An independent evaluation of NHS England's flagship Global Digital Exemplar (GDE) Programme
In 2016, the English government commissioned the US physician Robert Wachter to lead an independent review of the state and future strategic direction of digital health strategy in England. One of the key recommendations from this was to invest limited central resources selectively to create a cohort of digital centres of excellence. Consequently, NHS England's Global Digital Exemplar (GDE) Programme was conceived in 2017 with £395 million national investment designed to support “selected digitally advanced mental health, acute provider organisations, specialist provider organisations and ambulance provider organisations, who through funding and international partnership opportunities [would] become Exemplars over two to three and a half years”. The underlying assumption was that digitally advanced sites would become international centres of excellence that could share their learning with later implementers. These Global Digital Exemplars (hereafter GDEs) were paired with somewhat less-digitally mature Fast Follower (FF) provider organisations to help them share knowledge that would be captured in Blueprints to leapfrog and accelerate the spread of this learning nationally. Our team was commissioned to evaluate the GDE Programme over a period of three years, with evaluation activities commencing in January 2018. We are also involved in delivering the NHS Digital Academy, a related initiative also emerging from the Wachter report. The NHS Digital Academy is a virtual organisation training NHS staff in digital leadership.
In December 2019, then health secretary Matt Hancock announced the NHS Digital Aspirant Programme to build on the GDE Programme. This programme, which is still unfolding at the time of writing, is intended to build digital transformation capacity across a wider range of NHS provider organisations, each receiving much smaller amounts of funding than the GDE Programme.
Methods and analysis
Detailed methods can be found in our published protocol. We conducted a longitudinal qualitative formative evaluation, in which GDEs and FFs were conceptualised as case studies. This format allowed us to explore implementation, adoption and optimisation processes in context and to extract potentially transferable lessons associated with developments over time. For the purposes of evaluating the GDE Programme, we conceptualised each provider organisation as a case, where we could analyse context, processes and outcomes. Each case included a range of small-scale technology innovations as well as, in some instances, renewal of EHR infrastructures.
Our work took place in five complementary work packages (WPs), summarised below.
WP1 - Exploring digital maturity, infrastructures and optimisation plans across all provider organisations taking part in the GDE Programme
GDEs and FFs were at various stages of system implementation and optimisation, with a range of different information infrastructures in place. In this WP, we sought to make assessments surrounding the success of the GDE Programme and gain insights into progress (or lack of).
WP2 - Exploring digital transformation plans and their execution
To measure progress in a more focused way, we examined change processes and specific clinical outcomes in selected settings in-depth.
WP3 - Exploring spread of learning
To explore knowledge transfer and dissemination of lessons and networking activity across GDE and FF sites.
WP4 - Exploring the establishment of a broader learning ecosystem
Here, we sought to understand how the Programme contributed to the establishment of a wider digital health learning ecosystem within and beyond the GDE Programme, including both the formal knowledge transfer mechanisms planned under the Programme and informal knowledge exchanges that emerged. We conceptualised a learning ecosystem as inter-organisational knowledge transfer and learning that occurred over time across the entire health system (i.e. not only the GDE sites).
WP5 - Strategic implications of our findings for achieving the Programme vision
This final WP was concerned with the integration and dissemination of findings from the evaluation. We worked to connect the results from WPs 1-4, with a view to mapping out the wider overall picture and establishing insights for those planning, managing, and participating in future digital health deployments.