#CIO100 The 2019 edition…

Being part of the CIO100 has meant something to me every year that I have taken part, this year I didn’t make the event itself and it looks like it was a roaring success from the photos on social media and the WhatsApp commentary from so many of the CIOs that were there.

Being able to be part of a community of leaders every year that support each other, laughs at each other, finds ways to promote each other, shares stories and battle wounds with each other has been a great way to create a collegiate environment regardless of business area that the CIO works within. I think the key take away from the CIO100 celebration year on year is the similarities that the role brings ‘regardless’ of the business area that the CIO works within.

Its fascinating moving to a new organisation as a digital leader, no longer a CIO, but a member of the team with an interest and a remit in the key items of the CIO agenda I can see now how transferable the experiences of a CIO can be.

I remember reflecting on similar when I moved to Ireland, the way we described the issues faced by us every day delivering digital to healthcare in the UK were so similar to those described in Ireland and yet both sides of the Irish sea thought they were unique.

One piece of advice, if I am qualified to give advice, to all CIOs and aspiring CIOs, get out of the business bubble you may find yourself in, use events and groups like the CIO100 to learn about the challenges of other areas embarking on digital transformation and innovation in a business area. If you have an issue today, I will bet that either it has been solved at least once in a community like the 100 already or at the very least someone else in that group is going through the same issue.

The CIO100 is perhaps the greatest support group that a digital leader in the UK can be part of, a group I am proud to call ‘home’.

Well done to everyone in the list, looking forward to a year of connections, collaborations and having some fun.

… and perosnally from me, whilst I am no longer at Leeds teaching Hospitals Trust without the amazing team there my place would never be so in the CIO100, a huge thanks to all of the team for working with me for 12 months on the crazy journey we called #LeedsDigitalWay.

Super heroes each and everyone of you!

 

Prescribing art as a black dog beater…

What do we turn to when the black dog pops on to our shoulders?

So many people go to a song, a poem, a book; solace in the repetitive patterns of something comforting, something sad, something happy. Me, I always turned to musical melancholy or a trusted battered American novel, (Nobody’s Fool by Richard Russo or The Hour I First Believed by Wally Lamb or The Art of Fielding by Chad Harbach) a story that I know I could open on any page and dive right into the life of someone else for a short period of time, comforting time that takes you away and gives the brain chance to find a new synapse to fire, a new spark that will help me find a different path to go head down.

Music and literature and art; ‘THE’ arts, the saviour of many a dark mood, the difference between falling down the long and deep tunnel and being able to perform a U turn that puts you (me) back in the moment, able to make a difference and care completely about the world around me.

There is no cure to depression, there is no cure to being sad, we need a way to cope, to ‘be’ something else. Everyone needs their own recipe to happiness or at least to that momentary difference that you can build on, something repetitive to distract you, to give you enough time to breath.

Music after all is a series of repeating patterns of varying complexity; eight notes to the octave for mere mortals and that sudden leap to twelve notes per octave for the seriously darker genres of Country, Blues and Jazz. There is nothing really stopping the number of octaves other than the physicality of the instrument and therefore there could (indeed should) be a song for every mood of every person on earth. The ‘free bar’ of Apple Music and Spotify have made it so much more possible to find that musical moment that you need, although sometimes that now is overwhelming when there is one ‘thing’ you know you need.

I’m Richard and I am addicted to miserable music when I am low, Red House Painters, Nick Drake, Radiohead, Cat Power, Sun Kil Moon, Low, Mojave 3 crikey the list could go on, there once was a time when this was my music and only now when I look back do I realise why, my world now is full of richer brighter colours more often but the complexity of those songs and the mood they could change is never lost on me in 2019 or 1999 or 1989.

What can we rely on though, I know that a glass of red and Down Colourful Hill or Ocean Beach and a little bit of solitary time will normally stop me in my tracks and remind me of what I can do, what I am here to do, and that’s ok for me, but no one who has been there can really ever ‘prescribe’ their cure for the next person. I have only ever met one other person who would listen to Red House Painters at their worst for example, and he was a fanatic Red House Painters fan anyway!

