AwinguruTalks is a podcast and video blog in which we talk to technology thought leaders, experts and decision-makers. In it, we explore a wide variety of topics – including the current state and future of enterprise technology, IT security and remote working. For this episode, we have the pleasure to welcome Jas Cartwright, Head of Digital Innovation at Worcestershire Acute Hospitals NHS Trust and chairwoman at the BAME Network.

The Worcestershire Acute Hospitals NHS Trust is a publicly funded healthcare institution consisting of three hospitals, spread across the Worcestershire county. Running such an organization comes with many challenges, such as budgetary constraints, providing a way to let its clinical staff work from home and keeping their patients’ data secure. When COVID-19 struck in March of 2020, Jas lead the operation to equip their workforce with remote working tools by providing them with devices, giving them access to the already in-place Awingu workspace and enabling virtual consultations where possible. Let’s take a look at her conversation with our CMO, Arnaud Marlière.

  • About NHS Worcestershire
  • Digital transformation at the NHS
  • Budgetary constraints
  • Primary IT challenges
  • 'Work from home' in an NHS setting
  • Awingu at the NHS
  • Data security is crucial
  • What does the future hold?

Welcome, everyone, to this corona-proof edition of Awingurutalks. We will be talking about digital transformation at the UK National Health Service, the NHS. I have the absolute pleasure to welcome Jas Cartwright. She’s heading digital innovation at NHS Worcestershire Acute hospitals and she’s also chairing the BAME Network. Welcome, Jas – it’s an absolute pleasure to have you with us. Can you tell us a little bit about yourself before we get started?

Of course! As you’ve said, I look after digital innovation for our local NHS Trust and I’ve been here for a number of years. The role I have is really exciting: it’s about helping clinicians and addressing some of the clinical issues that they have by finding them innovative digital solutions that can help how we manage patients.

Since we have audience from outside of the UK, could you explain a little bit what the NHS and NHS Worcestershire Acute are?

Absolutely. We’re a publicly funded organisation, run by the government. We treat all patients, free at the point of access. Worcestershire is a very rural economy and county – we consist of three hospitals, and we’re about ninety miles apart from one hospital to the other. We provide different services in each of our hospitals. We treat emergency patients who are brought to us by ambulance, or patients can come in and see us if they’ve broken an arm or hurt some part of their body. Furthermore, we also do elective procedures as well, like when somebody needs a hip operation or a replacement knee operation.

So three locations, not very remote from each other. How many people are working in that context?

Our staff counts about 6,500, consisting of nurses, doctors, cleaners, porters, transport people, and back-office services like HR, finance, digital, et cetera. It’s a big workforce, one of the biggest in Worcestershire.

We’re recording this in the middle of the COVID-19 crisis. I think that when the pandemic hit us, it was tough for a lot of organisations – but I can imagine specifically hospitals had a lot of challenges, for many reasons. Of course, challenges equal opportunities, but still. Can you talk a little bit about your experience in terms of IT and digital challenges?

You’re absolutely right. When COVID-19 first came about around February/March and the lockdown was announced, we were faced with the question: “how do we transition our services to still be able to provide services to the patients who need them, but still protect our staff and patients in those scenarios?” Now, luckily for us, it was about our state of readiness. We had staff who needed shielding, we had patients that were shielding but still needed to access clinical services on an ongoing basis. We had to ask ourselves: “how can we marry the two with protecting both staff and patients at the same time?” So we moved a lot of our services to remote and virtual services. That’s a huge challenge, as you can imagine, both from a technical, digital perspective, but also in terms of change management. How do we get our clinical staff to start thinking about using digital in a different way? Before COVID, it would’ve been difficult to put that change in place. But what we’ve managed to achieve is, I’d say, three years of transformation in about three months. That’s an amazing feat to look back on, to see that change come through. We managed to stand up, and I think it was down to some of the good work that we’d already done. We managed to stand up remote services, using Awingu, for our staff. We were ending up having something like a thousand staff using Awingu, enabling them to work from home, access clinical systems, use our virtual consultation platforms to talk to patients, giving staff more devices to enable them to do homeworking, et cetera.

And then another matter arose: “how do we manage those patient relationships as well in terms of the digital and making sure that they were included?” In some cases virtual consultations don’t work for certain patient groups, which is fine. How do we still enable them accessing services through telephone, et cetera? It was a huge challenge and it was a lot of hard work from a lot of services behind the scenes. But, you know, to get that sort of feedback, where we were still able to see patients, patients and relatives could still keep in touch through virtual visiting, through iPads that we deployed, and through the remote access solution that you helped us provide and stand up. In the end, we were able to still keep providing services, which is key in a remote and rural countryside area that we live in.

Virtual consultation as an idea is not new. I don’t know the situation in the UK, but did you guys have experience with that before COVID? What was the adoption, what was the feedback on virtual consultations?

