Making time: using technology to make clinicians’ days better

HIN Chief Executive Rishi Das-Gupta writes about the potential of technology to reduce pressure on the NHS workforce.

The current industrial action by doctors and nurses is a symptom of a much deeper underlying problem which goes beyond pay, and the workforce crisis isn’t just that we don’t have enough staff. Our jobs have become much less human and ironically the way out may be through using technology better (and making it more fun) – giving us back time to care and improving our experience at work.

Workforce challenges

There are several complex factors that I think have led to a reduction in satisfaction, but among them are changes in working patterns and teams, increased workload and the need to use non-intuitive technology.

Firstly, we have been successful over 20 years in reducing the number of hours worked by clinical staff but often this has meant moving to a much more fragmented way of working with less continuity of care for patients and less satisfaction for medical staff. In addition, clinical staff now work with an ever-changing team and it’s harder to form the deep-peer support relationships.

Secondly, the workload has been increasing and we’ve had a 40 per cent productivity increase over the last 20 years in some areas.

Finally, poor interfaces for medical technology mean that new products and devices require training to use. This means that, rather than making clinicians’ lives easier from the outset, their adoption can be a struggle. Having spent some time looking at technology to support clinicians I believe that the next generation of technology can support our workforce in all three of these factors.

The four most promising uses of technology in my opinion are:

  1. Intelligent automation of note-taking and transcription tasks to make time to think;
  2. Scheduling staff and working patterns to make time for our lives;
  3. Remote working and communications technology to help at times of overload; and,
  4. Training and wellbeing support to prepare us to make the most of our time.

I will now briefly highlight the potential of each area with an example and I’ll expand each area in future blogs (depending where you’re interested)!

1. Intelligent automation

Firstly, the way we interact with computers to do day-to-day tasks is changing rapidly and some of the technology suppliers are using data from systems to improve the usability and staff satisfaction with their products – but this will take a product cycle (several years) to come to market. However, many of the processes we have are repetitive and require high levels of attention to do well. This is where we should be applying supervised intelligent automation (IA).

An example of this is automated note-taking in outpatients. I recently saw a prototype from Nuance for listening to a consultation in the background, transcribing this and using the transcript to populate a clinical note in an outpatient setting. This means talking as if there is an AI assistant in the room supporting us to write a clinic note. Voice interfaces and large language models (LLMs) are developing fast and have got a lot of press recently, but I think that the first application to clinical practice might be in note taking.

If we do this early, we’re likely to end up with products that suit our practices in the UK, and I can see advantages in partnering across the NHS with a tech provider to develop something to suit our needs. My hope is that if I’m a patient sitting opposite a doctor using this type of technology, they’ll look me in the eye and have time to think and to focus on me during a consultation.

2. Working patterns

Secondly, having moved to shift patterns and rolling-rotas, our ability to plan our lives has reduced. If I’m invited to wedding in December, I don’t know if I can attend. I recently saw a new product from Lantum designed to use artificial intelligence to fit rotas based on local rules to generate compliant rotas and enable swaps between people on the rota. Technologies like this offer the promise of more control over the trade-offs we make in our work-live balance.

3. Remote working

Thirdly, remote working and communications technology offers the ability to support us in real time but also the risk that we’ll always be working/available. We’ve all got used to zoom and phone calls for support but there is more we can do to have integrated communications that route calls to the right person to support us and to others if they are busy. The opportunity I see here is to support each other when the workload is really high or we need help to know what to do. This technology has been around for a while, but I’ve previously thought it suitable for deployment only by large organisations. At the Health plus Care show in April there were several companies with products addressing this including in assisted living facilities and care homes where I saw a demo of the Ascom solution which integrated an easy patient interface (using Amazon Alexa devices) with a clinician platform that meant that all calls can be prioritised. This need is reflected in the fact that a requirement for improved communications platforms has also been included in the new contract for GPs for this year.

4. Training and wellbeing

Fourthly, during the pandemic we saw a lot of training move online and we’ve been learning from this experience and adding well-being support to our staff development and support offers. Online and hybrid training can be delivered on-demand or at specified times in groups or alone. However, in addition to traditional training we’re also seeing other staff offers being delivered using non-face to face platforms such as mental fitness by Fika or meditation through apps like Headspace which were made available to NHS staff over the pandemic period.

This list isn’t exhaustive but I think outlines why I have hope that we could improve staff experience using technology that exists now… and the even bigger potential win would be embedding all this in a universal NHS staff app I could carry in my pocket that would integrate these features and my staff passport documents!

