Articulating a Vision for Digital Healthcare
Theme 1: Transforming the Culture of Care

The Culture of Care

This Vision-scape now explores the role of Culture in digital health innovation, and shows how the new technological era, rather than diminishing the relevance and importance of culture has rather increased, and now made it 'an amplifier' for digital strategy, and foundational to digital success.

#theideatory

#PI

The Role & Importance of Culture to Digital

The role and importance of culture in organizational evolution and progress has long been recognised. However, digital as we’ll come on to see, can enable a whole new medium for the interpretation, communication and expression of culture in some quite surprising, yet interesting and practical ways, which can align it very well to digital, especially in the context of the health sector's present-day challenge in grappling as they now are, with the simultaneous assimilation and adoption of industry 4.0 and 5.0 technologies into the health-IT estate, due to the convergence of the onsets of the Fourth, and Fifth, (4IR and 5IR) Industrial Revolutions.

The Influence of Culture on Digital Strategy

Health-CIO's have long recognised good strategy, as key to success of digital, and to be the critical foundational underpinning generally to any programme of technological evolution to advance the modern hospital, and technologically enable future innovative patient care.

Yet even a winning strategy is no guarantee of success of digital.

There is another critical factor, or component to digital success which is often overlooked, and that is the role of organisational culture.

Perhaps, the logical place to start in any discourse on culture, and its relevance to innovation in Healthcare is by firstly providing a definition for culture.

Defining Culture

For instance, Wikipedia describes Culture, broadly as:

'...a concept that encompasses the social behaviour, institutions, and norms found in human societies, as well as the knowledge, beliefs, arts, laws, customs, capabilities, and habits of the individuals in these groups. Culture is often originated from or attributed to a specific group, region or location'.

Normally when culture is spoken of in the context of healthcare, its usually interpreted in the narrow sense, of just relating to behaviours, though in reality, in relation to healthcare it more relates to, the accepted behaviours or conformed social norms, that have generally come to be agreed upon as the standard for acceptable, good and or best practice conduct for that organisation or hospital. The bar for such standards is usually set quite high, to besides high standards for patient treatment, to also include human attributes like compassion, respect, dignity, and so forth.

Carving Out A Niche for Culture in Digital Healthcare

We're going to explore in this article how digital can actually carve out a niche for culture, and for embedding the realisation of even aspirational values within a digital implementation, that can be quite powerful, unifying and aligning the people component of digital, (in terms of patients and staff) around the digital engagement, simplifying their interaction and understanding of it; and also nuance the provider, and resulting digital offerings, (that is the health treatment or service the citizen or patient will ultimately experience and or receive), with their own unique digital perception and identity; as well as have the benefit of facilitating access to treatments, and sources of credible medical information for patients in a range of ways they find readily consumable, and extremely convenient.

Why Articulate the Vision?

The ability of digital to be nuanced in this way does align it very well to delivering on the aspirations of our present-day technological era, which if you recall we'd said was to now admit 'values' to technological innovation, and transformative change. However, we've agreed that transformation is by no means an automatic by-product of digital. In order to achieve transformation we have to approach the question of innovation with vision and intent. Like the visionary pioneers of previous eras in the old analog world, who with a collective vision, or aspirations to create a better world for their descendants and future generations, bravely went in exploration of 'new lands' and territories, which we, (for better or worst) are now living in the manifestation of today. However, then as now, the challenges, though now systematised in the digital reality, are no less real, the stakes, no less high, the consequences no less prevailing.

The Elusive 'Grail' of Transformation

We've so far agreed that in starting to craft our models for future care, the vision, aspirations, and now the ethics of industry 4.0, and 5.0 technologies need to be important foundational considerations as we build. This is in order to assure we create the future 'Health-scape' we all really want to see emerge, that takes everyone forward together, and also because of the risks of some of these technologies to do serious harm to patients.

To attempt to move forwards in approaching such a monumental task (which in reality is a major paradigmatic shift), without such firmly agreed goals, and a clearly articulated vision, as to how we'll harness and utilise technology to both serve and improve the health and treatment experience of now not only patients, but also citizens, we'll only succeed in further dissipating the focus, and scattering the energy of the collective efforts of the sector at large to harness this new technological wave, and ultimately only achieve further implementation, and the sector as a whole still won't have transformed.

The confluence of these preliminary issues, namely fact that 'transformation' has continued to elude the sector, as well as the legacy issues around the sectors digital naissance, or immaturity, (as compared to other sectors of the economy), due to its late and incomplete adoption of digital or the industry 3.0 technological wave, will only serve to further exacerbate these gaps.

The sector is now extremely late in coming to the party of digital adoption, and could now risk being permanently technologically impeded, or left behind, as compared to other sectors of the economy if care is not immediately taken.

