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'Doing our job well is increasingly determined by technology'

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Josefeen Foxter shares her experience of working on the graduate trainee scheme in digital delivery at NHS Digital.

josefeen foxter

Josefeen Foxter

When I announced to that friends and colleagues that I had landed my dream job in on the graduate trainee scheme in digital delivery at NHS Digital, their responses varied. “Digital delivery – is that delivering babies only using your fingers?” and “Sounds like e-midwifery”.

I arrived in London from Australia with my nurse’s uniform in my backpack and wanderlust in my heart. I had travelled and worked my way around the world: volunteering in India, Guatemala and Tanzania.

Back in London, training and working as a midwife was a formative and profound experience. Delivering care in all areas of midwifery: delivery suite/birth centre, children’s centres and GP surgeries, homebirths and clinical governance, I came to understand this city through a different lens.

I had the privilege of working with people from all over the world and from all socio-economic backgrounds: super affluent people and homeless families, the orthodox Jewish community and self-identified pagans; famous artists and mothers who had been sex trafficked and were facing the most uncertain of futures.

“Every day in the life of a midwife is fascinating and fulfilling and brimming with its own challenges”

My intrigue with people’s diverse and complex relationship to their health, to healing and to healthcare structures and cultures compelled me to embark on an MSc in medical anthropology in 2015, which transformed my personal and professional paradigm.

Every day in the life of a midwife is fascinating and fulfilling and brimming with its own challenges. Increasingly, inside the hospital and in community settings, clinicians’ ability to do our job well is determined by the usability of our technology – ease of communication and access to data is vital.

In a single working day, a midwife may work in several different contexts using different systems and technologies to provide care. For example: the working day may start in the community midwifery office, where they organise and use the trust’s IT system to plan their appointments, visits and attend to their admin (such as referrals).

Antenatal and postnatal midwifery care is provided in GP surgeries, children’s centres and people’s homes – all with their own infrastructural complexities – sometimes the EMIS system doesn’t connect to the hospital electronic patient record (EPR), which doesn’t connect to the hospital Path Lab system – but it isn’t possible to speak to someone in the labs because they’re too busy.

A midwife may then attend a homebirth, where there may be no internet access, so the documentation will be hand-written (and must be added into the EPR later). If the midwife works in the hospital, the systems for monitoring maternal and foetal wellbeing may not interface with the EPR system – so that patient data must be entered twice or more.

“Inspired disruptions like this compelled me to get involved with using digital technology to improve safety, efficiency and patient experience”

Mostly, a woman’s longer-term history (including vital medical and surgical information) is documented in paper notes which must be retrieved from healthcare records wherever she received the care. These issues all create challenges, risk to patients and inefficiency for clinicians; every moment spent with administrative or technological issues is time not spent providing valuable care to patients.

A strong desire to improve this situation for everyone, like these innovators, plus a geeky fascination with digital tech galvanised my aspiration to work in digital design and delivery.

Inspired disruptions like this compelled me to get involved with using digital technology to improve safety, efficiency and patient experience such as expediting the roll-out of electronic patient transfers between trusts (done by fax until recently, which regularly resulted in postnatal visits being missed as the documents did not transmit successfully).

Keen to pursue a career in user experience, an online course provided me with the knowledge and ideas to apply for the NHS Digital Graduate programme. This was the perfect opportunity for me as I wished to remain in the NHS and to continue contributing to people’s health with my clinical knowledge and experience while developing as a digital practitioner.

My first assignment has been with 111 online, doing user research. From the first day, I was welcomed into the team and made to feel that my contributions were valued.

I have learnt so much in such a short time, which is due to my brilliant and supportive assignment manager, my lovely colleagues in my team and the outstanding opportunities for education and training. This has accelerated my development immensely and the value of a programme like this is that my learning can be immediately applied to my work.

I will start my second assignment soon with the intention to develop as a user researcher while also gaining experience in other areas: design, content and product management. I shall continue clinical midwifery work part-time to maintain my skills, to connect with the joy of midwifery and to act as a link between the clinical and digital worlds.

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