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12 February 2019

The Topol Report: An Essential View into the Human Side of Digital Transformation



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Ask any organization about the most important asset for their business success, and the most popular answer by a long way will be “our people”. While so many factors are essential ingredients within the overall collection of activities that build and sustain a business, all companies seek to develop motivated individuals in well-organized teams with leaders who inspire and set directions that others strive to follow in achieving the overall aims of the business. In spite of this, too often the experience of workers in many organizations is that their needs and aspirations are poorly understood, and inadequately addressed. Unfortunately, the most recent data reveals that the situation does not seem to be improving.

The figures from a number of studies reveal the depth of the issues. According to Hay Group’s “What’s My Motivation?” report from 2015, just 15% of UK workers consider themselves ‘highly motivated’, with almost a quarter (24%) admitting to ‘coasting’ and a further tenth (8%) being ‘completely demotivated’. But perhaps more worrying is that poor staff motivation is reducing productivity by close to half. Just a fifth (21%) of British workers consider themselves ‘very effective’ in their current job role. These figures are similar to those from the USA. A 2017 Gallup “State of the American workplace” report states that over half (51%) of the US workforce is not engaged, and little more than one fifth (22%) strongly agree that their company has leadership with a clear direction.

Will digital technologies improve the lives of those creating and consuming products and services? Perhaps the most critical element of digital transformation and the future of work is understanding what it will do to people at the coalface of our organizations. It’s a general problem all organizations must address. But nowhere more than in the public sector. A fascinating insight into the challenges and opportunities was published this week with the Topol Review. This work was commissioned by the Secretary of State for Health and Social Care and Health Education England in May 2018 as an independent review into the digital training needs of NHS staff. Digital transformation in the NHS is a polarizing theme, seen by some as the opportunity to leapfrog years of mismanagement and lack of investment, and by others as de-humanizing, de-motivating, and doomed to continue the long legacy of failed IT projects. This review seeks to assess the situation and set some priorities for the future.

So what is digital transformation in healthcare, and how will it make a positive difference? In his introduction to the report, Eric Topol, a California-based MD at the Scripps Research Institute, provides a very clear view of the opportunity that faces the medical profession in the 21st century, and highlights the reason for this as the confluence of three major advances:

There are three noteworthy changes that we expect to take hold: a much greater proportion of the population will have their genome sequenced; the empowerment of individuals who will increasingly be generating their own health data with the help of algorithms to interpret that data; and a marked improvement in the speed, accuracy and scalability of medical data interpretation afforded by artificial intelligence, which will provide robust support for all types of clinicians. Taken together, this will lead to an evolution of the patient-doctor relationship.

If the opportunity is clear, how does Topol see it being realized. The review is a substantial, wide ranging examination of the perspectives on digital transformation in the NHS, and involved a number of working groups conducting interviews and workshop with a range of stakeholders. Much is made of advances digital medicine, genomic medicine, Artificial Intelligence, and robotics. Their potential for improving health outcomes and refining health economics is very loudly touted. Lots of great discussion and analysis in these areas, and the review provides a much needed overview of the potential digital future for the NHS.

All well and good. And I am as much an optimist about our digital future as the next person. However, my personal challenge is that this ultra-positive view grates with the practical reality as experienced by anyone dealing with the health service today: Incredibly hard-working people coping with poorly managed processes underpinned by technologies (digital and otherwise) that are frequently unfit for purpose, unavailable, or inadequately supplied. Such reviews tend to lose a lot of their relevance and impact when the gap between the “state-of-the-art” and the “state-of-the-practice” as experienced by users of the system is just too wide. Rather than be wowed by the opportunities, I find I am rolling my eyes and asking “but how on earth do we get there from here?”.

The resulting recommendations are fairly broad, and consequently often rather rudimentary in nature. Lots of talk of improving the “learning environment”, and “empowering workers”. However, inside these rather bland (but beautifully written) statements are 3 key messages that should be emphasized as substantive areas of focus.

  • The constant reminder to concentrate on the needs of the patient, and the improvements in outcomes that will be achieved on their behalf. This patient centric view should be the touchstone for all digital transformation activities. The impact needs to be seen as a balance of clinical, social, and financial outcomes with the patient at the centre.
  • Data ownership, responsibility, and ethics needs to ensure that individuals are treated fairly and openly. New technologies should not be an excuse to remove agency and choice. Digital technology enables human choices and responsibilities. It does not remove them.
  • Processes and systems should support diverse knowledge, experiences, and needs. The communities affected in healthcare are broad, and individuals are being impacted at particularly vulnerable times in their lives. This requires multiple paces and pathways to treatment, and renewed effort to meet people where they are in their understanding of their circumstances.

These principles are hardly surprising. And read in isolation they may even be seen as trite. However, they are at the heart of a great deal of current debate on the future of digital transformation in society. To brush them aside is to misunderstand a fundamental tenant of digital transformation today: it is above all a human issue. And if the Topol Report does no more than remind us of that, then its still has performed a role of vital importance to the NHS, and to us all.