You are Ruth Menzies, Clinical Innovation Lead at Brookfield NHS Foundation Trust, a two-hospital trust in the English Midlands. A digital sepsis pathway has just finished a successful pilot, and you have 87 days to take its trust-wide rollout to the board. Before you plan anything, you must decide what "sustained" will mean when the board checks in two years' time.
The situation
Brookfield has 720 beds, 7,400 staff, a £610 million budget and a £12 million deficit. Two documents sit on your desk. The first is the evaluation of a six-month pilot on two wards: a clinician-designed sepsis detection-and-response pathway cut sepsis mortality by 18% and length of stay by 1.4 days. It was designed by Dr. Ahmed, an acute-medicine consultant who ran it on his own wards and, by common account, carried it there personally.
The second is a single sheet the programme office rarely circulates: fourteen digital tools piloted at Brookfield in five years. Every one earned a favourable evaluation. Eleven were still switched on at six months. None was alive at twenty-four.
The pilot also left three groups of nurses rather than one: 38% used the pathway consistently, 44% inconsistently and 18% kept a paper workaround. Trust-wide, the benefit is only realised at 75% consistent use. Rolling it out costs £1.8 million in capital (electronic patient record integration, devices, training) and £420,000 a year after that. The finance director has already warned that every line will be challenged.
The board decides on 30 April. Nine months after go-live, if consistent use is below 60%, central funding is withdrawn and the pathway reverts to opt-in. And the board has put in writing that it will judge the programme not on the launch but at a sustainability review at twenty-four months.