case study nhs

Sunday, January 20, 2019

• Labels: Case Studies , Project Failure

Case Study 1: The £10 Billion IT Disaster at the NHS

Is your project headed for trouble? Find out! Just answer the 27 questions of my Project Trouble Assessment , which will take you less than 15 minutes, and you will know. If you are an executive sponsor, steering committee member, or a non-executive board member and want to learn what you need to do so that your project does not land on my list with project failures? Then my  (Non)-Executive Crash Course  is what you are looking for. If you want to know where you are standing with that large, multi-year, strategic project? Or you think one of your key projects is in trouble? Then an Independent Project Review is what you are looking for. If you just want to read more project failure case studies? Then have a look at the overview of all case studies I have written here .

Timeline of Events

What went wrong, how nhs could have done things differently, closing thoughts.

• Media centre

Search the HCPC

Popular searches.

• the care act 2014
• care act 2014
• registration certificate

Recent searches

Suggestions.

• {{search.Title}}

Case studies and template

Case studies to help you to reflect on your practice.

These case studies will help you to reflect on your practice, and provide a summary of reflective models that can help aid your reflections and make them more effective.

Templates are also provided to guide your own activities. Remember, there is no set way to reflect and you can adapt these activities to suit your learning style and your role.

Your reflection should be about learning and improving your practice. If you’d like to see how reflection has impacted the practice of some of our registrants, watch this short video.

Getting started

Here are some tips to think about when you set out to reflect.

Sole practitioners' group

Case study: Carl is a podiatrist working in independent practise. He is a sole practitioner and has run his business for 10 years

Group reflection within a team

Case study: Munira is a physiotherapist working in private practice. She has treated her service user Russel for the last three months after he was involved in a fall at home.

Reflecting by yourself

Case study: Emily is a dietitian working in an NHS Trust hospital. She also volunteers at a local charity that raises awareness about diabetes at events and conferences

Reflective practice template

Template to help you guide your own activities

Holiday Booking System: We are aware of an issue with how the system is displaying information and are working to resolve this ASAP. Apologies for any inconvenience caused.

Mandatory Training Update: Please complete all mandatory e-learning modules expiring before 1 November 2024 by Thursday 5 September, to ensure you remain compliant before the system change. Access LearnSpace .

Case Studies

NHS Professionals works with over 100 NHS Trusts and healthcare organisations across the country, putting people in places to care. Below, you'll be able to explore the different real-world workforce solutions we continue to provide to support patient care.

HCSWD programme supports spouses of international nurses to bring their skills to the NHS

We worked with the Trust to devise a solution which enabled the spouses of international nurses to have their own pathway into an NHS career through our Healthcare Support Worker Development (HCSWD) programme.

NHS Professionals recruits call handlers for seven ambulance Trusts

We exceeded our target to recruit 250 whole time equivalent call handlers. Our recruitment campaign generated over 24,000 applications of which 299 of these call handlers were successfully appointed. Our work on this bespoke recruitment campaign has led individual Trusts to continue collaborating with NHS Professionals to recruit additional roles for the future.

New flexible support worker role launched at University Hospitals Plymouth NHS Trust

Starting in December 2020, NHS Professionals implemented a brand new support staff group into University Hospitals Plymouth NHS Trust to support patient experience during the demands of the COVID-19 pandemic.

The international team helps Lancashire and South Cumbria NHS Foundation Trust solve mental health nurse challenge

NHS Professionals International forged a new partnership with Lancashire and South Cumbria NHS Foundation Trust to support their Registered Mental Health Nurse needs. Due to geography, the Trust faced a significant challenge when it came to sourcing this workforce. As a result, this led to Lancashire and South Cumbria becoming the first Trust to recruit international Registered Mental Health Nurses at scale.

NHS Professionals International exceeds targets for international nurse recruitment across the Pan-Mersey collaborative.

NHS Professionals International (NHSPI) was appointed to recruit and deliver over 600 nurses by December 2021 and also help the collaboration form successful OSCE training hubs. NHS Professionals International exceeds targets for international nurse recruitment across the Pan-Mersey collaborative.

International recruitment partnership delivers hundreds of nurses to specialist areas

In the spring of 2021, University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) faced a recruitment challenge when it came to nursing, requiring approximately 40 posts to be filled.

A steady stream of international nurses successfully delivered for Hillingdon Hospitals

Building a positive and open working relationship with the Trust, NHSPI worked flexibly to navigate the unique challenge of interview panel availability over the busy winter period, in order to meet the target required. Additionally, an unprecedented problem arose as the Ukrainian crisis developed in early 2022, causing the priority visa service to be suspended which increased processing times.

Alder Hey Childrens NHS Foundation Trust

NHS Professionals International started working with Alder Hey Children’s NHS Foundation Trust in 2019. Despite the world renowned reputation of the Trust, they were not able to meet their recruitment requirements from the UK market.

University Hospital Southampton NHS Foundation Trust »

In 2016, University Hospital Southampton NHS Foundation Trust (UHS) were experiencing a high vacancy rate, with over 380 posts that they could not fill locally. The vacancies remained in spite of their strong reputation and a rating of ‘Good’ from the Care Quality Commission. In order to strengthen their recruitment, the Trust approached NHSP International to source nurses from the Philippines.

South Tyneside and Sunderland NHS Foundation Trust

After working with the Trust since 2016, NHSP International now routinely deliver 20 nurses a month from the Philippines. This stable programme enables the Trust to keep vacancies at a manageable level.

East Suffolk and North Essex NHS Foundation Trust (ESNEFT)

Colchester Hospital University NHS Foundation Trust began their partnership with NHSP International in August 2016, when the Trust had over 200 registered nurse vacancies. In July 2018, the trust merged with neighbouring Ipswich Hospital NHS Trust to form East Suffolk and North Essex NHS Foundation Trust – becoming the largest NHS organisation in the region.

Patient Safety Support Worker Programme helps eliminate agency use in enhanced care at Harrogate and District NHS Foundation Trust

NHS Professionals achieved a 100% conversion in agency hours to Bank by creating an Enhanced Care Pool Ward staffed by graduates of our Patient Safety Support Worker (PSSW) Programme, which trains people to care for vulnerable patients.

Collaboration boosts Bank fill and drives down agency costs at Southern Health NHS Foundation Trust

In June 2023, we improved overall Bank fill for nurses by 10%, compared to June 2022. This improvement translated into a reduction in agency use of over 3% for qualified nurses, helping the Trust reach the 3.7% national agency spend reduction target.

NHS Professionals generates significant cost savings using administration and clerical Bank Members over agency at Buckinghamshire Healthcare NHS Trust

Using the average hourly cost of an agency shift at the Trust, NHS Professionals achieved a saving of more than £215,000 over a 12 month period.

Mid Yorks saves £1 million a year

NHS Professionals (NHSP) were tasked with reducing excessive agency spend within the Trust and managing the internal staffing bank for Nursing and Midwifery, Admin and Clerical, and Allied Health Professionals (Operating Department Practitioners) to grow the number of bank members, and to make it more efficient.

Driving down agency spending at Somerset NHS Foundation Trust with the NHS Professionals National Bank™

In August 2022, Somerset joined forces with NHS Professionals to reduce its agency usage for Registered and Unregistered Nurses, and to create a flexible worker pool to take precedent over agency shifts.

Agency usage completely removed for the Healthcare Support Worker staff group at South London and Maudsley NHS Foundation Trust

South London and Maudsley NHS Foundation Trust currently provides the widest range of NHS mental health services in the UK and serves a local population of 1.3 million people. In May 2020, NHS Professionals launched a campaign to work with the Trust to remove Healthcare Support Worker (HCSW) agency use.

Partnering with NHS Professionals National Bank supports Agency reduction at The Dudley Group

The Dudley Group NHS Foundation Trust is the main provider of hospital and adult community services in the West Midlands area with three main hospital sites and over 40 community centers across the borough. NHS Professionals formed an agency migration partnership in January 2023 with The Dudley Group to help it reduce agency spend by 3.7% in line with NHSE’s latest guidance. Using our pioneering NHS.

Pilot partnership delivers significant staffing savings at Warrington and Halton Teaching Hospitals NHS Foundation Trust

As with all NHS Trusts during the pandemic, Warrington and Halton Teaching Hospitals NHS Foundation Trust experienced severe pressures surrounding their workforce supply agency usage in Nursing and Midwifery.

A rise in bank fill and reductions in agency usage at Southport & Ormskirk Hospital NHS Trust

With NHS Professionals’ (NHSP) support and expertise, the Trust wanted to grow their Bank Members, operate more efficiently, and ultimately, completely remove their reliance on external agencies which as of August 2018 was 22% of shift demand.

Estates and Facilities Department at The Pennine Acute Hospitals NHS Trust enjoys 0% agency usage

Eliminating agency usage at alder hey children’s nhs foundation trust.

Having worked with the Trust since 2014, NHS Professionals (NHSP) have been on a continuous mission to ensure safe, effective staffing, excellent patient care and exceptional value for the Trust.

Barnsley takes control of agency spend

Prior to engaging with NHSP in 2018, the nursing bank at the Trust was operated by a small internal team that reported through operations. Bank recruitment was inconsistent, compliance with necessary training requirements wasn’t well understood and the investigation of complaints and incidents wasn’t robust. The Trust spend on expensive agency staff was very high, operated at ward level and largely invisible, apart from the large invoices.

Upskilling Bank Members closes support worker gap at Alder Hey Children's NHS Foundation Trust

The trust has worked towards a 0% HCSW vacancy rate. From April 2021 to July 2023, we supplied 63 healthcare support workers to the Trust, delivering a total of 44,472 hours of care. Around 20 have gone on to be employed at the Trust on a substantive basis.

NHS Professionals Academy successfully delivers phase one of leadership programme

After a competitive procurement exercise in 2022, the NHS Professionals Academy was awarded phase one provision of a leadership course for University Hospitals Sussex NHS Foundation Trust.

Collaboration, co-operation and communication boosts recruitment performance across the North West »

Before the North West Client User Group was created, recruitment was often siloed amongst individual Trusts, not necessarily taking advantage of collaborative working, group leverage or associated smarter working and cost efficiencies.

Back to all publications

Read our latest news

Interested in partnering with NHSP?

Email our workforce specialists to arrange a call or meeting to see how we can help you: Fay Toms - [email protected]. If you are an agency looking to partner with NHS Professionals then for International Nursing supply email [email protected].

Already a partner?

If you're interested in any additional services please email our Senior Solution Team: Morgan Warrilow – [email protected]

Internet explorer is no longer supported

We have detected that you are using Internet Explorer to visit this website. Internet Explorer is now being phased out by Microsoft. As a result, NHS Digital no longer supports any version of Internet Explorer for our web-based products, as it involves considerable extra effort and expense, which cannot be justified from public funds. Some features on this site will not work. You should use a modern browser such as Edge, Chrome, Firefox, or Safari. If you have difficulty installing or accessing a different browser, contact your IT support team.

HSCN case studies

Case studies from users of the Health and Social Care Network (HSCN), the data network for health and care organisations.

The delivery of a new Health and Social Care Network (HSCN) to NHS hospitals and specialist trusts in Kent replaced an outdated N3 network, delivering improved access to information and technology and substantial cost savings.

University Hospitals Plymouth NHS Trust

How University Hospitals Plymouth NHS Trust completed a move from NHS N3 to the new Health and Social Care Network

West Midlands NHS trusts

How 2 major NHS trusts in the West Midlands planned their move onto the Health and Social Care Network (HSCN).

Earl Mountbatten Hospice

Earl Mountbatten Hospice were one of the first organisations to connect to HSCN, taking part in the HSCN early adopters scheme.

Humber NHS Foundation Trust

Humber NHS Foundation Trust used migration to HSCN as an opportunity to rationalise their existing network design, creating increased network capacity to support patient care.

How University Hospitals Plymouth NHS Trust have successfully migrated to better, faster and cheaper data network connectivity by replacing their legacy N3 services with new Health and Social Care Network (HSCN) services.

Sectra provide hospitals across the country with a portal for the transfer of medical images and reports. Here they explain how HSCN will allow them to provide a faster, safer, better quality service for clinicians.

Norfolk and Suffolk NHS Foundation Trust

This case study demonstrates the benefits of adopting HSCN services for Norfolk and Suffolk NHS Foundation Trust (NSFT).

Rennie Grove Hospice Care

Rennie Grove Hospice Care is a charity providing care and support for adults and children diagnosed with cancer and other life-limiting illness and their families.

North East Ambulance Service

The North East Ambulance Service (NEAS) NHS Foundation Trust were one of the first to migrate to the HSCN. Here they describe how they got there and the benefits they've achieved.

This case study demonstrates how Technomed, a provider of digital cardiology diagnostic services, successfully replaced their Transition Network (formerly N3) services with new Health and Social Care Network (HSCN) services.

This case study describes how regional collaboration with MLL Telecom is delivering interoperable services across Suffolk, Norfolk and Cambridgeshire.

Swindon Clinical Commissioning Group

Swindon Clinical Commissioning Group (CCG) has successfully achieved faster and more resilient network connectivity with new Health and Social Care Network (HSCN) services.

Moorfields Eye Hospital NHS Foundation Trust

This case study demonstrates how Moorfields Eye Hospital is now able to transfer large image files smoothly across the network at all sites following migration to HSCN.

Birmingham Women’s and Children’s Hospital

Following their migration to HSCN Birmingham Women's and Children's hospital have seen increased network speeds and faster access to cloud and internet based services.

This case study shows how NYnet, a small not for profit organisation owned by North Yorkshire County Council, connected all NHS sites across rural North Yorkshire.

Marie Stopes UK

Following migration to HSCN, Marie Stopes are no longer restricted to connectivity at a single site, and can access national services at all locations allowing for real time clinical decision making.

North East Lincolnshire Clinical Commissioning Group

Migrating to HSCN has enabled North East Lincolnshire CCG to respond to additional demands for remote primary care services during the pandemic, such as video consultation services. HSCN has also enabled additional primary care services to be delivered remotely such as supporting care homes and optometry services.

NHS North East London Commissioning Support Unit

NHS organisations migrating to HSCN have achieved significant cost savings of 60%. By providing increased bandwidth, and more responsive and resilient connections, HSCN has enabled each region to plan for new technology projects such as video consultations.

Last edited: 6 September 2022 5:55 pm

Cookies on this website

We use analytics cookies to collect information about how you use our website. We use this information to make the website work as well as possible and improve our services.

You’ve accepted all analytics cookies. You can change your cookie settings at any time.

• How NSS works

Case studies

Our case studies demonstrate how collaboration has been vital to improving Scotland’s health and wellbeing.

From alleviating pressure on GPs and countering fraud to improving quality in the healthcare built environment and supporting the national COVID-19 response, we’re delivering for Scotland and improving for the future.