The sheer size of the ‘medicinal’ arsenal available to us when we turn to literature holds even less bounds than music. There are 26 letters in the alphabet, five vowels and twenty one consonants, making up the books of the world, all 130 million of them, each book has an impact on someone, somewhere, sometime. Languages hold no bounds other than the learning required to make sense of them which simply adds more and more to the arrangement that is available to you.

Once it comes to words to create stories the world become less and less random. The art in creating with the twenty six letters of the alphabet, the five letters as vowels; A, E, I, O, and U and the remaining twenty one as the consonants never cease to prove the human capability to be ‘artful’. In The Science of Story Telling by Will Storr he opens with the comment,

We know how this ends. You’re going to die and so will everyone you love. And then there will be heat death. All the change in the universe will cease, the stars will die, and there’ll be nothing left of anything but infinite, dead, freezing void.

I think I mentioned already I love a bit of melancholy! His point though is the human ability to tell stories needs to be boundless to give us all a moment of hope for every single new day, hope is derived from thinking about what tomorrow brings, we need to be convinced that tomorrow is new and brings something different, after all we are not living in the Matrix (are we?).

In the same way as the jazz men of old decided to begin to count the black keys as notes in an octave in their own right when we speak the words of a story in the form of a poem or spoken word performance art we again hear something different. The letter Y is sometimes considered a sixth vowel by poets and spoken word artists because it can sound like other vowels. Unlike consonants, each of the vowel letters has more than one type of sound or can even be silent with no sound at all extending again the beauty and curative medicine contained in the written word. But, if we did adopt this principle whole heartedly it would ruin the Cheshire Cat’s song in Alice wouldn’t it, a true happines finding song if ever there could be one!

The story of the sixth vowel and the inclusion of the black notes in an octave should teach us that what we have in this world is ours to be manipulated, even the most steadfast rules can be bent to create a new normal, a new way to help each other and perhaps most importantly to give us new tools to help ourselves.

The reach we have to help each other should hold no bounds. But, we do need to remember that my prescription will not be the answer to the person sitting next to me and their ailment, and with depression, with Mental Health, all we can do is offer help in a consistent, reliable and honest manner.

Ah, but a man’s reach should exceed his grasp, Or what’s heaven for?

Robert Browning (1812 – 1889)

Writing, sharing from our own experiences in as honest and open manner as possible gives us an opportunity to achieve a different outcome I think. In recent times I know that my world has changed a lot and that as I head further into 2019 it is the most unknowable of years, with the support that I have built though I am convinced that I can make the unknowable more exciting than scary and I can avoid heading down melancholy hill. Knowing change and knowing the support you need to enable change to happen around you is one of the keys to life I think, a lesson for 2019 though is best taken from an Instagram poet;

“From stardust we must come

to stardust we go

this is for certain

the rest is”

#AYearInPoems #29 “Sometimes its good just to know how small you actually are.”

 

….and enjoy being that!

 

 

Don’t be salted about a problem, be marinated!

The digital revolution will not be televised! Its already here and televising a modern revolution simply will not be enough. The revolution will be live streamed in virtual reality for everybody to take part in!

Gil Scott Heron will be smiling from on high; to think that the immortal statement of wild abandon and a commentary on a somewhat dystopian future will never come true, largely because technology moves faster than the ‘humble’ human being can! The song and poem by Gil Scott Heron is said to be a reaction to the song “When the Revolution Comes” by The Last Poets, from their eponymous debut, which opens with the line “When the revolution comes some of us will probably catch it on TV”, how many of us are sitting by and waiting for the digital revolution to happen so we can watch it on TV.

In the last two weeks I have been stopped dead in my tracks whilst presenting with the same type of question;

… all this new-fangled technology stuff is all well and good but how do we manage inclusivity if so many services in healthcare become reliant on the digital platform we ‘all’ have?

