Improving Digital Literacy - Health Education England
Health Education EnglandImproving Digital LiteracyBIG DATA?RCN publication code: 006 129
Improving Digital LiteracyImproving Digital LiteracyContentsForewordForeword. 3Ian CummingJanet DaviesSound literacy capabilities are needed by everyone workingand learning in health and social care if we are to maximisethe potential of technology and digital in health and socialcare. It’s no longer possible to think about digital literacy aseither purely technical proficiency or just something ‘otherpeople’ do. We all need the right digital knowledge, skills,attitudes and behaviours that will enable us to provide thebest possible care for all.We are living through a technological revolutionand digitalisation is developing at an incrediblespeed. It will continue to impact on many aspectsof our lives and has the potential to transformthe art and science of healthcare creating manyopportunities for the population and those whocare for them. It will stimulate innovation andenable us to work in very different ways.Progressing the Department of Health and NationalInformation Boards’ Personalising Health and Care 2020agenda requires us to ensure that everyone working inhealthcare be able to learn, work and develop effectivelyin a digital workplace and society. Being confident andcompetent around technology and data will empower ourworkforce to provide more effective and compassionate care,give people, and anyone in a caring role, more control overtheir own health and wellbeing, reduce the administrativeburden and support the development of new medicines,treatments, technologies and practices.We may not be able to predict exactly howthese changes will shape our future howeverit is important the nursing and midwiferyworkforce are prepared and equipped to leadand deliver this change, working in partnershipwith our patients and clients and within ourmulti professional teams. We do know that oursociety and our workplaces will transform and weknow that we need to prepare for the emergingconnected world.Ian Cumming. 3Janet Davies. 3Working in partnership. 4Health Education England and the Royal College of Nursing. 4Health Education England and digital literacy. 4Introduction. 4Improving the digital literacy of the health and social care workforce. 5Why is this important?. 5A definition of digital literacy for all. 6Our definition and domains. 6Health Education England’s digital capabilities. 6The six domains. 6Improving digital capabilities. 7The challenges. 7Potential solutions to improving digital capabilities. 8Key findings. 8What is an e-nurse and why are they needed?. 9Introduction. 9Rethinking nursing. 9Why capabilities before competencies?. 10How can the digital capabilities be applied?. 10Who are the digital capabilities designed for?. 10Rethinking the nurse-patient, nurse-citizen relationship. 10Conclusion. 11Health Education England’s digital literacy project. 11Health Education England (HEE), working in partnership withthe National Information Board, is working to bring aboutthat improvement in the digital literacy of our learners andstaff. I am very pleased to see the progress made in havinga single definition of digital literacy for use across health andsocial care and the creation of a new capability framework tosupport the workforce in developing skills and capabilities.I am delighted that HEE is working in partnership with theRoyal College of Nursing and that they have endorsed ourwork to date. I would encourage the widest use of the digitalliteracy definition and domains described in this document.So, it is time to grasp this opportunity as thenursing and midwifery workforce is crucial tothe successful outcome of this revolution.Developing these digital capabilities is the firststep and the goal is to bring tangible benefits forcitizens and patients.Janet DaviesChief Executive and General SecretaryRoyal College of NursingIan CummingChief ExecutiveHealth Education EnglandThe Royal College of Nursing. 1123
Improving Digital LiteracyImproving Digital LiteracyWorking in partnershipHealth Education England and theRoyal College of NursingThe definition and digital literacy domains described inthis document are applicable for all working in healthand social care. Health Education England (HEE) hopesthat these will be widely adopted and used to informstrategies and policies directed at improving the digitalcapabilities of all staff.HEE welcomes working in partnership and is delightedthat the Royal College of Nursing (RCN) has endorsedthe digital literacy work undertaken to date. Digitalliteracy is a key strand of the National Information Board’sBuilding a Digital Ready Workforce and HEE is deliveringon this work stream. It is vital that the work is tested withdifferent professional groups and working with the RCNmeans that we can do this. Supporting the RCN ‘EveryNurse an e-Nurse’ work stream and nursing’s