In 2013 David Chalkley joined the newly formed Musgrove Park Hospital digital team, established to support and prepare the trust through a digital transformation programme, including the implementation of an electronic prescribing system. Initially, he joined the digital programme to lead the selection of the e-prescribing system, working within a multidisciplinary team to assess the broader needs of the e-prescribing implementation. Over time the role led to involvement in a wide range of clinical process digitisation and decision making, across a range of clinical areas. David has become one of the leads for the overall digital clinical strategy, particularly in the field of solution design and clinical safety.
Before the procurement of the electronic prescribing system started, he led the process of forming, upskilling and mentoring the project team and the setting of a digital strategy for e-prescribing and medicines administration (ePMA) moving forward.
In this interview, Mr David Chalkley, Deputy CCIO and Digital Clinical Safety Lead at Somerset NHS Foundation Trust, told us more about his experience of selecting and preparing to implement an ePMA system. As he said, in a big team each team member has different knowledge and strengths that in the end are the key to success.
Let us start with a digital programme. Could you explain what the digital programme is within your trust?
‘Our trust is one of the NHS global digital exemplar sites. We have central funding over three years to accelerate our digitalisation and the transformation of services using digital solutions via a digital programme. The exemplar status is a recognition for the way we not only implemented an open source solution but also the way we brought together a clinically led programme team.
This programme gives our trust the opportunity to work differently, forming partnerships with suppliers to help us accelerate digitalisation. It also gives us the opportunity to invest in skills and capability within our team and focus on things like person engagement, to allow patients and staff to contribute to systems, solutions and process design in a meaningful way. Ultimately delivering the transformation of care delivery through a collaborative approach.
Our trust has made a significant investment in a multidisciplinary team of clinicians, IT and project staff to lead, manage and deliver the implementation of a digital strategy and the new healthcare solutions within the hospital.
Along with this journey we will be producing blueprints for others to follow. The first of which is for e-prescribing. This will allow other organisations to look at the journey we’ve taken with regards to e-prescribing system selection and project initiation. It will potentially give them something they can follow to accelerate their journey in terms of how they select an e-prescribing solution and establish a project.’
What about the ePMA Lead? Who is the ePMA Lead and is one person enough to lead the electronic prescribing system implementation?
‘One of our key initial steps with e-prescribing was to make sure it was not seen as just a pharmacy system, ensuring that it was not pharmacy’s responsibility to own and drive forward the ePMA vision. ePrescribing is a key part of the overall clinical digital strategy, and therefore a core part of our digital programme. We ensured it has the same level of clinical ownership, skills investment and person engagement as any other major programme or project that what we have in our digital portfolio.
We wanted to avoid burdening any one individual with the sole responsibility for ePMA implementation instead utilising our emerging team of digital clinical leaders from different professions to lead the project. The project has a consultant lead, a pharmacist lead, a nursing lead, with me overseeing the overall ePMA strategy.
When you build these programmes, you want as broad an ownership and engagement as possible. Early effective engagement across professions, helps to ensure others understand how this kind of transformation will affect their work. At the same time, they have a chance to engage in the implementation and make it better for everyone.’
Are you saying that a multidisciplinary approach is the best key for implementing an e-prescribing system?
‘A big part of this journey for us and a key lesson learned from the programme is understanding the need to invest in the skills and capability within a team delivering goals via a multidisciplinary approach. In my opinion, this is the best way to identify, understand and realise the opportunities that e-prescribing solution presents. Through working with senior medical, surgical nursing pharmacy and IT colleagues from the very early stage, and we’ve been able to look at a series of opportunities that we potentially would have missed or may have committed to too late in the day if there was only one lead.’
What do you need to become an ePMA Lead? What are an ePMA Lead’s key competencies?
‘This is quite an interesting question ... I would say that you need a level of credibility within your fundamental understanding in both clinical practice and also business and organisational function. An ePMA Lead should be somebody who is quick to learn and adapt to different environments, somebody who can engage with a wide range of stakeholders and open up their way of thinking beyond just their own specialism or the experience at which he or she has worked to that point. This person needs to be able to see a broad picture from a range of different angles and distil that back down into the opportunity and challenges that digitalisation and transformation will bring about.
Even though my background is the pharmacy, I spend as much time as possible thinking about how a solution may impact a doctor or a nurse, not only a pharmacist.’
What would you say are the key challenges while establishing ePMA implementation team?
‘One of the challenges we identified is finding the right people who are prepared, with the knowledge and skills, to take the chance to do something different. There are a lot of very capable and skilful people out there, but it’s a significant shift in the digital programme environment and quite a significant step away from clinical responsibilities to project responsibilities.
The second challenge is ensuring that you have a good level of value and culture alignment with suppliers so that you can form a shared strategy and approach forward. For us, when choosing to partner with Marand and CGI, this was a key part of our selection process, and without this, effective collaboration would be very difficult.
Another challenge is the organisation preparing itself and being ready for the level of transformation and change that a solution like this will bring. If you haven’t set up the right structure and change management processes with regards to engaging and collaborating with your organisation, it can be a real challenge to sell this change to your staff.’
Can you share any past experience about spreading the awareness and finding key supporters for digitalisation not just within your team but also broader in the hospital?
‘Our approach has been to build on the work we have already established within the digital programme. Prior to e-prescribing system selection, we had already built a multidisciplinary team, which supported with exploring the ePMA market in the UK. Before we even went into the implementation process, people were already starting to form a picture what would be the opportunities and challenges around the ePMA.
We also invited senior leads and other people from a range of backgrounds across the organisation to join our ePMA steering group. We had clinical team leaders supporting this change from the early beginning, and it enabled a broad selection of stakeholders the opportunity to participate within the selection process through things like the system demonstrations and hands-on sessions. People can better understand the impact of change when they have the chance to engage with projects and see potential solutions as early as possible. This is especially important when you have to manage change in a big organisation.’
What do you see as a key benefit of having a really good team? How can these people help you during the implementation process and make sure that the implementation will be successful?
‘Establishing a team with the right skills and capability has benefited us in achieving a higher level of engagement within the organisation. A good team establishes the right networks, its members collaborate and support each other, they understand what they can learn from others inside and out of the organisation and identify opportunities.
When the team functions well, they are able to identify and anticipate issues and problems and work them through. They can get into the proactive mindset to identify challenges and solve them. It is a kind of synergy between the right team members that help them squeeze out those extra few opportunities and take them forward as a group.
For me, teamwork, skills, capability and mindset are all key components in really getting the most out of any project and helping the organisation achieve its true potential of the ePMA digital transformation.’
Follow David Chalkley via twitter @chalkley_david
Register for a free webinar ‘Why do we need ePMA’ recording with Duncan Cripps, Lead Pharmacist for ePrescribing at University Hospitals Plymouth NHS Trust and Roko Malkoč, Better Meds Business Unit Manager at Better.