As digital leaders, or in reality just as leaders, we need to humanise the issues we have if we are to truly achieve digital transformation then we need to discover a way to engage everyone, not just those involved in the revolution but those that want to watch from the side lines as it happens. Engage, engage, engage needs to be the phrase we use every day as we try to create a future that has a foundation in digital and is powered by digital capability. Whether building a new hospital here in Leeds or trying to delight a customer of a commercial organisation then humanising the digital change is imperative to success and engagement through digital will ensue once we have delight in digital channels, a truly omni-channel activity for all.

The urban myth or ‘trueism-research’ that suggests that waiting staff adding googly eyes to a tip jar will see the tips leap up by 6% is said to be because the customer in the café feels that it humanised the experience of tipping is something we can learn from with engagement of people in all that we do.

We need to marinate the problems that digital presents people with together rather pouring on salt.

I love that phrase, I heard it recently in a bar in reference to people being nice to others but it applies just as equally to the issue of digital transformation, let me try to explore and explain.

A plain steak, not a great steak just a plain one; by adding salt you can widen the flavour but you will never give it any depth, but, even a plain old steak marinated in spices and sauces chosen together by the chef and the customer will broaden the appeal and depth of flavour, lessen the harshness and achieve a better result for everyone involved. I think this works well for digital transformation, success will be achieved by working together on the flavours that we are trying to deliver. Digital leaders need to seek the advice, guidance, needs and desires of the ‘customer’ to ensure that the type of transformation works for all no matter the taste buds and previous culinary experiences.

Just a note here though, I’m not comparing the digital capability in the NHS to ‘any old steak’ I hasten to add!

Creating the right recipe for working together is a consideration for successful transformation. Agreeing on the desired outcome at the beginning of the project or deliverable and ensuring that everyone is clear what the outcome will be at the end is how success can be achieved. The same can be said for so many ways of working, in digital healthcare cross organisational teams, cultured networks of sharing have been created, but not everyone wants to join in even today in 2019. The accusation of not invented here still exists, the need to have the local flexibility needs to be in place but this cannot stop us all from marinating the issues we face today together and creating the best way forward for the whole system. In the most recent of years this has started to occur in digital health but perhaps not in other parts of healthcare delivery or even in single hospital teams. Things like Hello My Name Is… has created a framework that ensures that the patient is considered first and foremost but our cultural statements are still to fully impact on how we work together as one organisation with the right impact on each other all of the time.

The #PinkSocks world is a prime example of the wonder that can be achieved when people come together in new ways of sharing and supporting. Nick Adkins set about creating a way of connecting disparate people, people who traditionally were not empowered to share, in fact would often have been in competition with each other in reality. By gifting a pair of distinctive socks, by encouraging a hug as a greeting, by defining what ‘heart speak’ amongst peers should be like the movement has marinated the problems we shared rather than rubbing salt on them and the digital health world is way better for it.

Just be kind is the ethos of Ted Rubin as a leader in digital marketing. His theme extends into the realms of marinating the issue too. He suggests that ‘old’ marketing was dictation and ‘new’ marketing is communication and that we need to change from convince and convert to converse and convert. When we set about digital transformation this is what we need to use our Chief Clinical Information Officers (CCIO) in healthcare for. They have the immediate language skills to converse and convert that sometimes we don’t they also have something that digital is yet to create fully in the digital world, an even playing field of respect. We need to build the role of the CCIO as a forever role, a role of co-leadership and co-creation; the digital leader role is not to be sub-subservient to the CCIO in this new relationship, the role is now an equal, in leadership capability, in unique knowledge and experience and in position within the team. Getting that right is the new challenge of the CIO and CCIO. Ted offers some more words of wisdom in this;

You have to give to get. No relationship can survive without trust; simple in concept yet not always easy to see executed.

Ted’s # to follow is #RonR ‘Return on Reputation’, CIOs and CCIOs can together create the reputation that is needed to marinate not salt those problems that exist across a team.

