Hovem, CEO of The Accelerator at DNV, our business area dedicated to building businesses and technologies that shape the future of assurance.

LIV HOVEM

Hello and welcome to Trust and Transformations, Leaders Navigating Change. I am Liv Hovem and I'm joined by Ravi Baghirathan from the Royal Free London NHS Foundation Trust. The Royal Free London is a leading healthcare provider in North London. The Trust serves a population of more than 1 .6 million people across 70 sites.

It is a part of the National Health Service, which is the UK's publicly-funded healthcare system and one of the largest employers in the world. Ravi has been Chief Transformation Officer for the Royal Free London since 2019. His career spans a wealth of healthcare leadership experience, both within UK healthcare provider organizations and within the government.

Ravi, welcome to the podcast. It's really great to have you here.

RAVI BAGHIRATHAN

Thank you for the invite Liv, good to see you again.

LIV HOVEM

Very good to see you again too.

And I suppose that there has never been a more relevant time to be the Chief Transformation Officer at one of the UK's largest NHS trusts. We are recording this episode not long after the country has held a general election for a new government, where the state of the country's healthcare system was one of the single biggest issues for the voters on election day.

What does this tell us about the pressure that the healthcare system face today and the society's expectations on how healthcare system must transform for the future?

RAVI BAGHIRATHAN

I think it's a really good question. There's an increasing importance around healthcare, but particularly the health of the population. Countries are getting bigger, but also we know that people are living longer, which is wonderful. And part of why people are living longer is the advances in healthcare. But with people living longer, that puts more demand on healthcare services to support people into older life.

 We know when you look at different healthcare systems and not just in the UK, that therefore means we are spending a lot more money. But also some of the advances in that are also costing more. So obviously part of what's helping people live longer is some of the advances we're having around pharmaceuticals. There's big investments that we're making, rightly in pharmaceuticals around research and development - all of that costs more money.

So when I first started in healthcare, best part of 20 years ago, obviously we have a taxpayer funded system here in the UK with the NHS. We were talking about around 20 - 25% of the overall government budget was being spent on healthcare. Now it's well over 40%. So it's very important to us as a community and society to kind of help people to live as long possible and with wellbeing. But obviously we also then need to think about how we can deliver those services, help people to live longer, as cost-effectively as possible.

LIV HOVEM

So Ravi, tell me about the typical day in your life as a Chief Transformation Officer at The Royal Free London. What are the immediate issues that falls on your table?

RAVI BAGHIRATHAN

We are running a hospital, we are running healthcare services And obviously the main focus for us is delivering good patient care, focusing on patient safety. And that is always the priority, that is a priority for us. obviously in my role, being the Executive Director responsible for digital, although I am thinking about the future and transformation, we've got a service to deliver now. I often say to people, you know, compared to other businesses and industries, we are a 24/7, you know, business, we are delivering, patient care all year round and it's to support our staff, you know, in, in that environment. So there is a big focus on, on the today, but, as with my role, I need to think about the medium term and the long term, need to think about how we can transform services and not just for the sake of transformation, but to improve services, improve care, deal with some of the issues that we're dealing with. Obviously risk management is really important to us. With digital, it has a real opportunity to really improve patient care. That's both for patients, but also our staff, giving them the tools to actually be able to deliver care in a much more effective way. But those things don't happen overnight, So it's trying to plan those, prioritize those, put programs around those. And I know we will probably get into the discussion is a lot of that is looking at what are the technologies out there? What are the opportunities? But from my experience, actually the biggest challenge isn’t that bit, it's the change piece. It's working with our staff, but also our patients to make sure these things are a success. So we've got over 14 ,000 staff - you noted in the introduction - we've got quite a big population of people in North London that we serve, so those are the kind of considerations that I'm kind of getting, you know, I'm getting into on a daily basis.

LIV HOVEM

It must be incredibly busy and just prioritizing what's most important must be hard in itself. But one of the hospitals in your trust, I know is Chase Farm, which is one of the most digitally advanced hospitals in Europe. Can you please tell me a little bit about the Chase Farm story?