LeadingChange Adding Value programme or work around usingtechnology/digital is an opportunity for us all to workcollaboratively and effectively. Ongoing work together willlook at the specific needs of nursing staff in relation todigital literacy.Health Education Englandand digital literacyImproving the digital literacy of thehealth and social care workforceIntroductionWhy is this important?Health Education England (HEE) is the national bodyformed in 2012 to undertake leadership and coordination of education and training within both thehealth and public health workforce. HEE is responsiblefor delivering a better health and social care workforcefor England. It is the organisation responsible for theeducation, training and personal development of everymember of staff and for recruiting for values.It is no longer possible to think about digital literacy aseither purely technical ability or as something done bya few experts. Everyone who works in health and socialcare must have sound digital capabilities grounded inthe knowledge, skills, attitudes and behaviours thatwill enable them to provide the most effective andcompassionate care for all.In 2013, the Technology Enhanced Learning (TEL)Programme was established with the vision thathealthcare in the UK be underpinned by world-classeducation and training that is enhanced throughinnovation and the use of existing and emergenttechnologies and techniques. The Programme has a wideremit and has several ongoing projects, one of which isthe Digital Literacy Project.Digital literacy is about the ability for everyone workingin healthcare being able to learn, work and developeffectively in a digital workplace and society. The projectaims to promote the adoption of clear education,training and development strategies that will enable thisand which will also promote and support the adoptionand spread of new technologies and techniques forthe whole health and social care workforce. The DigitalLiteracy Project works to fulfil the requirements of theHealth Education England mandate, as provided bythe Department of Health, and as part of the NationalInformation Board’s Building a Digital Ready Workforcework stream.Healthcare has traditionally been slow to adopt newdigital tools and technologies that have significantpotential to improve how we can provide the verybest health and social care. By building and improvingexcellent literacy capabilities, the uptake andadoption of new digital tools and technologies can bedramatically improved. We can truly transform the waywe practise clinically and provide care.The evidence suggests that people who have betterdigital literacy tend to have more positive attitudes andbehaviours to adopting new technologies. With thefast pace of change in technologies that are developedto support and improve individual care and outcomes,everyone needs to be ready to support and lead onchange and innovation.Moving towards paperless.We must be ready tosupport and lead.45
Improving Digital LiteracyImproving Digital LiteracyThe pace oftechnologicalchange is achallenge to usall in maintainingand improving ourdigital capabilitiesin order to providethe best care.”Data and informationliteracies are key toimproved patient outcomes.We also know that the pace of technological changepresents a challenge to us all in maintaining andimproving our skills. Meeting technology that we’re notfamiliar with on a regular basis can lead to frustration andlack of confidence. However, there is good work alreadytaking place across professions, sectors and nations thatcan be built on and developed through this digitalliteracy project.We are increasingly digitally literate in our own personallives, whether it be smart phones, consuming TV andnew media, booking holidays or ordering a take-away;when we’re motivated to learn, we do. Many skills areeasily transferable to our work lives where they can beused in supporting the best outcomes for all.Increasingly, we are becoming digitally-enabled tobe active in our own health, wellbeing and carethrough wearable technologies, online tools andapps. Technology is enabling increased and improvedcollaboration between individuals and thosecaring for them with better outcomes as a result.Digitally-enabled, individual-centric care is alreadyhappening through the digital recording of highquality data, improved information management,communication and collaboration on care plans andreal time monitoring of patient journeys. These digitalinnovations lead to less duplication of activity, reducedmis-communication and increased patient safety.6The digital literacy work by Health Education England is: supporting awareness-building about those capabilitiesthat make up sound digital literacy across professionsand disciplines increasing individual motivation to develop thosecapabilities supporting individuals in accessing andusing digital tools and resources unlocking some of the barriers to accessing technologyin healthcare.We are all developing digitalskills in our personal lives.In this paper, we introduce six key domains of distinctdigital capabilities required to meet the challenge of livingin a digital society.7
