Inside the digital transformation of an ambulance service
"You think of the ambulance service and you just think of ambulances, but actually, there's a lot more to the North West Ambulance Service than that." Abigail Harrison, the Chief of Digital and Innovation and CIO for the North West Ambulance Service (NWAS) is describing the breadth of the services they offer. Run by the National Health Service (NHS), NWAS operates over a large geographical area in the north west of England, and runs an emergency 999 service with three emergency control centres, is the largest provider of 111 services in England, and also has a patient transport service.
"We serve more than 7 million people across the north west and we respond to over a million emergency incidents a year. We've also got 106 ambulance stations, so the scale of the work, the diversity of the services and the geography is an interesting challenge for us, as well as some of the digital challenges in different areas. We work in major cities, but we also work in very rural areas."
In 2019, NWAS published its digital strategy, with the goal of using digital solutions to radically improve how the trust meet the needs of patient and staff every time. This supports the overarching trust goal to achieve to become the best ambulance service in the UK by offering an integrated service to the population and acting as a gateway to the rest of the healthcare system. "We are the point of contact for every single other kind of provider in the healthcare system - emergency departments and hospitals are the obvious ones, but we also refer to GPs, pharmacies and mental health services as well" Harrison explains.
The digital strategy recognises that technology and digital investment will be necessary for NWAS to achieve its goals. There were other drivers too, as Harrison explains: "we were worried about cybersecurity, and we hadn’t been investing into our infrastructure for a long time. For the last two years we've been systematically investing in the infrastructure, replacing critical systems, and undertaking big digital transformation pieces to enable joined up working across the organisation."
Jonathan Sammut, deputy CIO, expands further on the aims of the strategy: "It's providing the right care at the right time, every time. There is an element of trust, which is a big word, but there must be an absolute reliability on the service we provide. "
"The other thing that's becoming more relevant, particularly in the last couple of years, is that people can control their own care digitally. I always go back to the "nan test" he says. My grandmother is quite digitally enabled and quite independent, so she'll push herself along a lot in terms of using technology like booking COVID tests and immunisations online. With anything I've ever done, in the back of my mind I run the nan test and ask, could she comfortably pick this up? It seems a bit cheesy, but I think it's important to bring patients on the journey with us, make it simple for them to digest and easy to interact with."
An important part of this is the use of data. From a patient perspective NWAS has implemented an electronic patient record. "This allows us to have real time access to patient records" Harrison says. "Integrated with our dispatch system it starts to give us a start-to-end view of when a call comes in, what resource have we sent, who is that patient, and are we providing the right care for them. The next step is to start painting a better patient picture, integrating with hospital records, GP records, and linking into other data sets to start having more predictive capability."
NWAS has also implemented Power BI, Microsoft's business analytics tool. "We’re just starting out but this will really enable us to give our clinicians and managers real time access to information to make decisions, to help them make the right decisions based on data," Harrison says. "It's also enabled us to really hone in on different groups in our population. For example, we've done a lot of work recently around mental health, pulling the data out to understand what variations, what experience our patients have with mental health issues, and how that compares to a physical health condition."
Sammut adds that while levels of data literacy and the hunger for data has grown, the aim is not to commoditise it, but use it to drive improvements, both for NWAS and for the patients. "As a nation, we've never been inundated with so much information before, and people really appreciate it because it's giving insights we'd never really thought about before."
Data is also an important component of the new dashboards they are developing, with an interactive platform that gives clinicians access to the latest communications. NWAS is also in the process of rolling out iPads to frontline staff. Part of a nationally funded piece of work from NHSX, Harrison says these will be rolled out in the next six months and for both personal use as well as accessing all of NWAS' systems.
Another product NWAS has developed is SafeCheck, a platform that enables staff to manage vital quality checks and to monitor quality and safety in real time. "We’re building on this as part of our Smart programme to use the latest technologies to reduce admin time and manage vital tasks," Harrison says.
NWAS is currently testing SafeCheck within the stock rooms of four sites, where they have automated smart lighting to enable staff to more easily find the equipment they need. "It's taking seconds out of the time it takes staff to do what they need to do," Harrison says. "All of this links back to our product safe check, which is our quality audit system that we developed in house which enables staff to digitally do checks of vehicles, like checking the tyres and what medicines are on board. The next step is to integrate that with our stock management so we can automatically order something that's missing from the vehicle when you walk into the stock room, and it's already showing you exactly where it is."
SafeCheck is also improving access to data. "We use it to track things like IPC audits and regular testing," Sammut explains. "Especially earlier this year it gave us an instant real time view of who was vaccinated, who was tested and who wasn't, and allowed the organisation to put the right measures in all the right places."
