Livewell Southwest is an integrated health and social care provider covering the areas of Plymouth, and parts of South Hams, and West Devon that accelerated their digital transformation with a Visiba-powered virtual clinic in late 2019. Since then and during the pandemic, the organisation has done incredible leaps in transforming not only their patient pathways but also adapting their regular workflows in a digital environment – and Visiba has been following and supporting their journey ever since.
While digital transformation has a few components for success, one of the most critical ones is the internal digital champion: A trusted member of the organisation, a team player with digital competence, profound knowledge of transformation processes and conviction to optimisation, change, and leading the way. For Livewell Southwest, this champion has been Michael Oliver, project manager – an admirable digital champion who ticks all the boxes above. Michael knows very well that digital transformation is about transforming organisational processes. He also knows that it takes commitment and buy-in for everyone involved and he is there to support and encourage his colleagues. Finally, Michael is relentlessly committed to making things better: improving care for patients and processes for healthcare professionals in Livewell.
We interviewed Michael to peep into the background, experiences, beliefs and disposition of an internal digital champion and to pick his brain on what he has done to promote digital transformation at Livewell Southwest – and in a complex healthcare service like Integrated Care.
Tell us a bit about your background
I qualified as a podiatrist in 2005 and I worked in the National Health Service straight away. Within a few years, I became a service manager and by 2013, I was also made the clinical lead for the service. I was given the opportunity by our then director of finance to do a couple of projects including eRoster.
What are you doing now as a project manager?
Our organisation is going into partnership with our acute hospital provider and as part of that, we have a very large transformation plan. One of my colleagues brought a list of about eight bullet points with digital projects that needed some attention – virtual consultations was one of them, wound photography was another, and the rest is history! I started working on lots of different digital topics almost 18 months ago.
I was approached by one of our service managers who was already in contact with Visiba for a small pilot service to trial the use of virtual consultations in one of our mental health services. Our plan was in line with the NHS Long Term Plan. The pilot was very slow to take off as, at that time, not all of the colleagues involved fully bought in to the need to trial working in this way.
Then the COVID pandemic landed and in March, the activity absolutely exploded: we have done 15,500 consultations since March and have trained more than 1,000 people in virtual consultations, which is absolutely fantastic. More transformation work has happened in six months than would have happened in six years!. We have given the whole organisation a flavour of what virtual is, so lots of people had a go with it and now we are in that crossroads of making it business-as-usual.
We know that digital transformation is all about change management and change management takes a lot of championing and effort. What keeps you motivated?
For three months, when we were in a complete lockdown, people didn’t have the option to visit healthcare unless it was something really urgent. At that point, it was really important to give people a different offer so that we could continue to deliver healthcare in some form. It wasn’t just a case of being unable to visit a healthcare setting; some people didn’t want to come into a hospital setting because they were worried about getting Covid-19, so it became really important to give as many colleagues the mechanisms to see as many patients as possible and to continue to deliver our services. You pick up the phone, but you can’t quite tell how people react there.
We had Visiba Care, which is a really great platform to use; it is pretty simple to train colleagues which made it very easy to scale – and scaling was quite a journey as well. We started with face-to-face training but then very quickly that was no longer possible because of the lockdown. So I started online training sessions with 50 or 60 people. It is a bit ironic to do virtual consultation training virtually as well! I turned the whole training session into online videos, making it very accessible to colleagues ; instead of having to take time out and set a date and a time for a training session I just the added the videos straight onto Microsoft Teams, so if anyone needed to get a user licence for Visiba Care, they just go into Teams and watch the videos.
Digital transformation is often met with a lot of resistance to change but you kept the motor going in your role and organisation. How did you manage that?
For me, it’s really important that we continue to offer the best services to people, even when it’s difficult to do so. I have seen the same reaction many times where people worry that their digital skills are not up to the task of using various digital systems, but they soon realise that the Visiba Care is an easy platform to use. It’s essential that questions from colleagues are answered quickly and clearly, as often their new confidence is fragile!
In order for virtual consultations to be successful, they have to be clinically led, so what I try to do is champion the different uses of the platform to the organisation. Especially in places like Children’s Speech and -Language Therapy and our Community Therapy teams, where we have some individuals who have really taken the bull by the horns: they are really trying to develop that offer and are bringing their colleagues with them.