Improving Digital LiteracyImproving Digital LiteracyDigital can help us lead and promote healthier lifestylesA definition of digital literacy for allOur definition and domainsThe term ‘digital literacy’ is in widespread use but there hasn’tbeen an agreed definition that could be used throughout thehealth and social care landscape.A stakeholder group, with wide representation from acrossthe healthcare landscape, was asked to establish an agreeddefinition and capability framework.Definition: Digital literacies are the capabilities which fitsomeone for living, learning, working, participating andthriving in a digital society.Digital literacy domains: Becoming a digitally-literate personinvolves developing those function skills, plus attitudes, valuesand behaviours that can be categorised under the followingdomains:Digital literaciesare the capabilitieswhich fit someonefor living,learning, working,participating andthriving in adigital society. Digital identity, wellbeing, safety and security Communication, collaboration and participation Teaching, learning and personal/professional development Technical proficiency Information, data and media literacies Creation, innovation and scholarship.You may be surprised that some of the domains donot appear to be digital at all. As Paul Gilster (1997),pioneer in the use of the term digital literacy, said, it isabout “mastering ideas – not keystrokes”. Being digitallyliterate is an ongoing process. Becoming more confidentand proficient over time, digital literacy becomessimply about efficient and effective use of technologiesin everyday life so that being digitally literate is anintrinsic part of who we are in both our personal andprofessional lives.Whether we are a patient, a carer, someone needingcare, a currently well person or a member of the healthor social care workforce, we are far more likely to leadhealthier, happier, more productive and satisfying livesif we are truly digital citizens who are confident andcompetent in those digital capabilities.89
Improving Digital LiteracyImproving Digital LiteracyHealth Education England’s digital capabilitiesImproving digital capabilitiesThe six domainsThe challengesHealth Education England encourages all organisations, professional bodies and individuals across health and social careto endorse and use this definition and the domains.We all know there are challenges and obstacles thatcan prevent individuals from accessing technologicalresources, devices and applications. Research led by theUniversity of Dundee, JISC, the TEL Programme teamand other partners into the barriers that prevent healthand social care staff from accessing technology in theworkplace identified three key areas of challenge:NOTCONNECTED Human behaviours and attitudes around digital literacySACCES Technical factorsDENIED Collaboration and information exchange.Of the human factors, a lack of confidence andunwillingness by individuals can sometimes prevent use oftechnology. Also, staff have difficulty securing time duringwork to undertake online learning or explore the use ofemerging workplace technologies.Sometimes, the barriers are artificial and created byorganisational policy or lack of investment in technology.The report identifies that there is unwillingness on thepart of some employers to accept the use of personalsmartphones and tablets at work to support learning,while access to Wi-Fi and the internet at appropriatespeeds continue to cause difficulties. Access to Wi-Fifor all is still ‘patchy’ and bandwidth can also be a realproblem and it is standard practice in many health andsocial care settings for access to specific websites andonline facilities to be blocked.?NO SIGNALCloud-based solutions have traditionally beendiscouraged leaving little solution for collaborative work,resource development or file sharing. Poor collaborationand information exchange policies and facilities arethe key reason for the lack of uptake and use of thesecollaborative tools. In a learning context, the lack ofappropriate physical spaces for accessing digital facilitiescan also act as a barrier.We have identified good practice solutions to barriers toaccessing technology and learning with case studies toresolve Wi-Fi, bandwidth, information governance issuesand more, which are presented in the accompanyingbarriers paper.Adapted from Jisc Digital Capacity Framework (2015) Jisc/Helen Beetham1011