Take a look at our case studies to learn more about how collaboration has been vital to improving Scotland’s health and wellbeing – with successes at both a national and local level.

2022 case studies

• NHS Scotland Assure - Equipping the Badenoch and Strathspey Community Hospital (Word doc, 826KB)
• NHS Scotland Assure - NHS Scotland Assure Information Management System (AIMS) (Word doc, 442KB)
• NHS National Services Scotland - Pan Lothian Joint Chronologies (Word doc, 542KB)

2020 case study - COVID-19

Building a COVID-19 testing lab (PDF, 358KB)

2018 case studies

• Colon capsule: transforming the patient experience through technology (PDF, 2.3MB)
• Continence: health improvements through collaborative working (PDF, 1.6 MB)
• Using data to alleviate GP pressures (PDF, 1.49MB)
• Tackling fraudulent exemption claims PDF, 1.4MB)
• Re-thinking decontamination (PDF, 1.43MB)
• Patient-centred transfusion treatment (PDF, 2.2MB)
• Modernising diabetes care in Scotland (PDF, 2.3MB)
• Major trauma in Scotland (PDF, 2.28MB)
• Best solutions for oxygen therapy (PDF, 1.7MB)
• Creating a healthy environment (PDF, 1.16MB)

Find out more

To talk to us more about these case studies, or discuss how we could work with you to in the future, contact us by email at [email protected]

Is this page useful?

• Yes  this page is useful
• No  this page is not useful

Help us improve NSS

Don’t include personal or health identifiable information like your Community Health Index.

To help us improve NSS, we’d like to know more about your visit today. We would like you to complete a short survey. It will take only 2 minutes to complete.

• Open access
• Published: 02 September 2024

The right care in the right place: a scoping review of digital health education and training for rural healthcare workers

• Leanna Woods 1 , 2 ,
• Priya Martin 3 ,
• Johnson Khor 1 , 4 ,
• Lauren Guthrie 1 &
• Clair Sullivan 1 , 2 , 5  

BMC Health Services Research volume  24 , Article number:  1011 ( 2024 ) Cite this article

Metrics details

Digital health offers unprecedented opportunities to enhance health service delivery across vast geographic regions. However, these benefits can only be realized with effective capabilities and clinical leadership of the rural healthcare workforce. Little is known about how rural healthcare workers acquire skills in digital health, how digital health education or training programs are evaluated and the barriers and enablers for high quality digital health education and training.

To conduct a scoping review to identify and synthesize existing evidence on digital health education and training of the rural healthcare workforce.

Inclusion criteria

Sources that reported digital health and education or training in the healthcare workforce in any healthcare setting outside metropolitan areas.

We searched for published and unpublished studies written in English in the last decade to August 2023. The databases searched were PubMed, Embase, Scopus, CINAHL and Education Resources Information Centre. We also searched the grey literature (Google, Google Scholar), conducted citation searching and stakeholder engagement. The JBI Scoping Review methodology and PRISMA guidelines for scoping reviews were used.

Five articles met the eligibility criteria. Two case studies, one feasibility study, one micro-credential and one fellowship were described. The mode of delivery was commonly modular online learning. Only one article described an evaluation, and findings showed the train-the-trainer model was technically and pedagogically feasible and well received. A limited number of barriers and enablers for high quality education or training of the rural healthcare workforce were reported across macro (legal, regulatory, economic), meso (local health service and community) and micro (day-to-day practice) levels.

Conclusions

Upskilling rural healthcare workers in digital health appears rare. Current best practice points to flexible, blended training programs that are suitably embedded with interdisciplinary and collaborative rural healthcare improvement initiatives. Future work to advance the field could define rural health informatician career pathways, address concurrent rural workforce issues, and conduct training implementation evaluations.

Review registration number

Open Science Framework: https://doi.org/10.17605/OSF.IO/N2RMX .

Peer Review reports

Introduction

Globally, healthcare workers (HCWs) face multiple pressures simultaneously: increasing demand for care, co-morbidities and condition complexity, budget pressures, and rapid digital disruption [ 1 ]. The digital disruption in healthcare promises an unprecedented circumstance to improve outcomes and strengthen health systems [ 2 ]. However, this opportunity depends on a capable healthcare workforce with adequate skills and knowledge in data and emerging technologies [ 3 ]. HCW capability in digital health and clinical informatics is increasingly acknowledged as an essential component to the delivery of high-quality patient care [ 4 ]. Universities do not yet routinely teach these curricula in clinical degrees, and the capability gap in the current workforce is often filled by brief, reactive, and on-the-job training [ 5 ]. Sustainability of healthcare includes developing a skilled healthcare workforce educated and competent in digital health [ 6 ].

The rural healthcare workforce is faced with the location-based issues of resource constraints, workforce shortages, high staff turnover rates, stress, burnout, and an ageing workforce [ 7 ]. The World Health Organization has acknowledged in a recent report (2021) the complex challenge of shortage of healthcare workers globally in rural areas [ 7 ]. This report has acknowledged that the workforce density is lower than national averages in most of these areas. In places where there isn’t a national shortage, maldistribution of the workforce has been noted [ 7 ]. Digitally enabled models of care are well placed to enhance health service delivery across vast and distributed geographic regions. However, rural health service organizations require uplift to align with their metropolitan counterparts in workforce digital readiness [ 8 ]. Building digital health capability in rural settings is critical because higher digital health capability is associated with better outcomes, including the ability to maintain an accurate patient health record, track patient experience data, track the patient journey, and mitigate clinical risks [ 9 ]. Rurality is contributing to widening digital health inequities [ 10 ] with significant efforts required to adequately manage the rural digital divide [ 11 , 12 ]. Building digital capabilities of healthcare providers in rural and remote settings through education, training and support is needed [ 13 ].

Existing evidence on the education and training the rural healthcare workforce is limited. Firstly, while health science faculties are progressively integrating digital health into the undergraduate curricula for the future workforce [ 14 , 15 , 16 ], it is unclear how the education of current HCW is approached [ 14 ]. Despite global exemplars such as fellowship training for physicians [ 17 ], certification for nurses [ 18 ], and advanced education for clinical and non-clinical professionals [ 19 ], limited evidence of successful workforce programs to build digital health skills exist [ 4 ]. None focus on the rural healthcare setting.

Secondly, in literature reporting digital health in rural settings, there is a notable scarcity on workforce training programs. Existing studies focus on efficacy of delivered healthcare [ 20 , 21 ], workforce perceptions of digital health tool implementation [ 22 , 23 ] or are limited to training of specific interventions (e.g., clinical telehealth [ 24 ]). This review sought to explore the literature where these two gaps coexist, the intersection of digital health education and training and the rural healthcare workforce, and synthesize the available evidence on digital health education and training for the rural healthcare workforce.

Review question

The research questions for this review were:

What are the existing practices and approaches to digital health education and training for rural HCWs?

How has digital health education and training been evaluated following implementation?

What are the barriers and enablers for high quality digital health education and training in the rural healthcare workforce?

Participants

The review considered studies and reports on any members of the workforce in healthcare settings outside of metropolitan areas. The healthcare workforce refers to ‘all individuals who deliver or assist in the delivery of health services or support the operation of health care facilities’ [ 3 ]. All clinical (e.g., medical doctors, nurses, allied health professionals, pharmacists, Indigenous HCWs, pre-registration/qualification students undertaking placements in health care facilities) and non-clinical workers (e.g., administration, executive and management, clinical support, and volunteers) were considered regardless of professional body or government registration status. Patients, healthcare consumers, and the public were excluded.

The core concepts of digital health and training were combined in this review. Digital health and clinical informatics are often used interchangeably, and both were considered in this review. While digital health refers to the use of digital technologies for health [ 25 ], clinical informatics refers to more specialized practice of analyzing, designing, implementing and evaluating information and communication systems [ 26 ]. Specific digital health systems (e.g., IT infrastructure, telehealth, electronic medical records) were included. Training relates to the education or training initiatives (e.g., programs, curriculum, course) that build an individuals’ digital health capability to confidently use technologies to respond to the needs of consumers now and into the future [ 1 ]. Both education and training activities were considered. Education often refers to theoretical learning (e.g., by an academic institution, qualification), and training often teaches practical skills (e.g., employer-provided professional development, ‘just-in-time’ training) [ 3 , 24 ]. This review did not consider HCW education delivered at a distance through technologies (e.g., telesupervision for clinical skills training).

This review considered studies and reports from rural healthcare settings defined as outside metropolitan cities, inclusive of regional, rural, remote, and very remote settings. When the term ‘rural’ is used in this review, it refers to all areas outside major metropolitan cities as described by authors of individual studies and reports. All healthcare facilities across primary, secondary, and tertiary care settings were included in any country.

Types of sources

All research studies, irrespective of the study design, were considered. Reviews, conference abstracts and non-research sources (e.g., policy documents, program or course curriculum) were considered. The grey literature was included to capture reactionary training developed by rural health services that were not published as peer-reviewed research studies.

This review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews [ 27 ] and reported as per the Preferred Reporting of Systematic Reviews and Meta-analyses for scoping reviews (PRISMA-ScR) [ 28 ] (Additional file 1 ). The review protocol was registered in Open Science Framework [ https://doi.org/10.17605/OSF.IO/N2RMX ].

A scoping review approach was chosen over a systematic review to address a general, formative review question on this topic that is emerging in the literature and where the literature is complex and heterogenous [ 29 ]. An initial preliminary search of the topic in the academic databases, Cochrane Library, Open Science Framework and Prospero registry resulted in a very small number of relevant articles. It was determined that a broader search strategy and inclusion of non-research sources was required, consistent with the scoping review methodology [ 29 ]. Scoping review format is also well suited to the vast, diverse healthcare education topic across different disciplines, interventions and outcomes realised [ 30 ]. Mapping and synthesis across sources in this scoping review aims to inform research agendas and identify implications for policy and practice [ 31 ].

Deviations from the protocol

There were no deviations to the protocol.

Search strategy

The three phase JBI search process was followed. An initial limited search of PubMed was performed to identify keywords on the topic, followed by an analysis of the text words and index terms contained in the title and abstract. A subsequent preliminary search in Prospero registry, Cochrane Library and Open Science Framework informed the development of a full search strategy in PubMed. The search strategy, including all identified keyworks and index terms, was adapted for each included database and information source after refining the strategy with an information specialist. The reference lists of all included sources of evidence were screened for additional studies.

The review included only studies and reports in English (due to translation resourcing limitations) in the last 10 years (due to the relative novelty of the digital transformation of healthcare). The search was conducted in August 2023. The databases searched included PubMed, Scopus, Cumulative Index for Nursing and Allied Health Literature (CINAHL), Embase, and Education Resources Information Center (ERIC). Scopus was chosen over Web of Science as it provides 20% more coverage and the relative recency of articles indexed (publish date after 1995 [ 32 ]) was not a concern for our research question. The search for unpublished studies and grey literature included Google and Google Scholar, using a modified search strategy as required. In addition, national and international stakeholders ( n  = 29) from Asia, the Pacific Islands, Australia, USA and the UK known to have subject matter expertise on the topic were contacted via direct email. Stakeholders were asked to share any relevant work underway or otherwise undiscoverable using our scoping review methods. The full search strategy for each information source is provided in Additional file 2 .

Study selection

Following the search, identified articles were collated and uploaded into Covidence review software (Veritas Health Innovation Ltd; Melbourne, Australia) and duplicates removed. Two reviewers (among LW, JK and LG) then independently screened the title and abstract of each citation and selected studies that met the inclusion criteria. The full text articles were retrieved and uploaded into Covidence. These studies and reports were assessed independently by two reviewers (listed previously) for full assessment against the inclusion criteria. Any disagreements that arose between the reviewers at each stage of the selection process were resolved through discussion or with an additional reviewer (among LG and PM). Three meetings occurred to discuss any voting conflicts that occurred during title and abstract screening and full-text screening. Articles that did not satisfy the criteria were excluded with reasons for exclusion recorded. Search results and study selection process is presented in accordance to the PRISMA-ScR flow diagram (Fig. 1 ) [ 28 ]. Quality appraisal of selected studies was not conducted, consistent with scoping reviews methods [ 33 ].

Search results and source selection and inclusion process

Data extraction

Extracted data included the specific details about the participants, concept, context, study methods and key findings relevant to each review question. Data was extracted by one reviewer (JK) and checked by a second reviewer (LW). Data were extracted using the data extraction tool developed and piloted by the team (Additional file 3 ).

Data synthesis and presentation

The characteristics of the included studies were analyzed and organized in tabular format, accompanied by a narrative summary. Results of each research question was presented under separate headings. The data analysis for research question three (barriers and enablers of high-quality digital health education and training) was enhanced. We adopted the socio-institutional framework described by Smith et al [ 34 ] and used in education research [ 35 ] to classify macro, meso, micro level enablers and barriers to help improve the generalizability of the synthesized insights and identify stakeholders that are able to influence change. Gaps and limitations of the current literature were discovered from the evidence with recommendations for policy, practice and future research provided.

Study inclusion

Database searching yielded 1005 articles and stakeholder engagement yielded two articles. After removing duplicates, 660 articles were screened for title and abstract, after which 29 articles underwent full text review. Of the 29 articles, 24 articles were excluded: the setting was metropolitan or otherwise inadequately described as non-metropolitan ( n  = 6); the intervention was not a training or education initiative for digital health or clinical informatics ( n  = 16), or the population was not rural healthcare workers ( n  = 2). In total, following full-text screening, five articles were included in the final review (Fig.  1 ).

Characteristics of included studies

Of the five included articles, three were academic publications including two case studies [ 36 , 37 ] and one feasibility study [ 38 ] (Table 1 ). The two articles identified through stakeholder engagement presented course summaries [ 39 , 40 ] where one described a micro-credential [ 40 ] and the other described a fellowship [ 39 ]. Most articles ( n  = 3) were published recently between 2021 and 2023 [ 38 , 39 , 40 ]. Healthcare workforce settings were distributed across the continents of the United States of America [ 36 ], Asia [ 37 ], Africa [ 38 ] and Australia [ 39 , 40 ], with no articles reporting a setting in the European continent. Further study characteristics are available in Table 1 .

Review findings

What are the existing approaches to digital health education and training for rural hcws.

Training and education programs were needed due to identified gaps in knowledge, skills and expertise to support healthcare delivery in rural contexts with digital health [ 36 , 37 , 38 ], [ 40 ]. One article reported the target learners as village doctors, who may have “limited training and inadequate medical knowledge, yet they are generally the mainstay of health services” [ 37 ]. The mode of teaching in the included studies were four modular online learning courses [ 36 , 37 , 38 ], [ 40 ] and one fellowship [ 39 ]. Of the four modular online learning courses, one was supplemented by a facilitator-led train-the-trainer model [ 38 ], informed by an academic framework [ 41 ], with cohort-based discussion via a social media platform. The second was a certification in the form of a self-paced micro-credential completed individually [ 40 ]. Of the four modular online learning courses, the number of modules ranged from three to eight and covered a variety of digital health topics including innovation, commercialization, bioinformatics, technology use, data and information, professionalism, implementation and evaluation. One had a particular focus on information and communication technology tool use [ 37 ] while another focused on remote consulting [ 38 ]. The mode of delivery of the fellowship was not reported in the article.

