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The King’s Fund’s latest report, Interoperability is more than technology: The role of culture and leadership in joined-up care, examines the long-standing challenges in overcoming silos and the culture issues that must be addressed.

The King’s Fund worked with two ICSs, Cambridgeshire and Peterborough ICS and Humber and North Yorkshire Health and Care Partnership, to look at practical solutions that can help address current challenges.

The report recognises the importance of digital technologies but asserts that good technology is not enough for interoperability to succeed, finding that lack of progress is largely due to cultural problems. The key assertion of the report is that solutions must be driven by improved relationships between staff and organisations.

The King’s Fund found there isn’t an agreed consensus on what interoperability is. The definition the report offers is “how people, systems and processes talk and work together across organisational structures and professions, supported by technology”. 

Key findings:

1. Digital technologies are key to enabling collaboration and integration between integrated care systems (ICSs) and provider collaboratives
2. The three key aspects to making interoperability a success: good technology, an enabling environment, and good working relationships between staff
3. Relationships need to be strengthened continually across organisations and professions
4. Improvements are needed to provide clarity around digital and data standards, and to address fragmentation
5. A collaborative working culture must be fostered – power dynamics between leaders need to be reduced, while staff must be supported to lead change projects

Key takeaways for suppliers:

1. Digital tools should be viewed as an extension of relationships – focussing exclusively on tech means that the way in which people use it is often overlooked
2. The inconsistency seen across the space means there is no whole-system approach to interoperability standards, so compliance in one part of the system is not matched in other parts of the system
3. There is a perception that there is a reluctance from industry to comply with existing standards, and that an uncertainty around standards not being issued as final versions is making suppliers wary of investing resources into making changes. At techUK, we have been working hard with our members to demystify some of the current beliefs in the market. Our recent response to the draft standards and interoperability strategy highlighted, among others, the lack of clarity around the standards suppliers are or are not being asked to prioritise. We called for an increase in engagement with industry to help provide an understanding of challenges being faced on the ground on both sides, which are ultimately stopping us from making progress
4. Information governance is currently very risk averse and there is an inadequate understanding of what governance is, discouraging appropriate sharing of medical information
5. Patient information is understood differently by different individuals, but staff development designed with support from clinical informaticians can help to improve this
6. Currently, due to staff shortages, staff do not have the time and space to think about and engage with interoperability projects
7. We need to create complementary workflows across organisations to relieve the demand on staff
8. Funding needs to be long-term, as opposed to being hurried with short application timeframes, often resulting in multiple small, short‑term projects that are disjointed
9. Metrics used to track progress must be aligned with care needs and designed to measure the actual impact of change