Oh, that’s such a good question, because had we have started the conversation around virtual consultations with our clinicians in, let’s say, January, we would’ve got the “no way, there’s no way this is going to be taken up, why do we need this?”-type of answer. “Our patients don’t want this service. They want to come see us face-to-face on-site.” But obviously, through COVID, we had to really limit and stop people coming on-site unless it was for emergency treatment (or COVID). Now, the only way that they could have an access to their services was through a virtual consultation platform. We had clinicians and services coming to us to say: “Look, we still want to provide support and exercise services to our patients. We still need to reach out to our patients. How can we do it?” So we trialled a number of solutions, found one that we and our clinicians liked, and we actually didn’t have to do much. It sort of spoke for itself in terms of the benefits and the outcomes. And really, when it comes to the transformation, I’ve never seen something move as fast as that moved in terms of the number of clinicians who were using it. In five weeks, we onboarded something like 300 staff. Those are amazing numbers.

Actually, your story reminds me of this joke that I read on LinkedIn. It’s a multiple choice question: “Who is driving your digital transformation? A. It’s the CEO, B. It’s the CIO, C. It’s the CTO, and then D. COVID-19.’ And, you know, COVID-19 definitely brought that platform and I think that’s where challenge and opportunity have met each other. Getting that platform and getting forced acceptance, that’s a big part of the puzzle. But, of course there are other things like budget, availability, et cetera. How was that tackled?

Those are some of the limiting constraints that we as an organisation face. Thankfully, the government has been really supportive around the digital enablement. That’s because they could see that without supporting us locally, we wouldn’t have been able to stand up these solutions so quickly. Thankfully, we already had Awingu in the bag and had stood that up, so that was a really good platform in terms of the foundations for us. Obviously, then we needed to equip staff with laptops, with webcams, with headsets, and set up the virtual consultation office. Some of this funding came to us nationally, from the center, and without that we really would’ve been delayed in terms of moving us at the pace that we were able to move at, to be honest. Being able to access virtual platforms that were being made available nationally to us really helped us to remove any procurement barriers that we would’ve had. Furthermore, adoption and support was there from the national teams as well. In other workds, I have to say: it’s all about working locally with the national teams to understand the challenges that we had around COVID. They were really supportive of that and helped us move at the pace that we were able to.

Jas, you’ve spoken about challenges and opportunities when COVID-19 hit you guys. What were, at the start, your top priorities? Do you have a top three list?

As COVID hit and lockdown came into force around the 23rd of March, we had to shield a number of our staff groups. Or we had to enable them to work from home, because they were recognized as being at risk. But obviously, a hospital doesn’t stop seeing and treating patients. So for us, it was about: “how can we mobilise those staff groups to be able to work at home successfully?” For them, it was about: “what systems did they need to be able to access to do their job from home successfully?” We had to give them access to the Awingu platform, which they can access on any device at home they had – that’s really good. If they didn’t have a device, we had to provide one that they could come and pick up at the hospital. After that, we had to figure out how to give them the equipment they need, like headsets and webcams. That was really challenging, because we had staff who had to shield or work from home. In some cases we asked them to work from home, so we were sort of marrying the two and working with staff from the digital team who were working remotely, providing all these services to these staff groups. All the while, we were making sure that from a well-being perspective the digital team were coping with all the anxieties that came with the enforced lockdown.

The second challenge was around virtual consultations. It was about still enabling our clinical teams to see patients that they needed to see – because a phone call just wasn’t good enough to clinically diagnose or provide treatment for that patient. We needed to figure out how to set up the right solutions for those patients. We tried a number of platforms, and in the end we moved to the national ‘Attend Anywhere’ platform and successfully onboarded hundreds of staff onto that. That enabled them to see patients. We also worked with a number of therapy groups to enable them to do support and exercise classes with patients, and the feedback was amazing! We got really positive comments from patients who were pleased to see that we could still give them access to these crucial services when they were having to isolate. Patients said to us that they maybe wouldn’t have accessed this service if it was face-to-face and would’ve had to come to the hospital, but through a virtual platform I almost felt it was easier for them to access that service. Because there’s a bit of anonimity, isn’t there, to a virtual platform? You don’t need to share your face if you don’t want to. So again, it’s just recognizing the needs of individuals

Really, those were the challenges and we were able to rise to it. Our patients are happy and the clinicians are happy. The digital team did a fantastic job in supporting all of that transformation that happened at such pace, really.

First challenge: work from home – that’s definitely not something new. How was that before COVID-19 with you guys?

