Success by degrees: how to overhaul inefficient healthcare with Small IT

In the tricky pursuit for next-generation healthcare technology, the NHS has often found itself entangled in the complexities of ‘Big IT’ programs. For decades, these large-scale nationwide programs, often championed by consulting giants, promised transformation but delivered little more than frustration and inefficiency. The time has come to pivot towards a new, and arguably better, notion: Small IT.

The allure of Big IT solutions, with their expansive scope and proposals of comprehensive integration, once held sway over healthcare decision makers. But bloated budgets, delayed timelines, and systems plagued by interoperability issues have become all too familiar hallmarks of these grand endeavours.

For the NHS, another fundamental flaw of Big IT initiatives lies in their top-down approach. These monolithic projects often attempt to impose standardised solutions across a diverse landscape of healthcare providers, disregarding the bespoke challenges and workflows of individual institutions. This ‘one size fits all’ mentality inevitably leads to adaptation struggles and, ultimately, suboptimal outcomes.

Adjusting to a nimbler evidence-based approach and building from proven localised successes allows for innovators to partner with the so-called integration giants in subsequent phases of rollout. The tail stops wagging the dog. Innovators lead, partnering with scale-out enablers at the right time and only after ROI proof-points have been demonstrated. This is where Small IT comes in.

The ethos of Small IT centres on leveraging modern technology stacks to empower innovators to tailor solutions to the specific needs of healthcare providers and patients alike. It marks a tactical pivot towards agile solutions delivered by passionate teams with a focus on both service and profitability.
Small IT also thrives on collaboration and customisation. By working closely with healthcare stakeholders, operations heads can gain a deep understanding of their needs and pain points, crafting solutions that seamlessly integrate into existing workflows while addressing specific challenges head on. This bottom-up approach fosters a sense of ownership and engagement among end users, driving adoption and ensuring that technology truly enhances, rather than hinders, the delivery of care.

The agility inherent in Small IT allows for rapid iterations according to evolving healthcare requirements and emerging technologies. Rather than being shackled to outdated systems and cumbersome bureaucracies, healthcare organisations can embrace change as an opportunity for growth and improvement. Dynamic responsiveness is crucial in an industry that changes as rapidly as healthcare, where the ability to swiftly respond to new challenges (spikes in patient admissions and evolving ailments, for example) can mark the difference between success and stagnation.

Critics of the Small IT approach may argue that it lacks the scale and robustness of Big IT solutions. But the goal is not to build massive systems that attempt to solve every problem under the sun, rather to create flexible, modular solutions that can be easily modified and scaled as needed. Small IT embraces the concept that solutions can’t do it all, yet are pragmatic, cost-effective, and, most importantly, deliver tangible value to end-users.

Plus the rise of modern tech stacks – cloud computing, microservices architecture, and open-source software – has democratised access to powerful tools and platforms for all Small IT users who can rapidly prototype and deploy solutions with minimal upfront investment. It levels the playing field and empowers a new age of healthcare entrepreneurs.

The era of Big IT dominance in healthcare is coming to an end. Decades of failed initiatives and wasted resources have demonstrated the limitations of top-down, holistic approaches. Software development efficiencies only add to the case. It is time to embrace Small IT’s agility, collaboration and customisation to revolutionise the delivery of care throughout the NHS.

By harnessing the creativity and passion of smaller IT teams, we can finally realise the promise of technology to improve patient outcomes, enhance clinician satisfaction, and drive efficiency throughout the healthcare system: a fundamental change meaningful to us all.

PRO-MAPP for joint replacement surgery: a slicker digital approach to preoperative assessments

As an application merging surgical experience, leading academia and software design, PRO-MAPP is specifically tailored to innovate and improve patient pathways. With healthcare systems under pressure from tight budgets, lengthy waiting lists, and evolving (and often complex) methodologies, the time to solve unnecessary operational lags has never been more striking.