RAVI BAGHIRATHAN

Yeah. It's quite it is quite an incredible story I see when you look at it. So Chase Farm Hospital is in, is in north London. it provided a range of services to the local population. but it was very outdated. It had, you know, it was it was built post-war, for those that want to go and look at the history, you'll see some very outdated buildings for any activity, alone healthcare. You'll also see lots of pictures of temporary buildings, full of bits of paper. So Chase Farm really needed, and not just for the hospital, actually for the local population, needed to be rebuilt. So we started that journey best part of a decade ago when Chase Farm Hospital came into the Royal Free London Group.

But what we were really clear at that point was we didn't want to just rebuild it as is. We wanted to use that building of a new hospital to really transform the services. And as part of that was really to use digital technology as much as we can. So we have really transformed how healthcare is delivered at Chase Farm, but also as an example, as an exemplar more broadly in the NHS.

You know, we talk about it being a completely digital hospital, digitally led, and that is for the whole experience for both patients and staff. So patients will come in and right from the beginning, as soon as they get through the door, it will be a digital experience from checking in through the patient journey to the point where they leave the hospital as well. But a big part of that wasn't just identifying the technologies to support that whole, that whole journey, that whole experience, but also working with our staff in terms of how do we digitize those pathways, those workflows and supporting our staff to use all those tools, which isn't just a point in time support piece, is a constant evolution, a constant development that we need to kind of get into.

LIV HOVEM

Very interesting. Can you also share a little bit about how the organization actually came to the decision of investing in digitizing this hospital in the way you have done?

RAVI BAGHIRATHAN

There was quite a process with the whole organization, but particularly the board in terms of developing the business case for the new hospital. I think it was bit of an opportunity really, which was, you know, I think 10 years ago, you know, there was much more interest in, in digital transformation - not to say that healthcare services haven't used technology, they have been using technology for a long, time. And actually, when you look at some technology development more broadly, actually, a lot of it has been driven out of healthcare originally. But I think there was an opportunity around it in particular, lots of developments around electronic patient records. And why that is important is it enables a single digital system to run through the whole hospital. Whereas prior to that, there were lots of individual systems for individual services. So we could think about a single spine, a single platform for delivering healthcare services. And then that could you provide the foundation for then other digital innovations that we could do.

 So I think there was a little bit for us in terms of the opportunity in terms of an increasing focus on digital and digital transformation in healthcare, some of the technology developments out there, which enabled us to then digitize the whole hospital end to end. One of the big things that I suppose we kind of got into straight away was interoperability. So you can digitize different aspects of your healthcare services, of the patient journey, but do they all talk to each other? And if they don't, then you end up having lots of handovers. And I think you have lots of examples where people printing off paper to then type it into the other system, so you might talk about a digital journey, but there's lots of admins, know, manual admin steps we do it, but we were able to kind of look at the patient journey and be able to digitize it and then link it all together.

So I think there was a number of items that helped us develop that case. But as we got into it, and actually that wasn't just for the board, as I said, it was for our staff and it was for our patients, we were able to kind of push and push and push more. And then, as you’ll know, I mean, there's one thing kind of developing a business case, setting out a strategy, it's then in delivery. And we were able to deliver it with our staff, with our patients, and have been able to build on it, actually.

LIV HOVEM

Let's dig a little bit more into that implementing this because I was fortunate to visit you less than a year ago at Chase Farm and talk to some of your staff and they were very enthusiastic and very proud of their hospital and seemed to be very happy with the solutions they had at hand. But I can imagine that during the implementation process there has also been some resistance and maybe even some, yeah, concerns about the change processes and all that. Can you share a little bit about how you worked as a leader in order to make that change a working?

RAVI BAGHIRATHAN

It is always the whole leadership, it's never about a single individual. I think what I would say is from the experience that we had with Chase Farm is the starting off with a hospital leadership - So we have a leadership team in the hospital - they were really supportive and really drove the identifying the digital opportunities and that digital vision. So that was driven by the hospital, the individual Chase Farm Hospital leadership. But it had support from the board, it had support from the exec.