Four [ 36 , 37 , 39 , 40 ] of the five included articles did not report an evaluation. One article in rural Tanzania described the evaluation of the train-the-trainer digital health training program using a mixed-method design [ 38 ]: (1) questionnaire informed by Kirkpatrick’s model of evaluation to capture knowledge gained and perceived behavior change on a Likert scale, (2) qualitative interviews to explore training experiences and views of remote consulting, and (3) document analysis from texts, emails and training reports [ 38 ]. Of the tier 1 trainees (senior medical figure trainers who were trained to educate their peers) that completed the questionnaire ( n  = 10, 83%), nine (90%) recommended the training program and reported receiving relevant skills and applying learning to daily work, demonstrating satisfaction, learning and perceived behavior change [ 38 ]. Overall, the feasibility study confirmed that remotely delivered training supported by cascade training was technically and pedagogically feasible and well received in rural Tanzania [ 38 ].

What are the barriers and enablers for high quality digital health education and training of the rural healthcare workforce?

Reported enablers and barriers are presented using the macro, meso, micro framework [ 34 ] (Table 2 ).

This scoping review reflects the scarcity of reported digital health education and training programs in existence for rural HCWs globally. This review responds to the World Health Organization (WHO) recommendation to design and enable access to continuing education and professional development programs that meet the needs of rural HCWs [ 7 ], and the Sustainable Development Goal for inclusive and equitable quality education [ 42 ].

Concurrent challenges of people (workforce), setting (rural) and content (digital health) are reported in included articles alongside enablers and barriers to education and training programs. Included studies reported a shortage of doctors and specialists [ 36 ], lack of technical knowledge [ 36 ] (people); higher cost of delivering rural healthcare, high burden of illness [ 40 ], medically underserved population due to rural hospital closures [ 36 ] (setting); and limited use of digital health tools due to coordination challenges among non-government organisations [ 37 ] (content). These additional macro, meso and micro level factors are described by authors firstly as influencing the need for digital health programs in rural settings, and secondly, as contributing to the challenges of implementing effective programs. The rural health workforce challenges in digital health education and training reflect the broader workforce development issues experienced globally [ 7 ]. While this review sought to identify workforce development programs, the WHO model indicates the need for attractiveness, recruitment and retention to enable workforce performance (i.e., appropriate and competent multidisciplinary teams providing care) and health system performance (i.e., improving universal health coverage) [ 7 ].

In low-resource settings such as rural areas, education and training may not be prioritized among other competing workload demands. As the value of digital health transformations are realized for strengthening healthcare systems [ 25 , 43 ], the value of digital health education or training programs may become realized. This value was evidenced in the implementation of the teleconsulting training intervention in rural Tanzania [ 38 ] in rapid response to supporting care delivery during the COVID-19 pandemic period. With evaluations of programs largely absent from an already small number of programs globally, it will be important for future research to focus on implementation evaluation studies. As Table 2 presents only limited enablers and barriers, more evidence is needed to build on the findings from this scoping review to inform strategies for policy and practice.

The interdisciplinarity of digital health presents challenges and opportunities for nurturing digital health expertise across the rural healthcare workforce. Included articles largely described the target learners of education and training programs as clinicians, practitioners and healthcare workforce. Walden et al. further indicated that users of online content may extend beyond rural health clinicians to healthcare administrators, researchers and providers relevant to address the regulatory factors of clinical validation and implementation [ 36 ]. Therefore, for their program of work, the University of Arkansas for Medical Sciences identified and fostered collaboration with an interprofessional team of clinicians, researchers, informaticists, a bioethicist, lawyers, technology investment experts, and educators [ 36 ]. No articles in the review described education or training health informaticians or similar digital health leadership role types, yet building defined career pathways for health informaticians is recommended [ 4 ]. Existing pedagogy shows that the learning principles of interprofessional practice is grounded in understanding one’s own practice as well as the practice of other health professionals and remains aligned to the educational needs of specific professions [ 44 ] (i.e., medicine, nursing, pharmacy). Defining new career pathways for interdisciplinary leaders in digital health within a specific clinical context, like the ‘rural health informatician’, will be important to identify or define the (hidden) specialized workforce.

Local, informal organizational initiatives for digital health learning were discovered alongside formal education or training programs in included studies. Programs were often reported in articles alongside concurrent digital health implementation or healthcare improvement programs, sometimes referred to as ‘outreach’ [ 36 ] activities. These informal initiatives included special interest groups, in-person conferences, networking events, working groups [ 36 ] and seminars [ 37 ]. Current evidence from this scoping review suggests that the efficacy and sustainability of education or training programs are reliant on integrated approaches, like the train-the-trainer [ 38 ] or academic organization approach [ 36 ], that foster translational research for rural healthcare improvement. As illustrated by Walden et al., success in digital health is likely to require a foundational environment where technologies can be discussed, developed and deployed [ 36 ]. Success in rural digital health skills acquisition likely requires a similar, longitudinal and collaborative approach beyond the confines of an online course completed individually. Previous research shows us that blended learning, which merges face-to-face with online learning, translates to better knowledge outcomes [ 44 ]. Blended learning can also overcome the barrier of rural HCWs travelling large distances to attend face-to-face training that comes at a great cost to themselves and the work unit. A key recommendation to improve the digital health training program described by Downie et al. was more face-to-face time with trainers, from the perspective of both trainee and facilitator [ 38 ]. This, however, can only be realized with targeted planning and budgeting of such offerings by involved rural healthcare organizations.

The opportunities to advance digital health education and training for rural HCWs are presented across the macro, meso and micro levels in the socio-institutional framework, with suggested relevant stakeholders suited to actioning the recommendations (Table  3 ). While the context for this is likely to vary across the globe, these recommendations and stakeholders are expected to provide a starting point to initiate a dialogue that can influence change. These recommendations are not meant to be prescriptive or rigid, but rather meant to flag actionable solutions that can be contextualized for any given setting.

Strengths and limitations

It is possible that there is a greater number of published educational and training programs than those reported in this review (i.e., publication bias). To mitigate this, we used a scoping review methodology and stakeholder engagement activity to identify unpublished or emerging programs that answer the review question but may not be discoverable in the academic databases. The review is limited to articles available in the English language. The small number of programs, heterogeneity of programs and limited evaluation of programs significantly limit generalizability of findings. Due to data availability, the barriers and enablers findings summary contain an overrepresentation from a small number of studies limiting conclusions that can be drawn.

Digital health offers the best opportunity for innovative sustainable change to address critical issues in health and care in rural settings. Workforce education and training initiatives in rural healthcare settings are scarce, largely delivered via online training, and are rarely evaluated. Current best practice points to flexible, blended (online and face-to-face) training programs that are suitably embedded with interdisciplinary, collaborative rural healthcare improvement initiatives. More research will expand the evidence base to deliver high-quality digital health education to strengthen rural healthcare delivery. Future work to advance the field could define rural health informatician career pathways, address concurrent rural workforce issues, and conduct implementation evaluations.

Availability of data and materials

No datasets were generated or analysed during the current study.

Abbreviations

Cumulative Index for Nursing and Allied Health Literature

Education Resources Information Centre

Healthcare worker

Joanna Briggs Institute

Preferred Reporting of Systematic Reviews and Meta-analyses for scoping reviews

World Health Organization

Australian Digital Health Agency. The national digital health capability action plan. Australia: Australian Government; 2022. p. 36.

Google Scholar  

World Health Organization. Global strategy on digital health 2020–2025. Geneva: World Health Organization; 2021. p. 60.

Australian Digital Health Agency. National digital health workforce and education roadmap. Sydney; 2020.

Woods L, Janssen A, Robertson S, et al. The typing is on the wall: Australia’s healthcare future needs a digitally capable workforce. Aust Health Rev. September 2023;2023:25. https://doi.org/10.1071/AH23142 .

Article   Google Scholar  

Younge VL, Borycki EM, Kushniruk AW. On-the-job training of health professionals for electronic health record and electronic medical record use: A scoping review. Knowledge Management & E-Learning: An International Journal. 2015;7:436–69.

Thomas EE, Haydon HM, Mehrotra A, et al. Building on the momentum: sustaining telehealth beyond COVID-19. J Telemed Telecare. 2022;28:301–8.

Article   PubMed   Google Scholar  

World Health Organization. WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas. 2021.

Woods L, Eden R, Pearce A, et al. Evaluating Digital Health Capability at Scale Using the Digital Health Indicator. Appl Clin Inform. 2022;13:991–1001. https://doi.org/10.1055/s-0042-1757554 .

Article   PubMed   PubMed Central   Google Scholar  

Woods L, Dendere R, Eden R, et al. Perceived Impact of Digital Health Maturity on Patient Experience, Population Health, Health Care Costs, and Provider Experience: Mixed Methods Case Study. J Med Internet Res. 2023;25: e45868. https://doi.org/10.2196/45868 .

Yao R, Zhang W, Evans R, et al. Inequities in health care services caused by the adoption of digital health technologies: scoping review. J Med Internet Res. 2022;24:e34144. https://doi.org/10.2196/34144 .

Clark CR, Akdas Y, Wilkins CH, et al. TechQuity is an imperative for health and technology business: Let’s work together to achieve it. J Am Med Inform Assoc. 2021;28:2013–6. https://doi.org/10.1093/jamia/ocab103 .

Esteban-Navarro M-Á, García-Madurga M-Á, Morte-Nadal T, et al. The rural digital divide in the face of the COVID-19 pandemic in Europe—recommendations from a scoping review. Informatics. 2020;7:54.  https://doi.org/10.3390/informatics7040054 .

Macklin S. Understanding the pathway to consumer centred healthcare information in rural and remote Queensland. Brisbane: The University of Queensland; 2022.

Aungst TD, Patel R. Integrating digital health into the curriculum—considerations on the current landscape and future developments. J Med Educ Curric Dev. 2020;7:2382120519901275.

Edirippulige S, Gong S, Hathurusinghe M, et al. Medical students’ perceptions and expectations regarding digital health education and training: a qualitative study. J Telemed Telecare. 2022;28:258–65.

Veikkolainen P, Tuovinen T, Jarva E, et al. eHealth competence building for future doctors and nurses–Attitudes and capabilities. Int J Med Informatics. 2023;169:104912.

American Medical Informatics Association. Informatics academic programs. 2022 https://amia.org/careers-certifications/informatics-academic-programs . Accessed 21 June 2022.

American Nurses Credentialing Center. Informatics nursing board certification examination. Maryland, USA2018, p. https://www.nursingworld.org/~490a495b/globalassets/certification/certification-specialty-pages/resources/test-content-outlines/427-tco-rds-2016-effective-date-march-2023-2018_100317.pdf .

Topol E. The topol review: preparing the healthcare workforce to deliver the digital future. United Kingdom: Health Education England NHS; 2019. p. 1–48.

McCleery J, Laverty J, Quinn TJ. Diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment. Cochrane Database Syst Rev. 2021;7(7):CD013786.

PubMed   Google Scholar  

Janjua S, Carter D, Threapleton CJ, et al. Telehealth interventions: remote monitoring and consultations for people with chronic obstructive pulmonary disease (COPD). Cochrane database of systematic reviews; 2021.

Xyrichis A, Iliopoulou K, Mackintosh NJ, et al. Healthcare stakeholders’ perceptions and experiences of factors affecting the implementation of critical care telemedicine (CCT): qualitative evidence synthesis. Cochrane Database Syst Rev. 2021;2(2):CD012876.

Odendaal WA, Watkins JA, Leon N, et al. Health workers’ perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2020;3(3):CD011942.

Edirippulige S, Armfield N. Education and training to support the use of clinical telehealth: A review of the literature. J Telemed Telecare. 2017;23:273–82. https://doi.org/10.1177/1357633x16632968 .

Article   CAS   PubMed   Google Scholar  

World Health Organization. Recommendations on digital interventions for health system strengthening. World Health Organization. 2019. 2020–2010.

Gardner RM, Overhage JM, Steen EB, et al. Core content for the subspecialty of clinical informatics. J Am Med Inform Assoc. 2009;16:153–7.

JBI. JBI manual for evidence synthesis. 2020.

Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169:467–73.

Peters MDJ, Marnie C, Tricco AC, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119–26. https://doi.org/10.11124/jbies-20-00167 .

Shead DA, Olivier B. Traditional or digital health care education? JBI Evidence Synthesis. 2020;18:861–2.

Tricco AC, Lillie E, Zarin W, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol 2016; 16: 15. https://doi.org/10.1186/s12874-016-0116-4 .

Falagas ME, Pitsouni EI, Malietzis GA, et al. Comparison of PubMed, Scopus, web of science, and Google scholar: strengths and weaknesses. FASEB J. 2008;22:338–42.

Peters MD, Godfrey CM, Khalil H, et al. Guidance for conducting systematic scoping reviews. JBI Evid Implement. 2015;13:141–6.

Smith T, McNeil K, Mitchell R, et al. A study of macro-, meso-and micro-barriers and enablers affecting extended scopes of practice: the case of rural nurse practitioners in Australia. BMC Nurs. 2019;18:1–12.

Desai D, Mayne C, Bates H, et al. A rapid review of the barriers and enablers of medical student participation in research in health settings. 2022. https://doi.org/10.17605/OSF.IO/5XZWN .

Walden A, Kemp AS, Larson-Prior LJ, et al. Establishing a digital health platform in an academic medical center supporting rural communities. Journal of Clinical and Translational Science. 2020;4:384–8.

Mridha M and Islam M. To improve patient care & safety of rural patients empowering the village doctors. In: EMBEC & NBC 2017: Joint Conference of the European Medical and Biological Engineering Conference (EMBEC) and the Nordic-Baltic Conference on Biomedical Engineering and Medical Physics (NBC), Tampere, Finland, June 2017 2018, pp.502-505. Springer.

Downie A, Mashanya T, Chipwaza B, et al. Remote Consulting in Primary Health Care in Low-and Middle-Income Countries: Feasibility Study of an Online Training Program to Support Care Delivery During the COVID-19 Pandemic. JMIR Formative Research. 2022;6:e32964.

Australian College of Rural & Remote Medicine. Rural Generalist Curriculum - Fellowship. Brisbane, Australia: ACRRM; 2021. p. 174.

