By Dr Leslie Willcocks
I have been working with Dr. John Hindle at Knowledge Capital Partners on a series of papers based on research into the strategic use of intelligent automation. Our research findings are very rich, and are available at Knowledgecapitalpartners.com. Here I want, with John, to focus on just the one sector and give illustrative examples of the headway that can be made.
During 2020–2021, spurred by the COVID-19 pandemic, intelligent automation galvanised many healthcare organisations. But has this been a quick technological fix, or the kick-start of something more lasting? Despite multiple obvious uses for automation, the healthcare sector has mainly been a follower, even a laggard. Will increased investments—up 70% this year—translate into impressive results or end in automation fatigue?
By 2021, according to Accenture, 69 percent of healthcare organisations were piloting, or had adopted, intelligent automation. During 2021, in the USA and UK, a majority of processes being automated have been around patient journeys; COVID-19 testing; appointment scheduling and management, patient data extraction and review, claims administration, medical procedure coding and billing, and payment cycle management. HR on- and off-boarding has also been a big use case.
Such positive automation applications during 2020–2021 suggest an obvious forward agenda. First, devising much simpler, more intuitive administrative processes for payments, patient records, and claims. Second, streamlining coordination between diverse care agencies, including insurers, patients, care providers, for preventive and therapeutic care. Third, and most obviously, moving to whole patient care—simplifying and speeding ‘moment of truth’ service, and building electronic medical records as a foundation for improved management, quality of care and patient outcomes.
But why is automation needed? The big picture tells the story. The World Health Organisation predicts a shortfall of around 9.9 million healthcare professionals worldwide by 2030, despite the global economy creating 40 million new health sector jobs by the same year. Larger, ageing populations, and increasingly complex healthcare demands and therapies, will create rising pressure on relatively fewer health workers.
The Brookings Institute estimates that around 33 percent of tasks currently performed by healthcare practitioners have the potential to be automated. Intelligent automation, allied with other emerging digital technologies, can transform patient experiences, access and outcomes. It can also transform self-care and prevention, diagnosis and triage, clinical decision support, care delivery and chronic care management. In addition, it can support further healthcare research and innovation.
In fact, they already are. Let us look at the inroads three leading healthcare organisations are making into these possible futures. Throughout we refer to three kinds of gains based on our Total Value of Ownership framework: Efficiency, Effectiveness and Enablement (see previous blogs and our book Becoming Strategic With Robotic Process Automation).
Case 1: A digital native health care provider
A new ‘digital native’ health care provider operates as a GP practice in the UK’s National Health Service, as well as a direct care provider in the US serving all economic levels from private practice to Medicaid. Its explicit goal is to disrupt existing systems by providing affordable, accessible, value-based care with a simple, clear strategy: delivering robust clinical outcomes and improved customer experiences while controlling cost. Or, as the company expresses the formula: clinical outcomes + customer experience ÷ cost.
The provider first deployed its RPA solutions in UK, where it built core processes, infrastructure and capacity to support 100k patients. The company developed fully automated processes for symptom checking (clinical team plus records), digital appointments (including by mobile), and after-care appointment processes. RPA plays a major role in making all these processes more efficient, as well as in clinical operations—coordinating care across patient special needs. It then rolled the automation program to other regions, focusing on core goals, in the face of greatly rising volumes, as measured by appointments processed. On basic operating performance, the company’s planned Efficiency gains were 30 percent but it reports having achieved 100 percent improvement—more than triple expectations.
Intelligent automation is delivering other kinds of value as well, including the ability to challenge and re-design all ‘as-is’ processes for greater enterprise Effectiveness. The company reports much higher throughput and volumes, with many processes now running 24/7, and much stronger IT focus on core infrastructure processes. Additionally, they have significantly improved compliance performance in HR and Finance functions through automation. Intelligent automation has ultimately enhanced human value, through proactive, easy-to-access care, for example by automating tests and data capture for high-volume services such as COVID-19, diabetes and smears. Productivity and security—for patients and clinical processes—have been much improved through automation, resulting in much higher customer and employee satisfaction. While the company had anticipated Effectiveness gains in the region of 50 percent from their automation program, they report actually getting 200 percent gains—four times expectations.
The company has also realised major benefits in Enablement. Intelligent automation has created a platform for innovation, generating analytics for new products/services, and giving employees and patients a differentiated experience. The company has accelerated time to market for new services and expand market penetration with enterprise-wide automation. RPA in particular has been instrumental in meeting enforced fast volume ramp-ups for services required to address COVID-19. While the company initially assumed limited Enablement gains of around 20 percent, they report actually getting 200 percent gains—10 times expectations.
Case 2: End-of-life hospice care
This US health care network provides end-of-life hospice care—an acute high-intensity service for patients, families, and caregivers at a critical juncture. Serving ten regional facilities, the company focuses on value-based care, delivering a superior quality, differentiated service with highly trained, dedicated staff. Its experience demonstrates that intelligent automation is not just for large multinationals, but delivers real value across all sizes and sectors.
The first automation aspiration: to fully leverage the valuable professional licensure skills of staff in delivering more direct care for patients by freeing them from administrative scheduling and record keeping tasks. Secondly, the provider seeks to differentiate itself on quality of personalised care from those private sector companies acquiring non-profit hospice organisations and reducing costs while pricing at previous levels.
The provider chose a cloud-based automation platform. It offered ease of deployment and management, and access to pre-built technologies and standardised software for health records, reporting and compliance. Business Process Management (BPM) and machine learning tools are being trialled, and enterprise business process modelling software is standardising and optimising processes across all branches.