Staff experience impacts patient safety and evidence shows that Trusts delivering the best care have tended to also record high performing staff survey results. With tools like this I think that staff satisfaction can be impacted in months – and we need to measure it during that timeframe. NHSE has launched a shortened quarterly (NQPS) and monthly versions of the staff survey it used to publish annually (we are trialling the monthly people pulse survey at HIN) and I think it’s time we reframe the conversation about our work to bring staff experience and staff satisfaction to the forefront, alongside patient outcomes, and that we use metrics like productivity/throughput as measurable by-products of happier staff.

Although it’s easy to highlight shortfalls in the current approach I think we are at a point where we can see concrete ways to improve staff experience and to demonstrate the impact of this (and spread learnings fast) to improve the lives of hundreds of thousands of people working in health and care over the next year.

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Is diversity in the workplace a good thing? (yes, but….)

HIN CEO Rishi Das-Gupta writes about the importance of diversity in the workplace and the challenges it can present.

The NHS recently dropped its diversity targets (they are not part of planning guidance for 2023-24) and some MPs and media are waging war to remove the posts which were added to make the workplace fairer and more diverse. While this is understandable in the current cost-constrained environment, diversity within the NHS is essential for providing high-quality, patient-centred care.

A diverse workforce brings a wide range of perspectives, ideas, and skills that can lead to better outcomes for patients and their families. However, it is important to acknowledge that there can also be challenges associated with having a more diverse workforce. One such challenge is that there are usually more opinions to take into account (which is the point!) and so it can take longer to reach decisions - at a time of crisis this can be frustrating. However, I think that now is a time of change. Including diverse perspectives is essential and we all must get more comfortable fostering disagreement within our teams.

I temporarily left the NHS to get experience in other industries before returning, so often feel I should speak up when I have a different view. I’ve always been surprised by how uncomfortable this feels in the NHS and call on all our leaders to understand and foster constructive conflict to get to better answers for our patients and staff.

It is possible to argue that the NHS has one of the most diverse workforces in the world. In London, where I work, providers have people with backgrounds from almost every country in the world and speaking scores of languages. In addition, across the service as a whole we have near equal gender balance (NHSemployers). We bring individual perspectives based on professional background, patient interactions, and personal circumstances. Despite this, some groups are still systematically over/under represented in senior decision making. As the makeup of decision-making groups changes, the conversations can be less comfortable.

Most NHS discussions start with common values and so if you disagree, you might not be ‘NHS’ enough. I temporarily left the NHS to get experience in other industries before returning, so often feel I should speak up when I have a different view. I’ve always been surprised by how uncomfortable this feels in the NHS and call on all our leaders to understand and foster constructive conflict to get to better answers for our patients and staff.

When a group of individuals with different backgrounds, experiences and perspectives come together, it can often lead to a wider range of opinions and ideas being put forth. This can be a positive thing as it leads to more thorough discussions and considerations of different options. However, it can also lead to a longer decision-making process as the group works to come to a consensus. Without good discussion facilitation or chairing, this conflict can feel uncomfortable.

Benjamin Laker and Vijay Pereira explored the reasons for team conflicts in an article in Harvard Business Review published on 31 May 2022 (that was not focused on diversity). However, they highlighted four common causes of conflict from a study of 1,000 managers across 76 companies – and I think that each of these can be exacerbated by diversity in backgrounds, professional experience and communication preferences:

    • Communication difference - 39%
    • Unclear expectations - 22%
    • Unreasonable time constraints - 16 %
    • Opaque performance standards - 14%

    These are all factors which are at play in our discussions in healthcare – and the risk of each of these factors coming into play increases as the diversity of the team increases and as we work across organisations as part of ICS working. It’s even more important as we work under time pressure and there is a need for swift and efficient decision-making.

    It is important to remember that this added time and effort is necessary to make well-informed and inclusive decisions that take into account the needs of all patients and staff. Which brings us to what we can do about it… In my opinion we should:

