DIGITISATION
Infrastructure: digitising the last mile of care
As hospitals continue to digitise clinical processes, the promise of faster, safer care increasingly depends on how well digital tools align with day- to-day operations. Vicky Morley, senior clinical advisor at Systematic, explores how fragmented operational systems create hidden friction in hospitals, and how better alignment between digital platforms and frontline operations can streamline care delivery and improve patient flow.
A clinical decision can be made in minutes. A doctor reviews results, confirms treatment, and agrees that a patient is ready to transfer or discharge. In digital terms, the system works – the decision is recorded in the electronic patient record (EPR), orders are placed, documentation is complete. But recording a decision is not the same as delivering it. What follows depends not only on clinical software but on operational infrastructure. For a patient ready to move, capacity must exist elsewhere in the system. A bed space must be identified and prepared. The room must be cleaned and made safe. The patient must be transported. Equipment must be located and verified as fit for use. Information must move between teams who do not share the same systems, screens or priorities. These actions determine whether the clinical decision
translates into timely care – or into delay. So why does operational flow still break down inside digitally enabled hospitals? The issue is not a lack of technology. Most hospitals
operate multiple digital systems across operational domains. Bed management platforms, portering and task management tools, maintenance and medical device management systems, and asset registers all perform defined functions. The challenge is that they are rarely configured around end-to-end workflow. Instead, they reflect functional ownership rather than the realities of day- to-day operations. Hospitals therefore rely on informal mechanisms to bridge the gaps: phone calls to confirm bed availability, whiteboards updated in parallel with digital systems, radio calls to reprioritise tasks, local knowledge of where equipment is usually located. These workarounds are not signs of poor practice; they are adaptive strategies developed to maintain flow in complex, high-pressure environments. The result is a loss of operational coherence between digital intent and physical delivery. This is the ‘last mile’ of care: the point at which a system’s
promise meets the reality of delivering it. If the NHS is to realise the full value of its digital investment, attention must shift to this operational layer. Digitising documentation is only part of the journey. The next step is ensuring that digital decisions translate into care delivered without delay.
Where operational flow breaks down Coordination challenges tend to arise at the boundaries between systems and teams. Across acute hospitals, three recurring patterns are visible.
1. Digital status does not always reflect conditions on the ground Clinical and operational systems depend on timely status updates. In practice, the pace of clinical work means these updates often lag behind real-world conditions. A patient may be clinically discharged, but if discharge is not entered promptly in the EPR, the bed remains digitally occupied. This prevents cleaning tasks from being triggered, obscures real-time availability for bed managers, and ultimately delays admissions. Similarly, portering or cleaning tasks may remain open in task management systems even after work has been completed on the ward, leaving operational dashboards out of step with the physical state of the environment. Asset visibility can present similar challenges. An
Frontline operational teams play a critical role in designing effective digital workflows.
Fragmented operational systems require staff to bridge coordination gaps manually, while integrated workflows automate routine task transitions.
Fragmented Fragmented vs. coordinated operational systems
Bed management
Task system Asset register
No shared status No shared status
Beds Assets Informal workarounds
• Phone calls to confirm availability • Whiteboards updated in parallel • Radio calls to reprioritise
• Local knowledge of equipment location People become the integration layer Event-triggered automation
• Discharge triggers cleaning task • Clean completion releases bed • Equipment movement updates location • Status visible across teams
Systems become the integration layer
Coordinated Shared operational layer Tasks
June 2026 Health Estate Journal 37
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72