In light of this, a programme developed by health economic research arm and consultancy York Health Economics Consortium (YHEC), in collaboration with Oxford Academic Health Science Network, placed four evidence-based digital solutions under the microscope for their transformative patient pathway abilities. PRO-MAPP was selected for its focus on preoperative assessment and digital patient outcome reporting, looking to showcase its digital effectiveness against standardised patient pathways for knee and hip replacement – one particular strand of clinical surgery blighted by long waiting times – at Nuffield Orthopaedic Centre.

The current healthcare burden

The pandemic’s hit on expanded patient waiting lists has been felt across multiple surgical cases, all equally difficult to solve in light of stripped-back resources and staffing. Existing pathways for joint replacement surgery suffers a range of challenges as a result of (or on top of) lengthy backlogs, including:

  • More than three preoperative appointments being undertaken before patients are deemed fit for surgery
  • Manual investigations being repeated unnecessarily
  • Expired preoperative checks (including blood tests)
  • Needless preoperative appointments being carried out on healthy patients

Digital pathway solutions can relieve the burden on the entire healthcare system’s human and material costs by simplifying each major step before surgery is carried out: lowering unnecessary face-to-face appointments; speeding up the steps between appointments, vital tests, and possible surgery; reducing the need for repetitive testing and data input; and fast-tracking those most fit or liable for secondary care (complex patients, e.g., those with high clinical frailty score that are over 65 years old).

Gaining the digital advantage

The PRO-MAPP application is designed to more swiftly and accurately identify patients fit for surgery and reduce numbers on backed-up waiting lists. Patients can be assessed via web or tablet, having been added to a waiting list following an outpatient visit. Health screening and occupational therapy questionnaires can be filled in on iPads by patients, with assistance available from staff.

Staff training, individually or in groups, takes 15 minutes on average, and this digital collection aims to accurately guide staff as to which investigations are required before patients leave clinics, including ECD, MRSA swabs or blood tests.

The digital interface speeds up diagnostics, operational decisions, and ensures complex patients can start preoperative investigations earlier, increasing the probability to be determined fit for surgery sooner. Optimising preoperative assessment can properly segment patients only requiring telephone appointments, saving resources and costs affiliated with necessary appointment visits.

Complex patients should start pre-op investigations earlier to avoid the risk of changes to health status or expired tests (and the need to repeat questionnaires and checks), as well as increasing the probability of being fitter for surgery.

In short: what we found

Based on a sample of 1000 patients, the investigation compared the PRO-MAPP pathway with a standard care pathway for those correctly (or incorrectly) identified as complex or non-complex patients. The number of tests undertaken (e.g. echocardiogram or chest x-rays) was dependent on this factor.

The study looked to identify the average differences between: patient management costs; the length of a patient’s hospital stay; the number of preoperative tests; the number of preoperative appointments; readmissions; cancelled surgeries; and repetitions for preoperative tests and appointments.

PRO-MAPP’s identification rate proved 98% correct for complex patients, and 95.4% for non complex patients. The length of stay was, on average, two days shorter for those on the PRO-MAPP pathway, while readmissions were lowered by 0.4%, and 1.3% fewer surgeries were cancelled.

In all, the PRO-MAPP pathway for knee and hip replacement saved £770 per patient in comparison to the standardised procedure. Per 1000 patients, this marks a difference of £726,944.

Future-proofing personalised patient pathways

Reducing the need for unnecessary face to face appointments, the lengths of hospital stays, and training and resources costs, the PRO-MAPP pathway is on course to speed up operations while alleviating budget stresses and achieving patient satisfaction. 92% of patients stated the questionnaire was ‘easy’ or ‘very easy’ to complete.

Staff similarly felt the bespoke application was helpful for the service, implemented according to speciality, workflows, staff numbers, and the level of training, support or technology needed. With reduced repeated health centre visits, health economic analysis also identified that PRO-MAPP has (so far) saved 51,381.6k of travel; a necessary step in improving climate issues through a reduced 8.8 tonnes of CO2 emissions.

Efforts are still ongoing to improve interactions between patients and staff, but PRO-MAPP has been included on NHS England’s website as a guide for providers on earlier screening, risk assessment and health optimisation in perioperative pathways. To learn more about our pioneering patient pathway solutions, get in touch with our team today!