Delivering a high standard of care relies on effective frontline communication. Recent headlines have suggested that many clinicians are turning to WhatsApp and other consumer-oriented instant messaging platforms - despite the risks to patient confidentiality and data security.
In fact, research recently published in the British Medical Journal found that 97% of doctors routinely sent patient data on instant messenger, despite the fact that 68% were concerned about sharing data in this way. However, there is concern that instant messaging is more ingrained in NHS processes than even this suggests.
To investigate the extent to which consumer IM applications have infiltrated the NHS, and the driving factors behind its surge in popularity; CommonTime commissioned an anonymised survey of 823 NHS staff across a range of functions. All age groups and regions under NHS England jurisdiction were represented, with participants from clinical, support, administrative and management roles.
In analysing and publishing the results, our aim is twofold. We want to bring attention to a major failing in the public sector IT marketplace that has allowed this to happen. Second, we want to highlight the communication needs of healthcare professionals so that solutions which work for governance teams & frontline staff alike can be found.
Key Findings and Implications
The infographic below summarises a number of the results that can be gathered from this research. Broken down into three sections, the graphic follows the themes and topics which the report investigates in detail. Don't have time to unpick the findings? Our team have also produced a short 3-minute video (opens in a new tab) that summarises the data points and conclusions that can be drawn from the infographic.
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An important, if ominous, finding of this report is that the issue of NHS staff communicating via consumer-oriented instant messaging services (such as WhatsApp and Facebook Messenger) is much wider than has been previously reported. Further, attempts to stem the tide through education, the provision of alternatives and enforcement of policy are doing little to discourage staff - with 1 in 50 receiving disciplinary actions for IM related incidents.
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|"1 in 50 NHS staff have been subject to disciplinary action due to their use of instant messaging."|
There is also evidence to suggest that using instant messaging apps to communicate with HCPs (healthcare professionals) for benign purposes such as shift handovers or rota management increases the likelihood that an individual will start to use the same technologies in more fractious ways. Examples identified include communicating directly with patients, storing patient content on mobile devices and sharing medical documents.
A key driving factor of this is a marked dissatisfaction with provided channels of communication when compared to the efficiency that consumer IM apps offer. In fact, their usage has become so culturally ingrained, that over 30% of NHS staff believe patient care would suffer if HCPs did not have access to WhatsApp or other consumer messaging tools. This leaves decision makers in a quandary - Characterised by a strained status quo, in which the dangers to data security are ignored in favour of the significant benefits that IM provides.
However, as adoption of such apps grows year-on-year (driven primarily by new entrants to the workforce), so too does the risk from accidental or malicious misuse. Participants were able to recall a number of incidents that suggest consumer IM is a space for inappropriate communication and behaviours that are a detriment to confidentiality. Examples include accidentally sending patient information to non-clinical staff, sharing ‘pertinent’ patient details on social media and sending patient photos to others for ‘entertainment purposes’.
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|"Instant messaging usage has been growing by 5% year-on-year between 2015 and 2017."|
This leaves NHS Trusts with a stark, uncomfortable choice; maintain this fragile norm until a catalyst for widespread adoption or rejection is found, or provide staff with the technologies they need in order to deliver the high standards of care expected of them.
Reaction from Digital Leaders
Prior to publishing this report, we reached out to a number of digital leaders and policy influencers in the NHS to understand how this behaviour is perceived and what current plans are in place to tackle the issues raised.
Dr Alexander Graham, founding partner of healthcare strategy consultancy AbedGraham said, "This research confirms my anecdotal suspicions that many clinical end-users are using consumer-oriented instant messaging applications for clinical work and patient data transmission. Furthermore, given this is a self-reported survey, the true number of users doing this may be much higher."
James Rawlinson, Director of Health Informatics at The Rotherham NHS Foundation Trust, provided a realistic view of the relationship between IM and policy, "Instant messaging applications are, in many cases, simply an alternative means of communication that are free & easy to use, comparable to a telephone call. Policies of record keeping and patient confidentiality still apply - whether communication is officially documented itself or by the outcome. However, I believe there is a balance to be found, and am concerned about the risks of yet another data silo."
Andy Hadley, Head of IT Development, Service Delivery & Transformation at NHS Dorset CCG noted a number of changes that need to take place, "We need standards based, cheap as chips, ubiquitous instant messaging for the NHS, and for this to integrate well with the clinical records. The NHS needs to step up to enable secure use of technology to empower staff, and this needs to extend to social care and others involved in providing multi-agency health and care."
These quotations and others - including comments from Rowan Pritchard-Jones, Martin Wilson and Steve Carvell can be read in the full report.
Explore the complex, strained relationship between consumer messaging applications and modern healthcare delivery by downloading the full report here.