Northern Australia Regional Digital Health Collaborative and James Cook University (NARDHC and JCU). Digital Health for the Rural and Remote Health Workforce Micro-credential (Brochure). Townsville: JCU; 2023.

Mormina M, Pinder S. A conceptual framework for training of trainers (ToT) interventions in global health. Glob Health. 2018;14:1–11.

United Nations Department of Economic and Social Affairs Sustainable Development. Sustainable development goals. 2023. https://sdgs.un.org/goals . Accessed 20 Feb 2024

Woods L, Eden R, Canfell OJ, et al. Show me the money: how do we justify spending health care dollars on digital health? Med J Aust 2022 2022/12/12. https://doi.org/10.5694/mja2.51799 .

Dizon JMR. Educating future health professionals to keep pace with changing times. LWW, 2021, p. 2904–2905.

Download references

Acknowledgements

Not applicable.

No external funding.

Author information

Authors and affiliations.

Queensland Digital Health Centre, The University of Queensland, Brisbane, Australia

Leanna Woods, Johnson Khor, Lauren Guthrie & Clair Sullivan

Centre for Health Services Research, The University of Queensland, Brisbane, Australia

Leanna Woods & Clair Sullivan

Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia

Priya Martin

Ochsner Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia

Johnson Khor

Metro North Hospital and Health Service, Herston, Australia

Clair Sullivan

You can also search for this author in PubMed   Google Scholar

Contributions

LW, PM and CS designed the study. LW, PM, JK and LG acquired data; analyzed and interpreted results and drafted the manuscript and all subsequent drafts. CS read and contributed to manuscript drafts. All authors read and approved the final manuscript draft.

Corresponding author

Correspondence to Leanna Woods .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

12913_2024_11313_moesm1_esm.docx.

Additional File 1. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

Additional File 2. Full search strategy for each information source.

Additional file 3. data extraction instrument template., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ .

Reprints and permissions

About this article

Cite this article.

Woods, L., Martin, P., Khor, J. et al. The right care in the right place: a scoping review of digital health education and training for rural healthcare workers. BMC Health Serv Res 24 , 1011 (2024). https://doi.org/10.1186/s12913-024-11313-4

Download citation

Received : 13 March 2024

Accepted : 15 July 2024

Published : 02 September 2024

DOI : https://doi.org/10.1186/s12913-024-11313-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Clinical informatics
• Health informaticians
• Digital health
• Health personnel
• Rural population
• Rural health
• Low-resource settings

BMC Health Services Research

ISSN: 1472-6963

• General enquiries: [email protected]

19/07/2024 – Please be reassured, our Sciensus systems are unaffected by the global Microsoft outage. All patient medicine deliveries will go ahead as scheduled.

Supporting the NHS’s service recovery through the Sciensus virtual ward

The COVID-19 pandemic placed well-documented strain on the NHS’s capacity to deliver planned services, such as surgery. As a result, waiting lists across the country reached record highs, emergency and urgent care departments have been under incredible pressure and local systems have had to work hard to find new ways to create additional capacity.

Over recent years the NHS has placed significant focus on developing virtual ward capacity across England to enable patients who are medically stable, but not medically fit for discharge, to continue treatment at home. Partnering with independent providers of virtual wards, such as Sciensus , could be a cost effective and practical solution for many NHS organisations. As one of the largest providers of virtual wards and out of hospital clinical care across the UK, Sciensus has been providing with safe, high-quality treatment in the comfort and convenience of their own homes for more than 30 years.

A proven track record of delivery

When Nottingham University Hospitals NHS Foundation Trust (NUH) decided to expand their virtual ward capacity, they turned to Sciensus as a trusted partner and one which they knew could set up a safe and effective service at pace.

“Having partnered with Sciensus previously, our chief operating officer was confident that they would be able to support us with the rapid expansion of our virtual ward,” says Heather Young, Virtual Ward Program Manager at NUH, “Ultimately, the health and wellbeing of patients on the virtual wards are still our responsibility and so it’s critical to choose the right partner. Sciensus offered us a team with a proven track record of delivery, robust operating procedures and a professional approach from the very beginning. Interestingly, other trusts are now contacting us to find out who we are working with and we are more than happy to recommend Sciensus to them.”

Helping patients to maintain their independence

The Sciensus team are fully embedded within the Trust’s multi-disciplinary teams to ensure there are no gaps in communication. They are involved in regular meetings to identify patients suitable for transfer to the virtual ward across a range of specialities and to discuss the progress of those patients already in their care.

“We have total confidence that our patients are safe in the hands of the Sciensus team,” says Heather, “They adhere to the same high standards as our own teams and are very quick to notify us of any concerns or changes in a patient’s condition. In many ways, for patients who need acute care but not necessarily an acute hospital bed, the virtual ward is safer and healthier than staying in hospital. They have a much lower risk of infection and can maintain their independence so much more so than they can in hospital, where longer term patients can often become desensitised and struggle to do basic things for themselves once discharged. This can mean that they can be eventually discharged from the virtual ward without the need for a social care package – helping to maintain optimum flow through the hospital.”

Reducing pressure across the Trust

This retained independence also means that patients on the virtual ward are often able to be discharged without the need for a package of care, supporting the timely flow of patients through the hospital.

NUH is one of the top performing trusts in England in terms of reducing their backlog of patients waiting for planned surgery, an achievement that they attribute in part to the ability of the virtual ward to free up physical hospital beds for people who truly need them. Similarly, if a virtual ward patient’s condition deteriorates, they don’t need to be readmitted via the usual pathway, which reduces some pressure on the emergency department.

“The virtual ward has been so successful for us that we have even found patients asking for it by name,” says Heather, “It’s also starting to become business as usual across the Trust with consultants actively considering it as part of the patient pathway.”

Patient feedback

Saq was first introduced to the concept of virtual wards when he was facing a six-week course of IV antibiotics. He had been having antibiotics for a couple of daysand felt practically back to full health (even working from his hospital bed for a time).

“That’s when the bombshell was dropped,” says Saq, “That it’s going to be six weeks, just to make sure that we can get a hold of it.”

Not only that, but the antibiotics would continue to be administered intravenously, ultimately tying Saq to a hospital bed for the duration.

“I was facing a time in the year when my daughter was going to start her first day at high school,” he continues, “I thought, I’m not going to be home for that.”

Thanks to his work in a company that supplies products to secondary care services, Saq was all too aware of the cost of a patient bed. Adding to that, the existing strain on the NHS post-COVID, with many people on waiting lists needing urgent care, he was even more reluctant to, in his own words, “throw a spanner in the works”.

“When the virtual ward was put forward to me, I felt so lucky I wish I’d written down six numbers.”

Through the virtual ward, Saq was supported in managing his own care at home, with regular visits from Sciensus nurses and an open channel of communication with the hospital. He says the staff were proactive in their care, ensuring he was kept in the loop and acknowledging his questions and concerns regarding the antibiotics’ eventual adverse side effects. All of this, ultimately, made Saq feel that he really mattered as a patient.

Being at home for the duration of his treatment, rather than in hospital, also meant he was able to be with his family, easing the concerns of his two daughters.

“When I came home, it took them all of about five minutes to realise I’m still that same irritating dad,” he says.

Case Studies

The COVID-19 pandemic placed well-documented strain on the NHS’s capacity to deliver planned services, such as surgery. As a result,…

Promising breakthrough for patients with rare form of cancer

A recent breakthrough in the treatment of malignant pleural mesothelioma (MPM) , published in JAMA oncology, may be a pivotal…

Sciensus continues to extend the full range of its services across Europe

Sciensus, a life sciences business, specialising in patient access, engagement and insight solutions has announced that it is extending the…

Search form

The nurses’ health study and nurses’ health study ii are among the largest investigations into the risk factors for major chronic diseases in women..

The success of the studies would not have been possible without our participants, who have made important contributions to scientific knowledge and public health advancements through their participation.

From the original Nurses’ Health Study established in 1976, the studies are now in their third generation with Nurses’ Health Study 3 (learn how to join) and count more than 280,000 participants.

Global Coverage

Building more engaged teams in the NHS

How Gateshead Health NHS Trust improved teamwork and reduced absence

It creates a common language that makes it easier to identify strengths and address weaknesses, so that individuals and teams can perform at their highest level.

The Gateshead Health NHS Trust identified that teamwork was one of their major development areas and introduced Insights Discovery to improve communication and collaboration.

We helped the teams to:

• Understand the behavioural preferences of individuals and how these can sometimes clash to cause conflict
• Identify practical actions to take that would help people with different preferences work better together
• Work together to make a more supportive and engaging team environment

One team worked within a particularly stressful unit and suffered from high levels of stress-related absence. After implementing Insights Discovery and taking real steps to promote its application in the workplace,  absence levels were reduced from 40% to 3%.

This team has since won three national awards.

reduction in absenteeism

It is life changing and the teams that I’ve worked with have a new language.

Joanne Coleman

Safeguarding Strategic Lead, NHS Trust

Share this page:

Let us help your business today. contact us now to start your journey..

Strategic Management of the NHS Case Study

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

Introduction

Aims and objectives of the healthcare system in the uk, stakeholders, analysis of major provider sectors, analysis of the nhs, recommendations.

The main objective of the NHS is to ensure that all residents of the UK are able to access medical services irrespective of their demographic, social, cultural or economic background (NHS 2014). One of the major advantages of the NHS is that it enables the residents of the UK to receive healthcare free of charge. In addition, it provides a variety of services to all patients. This has resulted into improved health outcomes in the country.

However, the NHS has faced serious challenges in the last few years. These include limited funding from the government and inadequate capacity to handle rising demand for medical services (Schmid et al. 2010, pp. 455-486). In addition, patients have complained about declining service quality standards, whereas physicians are concerned about deteriorating terms of service.

This has forced the government to intervene by implementing new policies and strategies to improve the performance of the NHS. This report will provide a detailed analysis of the NHS, with the aim of proposing recommendations to the government to improve its performance. The report will begin by highlighting the current state of the UK’s healthcare system. This will be followed by analysis using various tools and models.

First, secondary care institutions are facing sustainability challenges. This is illustrated by the fact that nearly 15% of the country’s hospitals that provide specialized care have been declared unsustainable in the recent past.

As more institutions become clinically and economically unsustainable, access to high quality healthcare will reduce significantly (Rothgang et al. 2008, pp. 132-146). Second, the government believes that it should reduce its expenditure on healthcare by 20%. This need arose as a result of the country’s poor economic performance in the last five years.

Third, there is no effective integration between hospitals and community services. Some of the factors that hinder integration include poor communication, conflicting objectives among care institutions, and competition among care providers (Williams 2011, pp. 100-113). Fourth, the public has lost trust in general practitioners (GPs). The GPs have focused on pursuing their interests at the expense of providing improved and accessible services to the public.

First, the government intends to cut its expenditure on healthcare without compromising quality and access. This objective is meant to improve efficiency in the healthcare system. Second, the NHS intends to distribute the existing workload between primary and secondary care institutions.

A fair distribution of the workload will enhance capacity optimization in existing care institutions, thereby improving access. Third, the integration between care institutions is to be improved. This objective will facilitate effective and efficient cooperation among care providers (Williams 2011, pp. 100-113).

Fourth, the NHS intends to increase the range of local services that are provided by the GPs. This will restore public confidence and trust in GPs (Costigliola 2012, p. 42). In addition, the demand for secondary care will reduce if improved services are provided at the local level. Finally, the process of commissioning healthcare is to be improved by increasing the representation of clinicians in the CCGs. Improved participation of clinicians will ensure that quality medical services are available in every region in the UK (Costigliola 2012, p. 52).

The stakeholders include the Care Quality Commission (CQC), National Health Service (NHS) England, Clinical Commissioning Groups (CCG), Health and Wellbeing Board, the government, the National Treasury, and Monitor (NHS 2014). The CQC monitors the health sector by ensuring that care institutions are providing safe, effective, and high quality medical services. NHS England facilitates access to healthcare by providing adequate care facilities, medical supplies, and qualified physicians.

The main role of CCGs is to plan and design the process of providing medical services at the local level (NHS 2014). This involves purchasing medical services such as planned hospital care and rehabilitation care. The Health and Wellbeing Board collaborates with the commissioners and the community members to facilitate equitable access to healthcare at the local level. Monitor regulators the health sector by ensuring that the services provided meet the varied needs of the citizens (Monitor 2014).

The government of the UK provides healthcare at different levels. These include primary care, secondary care, community care, and social care. Primary care is mainly provided by general practitioners and nurses as a first response to various health conditions. Primary care “provides universal and comprehensive access to all citizens” (Greener 2009, p. 76).

The services include diagnosing diseases, prevention of diseases, and encouraging healthy behaviors (NHS 2014). The main strengths of the country’s primary care system include high access rate and effective coordination of services. However, the system is underfunded and the demand for services keeps rising (Appleby et al. 2014).

Secondary care in the UK is provided by consultants who are hired by the NHS. The consultants are doctors and health professionals who specialize in specific areas such as cardiology and physiotherapy. Generally, the consultants provide their services in hospitals that are owned by the government (NHS 2014).

The main strength of the UK’s secondary care system is that it provides high quality medical services. In addition, it is less expensive than those of most developed countries. However, access to secondary care in the UK has reduced tremendously in the last decade due to limited capacity. Patients have to wait for a long time to be attended to by specialists such as neurologists. In addition, poor coordination between primary and secondary care institutions limits access.

Community care is mainly provided at the local level to specific groups of people such as the disabled and the elderly. The aim of community care is to enable beneficiaries to receive care while maintaining their independence in their residential homes or care homes (NHS 2014). The services provided by the community care system include meals, helping with domestic chores such as cleaning, personal tasks such as bathing, and recreational activities.

Community care enables the government to reduce the strain on health facilities since the services are provided in the patient’s home or in a care home (Appleby et al. 2014).

The main weakness of the community care system is that the criteria for selecting the beneficiaries is often complicated and time consuming. Social care is also provided at the local level to help citizens and their families to cope with the life challenges that are attributed to disability and illnesses. Social care is also negatively affected by the complexities associated with selecting the beneficiaries.

SWOT Analysis

SWOT analysis highlights the strengths and weaknesses of the NHS. It also identifies the opportunities that are available to the NHS and the threats in the health sector (Gerlinger 2009, pp. 145-175). Table 1 summarizes the strengths, weaknesses, opportunities, and threats.

Table 1: SWOT.

The main strength of the NHS is its ability to provide medical services on a large-scale to the residents of the UK. Moreover, it has an extensive infrastructure and well trained medical personnel. The threats facing the NHS include limited funding and the increase in the number of patients with chronic conditions. The opportunities that are available to the NHS include using NHS 111 call service to enable more patients to access healthcare. Moreover, the NHS can address its capacity constraints by collaborating with private providers to deliver healthcare.