Improving Digital LiteracyImproving Digital LiteracyPotential solutions to improving digital capabilitiesKey findingsOur research into ways in which employers/organisations,across sectors, are meeting the challenge of improvingthe digital literacy of their workforce has revealed somekey ways in which this can be done. The followingapproaches have been identified as significant factorscontributing to success in improving the digitalcapabilities of staff.Leadership is vital. Leaders need to clearly express theimportance of digital literacy, to encourage all staff todevelop their digital capabilities and to ensure that thereis appropriate access and resources to support thatdevelopment. Leaders and organisations must also builddigital literacy into their vision and strategies. They needto actively work to encourage an organisational culturethat is open and trusting with an ethos of informationsharing and control over digital working needs to bedecentralised and staff entrusted to a far greater degree.Organisations need to learn from the ways in whichinformal and social learning happen in today’s digitalworld and employ these in the work environment.In addition to recognising and utilising existing skills,organisations need to be identifying skills gaps and to berecruiting for digital skills.Improving access to digital, allowing time for thedevelopment and improvement of digital capabilities,ensuring access to digital resources and tools andrewarding learning are all essential to improving digitalliteracy within a workforce. A partnership learningapproach which recognises the role of both individualsand employers was also found to be significant tosuccess.The most significant success factor identified across allsectors is the role of digital champions. There can bedifferent approaches towards this type of role, formalroles, informal or simply recognising and rewarding thosewho offer spontaneous, ad hoc championing of digital,but all appear significant in seeing higher levels of digitalliteracy developed.What is an e-nurse and whyare they needed?IntroductionWe are living at a time when digital tools arecommonplace. We use them to help us connect withpeople, organise tasks and manage information.Healthcare has been slow to adopt these tools andunleash their potential and use in our professional lives.This potential can transform the care environment andoffer the type of care people want and deserve.But technologies can also fail to solve some problemsfor patients and citizens or address the things that reallymatter to them. Technology can frustrate nurses or hinderthem from doing the jobs that nurses need to do. Thepace of change is accelerating. We see new ways ofworking emerging and new roles defined. We can seethe relationship change between informed citizens orempowered patients and healthcare professionals.Nursing needs to be prepared to meet these challenges.We need nurses and midwives that are properly informed,trained and equipped. We need a workforce that isinvolved in the design, development and deployment oftechnology in healthcare.We need e-nurses.Leadership is vital.Rethinking nursingWe must change a common perception about nursingbefore digital technologies offer benefits. ProfessorDame June Clark has called this a shift from a “nursingis doing” model to a “nursing is knowing” model1.The “nursing is doing” model sees nursing as acollection of tasks or activities. Negative consequencesresult from this way of thinking. We have systemsthat reflect the task based approach. We have nursesonly rarely involved in the design and developmentof technology. Nurses might be trained in how to usesystems but not educated in how or why the systemssupport care.The “nursing is doing” model limits the developmentof nursing knowledge. The “nursing is knowing”model should be the core of all professional practice.It is the use of clinical judgement in the provision ofcare. This principle should underpin the developmentof digital tools and systems. In the “nursing asknowing” model the standardisation of nursing termsis a key goal. It promotes structure and the abilityto link elements within the record to one another. Itenhances communication and sharing of information.The digital capabilities framework promotes “nursingis knowing”.Positive consequences can flow from this. Nursesappreciate the digital record when it supports themin decision-making. Nurses finally using systems thatreflect the real complexities of care processes.Health and social care are becoming more complex.Population trends and the reliance on care at homeare two factors driving this pattern. Nurses will beco-ordinating care and supporting people navigatingthis environment. They ensure that services are patientcentred by collaborating with people about theirpreferences. They will alert people to new options likeaccessing social networks within their community.These and many other emerging roles, will beexamples of the “nursing is knowing” model in action.1 Clark, J (2007). The impact of ICT on health, healthcare andnursing in the next 20 years. Nursing informatics 2020: towardsdefining our own future. P.J. Murray et al eds. IOS Press. http://tinyurl.com/gmvlhtf1213
