Healthcare Management


We look at the progress of Great Ormond Street hospital, London, and ask – was COVID the driver of their reach-out; and can other hospitals learn from this?

I’m sitting at my office desk and the good people at HIMSS media have sent me a long link so I can easily register. The details of my credentials are already known to them and already pre-filled when I click the link. I am on auto-pilot, I click “yes”. Many times. I am going to the HIMSS20 Conference in Helsinki, except that it is no longer in Helsinki. It is staged in a TV recording studio somewhere in west London.

Instead of trains and planes and hotels – I click on this virtual panorama and I could be walking around the Convention Center at Orange County Orlando – I feel sucked in, I pass by the names of the well known vendors, who have their Announcements, and Booths, and I almost miss it. Hidden on day One, is the modest title:

“Lessons learnt from COVID-19: Supporting and protecting the front line”.

It is redolent of my own far distant days at Uni, the modesty of a non-engaging title that we all know hides far greater truths:

“Some new thoughts on Mozart’s Figaro”.

I pick up the phone, and get through the wait on reception at Great Ormond Street, and get connected. Catherine answers the phone. She is a nice lady.

“Do you want a Soundbite?” She laughs.

I laugh, in my turn. No. I want everything. I want to know how you do it.

What is obvious about this Presentation by Sarah Newcombe and Catherine Peters – is that – despite the turbulence of today’s times, and the recognition that everything has changed – in reality, nothing has changed. As Catherine says in her notes below – Great Ormond Street hospital started on this Innovation journey some four years ago. And HIMSS itself has always been the byword of digital tech reach-out. Speaking at HIMSS has always been a sign that you have made it.

Except that there are of course differences, Innovation itself does not necessarily mean tech. It may simply be a change in the way you approach things. There is no mention of technology in Steve Job’s mantra “think different”. And this is the point of convergence with Catherine’s thoughts; her standout advice is – if you want to get it right, then – “have a Plan; and do it now.”
You can argue that anyone can have “technology”. And anyone can have buzzwords. Just a few years ago it was “interoperability”. Today it is “digital”. I am not sure I know what “digital” actually means, but that does not matter. This discussion and presentation , is the journey that every hospital should be taking but that few have the courage or expertise to do, without a RoadMap.

The notes below, are the RoadMap. This is what Catherine says:

RB; “Innovation” is supposed to be the flavour of 2020.  If COVID had not happened, would you have gone down the innovation route that you discussed at HIMSS?

CP; GOSH has been on a digital maturation pathway for the last four years. The implementation of an enterprise wide electronic patient record (EPR) platform in April 2019 helped us leap forward on this journey. Having a fully digital and paperless health record meant that our staff were able to adapt to COVID rapidly and to continue to work remotely if needed.

The patient portal was included as a key element of our EPR from the outset, and we had actively encouraged patients and families to sign up prior to COVID. However, as the pandemic started, we could see the power of integrating video visits into the portal. Through concentrated power of will and the benefit of a highly functional team, we were able to work with our telehealth and EPR partners at a pace that was breath-taking and skilful. From a completely standing-start, we were able to deliver video meeting capability for 5000 staff and establish fully embedded video-visits capability within our EPR within eight days.

Our vision at GOSH has been to use technology, data and analytics to provide safer, better and kinder treatments and care. This has required strategy, focus and a plan. For us, true digital innovation needed to be a living, breathing entity underpinned by an empowered and enthusiastic workforce where continuous improvement is part of our culture. Innovation that is not nurtured or a fad does not thrive and become a reality.

We are very fortunate to already work within a highly functional and motivated team and for us, COVID has been an accelerating agent; COVID helped focus the minds of those around us to really move at a pace that is difficult to achieve in more normal times. In effect the COVID pandemic forced us to fast forward our plans

RB; Did you have to change your way of dealing with patients?

CP: Our patients are complex, and we have high numbers of face-to-face outpatient visits. This had to change, and we reversed the ratio of face-to-face and virtual appointments within a couple of weeks

The interactions between clinical staff and patients required both groups to adapt to new ways of working (environments, communication and medical assessment itself)
We also had to promote and actively sign up patients to the patient portal in order to schedule video visits. This in turn has opened up the possibilities of the patient portal to many patients and families. Messaging, lab results release and access to letters have been the most popular features of the portal. In turn this means we have improved engagement and communication with our patient groups.

This has fostered our patients being greater partners in their own help. Surely, the patient and their family are the most important members of the care team? We have
developed bespoke functionality (“heads-up”) whereby patients are encouraged to ask their doctor or nurse any questions on their mind before each clinic visit. We feel this is a powerful tool to enhance the connection between patients and their clinical team. We are really happy to share any of our news ways of working and ultimately feel this type of capability would strengthen any outpatient consultation.

RB; The impression we had, was that although you have changed how you cope with things – actually you are still restricted by existing processes, i.e., protocols, policies, etc – that in themselves become a substitute for actual new things. How much did you have to throw the rule book out, so to say, or actually – you have never been restricted – there is an inherent flexible mindset?