PESTEL Analysis

The PESTEL analysis highlights the external factors that are likely to influence the performance of the NHS in future. These include political, economic, social, technological, environmental, and legal factors (Greener 2009, p. 213). The influence of these factors is summarized in table 2.

Table 2: External Factors.

The main external factors that pose significant threats to the NHS include increase in the prevalence of long-term conditions and rapid aging of the population, as well as, reduced funding. These factors will lead to resource limitations, thereby causing failure. However, improvements in e-learning and digital inclusion provide opportunities for cost reduction through technologies such as telehealth.

Competition: Porter’s Five Forces Analysis

Porter’s five forces analysis highlights the nature of competition in UK’s health sector (Costigliola 2012, p. 115). Table 3 summarizes the main forces in the competitive environment that are likely to influence the competiveness of the NHS.

Table 3: Market Forces.

Table 3 shows that the NHS is able to overcome competition in the market. This is explained by the fact that the NHS is the largest provider of healthcare and its services perform better than those of the competitors in terms of accessibility and costs. However, the NHS should improve the quality of its services to overcome the threat attributed to alternative services such as medical tourism.

7S Analysis

The 7S analysis is a strategic management model that states that an organization must align and reinforce its soft and hard elements to achieve success (Sadler 2003, p. 56). The soft elements include staff, skills, shared values, and style. The hard elements include structure, strategy, and system (Sadler 2003, p. 56). These elements are summarized in table 4.

Table 4: The Soft and Hard Elements of the NHS.

The organizational values that have been adopted by the NHS include compassion, improving lives, commitment to quality, and working together for patients. Compassion and commitment to quality will enable the employees of the NHS to provide the best healthcare, thereby improving patients’ health.

In addition, teamwork will facilitate effective coordination of healthcare services. Professional development will improve the employees’ skills. As a result, they will be able to satisfy patients’ health needs. The NHS delivers healthcare through several organizations, which include CCGs, and NHS foundation trusts. The organizational structures of these organizations should be streamlined to improve efficiency in healthcare delivery.

Stakeholder Analysis

Stakeholder analysis identifies the individuals and organizations that are likely to influence the activities of the NHS. Generally, stakeholders with high interest and power/ influence on delivery of healthcare are likely to have a great impact on the strategy and activities of the NHS and vice versa (Sadler 2003, p. 73). Table 5 sheds light on the stakeholders.

Table 5: Key Stakeholders.

Stakeholders with high interest in healthcare are the main consumers of medical services. Thus, the NHS must align its strategy to the needs of stakeholders with high interest (patients) to achieve success. Non-medical personnel have low interest because they are not directly involved in the provision of healthcare. Thus, they are not likely to have a significant impact on the strategy of the NHS.

The union leaders and the government have high influence on healthcare provision. Thus, the NHS must satisfy their needs, which include cost reduction and maintaining acceptable quality standards. Medical staff, Monitor, and CQC have high interest and influence. Thus, the NHS must actively manage them to ensure long-term cooperation. The patients and Public Health have high interest and low influence. Thus, the NHS should keep them informed about its activities to facilitate access to care.

The government should adopt the following recommendations to reform the NHS. The main objective of the recommendations is to address the weaknesses of the NHS so that it can overcome external threats and take advantage of existing opportunities. The recommendations will also meet the objectives of the healthcare system in the UK.

Reduce Spending by 25%

Reducing expenditure is the major strategy that the NHS needs to reduce its budget deficits. Expenditure should be reduced by adopting the following strategies. First, the organizational framework of the CCGs should be decentralized. One of the major weaknesses of the NHS is high operating costs, which are partly attributed to centralization of CCGs’ organizational framework.

Significant cost reductions can be achieved by decentralizing CCGs. This will involve increasing the participation of the local communities in commissioning healthcare. The local communities will have high involvement in the ownership and management of healthcare facilities. This will promote cost reduction at the local level.

Second, specialized services should be merged. Services such as treatment of chronic diseases should be centralized or merged to reduce costs. This strategy is justified by the fact that specialized services are very expensive to provide. Centralizing the services will lead to cost savings through sharing of scarce resources (Wilstow 2012, pp. 5-13). For example, accessing specialists such as cardiologists who are in short supply will be easy and cost-effective if their services are centralized.

Reorganization of the Workforce

Reorganization of the workforce through professional development is required to improve the quality of healthcare. In this regard, the NHS should adopt the following strategies. First, the NHS should train more specialized medical personnel. The NHS has a long patient waiting list because of the limited availability of specialized medical personnel. Thus, it is important to train more specialized personnel to improve service provision (Charlesworth, Smith & Thorlby 2014).

Second, the NHS should focus on on-the-job training of non-specialized medical personnel (Hall, Miller & Millar 2012, pp. 49-62). Improved skills will enable the personnel to provide high quality services, thereby restoring public confidence in GPs.

Third, the NHS should deploy personnel to underserved areas. Increased influence of politicians in commissioning healthcare in the country has led to unbalanced access to care. To address this situation, medical personal should be redeployed from overstaffed to understaffed hospitals and clinics to improve health outcomes (Hall, Miller & Millar 2012, pp. 49-62).

Disease Prevention

The NHS should focus on disease prevention to reduce demand for healthcare, thereby reducing its capacity constraints. Thus, staff and patient education programs should be introduced to increase the information that is in the public domain about disease prevention. If the information is utilized appropriately, infection rates will reduce (Lombardo & Buckeridge 2012, pp. 7-20). This will reduce expenditure on healthcare and improve the health of the citizens.

Regular screening of members of the public should be conducted to facilitate early detection of various illnesses. As a result, it will be possible to provide timely interventions to prevent premature deaths (Gerlinger 2009, pp. 145-175). Moreover, chronic diseases such as cancer can be treated at a low cost if they are detected early.

Quality of Healthcare

Improving the quality of healthcare is the major strategy that the NHS should adopt to improve patient outcomes and to win the trust of the public. The NHS should introduce effective care pathways to improve the quality and safety of healthcare. Care pathways will use evidence-based clinical interventions, thereby reducing chances of medical errors. The resulting improvements in health outcomes will reduce readmission rates and strain on healthcare resources (Gerlinger 2009, pp. 145-175).

Monitor and CQC should provide guidelines and technical assistance to improve compliance. Moreover, Monitor should improve supervision of healthcare providers. This will ensure that only accredited institutions are providing medical services, thereby improving quality.

Use of Technology

Use of advanced information and communication technologies is one of the main strategies that the NHS should adopt to improve access to healthcare. The NHS should focus on using telehealth, websites, and mobile phone applications. Since majority of the population already has access to the internet and mobile phones, telehealth and websites will be convenient and cost-effective channels for delivering healthcare (Ramena & Staggers 2013, p. 14).

Furthermore, care providers should use text reminders to encourage patients to attend medical appointments. Empirical studies indicate that SMS text reminders motivate patients to attend all clinical appointments, thereby improving their health (Mitchell & Selmes 2007, pp. 423-434).

Participation of the Private Sector in Service Provision

The participation of the private sector is required to increase the capacity to provide healthcare to all citizens. The government should provide incentives to private insurers to provide affordable health insurance. As the cost of health insurance premiums reduce, more citizens are likely to pay for their healthcare. As a result, the budget deficits that the NHS is grappling with will reduce.

The government should also deregulate establishment of private hospitals and clinics. By eliminating regulations that prevent entry, the participation of the private sector will increase, thereby enhancing access and quality.

Capacity Change

The capacity of the healthcare system should be increased to meet future increase in demand for healthcare. The NHS should establish additional hospitals, care homes, and clinics to address the expected increase in demand for care. Moreover, the NHS should improve availability and functionality of medical equipment. One out of five public hospitals is not sustainable partly because of inadequate equipment (Appleby et al. 2014). Thus, the existing medical equipment should be improved to enhance clinical sustainability.

Integrated Care

The NHS should focus on providing integrated care to eliminate fragmentation of medical services, which often leads to poor patient outcomes. There should be improved collaboration among commissioners to facilitate pooling of resources at the local level to provide more services to citizens (Currie, Finn & Peters 2007, pp. 406-417).

Additionally, healthcare for the elderly and patients with long-term conditions should be centralized. Evidence from the Veterans Health Administration in the US shows that patient outcomes often improve if the services needed by specific groups such as the elderly are centralized.

The NHS is the leading provider of healthcare in the UK. Its main strengths include access to an extensive infrastructure and well trained personnel. Furthermore, it is capable of developing and implementing improved healthcare solutions. However, its effectiveness is threatened by several factors. These include rising demand for healthcare, reduced funding from the government, and declining quality of healthcare.

Despite its weaknesses, the NHS can still be reformed by taking advantage of the opportunities in the healthcare sector. These include the use of telehealth and partnering with private care providers. Moreover, the NHS must improve its internal efficiency to reduce operating costs. This calls for centralizing specialized services and decentralizing the organizational framework of CCGs. Furthermore, the NHS must improve the quality of its healthcare services in order to regain the trust of the public.

Appleby, J, Humphries, R, Thompsons, J & Jabbal, J 2014, How is the health and social care system performing . Web.

Charlesworth, A, Smith J & Thorlby, R 2014, The coalition government’s health and social care reforms . Web.

Costigliola, V 2012, Healthcare overview: new perspectives , Oxford University Press, London.

Currie, G, Finn, R & Peters, M 2007, ‘Spanning boundaries in pursuit of effective knowledge sharing within networks in the NHS’, Journal of the Health Organization and Management , vol. 21. no. 4, pp. 406-417.

Farnsworth, A 2012, ‘Unintended consequences: the impact of NHS reforms upon Torbay Care Trust’, Journal of Integrated Care , vol. 20. no. 3, pp. 146-151.

Gerlinger, T 2009, Competitive transformation and state regulation in health insurance countries, Edward Elgar Limited, Cheltenham.

Gilardi, F, Fluglister, K & Luyet, S 2009, ‘Learning from others: the diffusion of hospital financing reforms in OECD countries’, Comparative Political Students , vol. 42. no. 1, pp. 549-573.

Greener, I 2009, Healthcare in the UK: understanding continuity and change , Sage, London.

Hall, K, Miller, R & Millar, R 2012, ‘Jumped or pushed: what motivates NHS staff to setup a social enterprise’, Social Enterprise Journal , vol. 8. no. 1, pp. 49-62.

House of Commons 2011, Achievement of foundation trust status by NHS hospital trusts, Stationary Office, London.

Lombardo, J & Buckeridge, D 2012, Disease surveillance: a public health informatics approach , Palgrave, London.

Mitchell, A & Selmes, T 2007, ‘Why don’t patients attend their appointments: maintaining engagement with psychiatric services’, Advances in Psychiatric Treatment , vol. 13. no. 1, pp. 423-434.

Monitor 2014, What we do . Web.

NHS 2014, About us . Web.

Ramena, N & Staggers, N 2013, Health informatics: an inter-professional approach , John Wiley and Sons, New York.

Rothgang, H, Cacace, M, Frisina, L & Schmid, A 2008, The changing public-private-mix in OECD healthcare systems , Palgrave Macmillan, London.

Schmid, A, Cacace, M, Gotze, R & Rothgang, H 2010, ‘Explaining health care system change: problem pressure and the emergency of hybrid health care systems’, Journal of Health Politics, Policy and Law , vol. 35. no. 3, pp. 455-486.

Schmid, A & Gotze, R 2009, ‘Policy learning in health care system reform: the case of diagnosing related groups’, International Social Security Review , vol. 62. no. 1, pp. 21-40.

Williams, S 2011, ‘Safeguarding adults at risk in the NHS through inter-agency working’, Journal of Adult Protection , vol. 13. no. 2, pp. 100-113.

Wilstow, G 2011, ‘Integration and the NHS reforms’, Journal of Integrated Care , vol. 19. no. 4, pp. 5-13.

• Presidential and Congressional Decision Making
• Charles Kennedy's Speech About Drinking Problem
• NHS Trust Hospital Transformation
• Development Opportunities in the “New” NHS
• Health and Medicine: National Health Service
• Fundamentals of Law and Public Policy
• The War on Drugs in the US
• The Health Authority-Abu Dhabi
• Economic Development in Local Governments in USA
• Minority and Women Entrepreneurs
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2019, June 8). Strategic Management of the NHS. https://ivypanda.com/essays/strategic-management-of-the-nhs/

"Strategic Management of the NHS." IvyPanda , 8 June 2019, ivypanda.com/essays/strategic-management-of-the-nhs/.

IvyPanda . (2019) 'Strategic Management of the NHS'. 8 June.

IvyPanda . 2019. "Strategic Management of the NHS." June 8, 2019. https://ivypanda.com/essays/strategic-management-of-the-nhs/.

1. IvyPanda . "Strategic Management of the NHS." June 8, 2019. https://ivypanda.com/essays/strategic-management-of-the-nhs/.

Bibliography

IvyPanda . "Strategic Management of the NHS." June 8, 2019. https://ivypanda.com/essays/strategic-management-of-the-nhs/.

Final Report

Dr Hilary Cass has submitted her final report and recommendations to NHS England in her role as Chair of the Independent Review of gender identity services for children and young people.

The Review was commissioned by NHS England to make recommendations on how to improve NHS gender identity services, and ensure that children and young people who are questioning their gender identity or experiencing gender dysphoria receive a high standard of care, that meets their needs, is safe, holistic and effective. 

The report describes what is known about the young people who are seeking NHS support around their gender identity and sets out the recommended clinical approach to care and support they should expect, the interventions that should be available, and how services should be organised across the country.

It also makes recommendations on the quality improvement and research infrastructure required to ensure that the evidence base underpinning care is strengthened.

In making her recommendations, Dr Cass has had to rely on the currently available evidence and think about how the NHS can respond safely, effectively, and compassionately, leaving some issues for wider societal debate.

• Download the Final Report

(NB to open the report in browser, right click and select ‘open in new tab’)

The peer-reviewed systematic evidence reviews that informed the report and recommendations are available here .

We have received questions about the report’s findings and recommendations, including those raised by members of the public and other stakeholders. We have collated as many of those questions as we can in a series of FAQs.

Exploration of identity is a completely natural process during childhood and adolescence and rarely requires clinical input. However, over the past five – ten years the number of children and young people being referred for NHS support around their gender identity has increased rapidly.

As a result, young people are waiting several years to receive clinical support and during this time they and their families are left to make sense of their individual situations, often dealing with considerable challenges and upheaval.

There has been a similar pattern in other Western countries, with clinicians noting not only the rising number but also a change in the case mix of the young people seeking support.

There have been many more birth-registered females being referred in adolescence, marking a shift from the cohort that these services have traditionally seen; that is, birth-registered males presenting in childhood, on whom the previous clinical approach to care was based.

Clinicians also noted that these young people often had other issues that they were having to manage alongside their gender-related distress.