Paradigm's advice would be, to encourage Health CIO's/ Trusts, to do whatever they need to do, to move forwards as quickly as they are able, in completing the preliminary projects necessary to deliver what we defined as 'the Operational Backbone', the initial automation, and datafication of their hospitals end-to-end working and operational processes, and begin to map and implement their strategies to understand and attain their digital MVP, (minimal viable product) as quickly as possible. However,

The fragmentation due to the fact of some Trusts being significantly ahead of others developmentally in consistent adoption of new technology and innovation, does risk opening up a two, or multi-tiered health sector, technologically over time, if care is not taken

The importance of the sector having achieved Transformation in Digital in the Industry 3.0 era, should not be underestimated, as it is in reality key to the successful adoption of Industry 4.0 and 5.0 technologies due to their complexity, and is the groundwork that should ideally have been laid first. However the health sector, due to our now having entered in to the era of the convergence of exponential technologies, (see our previous Vision-scape: 'Healthcare and the Fourth Industrial Revolution, (4IR)' won't have this luxury, and will now be faced due to necessity, with a situation of simultaneous adoption of Industry 4.0 and 5.0 technologies, while still striving to assimiliate industry 3.0 digital to finally achieve the elusive grail of transformation. This poses a potentially existential risk to overall technological adoption, by the sector as a whole, meaning ultimately none of the eras technologically are successfully adopted by the sector overall. It's not purely the mastery of the technologies themselves that's important, but the journey itself. There's no substitute for experience, and the 'battle-tested' resilience that comes from digital maturity built by the Trust under 'load', or by 'doing' digital alongside its day-to-day operations over time. Its been proven that attempting to transform in the absence of this journey or resistance, in terms of it's gained wisdom, knowledge, and muscles, risks severely impairing the acceptance and integrity of the innovation ultimately achieved.

Our intention should be to 'design for digital', in order to create a lasting legacy or culture of self- perpetuating/ - sustaininable transformative digital advancement. As we'd said in our previous introduction to this Vision-scape: 'Transforming the Culture of Care', our aim is not to create a future health service that innovates technology blindly (without foresight or vision), purely for the sake of innovating technology.

Leveraging Values & Culture in Digital

Can culture be leveraged by digital?,

and if so then

What is its place and relevance in the new technological era?

Many at first glance might assume that culture is too archaic to still have an active role in our new systematised, or digital world, or reality. Yet as we're going to come on to see, it has such an important role, that a transformation will either stand or fall by the level of the organisation's cultural maturity. This Vision-scape differs a little to Vision-scapes we've done to date, in that we are now going to provide some practical suggestions, and advice to demonstrate how we can enshrine 'values', including for culture, to nuance the interpretation of the new digital care models that we create. This is also important, as we'd said in order to ensure that as we build, we evolve the sort of "compassionate", "kind", and "respectful" health service am sure we and reciprocally, society are keen to see ultimately emerge from our endeavours, to evolve future care.

Citizens

We're going to look in our subsequent post, which will be called 'Re-imaging the Culture of Care' at the requirements for the desired 'To Be' state for future healthcare, to evolve the present-day hospitalisation treatment model, and show why, health and care in the new technological revolution will require a broadening or widening of the definition of healthcare itself to extend beyond patients to now also include citizens, also.

The Contexts of Culture

Before we commence, we should qualify our use of the word Culture in the context of this Vision-scape, because we are actually using to refer to two separate things, firstly in our introduction we introduced 'Culture' in the context of referring to norms of behaviours, as per the standard definition we quoted from Wikipedia. However, we are also using Culture here in the context, or sense of relating to the nature of healthcare also, as we're also going to review the characteristics or features of our present-day model for care also, which we explained (in our previous ThoughtCast for our blog, The Digital Paradigm, Is The Hospitalisation Paradigm Ripe for Disruption), is Hospitalisation. We should also qualify at this point, the use of the word 'Values' in the context of this vision-scape, as our use of this word, should not be conflated with values as in Value-Based Care (VBC) or Principles, we are speaking here, purely in the context of values or attributes such as sustainability, compassion, and respect for example, as we'll come on to see.