That’s where it really starts to work because these people on the ground have the credibility to do that and they also have the inside knowledge of how this particular service works and how a digital offer can fit into their pathways. I’m just trying to support them to make sure that they have the training they need, they have the tools to deliver that offer, and ensure that they are aware of how to use the full capabilities of the system to their best advantage.
What I also find really satisfying is when I see the numbers going up. A lot of areas in the UK have seen their numbers virtual consultations drop quite a lot after lockdown but here we haven’t; those numbers are maintaining, so it feels like it’s working really well. That’s what keeps me going: my colleagues are engaged with it and this reflects in the number of consultations we are doing.
There are many ways to solve a problem but your professional life has presented you with digital tools as your problem-solving medium. What is it about digital solutions that make them appropriate to solve the particular problems in healthcare?
When it comes to hardware infrastructure that sort of flows over my head a little bit, but when it comes to software, I’m really not afraid of it. A lot of people will be given a laptop and think that there is a button that will make it blow up. I am the complete opposite; I’m almost trying to look for that button.
I tried to look at how software can work for us. There have been many ideas but what I try to do is get the basic idea, develop it and work out solutions for it. Personally, I try to push the boundaries to see what each software can do, because if I’m trying to solve this, it’s likely someone else has probably tried as well, so there is always a way of doing it.
How do you see the digital patient pathways unfold in the future?
I think we will get to a point where digital healthcare becomes as normal as face-to-face – up until the bits where you have to physically examine the patient. In healthcare particularly, a lot of time is wasted on processes and procedures – not just from our perspective but from the patients’ perspective as well. People come for a healthcare appointment that takes a long time out of their schedules and even when they get there, the whole process is quite slow. And once you get into the appointment, the actual value is from a small fraction of it.
A lot of what we have to do in healthcare, particularly in the UK, is getting the information; getting to the patient’s problem sometimes can feel secondary. Once we can make this part of the process more efficient, we can give this time back to actually dealing with the person’s problem, and then we will start to get much better outcomes.
In my clinical experience in podiatry, I often found that I would provide an intervention, and book another appointment in six weeks time to see how they got on. The patient may come in just to tell you that everything is okay. That takes two minutes of a thirty-minute appointment and the patient just wants the reassurance that everything is ok. That is not an efficient use of time at all, and that could be achieved more efficiently with a virtual appointment.
However, if we want to change that, we need to bring the public with us because we’ve been racing for the last nine months. COVID has been really beneficial in pushing digital transformation forward, but people in the UK want to get back to normal and that often means seeing people face-to-face. So it is important to not leave patients behind on this journey, and encourage people to see that this is a good mechanism. At the moment, both clinicians and patients have missed the face-to-face interaction and for some, sitting in front of the computer is not their idea of healthcare.
In terms of digital maturity, the UK is doing quite well and healthcare as an industry is perhaps not the most digitally advanced – compared to banking, for example. If you had a position of national responsibility to advance digital maturity in patients as well as clinicians, what would you do?
It is important to understand that digital healthcare is far more than just a secure video consultation. It is about looking at all of our end-to-end processes and to see what we’re doing and how efficiently we are doing it. For example, the district nursing service will see 15-16 people a day. What they don’t have is tracking orders to go through that in the most efficient way – it is all down to their individual discretion. We have the ability to automate that. It’s like parcel deliveries: the carriers are not planning their own routes. They have a smartphone with all the planning done for them and they take the most efficient routes that get them to as many parts as possible. This is something that we need to start thinking about in healthcare as well: the technology is there- we just need to start to apply it to healthcare.
We are always thinking about supply and demand in healthcare. What is traditionally done is trying to address the matter of capacity by putting more staff in or by finding ways of reducing demand. Access criteria are getting tighter and tighter, and in a way that is not addressing the demand that comes into our services. What we need to do to increase capacity is to look at our processes; which ones are working out, where is the inefficiency, where is the waste. Then we can spot digital solutions like auto-scheduling, roster planning etc. and increase capacity within our services.
If you look at how much money was spent in the UK for COVID over the last nine months, we are as a country going to spend a lot more time paying that back. I don’t see healthcare getting a big increase in funding over the next few years, so we have to start thinking really critically about how we deliver our services, to maximise the number of people who we can serve within the financial envelope that we are given.
The incentive to increase efficiency in the NHS seems to be there, with, for example, the Long Term Plan – and it looks like it has been there for quite some time when similar plans came along. What is the barrier in these plans becoming a reality?