The Independent Review set out to understand the reasons for the growth in referrals and the change in case-mix, and to identify the clinical approach and service model that would best serve this population. 

To provide an evidence base upon which to make its recommendations, the Review commissioned the University of York to conduct a series of independent systematic reviews of existing evidence and new qualitative and quantitative research to build on the evidence base.

Dr Cass also conducted an extensive programme of engagement with young people, parents, clinicians and other associated professionals.

Overview of key findings

• There is no simple explanation for the increase in the numbers of predominantly young people and young adults who have a trans or gender diverse identity, but there is broad agreement that it is a result of a complex interplay between biological, psychological and social factors. This balance of factors will be different in each individual.
• There are conflicting views about the clinical approach, with expectations of care at times being far from usual clinical practice. This has made some clinicians fearful of working with gender-questioning young people, despite their presentation being similar to many children and young people presenting to other NHS services.
• An appraisal of international guidelines for care and treatment of children and young people with gender incongruence found that that no single guideline could be applied in its entirety to the NHS in England.
• While a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices. 
• The strengths and weaknesses of the evidence base on the care of children and young people are often misrepresented and overstated, both in scientific publications and social debate.
• The controversy surrounding the use of medical treatments has taken focus away from what the individualised care and treatment is intended to achieve for individuals seeking support from NHS gender services.
• The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.
• The use of masculinising / feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.
• Clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity.
• For the majority of young people, a medical pathway may not be the best way to manage their gender-related distress. For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems.
• Innovation is important if medicine is to move forward, but there must be a proportionate level of monitoring, oversight and regulation that does not stifle progress, while preventing creep of unproven approaches into clinical practice. Innovation must draw from and contribute to the evidence base.

Overview of Recommendations

The recommendations set out a different approach to healthcare, more closely aligned with usual NHS clinical practice that considers the young person holistically and not solely in terms of their gender-related distress. The central aim of assessment should be to help young people to thrive and achieve their life goals .

• Services must operate to the same standards as other services seeing children and young people with complex presentations and/or additional risk factors.
• Expand capacity through a distributed service model, based in paediatric services and with stronger links between secondary and specialist services.
• Children/ young people referred to NHS gender services must receive a holistic assessment of their needs to inform an individualised care plan. This should include screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment.
• Standard evidence based psychological and psychopharmacological treatment approaches should be used to support the management of the associated distress from gender incongruence and cooccurring conditions, including support for parents/carers and siblings as appropriate.
• Services should establish a separate pathway for pre-pubertal children and their families. ensuring that they are prioritised for early discussion about how parents can best support their child in a balanced and non-judgemental way. When families/carers are making decisions about social transition of pre-pubertal children, services should ensure that they can be seen as early as possible by a clinical professional with relevant experience.
• NHS England should ensure that each Regional Centre has a follow-through service for 17–25-year-olds; either by extending the range of the regional children and young people’s service or through linked services, to ensure continuity of care and support at a potentially vulnerable stage in their journey.  This will also allow clinical, and research follow up data to be collected . 
• There needs to be provision for people considering detransition, recognising that they may not wish to re-engage with the services whose care they were previously under.
• A full programme of research should be established to look at the characteristics, interventions and outcomes of every young person presenting to the NHS gender services.
• The puberty blocker trial previously announced by NHS England should be part of a programme of research which also evaluates outcomes of psychosocial interventions and masculinising/ feminising hormones.
• The option to provide masculinising/feminising hormones from age 16 is available, but the Review recommends extreme caution. There should be a clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18.  Every case considered for medical treatment should be discussed at a national Multi- Disciplinary Team (MDT).
• Implications of private healthcare on any future requests to the NHS for treatment, monitoring and/or involvement in research, and the dispensing responsibilities of pharmacists of private prescriptions needs to be clearly communicated.

In this section

3 September 2024

Morag’s Story – Saying thank you with a gift in her Will

• Supporter story
• Western General Hospital

We spoke to Morag*, from Edinburgh, who recently completed her cancer treatment at the Edinburgh Cancer Centre. Morag has chosen to say thank you for her care by supporting the patient and staff of NHS Lothian with a gift in her Will.

While reflecting on her experience, she shared a heartfelt story of her journey and the profound impact of the care she experienced from the NHS Lothian team.

“The journey I’ve been on and the experiences I’ve had since being diagnosed with cancer certainly hasn’t been a walk in the park, but it doesn’t define me either. “It wasn’t easy, mind you. But I wasn’t alone. The staff at the Cancer Centre were my rock. My Oncology Consultant was so competent and professional, but also a kind soul who always kept me focused on the finish line. All the nurses who cared for me had a seemingly endless well of patience and a way of making me smile, even when I felt completely deflated. They were there for every appointment, every tear, and every worry, a constant source of encouragement. They helped me discover a strength I never knew I had. “Today, I was back at my art class in my local community centre for the first time in months. Picking up the brush, my hand was a bit shaky, a wee reminder of my cancer journey. It’s lovely to be back where I belong to see everyone, and I’m determined I won’t waste the gift the wonderful NHS staff have given me. “I couldn’t be more grateful for this chance, and in return, I want to help others like me live a longer life free of cancer. That’s why I’ve written a forever thank you into my Will, with a gift to NHS Lothian Charity.” *Name and some details have been changed to protect their privacy.

Are you considering leaving a gift in your Will to support NHS Lothian?

If you are considering leaving a gift in your will to NHS Lothian charity, and would like some further information on how to do this, please contact our Planned Giving Manager, Vanessa, who will be delighted to help

Privacy Overview

NHS Confederation response to NHS 111 offering crisis mental health support

23 August 2024

• Twitter logo
• Facebook logo
• LinkedIn logo

Responding to NHS England’s announcement that NHS 111 will be offering crisis mental health support for the first time Dr Layla McCay, director of policy at the NHS Confederation , said:

“Placing mental health crisis support in a single phone line across the country is a welcome step in the right direction. Making it simpler to access advice will hopefully make it easier for people experiencing a mental health crisis to get the help they need.

“We know from some well-established 111 services that providing mental health crisis support not only offers an easier way for people to access the services they need, but can also reduce pressure on other parts of the system such as GP services, ambulances and A&Es.

“Incorporating mental health support into existing 111 services may also reduce stigma and could encourage more people to come forward. But with long waits for mental health treatment, we need to make sure that providers are given the right resources to boost capacity and care for the people who come forward requiring treatment.” 

Related content

Mental health support for young people and working-age adults

The Bridge PCN has worked with partners within a locality and used community assets to support the mental health of children and young people.

4 February 2021

The role of digital in preventing and treating poor mental health

Explore the strategic role digital should play in managing and treating poor mental health.

10 December 2020

NICON24 is the premiere event for HSC Leaders and partners, bringing them together to discuss how to secure the best health and care outcomes for NI.

16 October 2024 08:00 - 17 October 2024 13:30 GMT

Welsh NHS Confederation Annual Conference and Exhibition 2024

Book your place at Wales' health and care event of the year under the banner of 'Ambition for a healthier nation'.

6 November 2024 08:30 - 16:30 GMT

Case study: Firm supports employees with cutting-edge health plan design

ISG takes a different approach to architecture and engineering — and their health benefits.

Building healthier workplaces together

Video transcript.

Alec: [00:01:23]: We're an architecture, engineering, planning and environmental firm.

Alec: [00:03:21]: We exist to make a difference. We want to make a difference in the lives of our employee owners, the communities in which we serve, as well as our clients. (music lift/aerial of ISG building)

Animate in - Banner Graphic

Organization: ISG

Industry: Architecture & Engineering

Established: 1973

Number of employees: 500

Alec: [00:16:44] We want to make sure that we are providing that best health benefit that we can for all of our employee owners.

Alec: [00:20:54] We switched to UnitedHealthcare a few years ago. The process was fantastic. I didn't realize what we were missing.

Alec: [00:22:59] Through our relationship … with UnitedHealthCare, they came forward with a new option for us. It was called Surest. And it was something that was innovative, something that really, gave us a new option.

Alec: [00:32:10] We want to provide that best experience, but also make a difference. Right. We are making a difference in our employee owners’ lives. 

Alec: [00:34:25] Here at ISG…we are a very collaborative group.  

Alec: [00:34:25] Here at ISG…we are constantly trying to try to find the best solutions for our team.

Aubrey: [00:49:04] As the employee experience manager, I want it to be as simple as it can be for the employees and really have it be, easy to access.

Aubrey: [00:55:36] Surest is a great fit for us... we are a younger demographic. I think we're very open to having some change and …having it on an app, being really easy and…knowing your costs upfront is just what our employees were looking for.

Aubrey: [00:56:12] Our employees are unique, creative and bringing on Surest. ..It's a unique and creative way of handling your health benefits.

Alec: I’m extremely proud of the benefits that ISG is able to offer. 

Ryan: [01:17:52] I'm a type 1 diabetic, been a type 1 diabetic for coming up on 20 years. 

Ryan: [01:19:49] It's really important from an overall health perspective that I have good access to health care. 

Ryan: [01:28:44] Surest plan really helped me identify a provider that's available that specializes in type 1 diabetes and is available to answer the questions or for me to really dial in on the program that I need to be on to take care of my type 1 diabetes.

Ryan: [01:34:19] I'm really thankful for ISG in in being able to think different in health care. … we exist to make a difference but we exist to make a difference with all the employee owners. ISG investing in our team, trying new things so we can always be the best version of ourselves is how we can help better serve our clients and truly exist to make a difference.

Innovation is the foundation on which I&S Group (ISG), an architecture and engineering firm, is built. As an employee-owned company, ISG is driven to turn big ideas into reality for the clients it serves by using forward-thinking methodologies and technology.

“At ISG, we exist to make a difference. We want to make a difference in the lives of our employee owners, the communities in which we serve, as well as our clients,” says Alec Pfeffer, chief financial officer for ISG.

Understanding that delivering on this mission requires employees to be the healthiest and most productive versions of themselves, ISG aims to think differently about the health benefits it offers to ensure they are meeting the needs of its 500+ employees. And that’s what led them to add a new copay-only health plan option.

“As we continued to build our relationship with UnitedHealthcare, they came forward with the new option for us,” says Pfeffer. “It was called Surest®. And it was something innovative that really gave us a new option.”

Offering a new plan built for cost clarity and a simpler digital experience

After years of offering a high deductible health plan, ISG was looking to add a health plan option that would give employees a new way to access health care.

“Surest is a great fit for us,” says Aubrey Lantz, employee experience manager for ISG. “We are a younger demographic. I think we’re very open to having some change and using an app … knowing your costs upfront is just what our employees were looking for.”

Offering no coinsurance or deductibles and a mobile app that allows employees to search for and compare care options, ISG felt confident that this health plan would appeal to its younger workforce.

“Here at ISG, we are 100% employee-owned,” explains Pfeffer. “Everyone feels the weight of that ownership and understands we have a duty to look out for one another, which includes providing the best health benefits package we can.”

Engineering a communication plan to drive enrollment

It’s one thing to offer employees a new and different type of health plan — it’s another to get them to understand, enroll and engage with it, especially as people are naturally averse to change.

84% of UnitedHealthcare member interactions occurred digitally 1

“We tried to be really forward-thinking when introducing this new health plan design,” Pfeffer says. “We wanted to build momentum into the communications plan and make sure that people were excited about it.”

Leveraging materials and support provided by its UnitedHealthcare team, ISG was able to successfully educate its employees about this new plan option, answer questions and help make the transition as seamless as possible for those who decided to make the switch, resulting in a 30% enrollment rate within its first year of offering Surest. 2

“Our rollout campaign included 3 separate email blasts ahead of open enrollment, using a demo to break down the plan and how it works,” explains Lantz. “We also created a podcast-style virtual event, which included a Q&A. Through it all, UnitedHealthcare was right there with us.”

Working to make it easier for employees to access care

Ryan Welke, senior project manager at ISG, was among the first to enroll in Surest. As a type 1 diabetic, Welke understands how much his health benefits matter to effectively manage his condition.

“The health benefits that my employer provides are really important as a type 1 diabetic. So, when looking at specific employers and their benefits, sometimes my wages took a back seat,” explains Welke.

With Surest, Welke hasn’t had to make that trade-off. When ISG introduced Surest, Welke’s initial reaction was that “it seemed too good to be true.” He goes on to explain, “the Surest plan really helped me identify a provider that specializes in type 1 diabetes and is available to answer questions, to really dial in on the program that I need to be on.”

“I’m really thankful for ISG in being able to think differently about health care,” says Welke. “ISG investing in our team and trying new things so we can always be the best version of ourselves is how we can help better serve our clients and truly exist to make a difference.”

More articles

Broker - page template - more news experience fragment, current broker or employer group client.

Access uhceservices to check commissions, manage eligibility, request ID cards and more.

• Biochemistry and Molecular Biology
• Biostatistics
• Environmental Health and Engineering
• Epidemiology
• Health Policy and Management
• Health, Behavior and Society
• International Health
• Mental Health
• Molecular Microbiology and Immunology
• Population, Family and Reproductive Health
• Program Finder
• Admissions Services
• Course Directory
• Academic Calendar
• Hybrid Campus
• Lecture Series
• Convocation
• Strategy and Development
• Implementation and Impact
• Integrity and Oversight
• In the School
• In the Field
• In Baltimore
• Resources for Practitioners
• Articles & News Releases
• In The News
• Statements & Announcements
• At a Glance
• Student Life
• Strategic Priorities
• Inclusion, Diversity, Anti-Racism, and Equity (IDARE)
• What is Public Health?

Achieving Universal Health Coverage in the LMIC Context; A Case Study from Khyber Pakhtunkhwa Province, Pakistan.

 Mr. Taimur Saleem Khan Jhagra, the former Minister of Health & Finance for KPK (Khyber Pakhtunkhwa), Pakistan, and former Partner at McKinsey & Company, is providing a special seminar on Universal Health Coverage in LMIC,

Mr. Taimur Saleem Khan Jhagra, the former Minister of Health & Finance for KPK (Khyber Pakhtunkhwa), Pakistan, and former Partner at McKinsey & Company, is providing a special seminar on Universal Health Coverage in LMIC,

Contact Info

Related content.

Xylazine: The Emerging Threat in the U.S. Drug Supply and Policy Responses

New Research Sheds Light on Treatment and Harm Reduction Gaps Among Drug Users

Understanding the Impact of Economic and Social Conditions on Health

Study Reveals Significant Barriers for TGNC Adults Accessing Healthcare in the U.S.

From the Frontlines: One Nurse’s Perspective on the Healthcare Community’s ‘Inventory Management’ Problem (and How to Fix It)

Unlike most clinicians, nurses at Hull University Teaching Hospitals don’t have to worry that patient care will be compromised due to missing equipment or medical supplies shortages. Why? They’ve found an unconventional but effective ‘cure’ using RFID.  