If you haven’t read Humans by Matt Haig go and do so now, it will help with this issue too. Professor Andrew Martin the key character in the book has arrived; food sickens him, clothes confound him and he cannot understand relationships, the only person to ‘get’ him is Newton, and he is the family dog. Professor Martin is a human ‘possessed’ by an alien sent to earth to evaluate the who, the what and the why, and he falls in love with the Human race! Something that I think we all need to do again to be able to achieve the delightful transformation that drives us in so many ways.

If you read Haig’s book then have Professor Adam Rutherford’s The Book of Humans: The Story of How We Became Us and Mark Britnell’s new book Human: Solving the Global Workforce Crisis in Healthcare right next to it. We need to learn from how we got to where we are, we need to be able to see in to the future and we need to be able to laugh at our own naivety, silliness and stupidity that occur every day as we strive to be a better me. These three books will enable us to do just that!

If ever there were three flavours needed for the marinating of the issue then these three pieces of written thought leadership applied in different ways are it!

And that is it really I think, lets understand our past and learn, lets predict our future together and do something about it and lets laugh from both the silliness of the past and the possibility of the future, two different types of laughter but two types we can get right together.

 

Its time to get down and marinate!

 

 

 

Huge credit goes to my good friend Bolly for passing on the marinated Vs salted comment, with her permission it appears in a slightly changed manner. Originally the phrase was related to people, those that know how to marinate and those that simply salt everything, Bolly is an expert at marinating beyond anyone else I know.

 

The Long View of a Hero…

The Long View is a Radio Four programme hosted by Jonathan Freedland where he uses stories from the past to increase understanding of current affairs and events. At Rewired tomorrow (25th of March) we are reusing some of the format, bringing heroes of past digital healthcare to the stage to shed a light on the lessons we can learn from the past and ensure we stop making the same mistakes time and time again. Why do we study history? I remember a teacher once saying to me, of course the answer was to do things better in the future!

Are we looking at heroes of digital as an example of the changes in the digital market place for health care today? If we are maybe it’s not an Alan Turing type hero we need (full genius style) but in-fact a mind more akin to Professor Richard Feynman, his famous four productivity strategies included;

  • Stop trying to know-it-all
  • Don’t worry about what others are thinking
  • Don’t think about what you want to be, but what you want to do.
  • Have a sense of humour and talk honestly.
  • Tomorrow’s heroes live on stage have been Feynman-esque in their approaches over the years.

 The Feynman way of working may be the best approach for leadership in the digital health and care arena that we could adopt.

“The only way to deep happiness is to do something you love to the best of your ability.”

And the heroes of digital health that take to the stage with me tomorrow are the embodiment of that quote. Professor Gwyn Thomas, Andy Williams and Beverley Bryant all overachieved (and continue to be huge parts of) the grand digital healthcare plan. They also applied the Feynman further principles of trusting in knowledge through teaching and taking others on a journey with them and trusting in people as friends and colleagues, not as competitors and antagonists.

Trying to shape the face of the next hero of digital health care is a challenge. We could try to use the Hasbro game Guess Who to create the ‘picture’ of the new hero we all need to step up to the front. Does it feel like the change is just about to come over the hill though with NHS X and a minister and team that seem to ‘get it’ so maybe we don’t need a Guess Who, more a guess how!

Although a hill that today has hidden Brexit shaped traps that could scupper all of our ideas and plans. We need that Long View vision of the future enabled by the lessons of the past to truly give us the blueprint we strive for. When we came up with the game we had a long list of the digital heroes of the past that we wanted on stage, Richard Grainger, Katie Davies, Nigel Bell, Gordon Hextall and Tim Kelsey all made that long list, but hero is a strong word and not everyone could agree to be on stage described as a hero.

“… but we’ve always done it like that!”

In Ireland, as Chief Information Officer I pushed hard for the removal of the culture of not trying something new. I even asked that the council of Chief Clinical Information Officers adopt the famous quote from US Navy Rear Admiral Grace Murray Hopper’s as their vision statement in year one,

“The most dangerous phrase in the English language; we’ve always done it that way!” became a way of trying every day to change the paradigm, a way of simply pushing harder to do something differently, sometimes simply because it is different it worked.