While early on its journey, the provider is already seeing impressive results. On Efficiency, this organisation planned for 20 percent improvement and has got so far 60 percent—three times expectations—with more to come. The gains have been mainly in security, accuracy in services coding, and avoiding rework—supporting more robust revenue streams. The company is automating parts of processes to deal with much more work with the same staff, freeing its highly skilled professionals to do more of what they’re trained for—delivering high quality patient care.
Effectiveness is work in progress, with 10 percent improvements planned and so far, realised, but more expected. The provider is getting value from wider workforce augmentation, more throughput, and improved regulatory compliance, with a big payoff from much higher employee engagement now freed from routine repetitive tasks.
The organisation had not planned any Enablement gains but the actual improvements to date are 20 percent, mainly from a fully optimised workforce, enriched employee experiences, and higher levels of patient care. Patient experiences have also improved in several areas. For example, automation enables early identification and pre-emption of additional government-approved ‘service intensity add-ons' for patients in the last few days of their lives. In the longer term, the company will provide services to a wider market through a national hospice cooperative. Finally, the company is more competitive, though this is harder to track, because it is one of the few organisations in its sector focusing on intelligent automation, thus creating a valuable performance dividend.
Case 3: A care home and insurance provider
This healthcare provider initially sought to capture Efficiency value from ‘automation arbitrage’—using automation to reduce inefficiencies resulting from what it terms ‘growth through evolution rather than design’. From 2016, the company focused on automating stable processes and reducing the transaction volumes sent to its BPO provider. One solution involved disaggregating the patient and customer on-boarding process, applying digital workers to handle complex transactional parts of the process, while relying on the BPO provider to handle parts requiring human interpretation. The 24x7 availability from automation was necessarily strengthened during the pandemic crisis. By 2021, the company had planned for and was getting some 150 percent Efficiency gains.
The automation targets have also moved to capture greater enterprise Effectiveness, creating what it calls an ‘evolving business case’. As we have seen elsewhere, automation greatly improved regulatory compliance through transaction accuracy, traceability and auditability. New automated processes handled new work and work spikes, without increasing headcount. Process improvement occurred as a by-product of automation and external pressures. The company reports that while it has not assigned any value in advance, its gains in Effectiveness were 150 percent.
Significant gains from automation also came in the Enablement category, in its ability, capability, and resilience to respond to a massive, unanticipated event. The company operated 130 residential care homes—each of them a potential transmission ‘hotspot’ when the COVID–19 pandemic suddenly hit. Intelligent automation enabled development and deployment of a robust, end-to-end testing regime and response at speed and scale, commensurate with the rapid spread of infections. With tens of thousands of tests required for patients and caregivers every month, the company developed automations to collect, process and triage the tests within seconds, on a 24-hour basis, and to send text message alerts instantly to front line managers to isolate identified cases for treatment. Moreover, having collected over three million data points from this activity by March 2021, the company gained a valuable overview of events in real time using analytics.
In practice, Enablement gains were unplanned, but the company estimated the value gained as 300 percent by April, and at 450 percent by late–2021. The head of automation stressed that, most often, Enablement value from automation was not easy to identify initially, but emerged powerfully once the right direction had been established and investments made.
Healthcare organisations are awash with massive, growing, and potentially very valuable, data. The COVID–19 experience has helped to showcase the importance of accelerating the long haul to digital transformation. Leaders demonstrate that:
- 1. Healthcare needs to apply intelligent automation, not just to internal administrative processes, but also to interconnectedness between providers, related agencies, government departments and patients.
- 2. Intelligent automation has a valuable role to play in transforming how patient data is collected, organised and used in order to greatly improve the patient experience.
- 3. Competitiveness amongst not-for-profit and profit-making healthcare organisations can be a spur to further automation and performance improvements.
- 4. The data and technology legacies, and the multiple pressures on healthcare organisations, make automation very challenging, but ultimately also even more urgent. The growth in demand for healthcare is projected to be massive, and likewise the pressure on limited resources. As in other sectors, intelligent automation has become a vital coping set of technologies, and for the long run.
Note on the Research
Our research draws upon a KCP/LSE proprietary database of 500 plus RPA and cognitive automation cases studies taken from multiple sectors and economies. These were studied over time (from 2015–2021), and included ‘leader’, ‘follower’, ‘laggard’ and ‘also ran’ users of the technologies. We gained additional insight from four annual surveys in this period and from reviewing over 350 award submissions covering innovatory and effective automation practices. Earlier findings appear in four books and in the Blue Prism series ‘Keys to RPA Success’ and ‘Just Add Imagination’, and published articles in Sloan Management Review, Harvard Business Review, LSE Business Review, Forbes and MISQ Executive. Building on these foundations, in 2021 we researched an additional 15 advanced user organisations taken from the banking and finance, insurance, health, telecommunications, and utilities sectors in the USA, Europe and Asia Pacific. We used interviews, documents, and survey questionnaires. We also reviewed over 350 award submissions covering innovatory and effective automation practices. The objective was to gain further insight into the technologies used and the business value being planned for, and achieved.
Willcocks, L. and Lacity, M. (2016) Service Automation: Robots and The Future of Work (SB Publishing, Stratford-upon-Avon)
Lacity, M. and Willcocks, L. (2017). Robotic Process Automation and Risk Mitigation: The Definitive Guide. (SB Publishing, Stratford-upon-Avon)
Lacity, M. and Willcocks, L. (2018) Robotic Process and Cognitive Automation: The Next Phase. (SB Publishing, Stratford-upon-Avon)
Willcocks, L., Hindle, J. and Lacity, M. (2020) Becoming Strategic with Robotic Process Automation, (SB Publishing, Stratford-upon-Avon).