I think the important thing was kind of engaging with our staff as part of that development process. So this was co-designed, co-developed. And that helps to change process. So it wasn't just a bunch of leaders developing a business case and then that was approved, and then we then said to staff, right, here's the solution. I think there was a development piece right from the beginning to support that as well as patient engagement as part of that. And then the change piece is always the most difficult bit. On the one hand, I've never done a technology rollout where there isn't some technology issues, but you usually can overcome those and that has a focus. But the change piece takes a long, long time and that's not a criticism of it. Change pieces, whatever they may be, tend to be a multi-year programs.

So I suppose one thing I would emphasize is having that continuous support to help people on the ground use the tools. But also, people change over time, so it's just making sure that is a continuous program but also thinking of it also as a kind of a continuous improvement cycle. So what we did know is once we rolled it out, we'd get to know actually its use. That would point to things that we would need to improve, but actually once we had that foundation, it would point to other things that we wanted to push harder on. I think it does start with leadership, but that's at all levels. Definitely one of the successes of Chase Farm was the hospital leadership at the time really drove this and really felt like that they were, they were in the box seat of this. So this wasn't driven by digital, wasn't driven by transformation or other aspects of it. It was really driven by, you know, the, you know, the hospital leadership team there.

LIV HOVEM

Thank you for that. another thing that impressed me when I visited you was not only kind of how you run the hospital, but also that you actually took time to explain to us visitors from DNV, but we were not the only visitor there. There seems to be that you have a big hospitality and you really want to tell the story. Can you tell me why is that so important for you to actually share what you have achieved?

RAVI BAGHIRATHAN

Yeah, I think I think it's partly the NHS, but it's partly the healthcare more generally, I think as an industry, there is a really good network, but a really good culture of sharing experiences, sharing innovations, and actually hoping that the others will learn from it and actually do it better so can go and learn.

So I think there is a general learning culture in healthcare. And that's true at all levels, you whether it's clinical services, whether it's research and development. So I think that is kind of embedded generally in the culture of healthcare. I think it is very much embedded in the culture of the National Health Service, and obviously being a, you know, a public service here in the UK.

But certainly what was important for us then was want partly to showcase what we had done, because it had been a big investment and actually a big investment, know, a big investment by the taxpayer and others in that. And just, you know, give our lessons to others about how we've done and actually hope that they could take on board that in terms of their own developments, but also learn from our lessons and some of the things that didn't, not everything always works kind of first time. So to kind of help that.

What we also find is we learn things from others, whether it be they will have a reflection on some of the things that we're doing and kind of go, have you thought about this? Have you thought about that? So it's definitely a two-way discussion. And also they will bring the things that they are working on. So as you say, when you came for your visit, there were a couple of visitors and actually different - so you came with some of the things that you are thinking about, but we also had a technology company, you know, UK technology company that was thinking about specific bits about how you manage patient waiting lists - so it's part of the innovation piece for us actually is to bring people together. And Chase Farm is actually a really good venue for that.

LIV HOVEM

Yeah, it was really interesting to see and also very encouraging to see that you actually see your role also as sharing the experience and to your experience then, how long do you think it will take before other hospitals are at your level?

RAVI BAGHIRATHAN

It's difficult to say. On the one hand, we often have referenced, you know, Chase Farm is being one of the most digitally advanced hospitals in the NHS and that's true. You know, we are, we are at HIMSS level seven. There are a few, there are only few hospitals in the NHS that are at HIMSS level seven. Actually, there are only few hospitals globally that are at HIMSS level seven. Obviously, there's different assessments of digital maturity.

What I would say is, is I think digital maturity is in healthcare does think about it more broadly because I think when I first started to look at it, you know, it was like, I said, what technologies are you using? Actually, it's not about that. It's about all these being used and how are these being used? It's about it's about use. It's as much about digital culture in an organization. So it doesn't necessarily need millions, you know, millions of pounds or euros or dollars of investment. It's one of those tools out there. And how do you support it? You know, how do you support its use?

