Having guaranteed financial backing for a digital transformation project is only half the battle.
That's the opinion of Lisa Emery, CIO at the Royal Marsden NHS Foundation Trust, who finds herself in the position of having ring-fenced funding to deliver digital transformation, but who also recognises that strategic success is dependent on an accompanying cultural shift across her organisation.
While Emery has the money to invest in technology, she also recognises there are still barriers to overcome when it comes to making digitally-enabled change stick.
"They're mostly the cultural challenges," says Emery. "That cultural barrier is about working out how much change the organisation can absorb. And how much you can actually ensure gets delivered on the ground with all of the other competing priorities you've got as a healthcare organisation."
Emery's focus on the cultural challenges to digitisation is a common concern amongst healthcare tech executives. Research from consultant McKinsey suggests the three barriers to digital transformation that are most-commonly mentioned by healthcare leaders are culture and mind set, organisational structure, and governance.
Those barriers are the kinds of things that Emery, who started her role in August 2018, is working hard to overcome. While she says her predecessor had done a really good job of enacting the digital strategy, her team felt that the approach probably didn't describe in enough detail what the strategy would mean for patients and staff at a basic level.
Emery's team started thinking about what "good" meant in terms of digital services for people working at, or being treated at, the Royal Marsden. The aim was to ensure that the benefits of digital technology were clear to everyone.
To avoid turning people off with talk about systems and platforms, Emery and her team started describing the digital transformation strategy in a different way, using phrases like "digital workplace" for the services that would impact staff and "digital health record" for services that would affect patients. There were other changes, too.
"We were called the computing department when I started, so we ran a little mini competition to redesign the logo for the team, and a name and a strap line for the team. So fairly early on, we rebranded ourselves as digital services. And I was amazed by the cultural shift this created," says Emery.
"It's fostered a sense of professionalism and helped show that the digital team is a very important part of the patient journey and the patient record. I think that's shifted how people see the service, so they will talk about digital services now rather than IT, and then it's also shifted how the team feel about themselves and their role in the organisation."
This focus on the cultural shift associated to digital transformation is also something that appeals to James Freed, CIO at Health Education England, who is currently the director of a programme responsible for delivering digital readiness to the three million staff in health and care in England.
Freed joined Emery at the recent HETT conference in London, which brought together UK healthcare CIOs to discuss pressing concerns in the NHS. The event included a keynote theatre for sessions on culture and implementation, something that Freed says would have been anathema even two years ago.
"It wouldn't have been discussed, other than in a little side room. We've now got support from the very top," he says.
"The juxtaposition of technology, workforce development and people is the sweet spot where we're going to be extracting value in health and care. It's a really exciting time."
Yet this enthusiasm for change at the top must be matched by an eagerness to embrace digital technology on hospital wards. McKinsey recently referred to the "modest" adoption of digitally-enabled tools for diagnosis, treatment and management across the healthcare sector. It quotes research that suggests adoption rates range from just 3% in Europe to 35% in the US.
Even when transformation does take place, the value of digitisation remains tough to quantify. McKinsey suggests the introduction of digital services rarely leads to the closure of pre-existing quality, access and financial gaps in healthcare.
But in the case of the Royal Marsden, Emery believes she will see "significant progress" during the next 24 months.
"I want to see a real digital workplace," she says. "I want fantastic network access, mobile devices, collaboration tools and video conferencing – I want that kind of thing to just be ubiquitous and easy for staff. And to me, that is absolutely achievable within two years."
Emery also expects to see progress in terms of the trust's digital patient record and its business intelligence systems. And she expects her team to have put in place the tools to spin up and spin down significant cloud capacity for the trust's researchers.
Perhaps the key point is that, while healthcare organisations often struggle to make the most of technology due to underlying cultural barriers, Emery and her team's focus on changing perceptions around technology will create a mind shift in an organisation that already understands the importance of organisational culture.
"Everybody knows why they're there and they've got a purpose around it," she says. "That drive to improve patient outcomes for cancer and drive research just seems to be like a stick of rock through everybody. You've already got that cultural buy-in to want to be excellent, so that was a really appealing factor when I took this job and it continues to be true now."