Looking to the past does not mean do it like that again, it means consider what happened, learn what needed to be done to get it right and avoid the mistakes that were made. We are rightly so concentrating on blueprinting the success at the moment, we do need to be careful not create one size will automatically fit all environment. My heroes of the past in digital and business didn’t simply take the blueprint and press copy, they tried hard to reapply with the lessons they learnt and make sure others could see how to apply and learn next.

My heroes from my reality today include; Tony O’Brien for his calm considered leadership. Jonathan Sheffield for his vision and steadfast refusal to take second best. Russ Branzell for demonstrating compassion as a leadership trait in the face of global influence. Kevin Holland for showing that expertise is a leadership trait best served shared. Gwyn Thomas for delivering the most inclusive organisational change a person could experience. Carrie Armitage for ensuring that the team around the leader is the most important. Phil Randles for never guarding his knowledge. Rachel Dunscombe for being all of our Messi. Andy Kinnear for leading us from the dark ages to the light. Molly Gilmartin for bringing an approach to innovation that others are just too frightened of. Gary Venchuk for teaching me when to swear appropriately. Ted Rubin for inspiring magical thinking on reputational importance. Amy Freeman for taking knowledge and constantly learning more with a goal of doing better. Sarah Moorhead for caring so much about the next person in the queue and frantically finding a way to take them with her. Dan and Chip Heath for delivering the most amazing stories and Frank Buyendijk for being my own stage presence inspiration.

Then I consider the Leeds team I am part of now and know as I look around we have a group of people that embody the long view in everything they do, a Chief Executive, an Exec, a Chair a team of digital professionals like none I have been able to work with before supporting a clinical team who learn lessons and apply them every day and can and will deliver with the patient at the centre of every moment of the day.

Heroes from a different reality and how the impact on our style is interesting as we head to London for two days of being Rewired. Seeing old faces is always a new inspiration and that’s whether we are laughing together in a social environment or listening intently to the latest story Rewired will bring us together for the first time in 2019 as a group of professionals who know how to do this, we just need to collectively move the blockers out of the way. The nations CCIO Dr Simon Eccles will undoubtedly remind us why we need to do this and why we need to do it in a better way, no jam for tomorrow but the reality of today.

Heroes of tomorrow, aspirational people who we know we can follow, stand up at Rewired and be counted because inspiring the next generation should be all of our most important job!

We could be heroes, just for one day, (or maybe at least the two days of Rewired)!

 

The Shades of Grey IT.

What is one of the most wicked problems in large organisations seriously adopting digital today? Many digital leaders would say it’s the challenge that Grey IT brings, and then some board members would turn to them and say what is Grey IT?

Digital functions the world over have adopted a multitude of phrases to describe a core issue that manifests in many ways and for many reasons. Grey IT is ultimately the organisation voting with its feet (or its projects) and buying and implementing technology without going through any digital function or digital governance. It’s a problem with its genesis in technology teams not meeting customer demands and the consumerisation of technology. There is an element of being careful what you wish for. In the 1990s technology leaders bemoaned their business functions for not being engaged in digital transformation, often the National Programme for IT and its perceived ‘failure’ within the NHS is accredited to the lack of business engagement; and now here we are a decade later complaining that the business is so engaged in digital solutions that they can deliver this stuff without digital teams getting involved.

The management training catch phrase of the 1980s, “Don’t bring my problems bring me solutions” needs to be turned on its head, when the business has an issue the ask now needs to be; “Come to me with your problem and lets together come to a solution for it.” This will be a first step to avoiding the Grey IT issue getting any worse, but once instigated the digital function now needs to be able to react to all the issues that are brought to the door, quickly, and in an agile manner that truly delivers on defined customer needs.

