Transference or transformation? The reality of COVID-19

CIOs claim that COVID-19 has moved their digital roadmap ahead by as little as 6 months, and as much as five years. Enhancements have been forced by necessity, implementations have been given the go-ahead without the time consuming and often arduous process of NHS procurement, and entrants have been let into the market in ways in which they could never have dreamed.

But a recent webinar, hosted by CECOPS, focused on the digital readiness of the NHS in light of COVID-19, in which the illuminating and out-spoken Sam Shah, former Director of Digital Development at NHSX, raised the question: “have we really seen transformation, or is it just transference?”

Which ultimately asks: has “transformation” merely manifested as a transference from paper and offline activities into digital ones, whilst largely keeping the process the same?

Let’s take something as crude as the London restaurant scene as a comparison: virtually all of the restaurants in central London are now delivering freshly made, hot meals to your door during their standard opening hours. Is this transference or transformation?  In truth, they’re using the same process of ordering, cooking, and presenting meals as before and will no doubt largely revert back to these methods after July 4^th .

In health and care, some great strides have been made, and there’s no doubt that people have moved at pace, with a mindset towards digital that has never been seen before – which is hugely positive.

For example, in the US there are pockets of significant transformation. We’ve seen the  Mayo Clinic announce new care models that will deliver innovative, comprehensive, and complex care to patients—all from the comfort of home via a new technology platform. Under the direction of Mayo Clinic clinicians, they’ll offer health care services including infusions, skilled nursing, medications, lab and imaging services, behavioural health, and rehabilitation services from a network of paramedics, nurses and an ecosystem of support team members.

In the UK, however, perhaps the biggest area of widespread change has been implementing agile working with a connected and distributed workforce, enabling people to work and access services from home via video conferencing. But again we ask: is this transference or transformation? The answer, honestly, is more likely to be transference.

So why are we seeing so much transference and far less transformation?

As COVID-19 hit, we all panicked. Many organisations no doubt grasped at what was in front of them, something which  caught their eye, and could be a quick ‘win’ to help their organisation face a hugely unprecedented period. During a frantic time of crisis, we focused on necessity rather than a planned approach, prioritising the underlying needs of the system and the people.

But as we start to see signs that we may be to emerging from the other side, and necessity begins to decline, the procurement of some services at pace may be questioned and the licence to bypass regulations and processes may be coming to an end. Those organisations which implemented truly transformative solutions that deliver impact are likely to keep them in place, but systems of transference may face a bigger challenge as those who traditionally challenged transformation start to revert to their old ways.

And unfortunately it’s already happening. A new report from the Commonwealth Fund found a “plateau” in the growth of telemedicine visits and that in many areas , visits have actually been declining since April. This all suggests that health providers are still finding the best ways to provide virtual services and the transformation we had hoped for wasn’t transformation after all.

Transformation, unfortunately, very rarely comes in the form of a quick win; it comes from understanding the end user need in great depth and having the infrastructure and the commercials in place.  But let’s not make that a negative, and instead focus on how to lock in the gains and the progress that has been made with both transference and transformation. This can be done by evaluating need and in turn providing investment to make digital health impactful, but most importantly sustainable.