People in the NHS are at the forefront of diagnostic innovation. But could more be done to communicate the impact and possibilities of new ways of working? Dr Emma Hyde, the president of UKIO, talks to Highland Marketing’s Matthew D’Arcy about fast paced change, technological developments, and the need for person-centred care.
Dr Emma Hyde’s career in NHS diagnostics has seen substantive change. A diagnostic radiographer by background, she is an associate professor in diagnostic imaging at the University of Derby, clinical director of the Personalised Care Institute, and is the current president of UKIO – the UK’s imaging and oncology congress.
What are the biggest changes that you’ve seen during your career?
I qualified in the 1990s. When I was a student radiographer and early in my career, we were still using film. That was sometimes processed manually in a daylight processor, or sometimes even going into a dark room to process those films.
I saw the introduction of computed radiography, which started to come in during the late 1990s and early 2000s. I’ve then seen the introduction of digital radiography. I’ve seen the shift from being a radiographer working on a single slice CT scanner, to multi detector arrays.
As an MRI radiographer I’ve seen us go from scan times anything from 40 minutes to an hour for a fairly standard examination, to now being significantly lower, enabling use of breath holding techniques.
I’ve seen the explosion of interventional radiology and the way that’s revolutionised how we can treat patients in the imaging department, rather than needing to go to theatre and have a general anaesthetic.
And over the last few years, the increasing use of AI, the potential for genomics, and the potential for robotics. So, massive changes over that time.
How far have you seen barriers breaking down between diagnostic disciplines? And what does that mean for the ways that patients are treated and diagnosed?
There are huge opportunities for diagnostic radiographers in the way that healthcare is changing, and the way we are starting to look more at pathways, and who is the best person within a pathway to do a particular thing.
And we’re looking at continuity of care, which from my point of view, as a researcher in person centred practise, is really important.
One of the best examples of where that is already working well is in breast services. For some time, diagnostic radiographers who have been working in breast imaging have been undertaking the reporting, as well as the image acquisition.
We have a well-established practise now with advanced and consultant radiographers who go on to do an ultrasound of the breast, and take biopsy samples.
I think this is a really good model for us to look at, and consider how this kind of approach could be rolled out in other pathways.
It’s much better for the patient because one person can see them through all of that journey. And it’s much better for the staff working in those roles because there’s a real sense of job satisfaction.
Person centred care is a key focus in your research. How could this approach help to address workforce challenges in the NHS, and rising demand?
One of the biggest challenges at the moment is recruitment and retention. We really need to work hard to address the retention issues that are affecting not just us in diagnostics, but across health and social care. A big part of that is pay. But other parts link to a lack of flexible working arrangements and lack of investment in education and training.
We know that in organisations where there has been a culture of taking a more person-centred approach for both patients and staff, this has proved time and time again a key retention tool. For staff it boosts their job satisfaction, it boosts patient satisfaction measures, and that’s really rewarding.
You’ve described empowering diagnosticians to do more, and how the role of radiographers has changed significantly over the years. How do you think that will change into the future?
I think there’s going to be a lot of change. I think health is an area which is continually changing, and it doesn’t just change across the board either. It varies significantly between different healthcare providers, between different regions, and even between the four nations within the UK.
At UKIO, in our proffered paper sessions and in our education and workforce sessions, we get to hear about things that are happening outside of our immediate locality.
We get to hear about the empowerment that’s happening, the additional training that’s happening, the quality improvement projects or research that’s happening, and what impact that’s had.
It’s about not just doing things within our own silos. It’s about telling people what we’re doing.
Very often we find that people do a project, but they don’t put it out there into the public domain. And so, the learning that other organisations could pick up from that isn’t possible.
It’s really important that we do share our work, we disseminate our work and tell people what we’re doing because very often we’re at the forefront, we’re innovating, and we need to share the possibilities with our colleagues.
One of those areas that we might think about sharing ideas, sharing innovation, is technology. You described your own visits to UKIO in the 1990s and that technology was one of your interests then. Have the opportunities that were presented by technology then come to fruition?
Yes, absolutely. There have been so many changes over the last 30 years or so.
But I think for me, the exciting bit is always how it makes things better for patients. If we can decrease our scan times, it makes it more tolerable for the patient, particularly in something like an MRI scanner. If we can use AI to help us make a more timely diagnosis, a more accurate diagnosis, that’s obviously better for the patient.
And the sky’s the limit really in terms of what robotics could do to help, and support us within diagnostics so that we can spend our time focusing on the patient.
How far do technology vendors need to think about the needs of different patients? For example, a patient that might have dementia, or younger patients in paediatrics who might have less tolerance for scans?