I think it comes down to people’s willingness to change. Some clinical staff see that there is inefficiency, but they are not always willing to address it – it’s what they are used to and they focus on getting through the day. It is a pretty uncomfortable notion for a lot of people to critically evaluate and change what they are used to doing. So, it is really about bringing people with us – that is the most important thing. You can put whatever strategies you want but you need to bring the people with you, because in five years it will be a completely different plan than what we are trying to work towards.
How did you bring the staff at Livewell with you?
We involved them in the process from the beginning and let them own it. In terms of virtual consultations, I’m not going to tell people what to do but I will give them the tools to enable them to do the work themselves. Clinical solutions need to be clinically led in order to gain traction and work.
For example, if I go to the Children’s Speech and Language team and tell them ‘this is what you need to do digitally’, it is not going to happen because I don’t have the credibility in that area. If I tell them on the other hand ‘here are the tools and here is a strategy to help you identify parts of your pathways that could be digitised’. That’s when you start to get buy-in.
If you look at the number of virtual consultations we’ve had, a lot of it comes from our children services where they have been really engaged with people. That is not because I told them to do it – that is because they realised it themselves. I just gave them the tools, the training and the understanding to be able to do that.
What is missing from the NHS to take digital transformation to the next level?
Part of it is the infrastructure we have in the NHS. The equipment has been ‘good enough’ for years in that it could handle Office products and EPRs and that was fine. We are now demanding from our IT infrastructure: we need to be able to do virtual meetings, have virtual clinics, so it is essential that the hardware is fit for the task. People very soon get put off if their laptops cannot deliver!
We need to start thinking about it long-term now and start investing in the right infrastructure. What I find is that colleagues can feel cynical towards working digitally and when they have a solution, if it doesn’t work because of the network or their laptops are not responding, they can be put off very easily and they lose trust, and will often blame the platform.
In health services, we have a lot of different systems that can do a good job but they’re not necessarily integrated with one another. We have to teach people to use lots of different systems and sometimes we try to fit our existing solution around the problem we are trying to solve, potentially creating further inefficiency.
Let’s say for example that people use Excel for project planning and management. We have created industries and poured hours into compiling spreadsheets that quickly become very complicated and difficult for anyone other than the person who wrote it to follow. People don’t always understand how it works, or it doesn’t work as expected, or it can be ‘broken’ quite easily. However, there is plenty of software that is designed specifically for this and we should not be afraid of using it.
What are your tips for succeeding with digital transformation?
The first is to bring people on board at an early stage. If you put a solution in place that no one wants, then it is all in vain. Then locate the problem you are trying to solve and find the right software to do it. Make sure that the hardware you have is fit for purpose and that it will actually solve the problem. We are very good at finding the software that solves the problems, but we need to make sure that the hardware and infrastructure are correct as well, as if this fails, people can very quickly get fed up with it and abandon the solution. Then it is a continuous quality improvement process of observing what we are doing, see what the outcomes are and acting on what we have learnt. We have to keep looking at our offers and making sure that they become as best as they possibly can because it is never going to be exactly right the first time around; You are going to hit problems and it’s okay to get things wrong as long as we learn from it, finetune it and then keep going again so that we get as close as possible to the perfect offer.
So, digital transformation – where do we go from here?
It is important to change peoples’ mindset when it comes to digital. I don’t think that people see all the opportunities very easily. There is so much more we could do and we need to see the use cases build and then demonstrate what we actually can do. That is how the opportunities will start to grow.
That is a slow process at the moment because people’s digital abilities vary. I was lucky enough to have computers my whole life and I am not afraid of them, but we still have a large proportion of the workforce for whom computers are still quite alien and scary and it takes them a lot of time to increase digital literacy.
I think what we need to do is to take the bull by the horns; really work with people in healthcare and convey how important digital is. For this, we should probably start at the undergraduate level. What we don’t want going forward, is people coming into the workforce with no digital skills because, in the future, the public will demand it a lot more.
We have been Skyping for 20 years now and it has taken a pandemic to really push this to make it big in healthcare. In the past, there have been technological barriers, but these barriers are long gone now but still, we haven’t brushed it off as far as we could do. Hopefully, if anything good comes from COVID it’s this; we have accelerated our journey towards full digital maturity.
How do you want to develop your digital vision and skills in the future?
I would like to formalise my knowledge and build upon the experience that I have developed over the last 18 months. I would also like to build contacts and a professional network because there are lots of other people doing what I am doing, so I would like to share ideas with them and learn from their successes and failures.