"When we run infection prevention control audits, vehicle audits and medicine audits, we've got the information readily at hand. But more importantly, we've enabled the business to be able to see the information. Previously people would spend a lot of time collecting data on spreadsheets and on paper forms, but because we've now digitised the actual work involved is just so minimal. It allows people to focus their time on putting in the improvements that the organisation needs rather than on the churn element of data."
A number of partners have worked with NWAS on their new solutions, among them MIS who provide their computer aided dispatch (CAD) solution. "This is really our primary critical system for 999" Harrison explains. "The phone system and CAD are the two things that enable us to respond to the population. CAD auto dispatches ambulances, and has our triage solution so it enables us to manage our patients."
MIS also provides NWAS' cloud platform, and helped to increase staffing levels during the pandemic as a result of sickness and to cover the rise in call volumes - to do this they deployed MIS' training system to train new staff in offsite locations such as schools. "It's a really important relationship for us," Harrison says.
"In the NHS we've got really good procurement processes, and one of the key scores within that is whether somebody has delivered what we needed before. being able to demonstrate that this is a safe system that's been used before is obviously an important part of that.
"We also work with lots of new technology partners on our Smart sites, such as Integrated System Technologies (ISTL), Cliq, Paxton, Sony and Deister technologies. We've had some great collaborations where we've been able to hone our approaches to problem solving together, as opposed to being sold something that maybe isn't quite what we need.
"Technically you have to have the right platform, procedures and processes, and provide assurance in terms of documentation checks, but the personal relationship is an important part of that as well."
Something Harrison and Sammut are particularly proud of is NWAS' digital design forum, which is a weekly space where people come together to support staff with solutions to their problems. "People from information governance, cyber security, our CTO, the BI team, someone from HR , our interoperability lead, different types of technical people, our developers - the forum is there for any staff member to come with either a problem or an idea," Harrison says. "The ethos of the forum is that we always say yes, we'll try to find a way to test it. Sometimes we'll test something using the systems we've already got. Or we'll go and talk to our providers, or we might want to develop a new system, or go and look at the market to see what's out there and find a way to test it.
When asked about their next steps, Harrison says that the really exciting phase is about to begin. "We've got ourselves in a really good position in terms of cybersecurity, safety, basic infrastructure upgrades to the Wi Fi, we're just about to finish replacing all of our telephony, we've unlocked access to data, and we've developed this approach to innovation and testing. But there is so much more to do - we're almost at that point where we can really build on it and start to push the boundaries a bit more and innovate.
"We've also now got the capacity to have interoperable systems, whether that's internally or externally. The next phase for our digital strategy is about the people in the organisation being able to interpret and use the information that we give them, and using the technology that we're putting in place to work differently."
This could include robotic process automation (RPA) for manual, time-consuming processes, "not to make efficiency savings, but to release some of that time back to employees so that they can finish work on time and aren't working till 10 o'clock at night churning through these processes" Sammut says.
Further down the line they are hoping to use artificial intelligence and machine learning, to drive further value from the amount of data they have. Another idea is the use of drone technology. "This is looking at drones to respond to incidents" Sammut says, "so this might be delivering a defibrillator or a particular drug in the scenario of a heroin overdose or allergic reaction. "The other thing would be surveying unsafe scenes, like a significant chemical spill, and this is using technology to get the right care to someone quickly without someone having to be there physically. This is relatively untouched technology outside of the military and search and rescue, but we want to pioneer solutions like this."
Harrison is a very passionate advocate for women, and for advancing women in technology. "There are some fabulous women CIOs, but proportionately there's a lot less women working in technology and progressing as quickly as men. I certainly think there's a perception that women are less technical. While I've been working in digital I've noticed this phrase that "she's not technical" and I feel that it's more likely to be said about a woman than a man. I've got a woman in my team who's worked in the IT team for 20 years, and is still perceived as "not technical". If a man had worked in an IT team for 20 years, I think everyone would assume he had the same kind of technical understanding as other people around them."
As a place of work, Harrison says NWAS is the most flexible place she has ever worked at. Flexible working is something she champions, as a crucial aspect of enabling more women to take leadership positions. "I am loud and proud about the fact that I work really flexibly," she says. "I don't work on a Monday because I look after my young kids. I really think that a lot of women would not believe that a woman could have a CIO job, and not work on a Monday.
"One of my kids is unwell a lot, and we're actually frequent callers of the ambulance service - that has an impact when I've been up all night, because maybe I can't make all my meetings the next day. But that doesn't mean that I'm not the right person for the job, if anything it gives me more resilience.
"I think that sometimes when women are in a field that mostly employs men, it can be seen as a weakness to want to work flexibly. We need to make sure that flexible working is a really accepted way to work as part of a digital team.