I think many manufacturers have responded to those sorts of challenges. We’ve seen the use of different scan protocols, fast scan protocols for patients who might struggle to keep still. They might be living with dementia, or a different condition like Parkinson’s which causes involuntary movements.
We’ve also seen lots of innovation around children and there are so many pieces of radiology kit that are children friendly now. It was amazing looking around UKIO and seeing some of the examples of that this year. There’s some of really great things that have been done to prepare children for their imaging.
Is that making a difference when it comes to capturing that quality of image needed, and to the patient experience?
As a CT and MRI radiographer, many times over the years patients would walk into the room, very anxious. Seeing a machine and what they need to do, sometimes causes Anxiety Induced Claustrophobia, which means that they were unable to tolerate the scan.
If they can’t tolerate their scan, they won’t get their diagnosis, which means they’re not getting their treatment.
Improvements to technology have played a big part in improving patient experience, which actually has a massive impact on patient outcomes.
Anything we can do to make imaging examinations more comfortable for patients is inevitably then going to impact on the next steps in their pathway.
What are the biggest technological innovations that you’re most excited about?
I am particularly excited about sustainability. Manufacturers are really putting a lot of time and resource into developing more sustainable products, and promoting to us in the diagnostic space about the impact that will have.
There are also lots of good examples around health tech solutions which help us with personalised care. For example, continual glucose monitoring for diabetes control, or blood pressure monitoring for people with cardiovascular disease.
It’s going to be interesting to see how those sorts of things come into the diagnostic space. We already have handheld ultrasound scanners, which are becoming quite commonplace in the emergency department setting. We’re starting to see small mobile MRI machines which can be taken into resus or ITU for head scans. So, what’s next? It’s going to be really exciting.
You describe mobile scanners. Does that change where that scan can be done, so that it is convenient for patients?
If we don’t need to bring an acutely ill patient down to the imaging department for their examination, that’s a good thing.
CT is often referred to as the most dangerous room in a hospital because that’s where many cardiac arrests, and patients becoming critically unstable, can happen. They are moved out from ITU or resus, to have their imaging when they are very unwell.
If we could go to them, like we do with a mobile x-ray, that’s only better for patient care.
And presumably, you can also do more to take that imaging into the community?
That’s the next step. We already have mobile units going into communities for things like breast screening. We have CT, MRI and PET in the community as well.
I think we can see that going further. The rollout of CDCs, community diagnostic centres, is going to be a key way that happens.
But with smaller technologies, there could be other ways that that happens as well. It opens up a lot more opportunities.
During COVID we really didn’t want people going unnecessarily into a hospital setting because of social distancing measures. That really did emphasise the question of why we were sending people into a hospital setting for those kind of tests.
It’s much better if patients could have it close to home, somewhere very local to them. That means they’re not going into a setting where they could potentially pick up other things that then may impact negatively on their care.
In terms of innovation, it would be wrong to not talk about artificial intelligence. What do you think is the real opportunity here?
There is huge potential for AI which we are starting to see moving into practise. We’ve had several large-scale clinical trials now using AI as a second reader in mammography.
We’ve also have examples in research of AI being used to spot hot zones. So, focusing the human reader on where to actually look, whether that’s on a chest x-ray or whether that’s on a pathology slide.
I think the momentum is increasing, and that we will see it speed up even more over the next few years.
I don’t think it’s ever going to replace humans. I want to be really clear about that. I think it always takes the human, the clinician, to piece everything together and come to the official diagnosis. But AI is undoubtedly going to be very, very helpful for us in terms of speeding things up.
Current priorities are being set out for the NHS. We are now seeing a period of transition in terms of government and with that comes an opportunity for change. What would you urge the government to change?
I think the biggest challenge for them is workforce. And I think the fact that we have such enormous waiting lists – we’re not going to be able to tackle those, if we can’t get the workforce right.
Industrial action and the impact that’s having on the morale within the workforce is considerable. We have so many people leaving healthcare at the moment because they are burnt out.
We’ve got to think about how we keep the really high-quality people we have in the professions.
And we also need to think about training capacity, about how we change our models to support increased numbers of people coming into our healthcare professions to actually help us deliver high-quality care.
We touched on the idea of innovation needing to and spreading ideas. Do you think enough is done to really communicate the good stories of technology and innovation in action, in healthcare diagnostics? Do you think there’s an opportunity to do more?
Events like UKIO are crucial to sharing innovation, to telling stories about what we’re doing. Hearing from exhibitors about their new products, hearing from the speakers about what they’re doing, and talking to other delegates, helps us to understand how we might bring change and innovation to life.
But that isn’t the only way. We need to supplement that because not all of our community can be at UKIO or similar events at any at one time. We need to think about other ways to get messages out there.
There’s a role for marketing, for social media, for journal articles, for blog posts, and for lots and lots of different ways to spread the message.