    • Spend time to outline what our values are (or have them pinned to the wall) and highlight whether a conflict is a result of us having different values or applying our values differently.
    • Spend time being clear about what problems we are trying to solve – my experience is that we always want to solve the problem without clarifying exactly what we understand by it. In a diverse group the chances of having different interpretations of the issues is high. Personally, I value using a problem statement worksheet to tease out the issues.
    • Recognise communication differences – in organisations I’ve worked with this has been done using Myers-Briggs or the Insights Discovery tool. These can be the start of a discussion but other factors are important too.
    • Spend time agreeing actions – and make these clear. Laker and Pereira suggest being clear about what is satisfactory delivery and what is good/above the required level which sounds like a great way to go… but I must admit I’m not always good at doing this!
    • Negotiate the time constraints if you feel this is what is causing frustration – I find the best questions to ask as a manager are “Is that a realistic timeline?” and “What will need to be delayed to get this done on time?”
    • Getting performance standards right in the NHS is harder… In general I think we are nicer than in other industries where I’ve worked. I think it’s important to highlight when performance is below the expected level and have seen this done sensitively with questions to understand why this was. Often, I’ve found it’s because the required outcome was unclear for instance, I might have a different understanding of what a “high-level financial model” is to a management accountant. Less frequently, the person didn’t have the skills and support needed, or there were personal issues that prevented delivery – it’s rare that people’s heart wasn’t in the right place (which I think of as a values issue).
    A diverse workforce brings a wide range of perspectives, ideas, and skills that can lead to better outcomes for patients and their families. However, it is important to acknowledge that there can also be challenges

    In conclusion, diversity within the NHS is a vital aspect of providing high-quality, patient-centred care. However, it is important to be aware that there can be challenges associated with having a more diverse workforce which include the potential for increased conflict within teams, taking longer to reach decisions and that discussions feel less comfortable.

    I think it is important to acknowledge these challenges and that it is crucial to remember that the added time and effort is necessary to make well-informed and inclusive decisions that take into account the needs of all patients and staff. As this is a change and doesn’t come naturally to all of us, supporting our teams and particularly facilitators and managers to foster good conversations is really important.

    So, the gauntlet is laid down! We need to create a culture of open communication and respectful dialogue (and implement effective conflict resolution techniques when things get heated). Together we can work through these challenges and ultimately create a more productive and successful work environment for the NHS.

    Working Together to Prevent Cardiovascular Disease

    Supporting the NHS workforce to develop skills and drive improvement is one of the HIN’s top priorities. As part of this we set up the Cardiovascular Disease (CVD) Prevention Fellowship and now we’re sharing guidance to help other organisations looking to run similar programmes. Sophie Mizen, Project Manager for the Fellowship Programme, writes about what we learnt from running the programme and how you help spread the word.

    We set up the Cardiovascular Disease (CVD) Prevention Fellowship to address an area which is a top priority for the NHS. There are six million people in the UK with CVD and taking action to prevent it is the best way of reducing harm and saving lives. With a total cost to the NHS of £16bn per year, it’s also a more efficient way to tackle the problem than treating CVD at a later stage.

    CVD Fellowship Stats

    • 85 participants from all 12 south London boroughs
    • 19 projects in hypertension impacting 21 GP surgeries
    • 14 projects in lipids impacting 22 GP surgeries
    • Three projects in familiar hypercholesterolaemia impacting seven GP surgeries
    • Four projects in atrial fibrillation impacting eight GP surgeries
    • 98 per cent of participants feel more confident in delivering care to patients at risk of CVD
    • 96 per cent are more confident in supporting their colleagues with CVD care
    • 95 per cent think patients at risk of CVD have benefited as a result

    The Fellowship is one of a number of collaborative learning opportunities provided by the HIN to develop skills in the workforce and support the delivery of improvement projects aligned to health and care priorities. This supports our objectives of developing the skills needed to power health and care systems of the future, as well as making an immediate positive impact in areas of need.

    The CVD Prevention Fellowship ran between April and November 2022, and included clinical webinars from specialists in the field, and collaborative quality improvement (QI) sessions where fellows could gain new skills, share learning and work on their own QI projects. The Fellowship was open to all health care professionals in primary care in south London.

    Running the programme presented some challenges – not least because the number of participants was higher than we expected with over 100 initially expressing interest! We also know that clinicians tend to have very limited time, and while the Fellowship was free to join, we were not able to fund back-fill for time taken out of work. As such we had to keep the time commitment to a minimum, and were flexible in our approach to collecting progress updates.

    We also adapted our approach to communication channels as we went. Our used of continuous feedback helped us listen to Fellows' needs and adapt the programme accordingly. As such, we switched our focus from quality improvement theory to practical troubleshooting when we realised this would be more beneficial to the Fellows and a more productive use of their time. We also incorporated some additional sessions such as a webinar on behaviour change in CVD and a drop-in clinic with a specialist going through lipids case studies.

    The response to the fellowship was overwhelming, with over 80 fellows being upskilled in various areas of CVD and quality improvement. The fellows were required to deliver an improvement project in their practice/primary care network, to apply their new skills and knowledge. As part of the programme 40 quality improvement projects collectively impacting a total of 63 GP practices, representing all 12 boroughs in south London.