I propose that Grey IT is often so rife in large public-sector organisations because of two key reasons; a capacity to keep up with the now consumerised technology delivery that is possible and an often-backward view of innovation that comes from the business by digital professionals. The expectation that digital innovation can only come from those within technology rather than those at the cutting edge of business delivery has to be reconsidered by us, the digital leadership of any organisation! Sometimes the customer does truly know best!

We must combat these two root causes of this if we are to remove the negative outcomes of Grey IT’s existence. Technology outside of a decent governance capability is ultimately dangerous for business and healthcare delivery in particular. Grey IT does just that, delivers a layer of technology that does not have any governance to it. The real manifestation of Grey IT in the NHS today is often seen 12 months after the initial project go live, when the bill for the second year of the licence arrives or the need to upgrade becomes obvious and the technology professionals are called to assist. Worse still Grey IT becomes clear the day the system built, supported, procured and run outside of IT doesn’t work anymore, suddenly Grey IT falls back to its base colours, black and white, whose problem is it and who is going to fix it!

My organisation has been on the receiving end of one of the worst outcomes of Grey IT, many years ago we suffered a significant outage in the digital systems that were used in the Pathology Lab. Whilst the solution had been bought through a governed and appropriate manner it had not been taken into the technology team within the trust it had been developed, evolved and supported by keen and enthusiastic users, but a workforce that had moved on, had a higher priority (patient care) or simply had forgotten how to do stuff was left supporting a solution that was on legacy infrastructure. So when a server went pop, a disc array went AWOL and a back-up was missing disaster struck. This is all stuff the good book ITIL teaches digital professionals to avoid, but once the grey mist has descended upon it even the good book couldn’t help! All that the technology team could do in this case was take control of the recovery and work hard to ensure that the right lessons had been learnt and applied to the future.

I think we are looking at a plethora of different types of Grey IT that all need a different solution; Feral IT Guerrilla IT, Shadow IT and traditional Grey IT.

Feral IT for me starts as a digitally led project often a collaboration, an exciting chance for the digital team and the ‘business’ to work together to come up with a solution. It gains ground as it delivers benefit but slowly drifts away from good governance, often because the project is so successful. Over time though the project will grow and its delivery focus and the team will change, as that happens the digital governance of the organisation can break down and the project is then being delivered outside the parameters of good governance.

The key to making Feral IT work is to ensure that the governance of the project is grounded in the foundations of the digital agenda, organisations are often looking for agility and a start-up culture to enable innovation to happen, but innovation becomes scalable only when a rigour of governance is applied. As digital leaders we should try to encourage the agility that this type of project culture offers, but it is also our role to ensure that the foundations of decision making and corporate risk management are clearly understood. It is tricky in a new decade where digital is a consumerised product, building an understanding of why we the digital function of an organisation needs to be continually part of the decision making in this kind of project can only be achieved with the right style of engagement, one that at least can light a candle next to the consumer style digital capability now available to everyone.

Guerrilla  IT is a phrase that best describes the technology project that has been actively hidden from an organisations digital team, a project that has wilfully been created outside of governance for so many possible reasons. Guerrilla warfare was a phrase first coined in 1808 to describe the Spanish resistance to Napoleon, Guerrilla IT is an identified need that a team has understood and has been unable to get help with the delivery of, at this point the business function decides to go ‘rogue’ and deliver it anyway.

In the NHS today Guerrilla IT exists for many reasons but I would suggest the key reason is an inability to make the national solutions that have been delivered work in the way that locality needs them to. When we have Guerrilla IT projects we need to understand why they exist, much of the reason will often be traceable back to the nature of the solution being sought by the business to the problem and the digital functions inability to react in a way that achieves the desired outcome. The use of WhatsApp in the NHS is possibly the best example of a Guerrilla IT project, organisations have been saying for more than five years that this platform should not really be used inside a healthcare environment, and yet every day that I am in Leeds I see and hear of staff using it in ways we have actively said it shouldn’t be used. Why, because it achieves a need, it is easy to use and it’s a consumer product, and in reality, alternatives to its use are very new to the digital fabric of healthcare. The same could be said for ERS, there is a desperate need fro the NHS wide booking system to offer a ‘many to many’ booking capability, hospitals refer to hospitals! And yet it doesn’t and therefore department after department has its own growing digital solution to enable the digital transfer of information about patients moving from hospital to hospital, we have to fix this!