During the pandemic, we were inundated with news stories about healthcare providers who had to get creative when treating patients because they couldn’t get the necessary medicine, supplies and equipment. Demand outweighed supply. But, for the most part, the supply chain has now stabilised, and nurses and doctors can source what they need to resume treatments and surgeries as normal.

So, I was shocked when nearly three-quarters of hospital leaders in the UK and U.S. agreed in Zebra’s Hospital Vision Study that cancellations of procedures or surgeries due to out-of-stock, low-stock, or lost supplies are a significant problem for their organisation.

If there aren’t shortages in the supply chain and every hospital could be fully stocked, why is anyone still reporting frequent out-of-stocks or having to stretch low-stock levels? Why are we hearing from nurse managers, divisional chiefs, and other healthcare leaders that they’re under pressure every day to chase down equipment or supplies? Why are nurses searching high and low, near and far, for what they need…having to make numerous phone calls to reps or sending taxis (and colleagues) to other hospitals to get the items they need to care for patients? And why are clinicians settling with ‘second best’ alternate medication, medical device, or equipment options when what they want, what is preferred, is available somewhere in the supply chain or perhaps stashed in a random supply closet? We’re no longer at that point where they should feel they have to ‘make do’.

When my colleagues and I started digging into this issue more with clinicians in both countries, it became apparent that the healthcare community as a whole suffers from a huge inventory management/material management problem. (No, it’s not just happening at your hospital.) This can’t be considered an acute pain point that came about during recovery from the pandemic, either. It’s been lingering unresolved for years, albeit flaring up now.

Some of the nurses we spoke with say it’s because the onus is being put on them and other clinicians to manage stock. They’re the ones having to count inventory, locate and log equipment, check expiry dates, rotate inventory, place orders, process items when they arrive, and more.  

Because they need the items most. They must ensure the theatre, lab, or ward is stocked for whatever kind of patient treatment is needed that day – often not knowing what will be needed. If you can relate, I’m sorry.

It shouldn’t be this way. The burden shouldn’t fall to nurses. It’s not a good use of your/their time and skills. Yet, this is the way it is in (too) many hospitals.

Not in the Hull University Teaching Hospitals here in the UK, though.

Fed up with the status quo, the nurses at these NHS Trust facilities went ‘against the grain’ and insisted on changes. Actually, they initiated the changes and drove them through to completion. They didn’t defer to administrators, IT or non-clinical operations colleagues to figure out how to make their jobs easier. They put their heads together and mapped out exactly what was needed to properly manage stock levels. They detailed the manual efforts they believed could be automated, then worked with technology experts to figure out which hardware, software and systems components could get things working the way they wanted.

If you didn’t have the pleasure of hearing Rachael Ellis speak at HIMSS 2024, this video is the next best thing:

Your browser does not support the video tag.

Of course, even after spending nearly the entire show by Rachael’s side, learning more about what improvements she has compelled at the Hull University Teaching Hospitals, I had questions. Lots of them.

I wanted to know…

• If the Hull team ever reached a point when they had to cancel procedures or surgeries because they didn’t have, or couldn’t find, the equipment and supplies they needed.
• Who the nurses leaned on to help solve their asset management challenges. Who was involved in the project scoping, solution design and testing efforts? (We know that non-clinical staff play a role in asset and inventory management, too.) Who did they call first? And how did they know who to call?
• Why the Hull nursing team ultimately took what was then considered ‘an unconventional approach’ to asset tracking and inventory management. Why focus on the patient pathway rather than the theater like most other healthcare systems do?

And that was just the start. So, I reached out to Sarah Atkins, a Scan4Safety and RFID charge nurse with the NHS Trust, to get her take as she was deeply involved in – and impacted by – the implementation . She was gracious enough to join me on an episode of the Clini-Chat podcast, and I must say her insights were enlightening. So, whether you’re a nurse, a nurse manager, hospital administrator, logistics or inventory manager, or just someone seeking to increase patient care capacity, improve patient care and safety, or make nurses’ jobs easier, you’ll want to hear what Sarah shared in this episode…

I don’t know about you, but I found it interesting to learn…

• Whether Sarah and others at Hull believe that a barcode-only system could be used to facilitate the same experience and achieve the same outcomes as the combined RFID+barcode system they’re using. Could barcode technology by itself help clinical staff maintain a steady (full) stock level and quickly locate needed supplies and equipment (knowing that in some hospitals, there isn’t any technology used for these things today)?
• Whether the Hull team found it more important to have an intuitive software app or a device that’s familiar and easy to learn and use as they started designing, testing and fully using the asset tracking and inventory management system. Should other hospitals’ nursing and IT teams focus on the software they need first? Or find hardware – mobile devices, barcode scanners, RFID readers, etc.– that work well and then develop the software to enable the desired user experience?
• How well the technology system – the ‘solution’ – the Hull team had designed on paper came together as they started to physically install and connect the components in their hospitals. Did it all come together nicely? Or did they have to make adjustments during the implementation before they could even turn it on? Was there anything that had been forgotten to consider in the design phase that they had to pause to work out during implementation?
• If there have been other positive changes they’ve seen or perhaps other nurses have reported, since putting these new inventory management and asset tracking processes and technology tools in place.
• Whether the Scan4Safety and RFID tracking systems they put in place also enables doctors and nurses to report – and hospital leaders to track – when patient safety is compromised because of inventory or equipment issues. If something goes missing – there’s a recall, someone forgot to restock certain supplies, or there’s a shortage in the supply chain and therefore low shelf stock – can that be reported easily? And, just as importantly, can that be addressed immediately? Does the info get routed to someone who can take action on it? (This was something cited by hospital leaders as a big issue in Zebra’s latest Hospital Vision Study, so I was hoping Hull might have found a solution that I could share with you.)
• How they measured success. The Scan4Safety and RFID-based asset tracking and management systems put in place at Hull have become the gold standard for hospitals around the world. But do the clinical and non-clinical teams have tangible KPIs or metrics tied to waste, replenishment or something else inventory-related? Or is success more about the sentiment among clinical staff and the capacity they gained to serve more patients?
• How much work it really took to make these changes happen. From the outside in, it seems like this was a significant undertaking. Not only did the nurses have to find a new way of working to ensure patient care wasn’t hindered by low stock, out-of-stocks, or lost supplies and equipment, but they had to get the entire hospital staff working in this new way. So, I wonder if there are things they feel made the process harder than it had to be? Things they would suggest others in your position keep in mind as you start down a similar path? Or is there something they think made this process less painful than it could have been from the ‘people, policy and tech system’ perspectives?

If you don’t have time to watch the episode now, I’ve also shared the transcript here if you only have a few minutes to skim through our conversation.

I’m grateful for Sarah’s transparency, as I know that you’re probably in the same position she and the Hull team were a few years back, just trying to fix a broken inventory management process and give nurses a bit of a break. I hope the steps they took to introduce lasting changes help you know what steps you need to take to do the same. Material/stock management shouldn't be so difficult, and it certainly shouldn’t hinder your patient care capabilities as much as it probably does today. So, check out the conversation with Sarah, watch the video with Rachael, and let me know if you’d like to connect with either of them to get more guidance on how your hospital’s clinical team can get to where the Hull team is today.  

Don’t have time to watch/listen right now?

You can download the MP3 for later or keep scrolling to read the transcript of the full interview.

LISTEN NOW OR DOWNLOAD TO LISTEN LATER

Zebra Your Edge Podcast: Clini-Chat Episode Transcript 

Host : Lorna Hopkin, International Marketing Manager, Zebra

Guests : Sarah Atkins, Scan4Safety and RFID Charge Nurse, Hull University Teaching Hospitals, NHS

Lorna Welcome back to our Clini-Chat podcast series. I thought we could spend some time today talking about some of the non-clinical challenges being reported across the global healthcare community right now, because the issues at hand directly impact the ability of clinical teams to do their jobs. Zebra just released the results of a new Healthcare Vision Study that focused on material management in hospitals. Specifically, this study was aiming to uncover the crucial link between digital inventory management and improved patient care. I know that I haven’t been immersed in the inner workings of healthcare as long as most of you, but I feel like I’ve got a grasp on some of the problems that physicians, nurses, and other practitioners face day to day. I mean, we all got to sort of have a reality check during the pandemic, when the veil was pulled on how things work and how well they sometimes don’t work. But I admit, I was shocked when I saw some of the stats coming out of Zebra’s latest vision study. For example, nearly three-quarters of hospital leaders in the UK and US acknowledge that procedures or surgeries are sometimes being canceled due to out of stock, low stock, or lost supplies, which is a significant problem. As digitally mature as we are as a society, one wonders how this can still be a problem. There’s all sorts of technology available to help track down what you need in a building, or even a supply chain. You can even automate orders when items start running low, alert someone when items are reaching expiry dates, and quickly activate retrieval procedures for recalled items. So with most in the healthcare community still challenged in these situations, that’s what I’m hoping to get to the bottom of with my guest today. Sarah Atkins is the Scan4Safety and RFID charge nurse at Hull University Teaching Hospitals here in the UK. And she is in the minority in that she and her team have figured out how to easily locate and manage items across their campus. They successfully solved the problem that three-quarters in the healthcare community still face, which is clinical staff spending too much time locating medical equipment, materials, and/or supplies when needed. As I understand it, the reason why the clinical staff at Hull aren’t struggling anymore is because Sarah and her team decided to go against the grain, so to speak, in their approach to asset management and material management. So, Sarah, before we talk about what you did to solve what is clearly a very big problem, why don’t you take us back to the beginning of your story? What were the early days of your nursing career like? What issues did you experience in caring for patients?

Sarah Hi Lorna, nice to speak to you today. I’ve been a nurse for 20 years. I spent 18 years working in the operating theater environment where I was a scrub nurse. Then I did my anaesthetic nurse training so I was able to help put patients to sleep. Then I worked a bit as a charge nurse, and I was the nurse lead for the robotics suite center implementing robotic surgery into the trust. Before Scan4Safety and RFID, the way we used to do things in theatre was to order our sets and instruments from Sterile Services. We used to do that by telephone or by sending an email the day before, notifying them of what sets we’d like for the following day and also including any sets for unplanned emergencies for out of hours at Castle Hill. We had patient sticker books which we used to put patient labels into and document - put the CDU sterile tray label stickers in that - and then we also had an implant register book, which again had a patient label. And then any stickers that came with that implant, whether it be a stent, a heart valve, or orthopaedic implant for a knee or a hip. So until we got Scan4Safety, if there was a product recall or anything, we would have to physically manually search through the books to find that patient and when that patient was operated on.

Lorna Okay. Interesting background to hear about. So like most clinical staff these days, you were clearly spending too much time searching for medical equipment, materials, or supplies. But was your team ever at the point where you had to cancel procedures or surgeries because you didn’t have or couldn’t find what you needed?

Sarah As an anaesthetic nurse, we used to set up our theatre for the following day. We would get a pump and a pod ready to start the kit. Quite frequently, we’d go on shift the next day, and the theatre would have been ransacked and most of your equipment would have been taken, whether it be positioning aides for the operating table or like I said, a pump and pod to go with that patient. So you would spend a lot of time looking for equipment in the morning. We’ve never had to, in my experience, we never canceled a patient because we didn’t have the kit. But sometimes surgery was delayed. Maybe until we found a pod or a pump to put that patient to sleep safely with. To get around that, we…if there was any patients that were having local anesthetic cases…we would often sort of move the list around. Fairly rarely, but there were those were the challenges that we had, Lorna.

Lorna Yeah. So quite stressful for you guys I guess.

Sarah Yeah.

Lorna So how did you end up spearheading what we can now say is one of the best and admittedly untraditional solutions to healthcare’s asset management problem. How did you personally get into a position to implement such a huge change?

Sarah I first met Rachael Ellis, who’s the program director for Scan4Safety at Hull, when she came to implement Scan4Safety in the department that I was managing at the time. Had a really good working relationship with Rachel and the Scan4Safety team, and I saw a job offer came up. I got in contact with Rachael as a big Scan4Safety advocate and champion of it. I just thought I’d see what the role entailed. She mentioned about the RFID project, which I was really excited to hear about. I applied for the job. I got the job. I’ve now been doing it two years. Oh, wow.

Lorna Time flies. So your nurses, not technologists. So when your team at Hull started down this path to figure out a better way, where did you start? Did your team instantly pick up the phone and call tech companies? Did they do some online research? Talk to others in the healthcare community? I mean, where do you even begin when you’ve got such a big problem to solve? And it seems to be so many different approaches, or maybe just one preferred approach to solving it.

Sarah You just hit the nail on the head there, Lorna, when you said about a problem. We knew we had a problem with missing kit - our other theatres, our other departments borrowing theatre equipment - so we knew we had that problem to solve. We reached out to different companies to see what solutions were out there. The NHS…things will have to go out to tender. So it was a case of for us finding a company that we were comfortable working with that could provide a solution to the problem of disappearing assets that we wanted to work with.

Lorna So Hull ultimately took what was quite an unconventional approach to asset tracking. It focused on the patient pathway rather than the theatre. How did the Hull team arrive at the conclusion that this was the best approach? And did it take a lot of convincing that this was best when you were making the case to the people signing off on the spend and resources required for the approach?

Sarah Yeah. So six demonstrator sites that originally implemented Scan4Safety, they were the ones that just did the theatres. But for us at Hull, the patient is at the heart of everything that we do. So we wanted to put the patient in the middle. Quite frequently, when a patient leaves an operating theater, they will go to the recovery with a syringe driver attached or a pod. So what’s following that piece of kit, following that patient from their journey from the theater to the ICU or to the recovery unit, and then from the unit into the ward which is really valuable to us because that same piece of kit stays with that patient. So for us, it’s about following the patient’s journey, putting the patient at the heart of everything that we do at Hull. That’s great.

Lorna So as a daily user of RFID now and someone who had to use a barcode system previously, how big a difference has it been? Do you think that you could accomplish the same thing using a barcode only system?

Sarah With RFID, definitely not. No, we need the RFID because in the first month alone we had over a million moves. So if it was working on a barcode system, somebody would have to physically manage that barcoding system. Whereas the RFID, it’s all done instantly. It’s passive RFID, so when an asset moves under a reader or antenna, you get the last known location in real time location. So for us, if a patient in the middle of the night, needs a bladder scanner, and you can’t find it on the ward, all they have to do is look in the system, and they can find their bladder scanner or a bladder scanner that was close to that department. So somebody can just slip off and get it. So that patient is not waiting in urinary tension for very long waiting for a bladder scanner.

Lorna Wow. Some big numbers there. So, something that I’d love your perspective on as an end user is this notion of which should come first in the system build phase, a decision on which software to use or which hardware to use to accomplish the goal? Now, I know you weren’t in the room when decisions were made, but based on your use of the kit, do you have a strong opinion one way or another? Is it more important to have an intuitive software app, or a device that’s familiar and easy to learn and use, and which should lead the tech selection process? Should other hospitals’ teams focus on the software they need first, or find hardware devices that work well and then develop the software to enable the desired user experience?