Working from home is a novel concept, isn’t it? Managers work from home. There’s a trusted relationship, when it comes to letting other staff groups successfully work from home. Can we trust them? Can we trust that they aren’t watching TV? As an example, I’ve only been in the office seven times since the 23rd of March. In my team, I have another staff member that works from home permanently. I think it’s a culture change. What COVID-19 has enabled us to do, is to look at ourselves as an organisation and say: “Actually, if we give the staff the right tools to be able to do their jobs from home, and we have a good relationship in terms of being able to support our staff, then why isn’t it a good way of working?” We’ve proven that staff can actually work from home if given the right tools, and it’s a trusted relationship.

Working from home can work for some staff, but for others it doesn’t. I think it’s just being able to be aware of your own team’s abilities to cope with that and what mechanisms we need to put in place to help them. For some of our staff in digital, they need to be on-site, and we’ve made that happen for them. And then there are those that are absolutely happy, like I am, to work from home, and that is great. In other words, it’s about a mixed economy and making it work for both groups.

Do you have an official policy or something that supports work from home? Did you have it before COVID?

No, we didn’t have it before.

So that’s really the result of the pandemic, then?

Yeah, absolutely. We were just working up a flexible working policy. One of the key changes that we’ve implemented in our organisation is tjat we’ve reflected on the changes and transformation that COVID-19 has helped us bring about. We’ve encapsulated those changes in what we call “the high-impact changes”, and one of those changes is around remote working. So there’s a group that’s been formed to look at how to sustain this going forward, and what the underpinning policies and procedures are. We needed to ask ourselves: “How do we make sure that all staff groups across the organisation, where they can, be offered the opportunity going forward?” That it doesn’t suddenly just stop once we have a vaccine and we all go back to normal. That it becomes the norm, and it’s not just about COVID-19.

As an organisation, we’re really keen to make sure that we’re sustaining that change and putting in the right policies and procedures to underpin that change, really. We’ll have a work-from-home policy and this is going to be part of the new normal. It might not be 100% work-from-home, it’s going to be a part of that mix.

I guess it also solves some other challenges like parking lot availability and things like that, which are common issues in hospitals.

Oh, completely! Come to a hospital at 10 o’ clock, you won’t find a parking space. And that’s for patients and for staff. We need to now look at our estate management and go: “Actually, what do we need where to house staff, to see our patients?” I guess in a hospital, the difference is that we will still need to be on-site. The clinicians and nurses will still need to be there to provide those clinical services. But actually, if a clinician has an afternoon of doing administration, do they really need to be in the hospital to do that? Do they really need an office? And I’m not saying that we’re not going to have offices, but do corporate back-office staff need as much capacity on-site as they did pre-COVID? I think it’s that challenge and debate that all organisations, regardless of the sector they support or work in, are going to be having. It will be important to ponder about what our estate strategy will be going forward, combined with sustaining a remote working policy.

I am a happy and motivated person because I have the ability to work from home and balance my personal and professional life, and I’ve managed to do it really successfully. But I have a trusted relationship with my manager, and I think that makes a huge difference. It really does. From an industrial perspective I think it’s about the next shift in terms of homeworking will change the face of a lot of economies.

NHS Worcestershire was already using Awingu before COVID, and I understand it helped you scaling up once COVID-19 was there. Still, you had to go out and buy devices for certain users, and others were using more a ‘bring your own device’ context. How did you deal with this part?

The reason we chose Awingu is that it gave us the flexibility to allow staff who were working remotely to use their own device as opposed to providing a Trust device. That’s crucial, because we’re a financially constrained organisation. Tackling our COVID-related challenges with Awingu was great, because we simply had to uplift the number of licenses that we had – and we could do that at a fast pace. On the other hand, we only had a finite number of devices that we could give out to staff so we had to have a necessary conversation and ask our staff: “Okay, what do you need to access? Have you got a device at home that you’d rather use or can use? And if you haven’t, okay, you can have a Trust device to support you.” But had we not already had it set up and ready to go, then, really, in terms of where we were from a timescale perspective, it would’ve taken us so much longer to get our staff working from home and to deliver virtual consultations and all the rest of it. Our staff started to work from home at the beginning of March. You know, two to three weeks before lockdown actually happened, when we started to move shielded staff home.

Obviously not all users had access to the Awingu platorm. And then, in comes COVID-19 and lockdown and a lot more users needed to have access to it. Now, there’s technical sides of giving people access to the Awingu platform, but there’s also informing them and explaining them how to work with it. How did you go about this?

Yeah, that’s a good question. So we worked with our IT partner before COVID, to get the platform in place. In other words, that foundation was already there – and we already had e-learning set up to access it. But the reason we chose it, is that it’s really easy to use. So in terms of the training somebody needs, it’s absolutely limited. You need the URL, we pushed it out to desktops, and gave people the URL. We linked it through to our AD (Active Directory) and then we made sure that everyone was given access to it. As we rolled out two-factor authentication, again we just updated our learning material. The landing page is really good, because you can just put on there where people need to go to if they need any help and support. And then, what our partner was able to offer to us was that as people came on board with the solution and they needed to access other systems that we hadn’t considered prior to COVID, we could quickly publish those systems to the landing pages. It just worked really well.

