Healthcare professionals would benefit from greater clarity around the standards required for measuring environmental impact from NHS leadership. The best way to create a standardised approach to working methods is by outlining a detailed competency framework or ‘gold standard’ to serve as a point of reference when there is uncertainty.[1] Combined with channels for providing immediate feedback to data providers when there are quality issues and allowing them to reflect on the given criteria for improvement it would help support system-wide accountability and improve sustainability practices.[2] For example, ensuring all trusts have a set standard for how they should measure their environmental impact.
Ben Goldacre, director of the Bennett Institute for Applied Data Science states the standard of data within the NHS can be improved through the professional development of NHS data analysts and ensuring training in basic data skills is available for all staff in order to create a data positive culture.[3]
The NHS knows how important data analysts are for its success and wants to attract and retain the best talent in the field. This can be achieved by creating visible career trajectories with an explicit framework detailing what is required to progress. By adjusting increasingly senior analyst roles with pay bands according to the ‘Agenda for Change’, delivering on-the-job training, and positively affirming their work through accreditations retention is incentivised and increases the likelihood of sustainable change being made.[4],[5]
If staff could become better users and customers of data, quality and communication issues will crop up less as analysts would no longer be working in silos.[6] Goldacre states the training of clinical leads and the front line workforce whose day-to-day responsibility is not scoped with data-based tasks is crucial in creating a culture willing to adopt data driven initiatives. Non-analyst staff wouldn’t feel alienated from targets like their trust’s sustainability goals if they are literate in basic data analytics and thus more likely to engage in initiatives and have informed conversations about data. If they feel their contribution is valid and can see the change being made.[7]
Mixed teams could include analysts, clinicians, managers, researchers, software engineers, and great communicators. This would address the issue of senior managers and clinicians feeling out of their depth when commissioning or evaluating analytic insights, and analysts feeling frustrated by unrealistic questions or expectations.[8] Good data analysis is contextual, it is not “just about knowing how to ask and answer a question using data, but knowing what the important questions to answer are.” [9] By increasing data literacy among managers, they will be able to ask better questions and differentiate between good-quality and poor-quality work. Specific and timely analysis can only be achieved if teams understand where the data comes from, its strengths and weaknesses, the right technical analytic approaches, how to communicate the outputs and how the outputs will be used to inform practical decisions in the organisation. Thus, the NHS could look to run data-driven innovation as a service by helping non-analyst staff feel more confident in sharing, adapting and challenging data methods. Supported through simplified government guidance that is regularly updated to reflect the current best practice, a data positive culture is well within their reach.[10]
To foster a sustainable data-driven culture, it is essential to establish a visible community of volunteer senior analysts who push for engagement in sustainability data across the organization e.g., waste management, energy efficiency and circular thinking within procurement. These champions should be provided with resources for capacity building, a platform for sharing their knowledge, and mentees to mentor as to encourage junior analysts to remain in the workforce and sustain the trust’s Green Plan. A mentorship program can help bridge knowledge gaps and create a more data and sustainability friendly environment. Analysts can then connect with other departments to promote good data practices and expand their audience. Successes ought to be openly communicated to motivate others to participate and reinforce engagement. Centralizing these initiatives in a hub can make it easier to incentivize engagement, track progress, and concentrate efforts rather than having lots of pockets of information, making it harder to keep up with. Realizing the potential of shared care records will require well-thought-out strategy and maintenance assessments, as well as resolute personnel with sufficient data skills.
James Rawlinson, the health informatics director at Rotherham Foundation NHS Trust, believes that the NHS needs an improved local approach to managing service pressures, directed by a deep understanding of data. Rowlinson trusts agile leadership inspired by efficient technology will effectively manage demand and activity through the organisation’s systems. [11] The best way to provide actionable insights is through expanding knowledge on what data flows through NHS systems and knowing the relevance that should be assigned to it. Having a good handle on all local data will ensure the national data is robust.
There should be consistent knowledge sharing and a standard of excellence within data management in the NHS. A culture of building something once and sharing it with everyone is deeply necessary.[12] Through dedicated digital platforms and greater collaborative efforts, duplication and wasteful analytical work can be avoided.[13] These platforms would work best if available on local, regional, and national levels, with dedicated channels of communication for specific analytic enquiries. This would make it easy for users to find the information they need.
The adoption of modern, open analytic methods could rapidly build a collaborative culture that would support rapid innovation and capacity building. This could include reusable scripts and open coding tools. Not only would this benefit any existing analytical work, but it will attract more highly trained data scientists who are used to working this way,
Consultants could provide guidance in the use of open script-based tools like Stack Exchange to gather information from experts and utilize data. Stack Exchange is made up of a network of websites where users can ask and answer questions on various topics as each website covers a specific, exclusive topic with claims backed by a reputation system there is no reason this tool cannot be utilised by NHS staff in a professional capacity.[14] Staff could ask and answer questions related to their field of expertise or gather information from other experts in the field to truly utilise the data at their fingertips.
A big blocker in monitoring sustainability metrics is the varying formatting styles, an incompatibility in system choice, and diverse stakeholder requirements when collecting data on carbon emission sources. This can be overcome with open analytic tools like GitHub; a platform that allows developers to securely store their code from which they can monitor, revise and work in partnership on it with other analysts. Such data could be on the carbon emissions benchmarks that once entered into a repository, collaborators can identify areas and the subsequent goals for improvement. The software can be tailored to suit local needs whilst still having the original source remain in a digital space that everyone can learn from.