And so therefore it can look different in different places. know, Chase Farm is a particular hospital, you know, it's our elective surgical centre, so it's very much focused on that bit. But obviously our other hospitals have, you know, accident and emergency departments, so a very different, so it was not just a lift and shift model.

I think that is the direction across healthcare, so I've looked at the NHS, digital maturity is improving. I think a lot of this is about digital culture. I always say that our biggest focus is our staff. And I think the digital training of staff and that element is increasing all the time. Actually, what we're seeing now compared to 10 years ago is some of those digital innovations are being developed by our own staff. So that is moving kind of in the right direction. And I see that case globally, but it is a long journey. Chase Farm, and what you saw, did not happen overnight. Yes, the new building you can see, you know, took a couple of years to build, but actually the use cases that you saw with our staff takes a long time.

LIV HOVEM

Now I realize that, but I would also think that there would be, there will be even increasingly a push also from the patients who experience the more and more digital society that also when they enter a hospital, they expect certain digital infrastructure to be in place. Do you see increasingly higher expectation from patients on this topic?

RAVI BAGHIRATHAN

Yes, yes, absolutely, so that's why it is a constant development. On the one hand, I described, you when we opened Chase Farm having that digital patient journey. And that was actually seen as quite revolutionary, really. But people take their experiences from their private life,  you know, whether it be, you know, they go to the supermarket or the grocery store and they can do it all digitally compared to what they was like 10 years ago or how much of their life they can run through their phone.

So even though we did change it, and I remember some of the initial feedback was, you know, where are the receptionists gone? You know, where is it like, check in with my piece of paper? And was like, you just go over to the booth and, you know, you press the screen, you identify your name, and then an arrow shows you where to sit, and then you wait for your name to pop up. And it was like, right, this is very different. But some of the feedback we now get is, well, look, I can, you know, manage all my appointments on my phone. Why can't I do that? And we've rolled that out. So you can do, so you get all your communication.

It's not revolutionary to do some of the stuff that you do in your private life. So expectations are increasing. And actually it's not just patients, it's our staff, you know, to our staff also think, well, I can run all my life through my phone while I'm wandering around the hospital. Why can't I do more of my hospital business on you know, on my phone, whether it be, you know, reviewing the patient communication on the way home or dictating the letter or whatever it may be. So expectations increase from everybody and actually that's a helpful thing because again, transformation, whether it's digital or not, needs to respond to, always is helpful if it responds to the needs of whether it be our patients or staff, because it then follows the energy. coming back to the change bit, it then helps with then implementing the change.

LIV HOVEM

Great, Ravi, and it's great talking to you about one of the most important transformations that are happening in society today. But one final question before we end, Ravi.

What is the most important piece of advice that you would like to give to another healthcare leader who is embarking on the transformation program such as you have done in your organization?

RAVI BAGHIRATHAN

I've referenced it a number of times. I think it's important to think about these as transformation programs and change programs. And then it's therefore really important about taking everybody along with you right from the beginning and not just taking them along with you, making sure that they are inputting into that, both in the development of the plans, the design of the plans. And that will then really help you with the kind of the implementation and actually making the most out of it.

So I often say, as I've said here is, is the technology piece is, is, complicated, you know, doing the rollout piece, but actually the change piece is what takes what, what then takes years. And that's not a bad thing.

And I suppose the other thing I would say to other leaders is, don't expect this suddenly overnight to deliver everything that you want it to deliver. It is a long journey and you need to take steps through it and understand that adoption takes a while, but also that will give you the opportunity to look for improvements as well, so.

LIV HOVEM

Yeah, very good. involve and engage the people you work with, everyone, bring everyone along. That was very good advice, Ravi. Thank you very much for the conversation.

RAVI BAGHIRATHAN

Thank you, Liv and thank you for the invite again.

REMI ERIKSEN 

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