Improving Digital LiteracyImproving Digital LiteracyWhy capabilities beforecompetencies?Who are the digital capabilitiesdesigned for?Competence-based education has usually focused onwhat a professional is able to do. Competencies describecurrent practices in known roles. Capabilities describenew, and emerging challenges. They prepare us for theserather than our ability to meet existing ones.The framework applies to all registered nurses andmidwives. We can map the capabilities to the NMC code.So the framework supports the revalidation process.We need new approaches to learning and development.We need ways to prepare nurses and midwives for thedisruptive innovations ahead.Employers can prioritise areas for organisationaldevelopment. We encourage the development ofresources that help prepare nurses in these areas.Educators and policy makers are an audience too. Theyhave a stake in developing the future nursing workforceand the evolution of the health and social care system.Rethinking the nurse-patient, nursecitizen relationshipEvery nurse should be confident in their understandingand use of digital tools. The framework provides a profilefor what digital professionalism should be.Digital capabilities are not only about the individualnurse. They open up the possibility of a new healthcareparadigm. The promise is for a true partnership. Patientsand citizens engaged and involved in their health andhealthcare management.The acid test will be whether these capabilities createlong-term benefit for citizens and patients.How can the digital capabilitiesbe applied?Modern health and social care environments needlifelong, self-directed learners. They also need capabledigital users and knowledge workers. We need to knowwhich learning and teaching approaches fit with futurepractice and support better learning outcomes.The framework sets the direction for a different approach.It gives an overview of activities at a broad level thatapplies across the profession. It also provides a sharedlanguage and common definitions for key areas ofdigital practice.14ConclusionImproving digital literacy across the health and socialcare landscape needs to be embedded in organisationsand individuals. Our work encourages that embeddingof digital literacy into everyday practice for all workingin health and social care. It is not intended to be anadditional responsibility or burden for the workforce.Improving digital literacy should be an enabler andsupporter to providing improved individual care,reducing the administrative burden, helping give peoplemore control over their own health and wellbeing andexploiting the potential of technologies to close gaps infunding and efficiency as well as care and quality.Health Education England’s digitalliteracy projectThe Royal College of NursingWe intend to: Support the nursing profession in meeting thechallenges of: Improve the speed and uptake of new technologies torealise their potential in health and careWe intend to: realising the potential of new technologies, Build digital capabilities that enable confident use andadoption of new technologies leading on the development of new care relationshipswith informed and empowered citizens and Develop skills, attitudes and behaviours that utilisetechnologies to improve outcomes, improve safety andprovide more efficient and effective care leading on the design, development and deploymentof technologies in health and social care. Improve communication and collaboration betweenindividuals and those that care for them Promote nursing based on ‘knowing’ rather than‘doing’. The digital capabilities framework promotes themodel of ‘nursing is knowing’. Reduce and remove some of the barriers to accessingand implementing technology in the healthcareenvironment Promote nursing being at the forefront of new roles andmodels of care in a digital society. Build digital capabilities that enhance personaldevelopment and satisfaction at work, in learningand in life. Promote and develop capabilities that describe new andemerging challenges rather than competencies focusingonly on current skills in known roles. Support the HEE digital literacy definition andframework which applies to all registered nurses andmidwives with capabilities that can be mapped to theNMC code. Develop digital capabilities throughout nursing to openup the potential for a true partnership that encouragesindividuals to be fully engaged in their health andhealthcare management.We are working with many different professional groupsin the field of digital literacy. If you are interested incontributing to our work in any way, please get in touchwith us at: hee.tel@nhs.uk15
For access to the full research papers informing some of thisdocument, please go to the TEL Programme Digital Literacy pages onthe HEE website.For further information on the RCN’s “Every nurse an e-nurse” workstream, please go to the RCN website.@HEE TEL@theRCN
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