This promotes a uniform approach to oversee similar data metrics from different estates and trusts as well as allowing NHS staff to share best practices. There is an inbuilt feature that lets users create and participate in conversations within a repository or an organization. By joining online communities NHS staff can exchange ideas as well as resources, and feedback on how to improve their environmental action plan with constant data scrutiny laying at the heart of these discussions. Having this level of flexibility and knowledge exchange is well apt for creating a low carbon healthcare system.[15]
Staff working for the NHS are under a lot of pressure to deliver an excellent standard of care and sharing data appropriately may be poorly executed without best practice guidance or time dedicated needed to share. To make this a smoother process any shared analytical code should be supported by ‘good enough’ documentation to promote reuse.
There could also be workbooks and ‘how to guides’ designed for reuse which would require curating an easily accessible library of documents with patient data anonymised and the ability to edit and tag user creators without any hassle.[16] To ensure this library contains resources it could be made mandatory in the job scope of NHS analysts to share code once it’s been developed with public resources.
This shared resource would hope to minimise duplication as when analysts start a new project, it would work in their favour to begin by searching the library and identifying and evaluating existing solutions, even if the exact work they need does not exist there is the option to borrow bits of other work as a starting point. Goldacre stated we should not underestimate the power of pooling technical skills and domain knowledge, only through sharing information and making it accessible to people can we make the improvements required. [17]
Networking and dialogue over data can be boosted through conferences and events, ran during work time, and centrally funded, which brings together the healthcare analyst community.[18] This would be an opportunity to communicate insights, present novel approaches to data management and open up conversations on the barriers of data work. Instances of excellent work exhibited at these events could be written up with the necessary technical detail and added to the collection of resources.
An example of taking a data driven approach to improve care delivery, lower costs, and save emissions was conducted by Goldacre. Over a 6-month period, he collected data from 6500 practices to identify wasteful and unusual prescribing behaviour, including forty-two sustainability and transformation partnerships. [19] The objective is to remove the reliance on hypothesis, ‘feeling’ based metrics to determine unusual prescribing behaviour, which is unable to capture variability or identify. By analysing the full scope of data, he was able to identify common, unnecessary prescriptions and thus allows prescriptions to be used more sustainably and when necessary, gives the patients better quality of care as they are only receiving what they need and lower the carbon footprint of pharmaceuticals.
To summarise, appropriate use of NHS data could reduce the cost, time and resources spent on generating excessive or insufficient evidence for necessary environmental or care related interventions. The healthcare landscape is complicated and the NHS is already stretched thin, with mounting pressure to deliver the best care for its service users. In looking to build a sustainable, data positive culture as well as the resources, training and frameworks to go with it, the NHS should be supported by experienced contractors, well versed in implementing successful sustainability projects. Agreed upon solutions and insights should be communicated by NHS spokespeople and celebrated with stakeholders, such as staff, patients, partners, or regulators ensuring there is transparency and accountability on their journey to net zero and potentially be a point of inspiration to other businesses and industries. [20]
[1] Goldacre, B., Bardsley, M., Benson, T. et al. (2020) Bringing NHS data analysis into the 21st century. Journal of the Royal Society of Medicine. 113(10), pp. 383–388. https://doi.org/10.1177/0141076820930666
[2] Health Foundation (2021) How better use of data can help address key challenges facing the NHS. Available at: https://www.health.org.uk/publications/long-reads/how-better-use-of-data-can-help-address-key-challenges-facing-the-nhs.
[3] Goldacre, B., Bardsley, M., Benson, T. et al. (2020) Bringing NHS data analysis into the 21st century.
[4] Goldacre, B., Bardsley, M., Benson, T. et al.
[5] Guide To NHS Pay (Agenda for Change) 2023/2024 | BMJ Health Careers
[6] Health Foundation (2021) How better use of data can help address key challenges facing the NHS.
[7] Goldacre, B., Bardsley, M., Benson, T. et al.
[8] Goldacre, B., Bardsley, M., Benson, T. et al.
[9] Goldacre, B., Bardsley, M., Benson, T. et al.
[10] Shaping Cloud (2020) Data Analytics within the NHS and why it’s so important. Available at: https://shapingcloud.com/data-analytics-within-the-nhs-and-why-its-so-important/.
[11] Digital Health (2020) Could data be the route to the efficiencies the NHS needs? Available at: https://www.digitalhealth.net/2020/12/could-data-be-the-route-to-the-efficiencies-the-nhs-needs/.
[12] Goldacre, B., Bardsley, M., Benson, T. et al.
[13] CHS Healthcare (2020) Driving quality, safety, and efficiency with data in Continuing Healthcare. Available at: https://www.chshealthcare.co.uk/driving-quality-safety-and-efficiency-with-data-in-continuing-healthcare/.
[14] Welcome to Stack Exchange. Stack exchange. Available at: https://stackexchange.com/tour
[15] Build software better, together. GitHub. Available at: https://github.com/topics/healthcare
[16] Goldacre, B., Bardsley, M., Benson, T. et al.
[17] Goldacre, B., Bardsley, M., Benson, T. et al.
[18] Goldacre, B., Bardsley, M., Benson, T. et al.
[19] Hopcroft, L.E., Massey, J., Curtis, H.J., Mackenna, B., Croker, R., Brown, A.D., O’Dwyer, T., Macdonald, O., Evans, D., Inglesby, P., Bacon, S.C., Goldacre, B. and Walker, A.J. (2023). Data-Driven Identification of Unusual Prescribing Behavior: Analysis and Use of an Interactive Data Tool Using 6 Months of Primary Care Data From 6500 Practices in England. JMIR Medical Informatics, [online] 11(1), p.e44237. doi:https://doi.org/10.2196/44237.
[20] Health Foundation (2021) How better use of data can help address key challenges facing the NHS.
Written By Charlie Dawson