26 January 2021 Dr. Maddy Borhani (Partnerships Manager in the Innovation Development team at NHSX)
Dr. Maddy Borhani, Partnerships Manager in the CDO team, has particular interest in practising a design thinking approach to understand how to utilise digital tools in health and care to improve productivity and increase staff and patients’ satisfaction. She conducted a survey a while back to gather intelligence on how to use automation to create value in the system. This blog summarises the findings.
Since the start of the pandemic, the NHS has had to significantly increase its speed of digital transformation and delivery. One of the simple technologies that has been used as a tactical solution to support this rapid transformation is software called robotic process automation, or RPA. This software uses ‘virtual workers’ to automate highly repetitive and mundane tasks.
Over the last three years, an increasing number of NHS Trusts have successfully automated a variety of admin-heavy tasks. One simple example is cancelling patient appointments in the patient records system, where patients are sent an automated text message giving them the option to cancel their outpatients appointment. If they do, then the ‘virtual workers’ are notified about the cancellation and can swiftly reallocate the unwanted appointment by offering it to another patient on the waiting list within moments, reducing the overall waiting times experienced as well as saving staff time.
Last August, NHSX published a blog and launched a survey to understand the challenges and barriers to adoption and scale of automation across health and social care. This was designed to find out about the challenges and opportunities to safely and rapidly implement RPA as a first step towards extensive automation. We received over 170 responses, 54% from the NHS and social care and 39% from digital health innovators providing RPA solutions (7% did not clarify what sector they were representing).
RPA and strategic priorities
The survey highlighted that the strategic objectives of the participants’ organisations go well beyond reducing costs. Over 65% of the participants who are already implementing RPA identified the following as their top priorities:
Increased productivity and time management
Increased clinical efficiency
Improved process integration
Focus on continuous improvement
RPA maturity in the NHS and social care
We asked respondents about the level of maturity and use of RPA. From 94 respondents we heard that:
32% of them were either maturing or at an advanced level of automation
20% were either at implementation or experimenting stage
more than 40% were only exploring
7% were not considering RPA
Although many organisations were at early stages of RPA adoption, they have expressed their intention to expand their RPA development in the next two years. They are planning to automate highly repetitive and simple tasks to clear backlogs as the first starting point in their automation journey, a particularly pressing issue given the impact of the pandemic. Respondents who were in the experimenting or implementing stages were often using RPA as a stopgap, while they decide what data repositories will work best for them.
From the survey, less than 1 in 6 organisations are at the maturing stage of RPA development and are considering using more advanced levels of automation to improve productivity and patients’ experience. Organisations that did not consider investing in RPA have revealed that the two main factors that stopped them from exploring RPA were:
the lack of financial resources
the lack of information related to the realisation of benefits
Building an RPA technology plan
The survey highlighted the need for an effective RPA implementation plan by the organisations to ensure that appropriate teams are involved in developing and maintaining the processes. Over 35% of the respondents had no centralised RPA team to lead their RPA development. When they were asked who governs the development of RPA in their organisations, 17% of respondents had a comprehensive governance structure for RPA, and 39% were only starting to design a governance framework. It was highlighted in our survey that, since software for developing RPA tools has now advanced to the point that user interfaces are intuitive and easy to employ, the individual departments that use RPA often develop and deploy bots on their local IT systems. While there are significant advantages to this in terms of speed and local tailoring to solve problems, as a result, RPA can enter organisations “under the radar” with little documentation about how it works.
Barriers to adoption
We asked the respondents about their current challenges and barriers to scale or adopt RPA in their organisations. Current users of RPA reported their most common challenges as:
knowledge gap leading to an inability to prioritise RPA initiatives
lack of skilled workforce to develop, deploy, and maintain RPA processes in-house
process variations and lack of governance
For respondents who were not using RPA, the main reasons that stopped them from implementing RPA were lack of:
awareness of RPA processes
evidence around the value for the money and the realisation of benefits
knowledge sharing by organisations who have successfully implemented RPA
Benefit driven approach
Based on our survey results, organisations who have successfully and safely automated a number of their processes across different services, ranked increased productivity, accuracy, and staff and patient satisfaction as the highest benefits realised using RPA. Most organisations mentioned that cost reduction was a by-product of increased productivity, but even so, substantial savings were anticipated in this area. Organisations that were at the matured or advanced stage of RPA adoption highlighted that it is critical to monitor the full value that automation is delivering, i.e. beyond efficiencies and cost savings. For example, one of the participants commented that “we started automation in 2019 and so far automated over 27 processes across the administration function and contract centre which resulted in saving equivalent to 16 FTEs worth of workload, which allowed our staff to spend more time with patients to improve their quality of care”.
Blended team approach
We asked the respondents to specify the resources that are required to implement and scale up their RPA capabilities. It was evident that most organisations need a broad cross-section of professionals, including RPA developers, business analysts, and project managers to safely and successfully implement their RPA plans.
We also asked about the internal capability of the workforce to develop RPA processes across the health care system. Organisations at mature and advanced levels reported to have highly-skilled workforces, including at least one subject-matter expert. The workforces' skill sets across organisations that were at the implementation stage were either at the basic level or they were in the education mode. In addition, 10% of the organisations at the experimenting stage reported that they either were unaware of the skill set of their workforce or they have fully outsourced their RPA work. It was also highlighted that 40% of participants were developing internal talent through formal training of which 60% of organisations were at the mature or advanced stage of RPA development.
Innovators and RPA suppliers highlighted that one of the biggest challenges they experience working with the NHS and social care is the complex organisational structure, and the lack of knowledge of NHS and social care teams in understanding their technological limitations and infrastructure, and the processes to be robotised. They highlighted that those who work in the system must fully understand the process they want to improve before considering and implementing RPA as a solution. It was highlighted that RPA is not a single solution; rather, an enabler of digital transformation and should be considered as a gateway for other technology advancements, such as machine learning.
Our survey highlighted that there are a number of pockets of automation excellence and solutions within the NHS. There is a genuine appetite among survey respondents to work together to find solutions to some of the barriers they are facing, to share knowledge and help scale.
They also highlighted several challenges to the adoption and scaling of RPA across the NHS. These challenges include:
lack of knowledge and guidance to ensure that opportunities are properly explored, prioritised and that the expected values are delivered
silo implementation and lack of awareness of success stories, including a benefit realisation framework to track improvements in productivity, quality, and speed
lack of diverse teams to enhance the knowledge and skill sets among the workforce concerning automation, and to leverage their skills in driving the use of tactical and strategic information in handling automation challenges
By simply automating high-volume, repetitive processes, we can streamline the patient experience, as well as offering precious time back to clinicians and operational staff.
As Roy Lilley highlighted in his recent blog, RPA is so useful and we need to avoid over complicating this technology and start utilising it “closer to where it is needed”. Roy said “The headline I’m looking for: ‘NHS uses basic technology to do boring stuff’ - hence inspiring our headline for this piece.
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