    Patients positively responded to the work and we received some great feedback on the impact the quality improvement projects had on an individual level:

    Thanks for giving me the information about statins. I did not realise that statins had anything to do with protecting the heart. I just thought it was to reduce cholesterol which I have been trying to do by good diet and exercise. Although sometimes I like to enjoy myself a little and eat the unhealthy stuff, I take my atorvastatin daily and I have not felt any side effects. Looking forward to the next blood test.

    You can find out more about the patient experience in our case study pack which includes information on all the projects.

    Throughout the programme feedback was received on the beneficial impact of education and training. A final feedback survey revealed that 98 per cent of fellows felt more confident delivering care to people at risk of CVD, and 96 per cent said they are supporting colleagues more with CVD prevention. Most importantly, 95% per cent said their at-risk patients have benefited from what they learnt. We also received great feedback from participants – you can find out more in the video below.

    We learnt a lot from running the programme and wanted to share this to make it easier for anyone else thinking of running a similar programme. That’s why we’ve put together a guide outlining our approach, learnings and what we would do differently next time. Please share with any individuals or organisations who might be interested.

    Find out More

    Find out more about the Fellowship and access the resources mentioned in this blog.

    Find out more about the CVD Prevention Fellowship.

    Hospital staff use ‘nudge theory’ to boost health and wellbeing during Covid-19

    #OnlyHuman promo film

    Featured on BBC London TV news and in the Revealing Reality-produced film above, King’s College Hospital (KCH) has adopted the HIN’s behavioural science workforce support campaign #OnlyHuman to help prevent staff burnout caused by the pressures of the Coronavirus pandemic.

    Key statistics

    King’s College Hospital NHS Foundation Trust employs over 11,000 staff.

    Hundreds of staff at King’s College Hospital have embraced ‘nudge theory’ to help protect their wellbeing during the pandemic.

    The hospital has become the first to adopt a workforce-wide campaign called #OnlyHuman that uses behavioural insights to prompt frontline staff to take action that helps protect their physical and mental wellbeing. The move comes after King’s trialled the campaign last year and emergency and critical care teams reported a positive impact during a highly challenging period during the pandemic.

    The campaign takes a peer-to-peer approach to prompt staff, who sometimes struggle to identify
    signs of stress in themselves, to spot early signs of strain within colleagues and use these tools to then take simple actions. These include check in with colleagues regularly to make sure they’re taking breaks, drinking enough water, implementing brief huddles before and after shifts and simply showing kindness to each other.

    Behavioural experts maintain that if staff can are prompted to use these behaviours, this creates a ripple effect because social cues reinforce the behaviours and embed them into the workforce.

    Devised at pace over eight weeks in response to Covid-19, behavioural insight specialists worked in conjunction with healthcare professionals across multiple trusts to identify key themes to address. The themes included: Checking in, Recharging, Managing Uncertainty, Warming up and down and Kindness.

    This was a joint project between behavioural research specialists Revealing Reality and the NHS’s Health Innovation Network, funded by The Health Foundation.

    Dr Claire McDonald, Principal Clinical Psychologist and Lead Psychologist for Staff Support at King’s College Hospital, said:

    “The Covid-19 pandemic has been an unprecedented time for our frontline health and care staff. Staff have worked tirelessly to care for patients including those who have been critically ill. There is also the broader context of fear and uncertainty about the risks and evolving situation, coupled with an erosion of our natural ways of coping due to restrictions.

    “This understandably takes a toll, as we are ‘Only Human’. That’s why we rolled out the campaign, as one strand of our KCH staff support offer, to encourage staff to look after themselves and each other through various tips and simple measures. We brought the campaign into our Wellbeing Hubs and many teams and departments including Emergency and Critical Care. To provide the very best care to patients our staff first need to be well resourced. Extra levels of stress require extra levels of self-care and looking out for each other.”

    KCH’s Christine Brown Intensive Care Unit (ICU) Team Leader Mairead Trant said:

    “I think this is a fantastic initiative to help frontline staff cope with the emotional strain that sometimes comes with the work we do. It’s important that we take time to look after ourselves and each other and reflect on what happens each day.

    “By taking time to talk to someone you trust, it can help greatly to ease the stress and improve mental wellbeing. This initiative really focuses on this theme and will have huge health benefits for staff.”

    “I think this is a fantastic initiative to help frontline staff cope with the emotional strain that sometimes comes with the work we do.”KCH’s Christine Brown Intensive Care Unit (ICU) Team Leader Mairead Trant.