I don’t know where we’d have been if we did not have that in place. It would’ve been really challenging for us as an organisation to respond to COVID-19, to be honest. And I think it’s just helped people’s transformational change with digital. But again, it reinforces that actually, it’s about finding the right solutions to address the problem. And people need things that are simple, easy to use, and that are just not complicated.

I love that answer, I have to say, Jas, because it’s not just marketing bla bla, you’re confirming it’s actually true!

Haha, you didn’t pay me for that! But it’s true!

There was this story I read, it must’ve been like end of March or early April on Twitter from one of your employees, somewhere, and I think she was based in Singapore and said something along the lines of: “Thanks to the Awingu platform I can still get work done.” What was this about?

Oh my goodness, I remember that. I can remember being on a daily call and since our cyber security concerns have increased during COVID, we were really actively monitoring what was happening. Suddenly, we noticed this IP address coming from Singapore. And we were like: “How can that be? What’s that? We need to lock them out right now, and investigate.” We were all on heightened alert around this particular user, and then we subsequently found out later that day that is was this clinician that had been on holiday, had gotten stranded in Singapore, and couldn’t come back. Actually, they could just carry on working.

In terms of the change, I just can’t explain how much digital transformation has enabled virtual working regardless of location. You know, I was in a meeting only on Tuesday evening where we’ve got a consultant who’s in Australia who dialed in to an MS Teams meeting and was partaking in this conversation on projects he’s working on. It was four o’ clock in Australia and five o’ clock here. And yet, technology is enabling those clinical conversations to still take place, which is as it should be, given we work in a 24/7 environment.

You know, we have a broad spectrum of staff that come from different parts of the world, and it’s about enabling that remote work when staff go on holiday or end up being stranded because of COVID and having to isolate – which is what happened with this particular consultant and colleague of ours.

That was a very interesting anecdote there. And, I guess, with there being some kind of detachment between where you’re based and where the company is based, that might also evolve things going forward in just the way we think about the workforce.

Oh, completely. The opportunities now are immense. We’re moving more of our workflow processes to digital ways of working. You’re not restricted to Worcestershire staff, we can outsource or bring staff in from Australia, America, wherever, to help us manage our workload. That’s is huge, because our demand is not decreasing – in fact, it increases year on year. So it offers us an ample opportunity in terms of thinking differently about how our services are supported and provided.

You mentioned security, and being increasingly vigilant around March/April timeframe. Obviously, you can’t talk about specific details, but where did this increased vigilance come from?

Well, you know… As an NHS, we are very aware of the data that we hold of our patients. We’re a high profile organisation in terms of the NHS, and there are people out there that want to take advantage of that. So, as an NHS, we have over the last couple of years strengthened our cybersecurity position. You know, we do a lot of work around that and we all have things that we have to be doing and have to abide by from an essential cybersecurity perspective. But again, we get a lot of support from the center around this.

It’s about knowing what we need to do locally to train our staff to be more aware about cybersecurity and about emails that they’re opening. “Don’t click on the link if it’s not from somebody that you know!”” It’s just a key message that you have to keep reinforcing all of the time because we’re cognizant of the data that we have, privilige to access, and that we have to keep secure.

Absolutely. And I’m pretty confident that Awingu as a solution can really fit into that philosophy and priority. We’ve seen a lot of new projects get started and budget made available, adoption from staff and users growing. How do you see the future?

Gosh, if only I could see the future! For us, it’s about: “How do we carry on with this journey? How do we carry on understanding what our problems and issues are? And how can we help introduce, where we know it can help, those digital tools that can transform an organisation?” In an NHS organisation, you can’t just make people use things. They have to see the value of it themselves, to go on that journey. So again, it’s about working in partnership with suppliers like you, for you to help understand the problems and issues that we have and how your solutions can solve those problems. Or about how we can work with you to provide a better outcome for our patients and our staff. For me, there’s a lot of work that we need to do to help suppliers enter the NHS market and be aware of us, and how to help us.

I see having a greater partnership with organisations like yourselves as quintessential. And with that comes mutual understanding so that we’re continuing to make the lives of our clinicians easier – and, in essence, ensure that our patients get the best treatment that they possibly can from us, as an organisation. I’m really optimistic about the future from a digital perspective, because I think people are starting to understand the value that it can truly add in terms of hearts and minds. And, next to that, making staff work more efficiently and productively, regardless of where they are. So, let’s hope – you know, past COVID – that that sort of thinking continues.

I couldn’t summarise it better than that. Thanks a lot for the great talk, Jas!

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