The Role of Organisational Culture in Digital Optimisation

However, why is culture important at all in digital transformation? McKinsey & Company defined

'Organisational culture as 25% of the overall digital intelligence, or acumen of an organisation, but 'an amplifier of everything else',

stating that good corporate and organisational cultures 'play the role of an amplifier,' particularly for organisations or a Trust implementing digital. in so much as it enhances an organisations operational performance, enabling it to propel itself towards achieving its (digital) strategy, so that conversely, the presence of poor culture, will negate the achievement of even the most robust strategy, with the knock-on effect of inhibiting the ability of the organisation to propel itself forwards technologically. Furthermore, MIT Sloan, a number of years ago now, went on further to prove, that organisations must additionally be "well run", in order to realise their strategies for digital innovation. For these reasons, the sentiment or adage has evolved, that

'Culture eats strategy for breakfast'

A quote which is often mis-attributed to Peter Drucker, the late, US Management Consultant and educator, (who's believed to be the founder of modern management theory). While this maxim can convey an interpretation of what he perhaps meant, it has proven to be a misquotation, what he actually said is that “Culture, no matter how defined, is singularly persistent.” meaning

Culture is all prevailing in its nature and influence on all aspects of an organisation from its daily interaction and operation through to its technological advancement, future innovation and evolutionary development.

We pointed out in our previous Vision-scape, 'Healthcare & The Fourth Industrial Revolution (4IR)' that the convergence of the 4th and 5IR's of our present day technological Paradigm, or reality, now admits the inclusion of Values to be embedded within our technological implementation, but what do we mean by that exactly? and what are the benefits?

Why Does Digital Need Values?

The benefits of embedding values within digital implementation is that, if harnessed well, values can act like a catalyst, simplifying and even supercharging the people, or staff engagement, mobilising, and enabling them to participate and engage directly with the digital initiative, and embrace the change. The first principle of digital for a Trust wishing to embrace digital is that they must recognise that

Digital is everyone's responsibility

and not the sole responsibility or preserve of the CDO, CIO or Programme or Project lead, or person the Trust or health organisation has brought in, or assigned to lead it. Infact, MIT Sloan actually suggested that it can be beneficial for companies, conversely we can say a Trust, wishing to develop digital solutions, to hold off actually hiring or bringing in a CIO, or digital director to co-ordinate and oversee their digital initiative, until staff have grasped this fundamental principle. We're going to come on to see, just how culture and values can be used to both tailor and fuel a Trust's digital engagement, and good people/ staff engagement is key to enabling a Trust to both realise and or manage a sustainable, achievable program of successful transformative change over the journey that is digital

Mobilising Values & Culture

The benefits of now embedding values within the digital implementation, is that

It simplifies the vision, aiding the people, including staff engagement aspect of digital, helping to translate and make digital initiatives more readily accessible, relevant, and easier to understand, and interpret to people/ staff in ways that are more meaningful, and deliver the most value to them.

As such it can be a powerful tool, for staff and teams at all levels of the organisation or Trust, empowering and mobilising them, enabling them to contribute to the transformation. This will have the advantages of enabling everyone in your organisation to easily engage with the vision, understand its impact, including for their individual roles and working processes also, and will have the secondary beneficial effect of acting as a central unifying point or theme, like a rallying cry around which the whole organisation can align.

Operationalising the Vision.

Digital should never be perceived as a 'one-size fits all' approach. Its very important that

Each organisation, or Trust crystalise their own unique Digital Identity.

For this reason, it's important that as the Trust starts to take its initial steps into its digital journey in beginning to think about how they'll articulate a Digital Vision for their Trusts, they firstly work to build consensus within their Trust, including around simple things like agreeing a common definition for digital for their organisations, and in doing this they'll need to be quite specific to define what digital looks like or will be for their individual Trust or health organisation. This is important, because opinions as to what constitutes digital can vary vastly between organisations, from one Trust to another, and even from person to person.

Manage Expectations

The reality is that digital can mean different things to different people, so in order to assure everyone, organisationally is on the same page, and that you haven't left anyone behind, and are all communicating in common terms, you'll need to commence your digital journey by not only agreeing a definition collectively for digital, but should also confirm a common understanding, or consensus in advance for what digital success will mean for your Trust or organisation, and from there, build a common, practical understanding of what success will actually look like, in reality for your transformation, or digital innovation. In so doing, you should also agree answers to other simple questions like, 'How will you know you've arrived?', 'How will you known when or if you've achieved the goals of your transformation?' It's important to have answers to these questions. This can be overlooked as an exercise, meaning that perceptions as to whether an implemented transformation was successful or not, and or yielded the desired change or result, can be mixed, or even in the worst case become points of future contention within a Trust, simply because there wasn’t a firmly accepted, agreed organisational sense/ agreement of what ‘success’ actually was, or would look like, in the first place. So here we see again, that 'success', like 'digital' can mean different things to different people. So to summarise. it's important while you work through your pre-transformation delivery engagements you also

Take the time to manage expectations, and get organisational agreement about the desired outcomes, and ideally also agree some measurable indicators for the outcomes as well.

You could even start to take some initial (pre-implementation) measurements, and in so doing, start to build and confirm the metric or benchmarks you'll use to evaluate your success as it unfolds.

To access the complete article with additional resources and guidance, pls click on the button below