Sarah With us, Lorna, at Hull, one goes, ‘You can’t have one without the other.’ You need a tech company that offers the solutions as well as the software and hardware solutions. With us working with Zebra and Tagnos and the Barcode Warehouse, we were comfortable that you could provide us with the solutions to the problems that we wanted to solve. So for us, the tech and the hardware go hand in hand.

Lorna Okay, that’s good to know. So the team had your tech system designed on paper. Then you started to put it all together in your hospital. Did it all come together nicely, or did you have to make adjustments during the implementation before you could turn it on? Was there anything that had been overlooked in the design phase that you had to pause to work out during implementation?

Sarah There was quite a few learning curves, shall we say Lorna, for the implementation of the RFID as we had to know other hospitals to learn from. So if we was to roll this out again in another hospital, yeah, there was definitely key learning points for rolling it out. Definitely learning curves when we were learning RFID. We haven’t had to make too many adjustments to plans, but one thing we did learn was that RFID labels do not work on recycled paper. They don’t read. So, if you’ve got a piece of paper putting an RFID label on it, it will not read through that recycled paper. We also didn’t sort of think about cable labels for the tech that’s got cables. So we have to find a solution for cable labels. So we’ve worked with clinical engineering. We’d also work with key stakeholders. Again, get them involved in the very beginning, Lorna, the key stakeholders.

Lorna Lots of learnings along the way. So obviously the ultimate beneficiary of what you’ve done is the patient. But as a nurse, how have all the processes and technology tools you put in place made your job easier? I know you spoke a bit about RFID versus the barcode area, but what are some of the other positive changes you’ve seen? Or perhaps other nurses have reported?

Sarah So for Scan4Safety, for me with since I’ve been in post, we have to now go-live with Max Fax. We’ve just implemented a go-live in orthopaedics where we’ve just set up the green light system, which is where if you’re doing a left hip replacement and a right hip implant is scanned, it comes up with a warning to say this is an incompatible product. ‘Do not use that’. That has been a complete game changer because of […] down the country, wrong type surgery, etcetera, etcetera. Also when there’s been product recalls, we’ve been able to identify if the product’s being used on a patient and, if we’ve got any in stock, we’ve been able to notify the stock controllers. Notify the band sevens of their areas to take the affected stock, if we’ve had any affected stock, out of the system so they’re not used on patients or potentially not used on patients. We also had an MHRA recall for sutures. We were able to look in our system. To look previously in a manual patient record would take hours and hours and hours of nursing time, whereas I think within an hour we were able to identify what patients had had a suture. And it would…the clinicians are being emailed, the business managers are being emailed…all within that hour. Yeah, definitely. Also out of date products…products that have expired…when you scan them in a theatre, it comes up with a warning alert. Yeah, because programs are digitized, we are really able to sort of look at heart valves that have been used that are being affected from recalls, notify clinicians… It’s just saved so many hours of manual nursing time or clinical time to look through these patient records to find out. It’s been an absolute game changer has Scan4Safety. So patient care records and inventory management as well because we work with procurement as well. So it’s about having an up-to-date procurement catalog…working with other key stakeholders as well departments to ensure that they’ve got the right minimum and maximum level. So they’re not overordering… some products are going out of date…it definitely digitizes the way forward.

Lorna Okay. That brings me nicely into the next question. So we know that non-clinical staff play a role in asset and inventory management too. So who else outside the clinical team was involved in the project scoping, solution design, and testing efforts? And what has their feedback been since the new tools were put into place?

Sarah So key stakeholders, we work with clinical engineering an awful lot. We’ve recently, within the last six months, done an implementation, an integration with E-Quip, which is the database for our clinical engineering use. So when they commission a piece of medical equipment, they can automatically print a barcode label from their record because it’s integrated with Tagnos. We also work with IT closely because they’re the ones that connect the data and the power to our infrastructure. But when it comes to the privately funded investment buildings, we’ve currently got two on our site at the moment. You’ve got to work with those key stakeholders because you’ve got to raise purchase orders about their tech specs - connecting data and power to the readers. So again, just working with key stakeholders, IT, clinical engineering. The next phase we want to do is work with waste management and put an RFID reader and technically have an “off” bin sort of. So when an asset goes to waste compound, we know that it’s not going to be recommissioned or reused. And it’s either being for scrapping or it’s being donated to another hospital. So we know that when that piece of equipment reaches waste compounds, we know that then that kills the life of the RFID tag so that they so that the off switch. So that piece of kit’s life comes to an end. This project is forever growing because more and more departments are coming on board with it to see the benefits of it. and it’s just really, really good, Lorna.

Lorna It’s great to hear that.

Sarah Yeah, yeah, we’re getting positive feedback from end users as well of the system.

Lorna Just a huge collaboration. So, you know, something else that came out of this study is that most clinicians don’t have a good way to report problems relating to out of stock, low stock or lost inventory, equipment or supplies. When patient safety is compromised because of inventory or equipment issues, they can’t easily report that or hospital leaders can’t easily track it at least. Is that something that was fixed with your Scan4Safety and RFID tracking system? If something goes missing, there’s a recall, someone’s forgot to restock certain supplies, there’s a shortage in a supply chain, and therefore load shelf stock cannot be reported easily and, just as importantly, cannot be addressed immediately. Does the info get routed to someone who can take action on it?

Sarah Absolutely. Yes it does, Lorna, for this government safety platform. like I said earlier, we work with suppliers, we work with stock controllers, with everything being digitized from the point of care, whether it be anesthetics and theatre, all of those pumps. Everything we ever report, we pull a report for everything, Lorna. For expired stock, stock coming out of date. just teaching people about stock rotation if they don’t already know. It really has changed the way that we work at Hull regarding ordering stock, stock receipting, ensuring the maximum/minimum levels of sets so we’re not over ordering. If a department decides that they want to order more or have more stock on the shelf because of patient use, then it’s something we can do very easily on the system. It’s just up the level working with reps as well, because when we work with consigned stock, if the department wants to up the levels or have to work with reps so the stocks come down to a level at their end as well as ours. So it’s consigned rather than we don’t earn it as a trust. There are lots of benefits. to working with the Scan4Safety platform. We can recall patient information within minutes. You can find a sterile tray in the storeroom because we have a system at 12:00 midnight, a couple of minutes to 12, anything that gets put back in the storeroom that’s still sterile, it’s changed back to sterile. Say staff couldn’t find that tray easily, it’s all there. It’s all really good, Lorna. All very positive.

Lorna It’s brilliant. So for all intents and purposes, the Scan4Safety and RFID-based asset tracking and management systems you put in place at Hull have become the gold standard. We want those people who say they can’t find what they need to follow your lead. So how do you measure success? Do you have tangible KPIs or metrics tied to waste, replenishment, or anything else inventory related? Or was it more about the sentiment among clinical staff and the capacity you had to serve more patients?

Sarah We measure success by reporting and working with key stakeholders. If we can help somebody solve their problem, that is a success to us. It really is. And if somebody comes to us said, they can’t find it…because it’s digital, some people really thrive on change. Some people don’t like change. It’s about the individual staff member helping them make sure they’re comfortable with the system, helping them to find the way so they can use the system easily. And if we can develop somebody’s skills IT-wise, then yeah. So they’ve got the confidence to use the system as well, Lorna. Yeah. That’s how we measure. Yeah. That’s what we mentioned success as well by reports as well and activity at some of the sites for Scan4Safety and RFID as well.

Lorna Yeah. No that’s brilliant. So from the outside in it seems like this was a significant undertaking. Not only did you have to find a new way of working to ensure patient care wasn’t hindered by low stock, out of stock, or lost supplies and equipment, but you had to get an entire hospital’s staff working in this new way. Are there things that you feel made the process harder than it had to be? Are there things you would suggest those in your position keep in mind as they start down their own similar paths? Or is there something you think made this process less painful than it could have been? And I’m curious from the three different people, policy and tech system perspectives, because I would imagine there are valuable takeaways relating to each.

Sarah Yeah, well, one thing I learned a long way from this project was to listen to my gut more, when things wasn’t working that was expected to. You just got to listen to you. Go on, go with things, break things, talk to people. communicate with people. People. Some people don’t like change for people, for change. And again, it’s getting those people who are susceptible to change. So with, to get them on board and to get those people trained up, to get them comfortable using it. And also, another problem that we had was some staff were peeling the RFID labels off equipment. It was mainly anaesthetic equipment, and I could see why they were doing it. But by peeling the labels off equipment, it sort of doesn’t. You’re hiding equipment away which is for patient use, whereas if you’re hiding equipment and peeling RFID labels off, you don’t know where the equipment is and…the RFID can also highlight where there’s shortfalls of equipment. So if you can access Tagnos and you can look at what areas are stealing your… ‘borrowing’ your… equipment, you can then take this information and you can go to the business managers and say…or band seven of that area and say… And say, well I’ve noticed that your department keeps borrowing X, Y, and Z a lot, you know, have you thought about maybe buying your own, taking you know, using the information as an audit tool? as well as being really helpful. Yeah.

Lorna Gives that visibility. So that’s all my questions for today. So I would like to thank you very, very much for your time. It’s been incredibly insightful to hear from someone who is actively involved in the implementation and the day to day running of such a major RFID installation. We wish you all the best as the project evolves in the future, and look forward to hearing a lot more about this project. So thank you everyone for listening. For more information and to see a video case study about the project, head to  zebra.com . Thanks for now.

Sarah Goodbye everyone. Thank you online. Bye bye.

Lorna Hopkin

Lorna Hopkin is Product Marketing Advisor at Zebra Technologies with responsibility for Zebra healthcare solutions and advanced location technologies. Lorna joined Zebra in August 2018 as part of its acquisition of rugged tablet specialist Xplore Technologies.

Lorna is a chartered marketer and has two and half decades’ experience across a wide range of industries. At Zebra, she has launched a variety of products into the healthcare space and other verticals.

Lorna is a tireless advocate for health and fitness at Zebra and in her spare time participates in Ironman competitions and enjoys writing about her experiences at   https://theordinaryironman.com/

Zebra Developer Blog

Are you a Zebra Developer? Find more technical discussions on our Developer Portal blog.

Zebra Story Hub

Looking for more expert insights? Visit the Zebra Story Hub for more interviews, news, and industry trend analysis.

Search the Blog

Use the below link to search all of our blog posts.

Most Recent

Chalk Talk: NFL Rookie TJ Tampa Talks about What It’s Like to Go Pro – and What He’s Been Doing to Make Sure His Coaches, Teammates and Fans Like What They See on the Field

What's it really like to be a rookie in the NFL? That's one of the things that Adam Petrus and Hale Hentges wanted to get TJ Tampa's take on when they connected for the latest Chalk Talk. Hale's been in TJ's shoes. He knows what it's like to try to find your place as a pro athlete. But everyone's experiences are different, and TJ's experience has not been what you might expect. Hear how the all-star cornerback has been prepping for this season with the Baltimore Ravens and how he's hoping it will play out for him and his team. 

Why Your “Loss Prevention” Efforts Aren’t Working

Do you know exactly when, where and why losses are happening within your operations? If not, it will be hard to figure out how to prevent them, fix inventory distortion, and eliminate friction within your operations. So, let’s talk about loss detection.

One Nurse’s Perspective on the Healthcare Community’s ‘Inventory Management’ Problem (and How to Fix It)

Unlike most clinicians, nurses at Hull University Teaching Hospitals don’t have to worry that patient care will be compromised due to missing equipment or medical supplies shortages. Why? They’ve found an unconventional but effective ‘cure’ using RFID. Hear about the inventory management solution that is helping clinicians focus on patient care.

5 Tips to Prevent Shrinkage in the Age of Self-Checkout

Shoppers want more convenience, which means more self-serve and self-checkout options. You want to protect profitability. It doesn't have to be an either-or choice. Take these steps to measurably reduce shrink at the POS. They've worked well for other retailers.

Wish You Could Create Digital Forms, Automate Your Form-Dependent Workflows, and Go Paperless Once and For All? It’s Not as Difficult as It Used to Be.

Find out how one Fortune 1000 manufacturing company is going to save $1.1 million annually…just by digitizing forms and going paperless with a zero-code, SAP-friendly software solution.

Connect with our team

• About Zebra
• Story Hub/Newsroom
• Corporate Social Responsibility
• Global Locations
• Success Stories
• Resource Library

Support Resources

• Support and Downloads
• Contact Support
• Request a Repair
• Product Warranty Information
• Developer Portal
• Report a Potential Security Vulnerability or Concern

Stay up to date with Zebra.

Sign up for our newsletter.

Legal  Terms of Use   Privacy Policy   Supply Chain Transparency

ZEBRA and the stylized Zebra head are trademarks of Zebra Technologies Corp., registered in many jurisdictions worldwide.  All other trademarks are the property of their respective owners.  ©2024 Zebra Technologies Corp. and/or its affiliates.

Cookies on the NHS England website

We’ve put some small files called cookies on your device to make our site work.

We’d also like to use analytics cookies. These send information about how our site is used to a service called Google Analytics. We use this information to improve our site.

Let us know if this is OK. We’ll use a cookie to save your choice. You can  read more about our cookies before you choose.

Change my preferences I'm OK with analytics cookies

Case studies

Improving personal health and wellbeing.

• Helping our people manage stress and anxiety – West Midlands Ambulance Service
• How to establish a model of psychological support for employees during COVID-19 and beyond – Wrightington, Wigan and Leigh NHS Foundation Trust
• The impact of listening – University Hospitals of North Midlands NHS Trust

Relationships

• Conversation workbook – Lancashire and South Cumbria NHS Foundation Trust
• Wellbeing conversation and compassionate toolkit – Northern Care Alliance NHS Group

Fulfilment at work

• Working from home – Pennine Care NHS Foundation Trust
• Employee engagement – Birmingham Women’s and Children’s NHS Foundation Trust

Managers and leaders

• Leading by example – Birmingham Women’s and Children’s NHS Foundation Trust
• Building the skills of line managers – University Hospital Southampton NHS Foundation Trust

Environment

• Health needs assessment – Northumbria Healthcare NHS Foundation Trust
• Improving physical infrastructure – Lancashire Teaching Hospitals NHS Foundation Trust

Data insights

• Measurement and return on investment capture – Imperial College Healthcare NHS Trust
• Sickness and absence reporting – Norfolk Community Health and Care NHS Trust

Professional wellbeing support

• Multi-disciplinary case management – Northumbria Healthcare NHS Foundation Trust

Download a PDF of the above NHS health and wellbeing model (2021): creating a health and wellbeing culture infographic