Shadow IT manifests often from the digital team, when disagreement exists in strategic direction, standards to be adopted or simply in the procurement of a system. Digital professionals can be a real pain, we all know best, we all know our subject matter and sometimes this can boil over into a Shadow IT project. A project that is delivered against the wishes of the governed decision and with an intention to compete with a decision made. Shadow IT will often be kicked off with good intentions; a project just in case the agreed and governed solution misses a deadline or as a risk mitigation to functionality delivery, but sometimes the project is started because it is a ‘pet project’ of a leader of the organisation, digital or otherwise. Shadow IT can be a useful mitigation to risk, but needs the same level of governance,  risk management and rigour applied, it needs to be managed as a project that has goal of being there just in case and should not be tolerated as a vanity project because someone with the digital function is unhappy with a technology decision that has been taken.

Grey IT becomes the collective term for these issues, all shades of grey, successful in some ways in delivering user defined need but with risks to the business that need to be quantified and mitigated against. Removing Grey IT has already become one of the wicked problems, maybe we should accept that we can’t remove Grey IT from what we do, but we should look to understand where it is, why it is and what the risks are to us. There is also an element now of learning from the collective Grey IT projects and understanding better how to avoid them starting up, and that I think is about understanding the investment decisions that are required to initiate a digital project and the engagement needed to enlighten everyone in decisions being taken.

Investment and the return it brings has to be part of the equation in the answer to the ever-present Grey IT problem. Investment in infrastructure for healthcare needs to have a digital element in the same way as the investment decision would call for electricity, heating and light. In 2015 KPMG Ireland called out the need for the fourth ‘utility’ for the building of the National Children’s hospital in Dublin to be digital, it wasn’t, and we now see a furore in the media as the whole digital backbone of a brand new hospital is going over budget because its digital element was expected by decision makers to be run as a Grey IT project. Misunderstanding or on purpose I am still not sure but I do know that the digital team across the project, the ‘centre’ and the department were clear that the hospital had to be a digital hospital and yet the return on that investment was not judged to be worthwhile capturing properly and openly, IT costs money, when will we learn!

We are asked to consider the Return on Investment (ROI) that digital makes when we build a case for spend, perhaps the key to removing the plight that is Grey IT from digital health care could be to start to consider a different set of terms more strongly, what if we considered the Value on Investment (VOI) instead? Let’s not pretend anymore that investment in digital in healthcare anywhere in the world will ever return money back to anyone’s budget, capacity and demand are so ‘topsey turvey’ right now that no amount of digital innovation will return investment, what it will do though is increase efficiency to bring us closer to the demand need, increase quality to bring us closer to the required need and bring a new interest back to the daily roles to deliver a new enthusiasm for what we do. If we all consider the VOI together then just maybe no one would want to set up their own little Grey IT project anymore because we would all be heading towards the same increased value curve.

So we move from ROI to VOI and start to build the case for change in a different way, we still are missing a piece of the colourful puzzle that will be laid over the top of Grey IT though. Return on Reputation (ROR) was a phrase I first heard uttered by Ted Rubin a digital marketing expert and social media evangelist, Ted suggests that the way to building reputation is by building the network of believers and doing this by being ‘nice’. Quite an American ‘thing’ to want to do I guess but there is something in this I think. Digital functions all over the NHS have not adopted any form of ‘Del Monte’ attitude, we are quick to say no, we are quick to say get in line we have a prioritisation process you know! When we do this without listening, we do two things, we set the preference for our customers to understand that its quicker to ‘go elsewhere’ and that we are not part of the team, we are ‘another’ corporate function, maybe even an overhead, with our own benefit blocking agenda. If we adopt Ted’s principles then we should be more open to listen, more transparent in what we will do once we have listened and allow the ‘business’ to work with us to decide what to do first, second and third. The return we would all then get from this is an improvement in the reputation we have.