    Health Innovation Network Programme Director in the Patient Safety and Experience team Catherine Dale said:

    “It’s great that King’s College Hospital staff found our #OnlyHuman campaign useful during Covid-19 and have since adopted it.

    “When the pandemic hit we recognised the emotional toll it was taking on healthcare staff. Behavioural insights – also known as ‘nudge theory’ – encourage people to act in helpful ways. We applied this approach to develop a suite of materials to help healthcare professional support each other during these enormously challenging times.”

    Further information

    Download the #OnlyHuman resource pack today.

    Download now

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    Contact our Patient Experience & Patient Safety team.

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    Invitation to pitch: digital workforce transformation showcase

    Invitation to pitch: digital workforce transformation showcase

    We all know that the NHS is facing increasing demands on its services. Alongside the challenges of recruiting and retaining clinical professionals, there is a role for technology as a driver of productivity within the clinical workforce.

    Working in collaboration with NHS England, and NHS Improvement, the DigitalHealth.London Accelerator is running a showcase event for HR Directors exploring how technology can help NHS staff and employers to improve workforce productivity, recruitment and retention.

    We are looking for ten companies to present their innovations, and in particular, innovations that are already being used by NHS employers and that meet workforce challenges including:

    • Recruitment / time to hire
    • HR transactional tasks / HR productivity
    • Workforce capacity management / clinical workforce productivity
    • Retention
    • Staff wellbeing (physical and mental health)

    If selected, you will give a three-minute pitch to the audience on how they could adopt your innovation(s) in their organisations. You will also participate in our “world café” session to discuss your solution in more detail. We aim to help you generate warm leads by curating a receptive audience for workforce innovations.

    We are looking for innovations that are already well-developed – this is not an event for innovations at the idea stage.

    Please apply to take part by downloading and completing this short form and returning it to by 5pm on Friday 10 May.

    Event details

    • Date and time: Tuesday 11 June, 17:00 – 20:30
    • Venue: DAC Beachcroft, Walbrook Building, 25 Walbrook, EC4N 8AF


    • 16:30-17:00 Registration
    • 17:00- 17:05 Welcome
    • 17:05-17:15 Clinical Productivity – Andy Howlett, Clinical Productivity Operations Director, NHS England / Improvement
    • 17:15-17:25  Can technology and artificial intelligence help to improve workforce productivity and create a more agile workforce? What can be done now? – Lesley Soden, Head of Innovation, Health Innovation Network
    • 17:25-17:35 NHS Trust Case Study: Lessons from transforming our medical workforce – Alfredo Thompson, HR Director, North Middlesex Hospitals NHS Trust; Dr Frances Evans, Medical Director, North Middlesex Hospitals NHS Trust
    • 17:35-17:50 Q&A
    • 17:50-18:20 Company pitches
    • 18:20-18:30 Close – Lesley Soden, Head of Innovation, Health Innovation Network
    • 18:30-20:00 Refreshments and networking


    Health innovation body in south London scoops Financial Times/VitalityHealth healthiest workplace prize

    Health innovation body in south London scoops Financial Times/VitalityHealth healthiest workplace prize

    HIN has been recognised as one of Britain’s Healthiest Workplaces in the prestigious Financial Times/VitalityHealth Britain’s Healthiest Workplace competition.



    A south London organisation that promotes the spread of health and care innovations into the NHS is the healthiest small new entrant in the prestigious Financial Times Britain’s Healthiest Workplace survey.


    The Health Innovation Network in south London, which employs 70 staff including nurses and paramedics, offers free yoga and mindfulness classes as well as ‘standing up’ desks, showers for running and cycling clubs. It also promotes a book club and discourages staff from engaging with emails after 7pm or at weekends.


    “We want to make sure people switch off, so we have a curfew to help our staff recharge. You need to be with your family and friends in your free time,” says chief executive Tara Donnelly. Tara switched off digitally on holiday in August for two weeks.


    “I’m delighted that we have won such a prestigious award and against such tough opposition. We take pride in promoting healthier living for all of our staff and encouraging colleagues in the NHS to do the same. Given we are in the business of innovating in health care and helping people take healthy decisions it is only right that we seek to do the same as an organisation.


    “We are very proud of our staff at the Health Innovation Network. We need to look after them and keep them. It makes sense morally and it makes business sense,” she added.


    Britain’s Healthiest Workplace was developed by VitalityHealth and is delivered in partnership with the Financial Times, RAND Europe, University of Cambridge and Mercer

    Britain’s Healthiest Workplace aims to celebrate organisations that have an outstanding approach to their employees’ health and wellbeing and is one of the UK’s largest and most comprehensive surveys into employee health.