Can small improvements really make a difference?

Can small improvements really make a difference?

For my Digital Academy project I decided to make small changes to our IT support processes to improve the service received by our busy clinical and medical colleagues. Could small improvements lead to significant benefits?

“There is evidence that small scale quality improvement can lead to significant benefits. At a time of high demand and financial pressure the NHS should equip staff to discover these low cost high impact opportunities.”
(The Kings Fund, 2017)

In the NHS big changes are high risk and can take time to gain approval and acceptance – I believe small changes are an effective way to make transformation happen more quickly and simply.

User experience should guide culture change (Gartner, 2015) and I wanted to try and understand the impact on user experience to help focus our improvement efforts.

I believed the benefits of improved IT support would be:

  • happier colleagues with less stress caused by IT problems
  • better support services who listen and show empathy to users
  • empowered colleagues able to use IT more efficiently to achieve better patient outcomes

42% of users were unhappy with the responsiveness of IT
Only 50% of calls were answered in under 30 seconds
Over 20% of calls were never answered.
Average resolution for issues not solved at the time of the call was 10 days.

Capacity
After spending time on the IT Helpdesk I quickly realised the service didn’t have sufficient capacity to meet demand. I believe that good IT services should be sufficiently resourced to provide the responsive service needed by users. The best IT services have low call volumes because they deliver systems which are relevant and reliable – designed with the user in mind.

Generification
A shared service approach requires the support of multiple customer organisations with many systems and differing priorities. This has the potential to dilute quality because it is unlikely that one member of the team has extensive knowledge of all user contexts and priorities. This reduces empathy and understanding and requires excellent knowledge management to mitigate.

Complexity
The NHS uses many solutions in the delivery of care which itself is often complex and uncertain. The plethora of systems and services requiring support in our NHS is huge and extends to hundreds of different products.

Supportability
Legacy systems are a big issue with some essential systems running on unsupported platforms. The old systems make support, maintenance and system updates a significant challenge.

Funding
If digital transformation is to make the difference it promises, investment in technology programmes will need to increase. National initiatives often offer capital but with more services becoming pay as you go there is a need to ring fence more revenue for digital services.

People
A whole lot of people depend on technology in their day to day role. It’s these ‘users’ of systems who should be at the forefront of influencing the future digital solutions. Shadowing and understanding what makes life better (or worse) is something all IT professionals should prioritise.

Peer Group
In our Peer Group we had many discussions. The support from my Peers was a real help – it was useful to gain insights from others experience. Growing our digital communities to provide support and share best practice is essential.

Small Changes
After thinking through the challenges with my team we made a number of changes to try and reduce the need to call for IT Support. These included:

  • Floor walking to provide face to face support
  • Spending more time with system users
  • Automation of frequent tasks
  • Self service solutions to empower users
  • Analysing service performance
  • Focusing of top 10 support calls and developing workarounds
  • Looking at the ‘real impact’ on clinical services
  • Influencing change in service provision using the data

Outcomes
Whilst the outcomes have made a difference there is still much to do. The Digital Academy learning has taken me on a journey that has changed my approach in many ways and provided tools to support me in delivering change that really works.

Often in IT we tend to just focus on solving the problem rather than understanding the user context and whether our solution is really the right one.

Seeking to properly understand all perspectives and how they were formed can make a real difference to how we see a situation and how we respond to it.

Using this understanding and empathy in change programmes, and making co design a reality, will be key in future projects because I know it will improve engagement and outcomes. 

Can one small change transform healthcare IT?

Yes 100%. Getting IT staff closer to the operational business was a great decision and I know my users think so too.

At home we all use IT and utilise software and services with minimal need for support – this is the future the NHS needs to aim for.

We need systems that are
Simple, Inclusive & Responsive

Our clinical colleagues who deliver frontline services really are remarkable. It’s about time IT better supported our doctors and nurses.
It’s about time IT was remarkable too.

So, I’ll keep finding changes that make life better and I hope to look back in five years and see those small changes really have transformed healthcare IT.

Incremental small changes will add up to a big difference if we keep making them happen each week.

What will your next small change be?

Rob Blagden