CP; There are many ways in which our staff and patients have had to be flexible and change working patterns and environments. At the onset of the pandemic, team meetings, patient discussions, and operational meetings moved to telehealth and video conferencing platforms. Patient safety, clinical governance and safeguarding of course remain of paramount importance.

As a specialist children’s hospital, it is vital that our governance, while done in a timely manner, is done to the highest standards. Our approach to using technology and data successfully has been to incorporate it into the workflow of clinicians and we ensure it supports care delivery. This approach itself acts as a built-in parity check.

We also wanted to help the system and all paediatric patients across the country during the pandemic. Working closely with our colleagues in North Central London, we opened up GOSH to take patients with general paediatric conditions.

Our hospital is centred geographically between many other large hospitals. We were able to support patients and staff in these other locations by opening new ward environments and transferred general paediatric patients to our site. This in turn meant beds in other hospital units were available for adult COVID patients. We onboarded over 200 paediatric staff from other sites within weeks. The need for adaptability and flexibility has been required and achieved in so many areas of clinical care and we are really proud of our staff and patients.

Our greatest asset has been our staff and we are very fortunate to have full executive backing at Board Level in the Trust to leverage digital tools and capability to make a difference and enhance the care we delivery.

Charities Financial Healthcare


We look at the growing gap of understanding between Government and the needs of society, and ask; is it time we woke up and sorted out our social needs, ourselves? We suggest some alternative thinking and practical ways forward.

I drive carefully down the unmade road in the centre of town – they are renovating the offices adjacent. The JCB swings out into the carriageway and I continue, but this time driving on the pavement. It is wet and muddy. There is nowhere to park so I abandon my Volvo half on the pavement and next to the narrow entrance of a place where they fit car tyres. It reminds me of walking in the suburbs of Kiev, Ukraine. Larger cars are struggling to swing into the entrance”.

“You can’t park there mate!!”

We reach a deal. I’m going to the office next door, I say. I won’t be long. I hand the keys of my car to the young guy who I’m not sure I would ever want to go out with my daughter, and I ring the door of the Shekinah offices. So, this where it happens.

Kristy Winters, Shekinah Events and Community Assistant, opens the office door and smiles; “you made it then!?”

If there was any proof that our reliance on Government, is failing us, and that we need to take stock of society’s problems and find solutions ourselves – it is the existence of such charities and outreach that I am visiting now. “We served over 150 hot meals last week”. Kristy says. This is both a good day at the office, – and both an admission that there is an actual need, every week, for 150 hot meals. A perfect day, Kristy continues – would when they serve zero meals. It is an irony.

My initial prejudices were that such charities as Shekinah spring up in some sort of random way, and they continue in that format, because the public sector cannot cope and in some instances does not want to cope. We are becoming inured and totally used to reaching out to the smartie jar of big Government handouts, whenever anything in our personal life goes wrong, a bit like the classic Apple advert; “lost your job? – there’s a handout for that!

This is clearly incorrect. If we agree that society needs help from you and I, then the example here is that an integrated approach at a local level, which brings together local government (not national), along with all of the key private players – works best. In this case – Shekinah is one of an alliance of seven similar reach-out organisations, each specialising in one or two specific areas. Boosted by an ESF Grant (remember these?), which gave part of the necessary funding, that enabled Shekinah to build its own office, which in turn was a catalyst for a series of additional revenue earners, such as Training, Job Support.

It is also a recognition that the situations in which so many people seem to find themselves – are multi faceted. A customer (let’s use that term), may be homeless – but that situation may be caused by some additional factor, which needs to be sorted before the individual can start to contribute back to society.
It also recognises that future funding will come from frankly anywhere. There is as much need for the £100.00 cheque from a local company, as there is a larger public grant. And there is a direct appreciation of the value of each and every donation.
“£100 cheques mean we can make 100 more meals”. says Kristy.

This appreciation drives a continual outreach for food bank contributions, redundant clothing, innovative use of resources. The successful solving of life’s problems, means that everyone here is an entrepreneur. There may well be blue-sky thinking, but this is no marketing paradise. We are at the sharp end of delivering a lot, that makes a big difference, with very little.

I descend the stairs as Kristy shows me around the drop-in and residential walk-in areas of the building. And I am musing. It could well be that the local organisation of like-minded groups, the creation of social hubs, so to say – will increasingly be the answer to societies issues as a whole.

After all, we all know our own local area best. This optimistic thought process gives me hope. In the same way that small local “savings banks” can generate whole new economies – so the network of small but focused charity outreach, can put an end to societies problems in general.

There is an expectation of increased homelessness over the next six months due to COVID and lack of the bigger national schemes which finish any time now. There is some mud on the rims of my car as I collect my car keys from the depot next door. There was a time when that sort of thing meant a lot to me. I think I have other more valuable things to focus on, now.

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