DIGITISATION
captured in formal procedures – such as the order in which rooms are prioritised for cleaning or the informal escalation pathways used when equipment cannot be located quickly. Encoding these relationships into digital workflows allows systems to support operational coordination rather than disrupt it.
3. Operational performance metrics Success measures extend beyond system deployment. Metrics such as bed turnaround intervals, on-time task completion, equipment utilisation, theatre start-time reliability, and reductions in manual reconciliation provide tangible indicators of improvement. Monitoring these measures over time allows
organisations to assess whether digital tools are genuinely improving coordination or simply shifting workload elsewhere in the system.
Reliance on desktop workflows introduces delays between clinical decisions and operational action.
occupancy, for example, shows how reducing friction at the point of request can accelerate the entire discharge- to-clean sequence. Nursing staff previously had to walk to a workstation, log in, and navigate multiple screens to request a discharge clean – an estimated five minutes per request. By replacing that process with a single mobile interaction at the point of care, the time between discharge and cleaning task initiation reduced significantly. Even modest reductions in that interval compound across the day. Internal modelling suggests that optimising task flows could free up to 12 inpatient beds per day. The distinction is not between automation and manual
practice. It is between automation that reflects operational dependencies and automation that ignores them. Digitising the last mile of care therefore requires more
than connecting systems. It requires designing digital infrastructure around how work actually unfolds so that technology strengthens operational coherence across the hospital.
What successful implementation looks like
Vicky Morley
Vicky Morley is a senior clinical advisor at Systematic. Drawing on 15 years’ experience across healthcare, from intensive care nursing to clinical operations and digital transformation, she brings a frontline clinical perspective to the challenge of digitisation. At Systematic, she works with NHS organisations to close the gap between digital systems and frontline reality – improving patient flow, reducing operational friction, and supporting the teams who deliver care under pressure.
If automation must be grounded in lived workflow, what does that look like in practice? Hospitals that have improved operational coordination tend to follow a disciplined approach. The common factor is not the specific technology selected, but the discipline with which it is embedded into day-to-day operations.
1. Observation before configuration Frontline operational staff are engaged early in system design. Workflow observation is conducted before technology decisions are finalised. Informal workarounds are treated as valuable insight into the coordination gaps that formal systems currently fail to address. In practice, this means spending time with the teams
who manage the daily movement of patients, equipment and tasks across the hospital. Walking in their footsteps and listening to their challenges often reveals the small sequencing decisions and local adaptations that allow patient flow to continue under pressure.
2. Mapping workflow reality Observed workflows are then translated into structured process maps. The goal is not simply to connect digital platforms but to ensure that system configuration reflects how tasks move across teams and spaces. This stage often surfaces dependencies that are not
40 Health Estate Journal June 2026
4. Targeted automation Automation is introduced selectively. Event-triggered processes such as discharge, initiating cleaning tasks, or equipment movement updating in real time will reduce manual coordination and improve visibility across teams. When implemented carefully, these automations remove routine coordination work from frontline staff while preserving flexibility for teams to adapt when operational priorities change.
Engaging infrastructure leaders earlier A recurring challenge in hospital digitisation programmes is timing. Clinical systems are often prioritised, with operational infrastructure addressed later once architectural decisions have been made and workflow assumptions embedded. Estates, facilities, and clinical engineering teams manage the physical and asset environment that enables care. Their insight into spatial constraints, compliance obligations, asset lifecycles, and operational dependencies is critical to system design. Excluding these perspectives from early procurement decisions risks embedding fragmentation into the digital environment itself.
Reframing the last mile Digitisation has transformed how clinical decisions are recorded and communicated. The next phase of transformation must ensure those decisions can be delivered reliably within the physical hospital environment. When digital systems align with real-world workflow,
the impact extends beyond efficiency. Hospitals gain clearer operational visibility. They reduce hidden coordination labour. They strengthen compliance and improve flow. Most importantly, they build resilience into the system rather than relying on individual adaptation to hold it together. Operational infrastructure is not a secondary consideration in hospital digitisation. It determines whether digital investment translates into measurable value. Addressing this challenge requires earlier and deeper engagement of estates, facilities, and clinical engineering leaders in digital strategy. It means designing automation around temporal, spatial, and resource realities – and recognising that transformation remains incomplete while digital intent and physical delivery remain misaligned. The last mile of care is not a clinical problem. It is
an infrastructure and coordination challenge, and the operational teams who manage it are not peripheral to hospital digitisation – they are central to its success.
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