Grey IT is here now and no matter how big your One IT (insert other corporate programme name here!) is that you are instigating to remove it you won’t without attitude and aptitude change in the digital functions of healthcare. Change is hard to make happen but we have to make it happen, as a journey we are on not as a demand dictated to the system we can become one transformation function for the NHS.

Bring out the problems, let’s work together to create new ideas to solve them and then lets seek the right way of describing the investment and the way we are all going to deliver this together, let’s create joint solutions to problems we consider to be joint as well.

Somehow let’s make digital first be a way of working together that is about innovating for the future not simply concentrating on tomorrow.

 

 

NB If you ever see Ted Rubin on an agenda at an event you are at, go and see him speak, one of the most inspiring speakers I have ever had the joy of seeing, he changed my outlook and I still quote him years later, ‘just be nice!’

A ‘new’ trend, CHR, what is and how do we get there…

When arguably the largest digital health vendor in the world starts to consider how they move to a new terminology for what they deliver we need to prick up our ears and at least understand what the noise is about; a Community Health Record (CHR) is now the direction of travel for EPIC one of the worlds largest digital health care organisations. In the same period the Secretary of State for Health and Social Care has begun to add some flesh to the digital vision he published earlier in the year, particularly around the state of the GP System in the UK and the desperate need for interoperability of the systems, ie. enabling the creation of a CHR in the NHS on a national scale.

I remember a pre-NPfIT world where the NHS had a choice of GP Systems from a vibrant market, and even when you were with a single vendor there was often a plethora of systems with a multitude of functionality levels available to you; who remembers EMIS LV, GV, PCS and Web all being on the market at the same time. SeeTec, Microtest, TPP, InPS, Torex and iSOFT all with the ability to deliver new exciting functionality and at the same time support legacy and green screen solutions. The move that we all took as NPfIT to rationalise the market was meant to modernise what was available, was meant to support innovation and create a new market place one where a CHR would be delivered. It didn’t it created a duopoly that has stifled innovation removed any kind of ‘start-up’ culture within the market place and disempowered much of the ‘family business’ loyalty that existed between vendor and GP. The GP element of a CHR can now only be delivered by moving to a single supplier base across a region and even then only through the movement of information in ‘old technology ways’ in the most part. What were we thinking!

Matt Hancock Secretary of State said the week before Christmas,:

“Too often the IT used by GPs in the NHS – like other NHS technology – is out of date: it frustrates staff and patients alike, and doesn’t work well with other NHS systems. This must change.”

The move from the mega-vendors in this space to try to create systems that span acute, community and primary care will not alter this paradigm and we need to take care as a joined up health and social care system to not start to drink the cool-aid again. EPIC now ‘offering’ a CHR is not the solution to a GP market place that has shrunk in size and is currently slow to consider how interoperability can be achieved outside the walls of their own systems.

In the same week that the Secretary of State made these comments Sarah Wilkinson the Chief Executive Officer added,

“The next generation of IT services for primary care must give more patients easy access to all key aspects of their medical record and provide the highest quality technology for use by GPs. The suppliers must also comply with our technology standards to ensure that we can integrate patient records across primary care, secondary care and social care.”

The simple fact that our national body for digital followed up the Secretary of State’s comment with this is a good sign, an ask for vendors to integrate across the care setting that make up the NHS against an agreed and publicised set of standards is what NHS IT teams have been asking for since the demise of NPfIT. Enabling patient ‘easy access’ cannot be done at a national level, that has been proven when the centre’s attempt at Health Space and Microsoft’s cancelled Health Vault solution. What can be done though are elements of patient access; security layers, a unified front end and entry point, promotion of the solution, standardised sets of data and ways in which this is presented and access to national data sets and information; but access to local information is best managed at a local level!

The work done in Southampton and now in Leeds and now many other places is showing that elements of an open Person Held Record (openPHR) can be achieved with connectivity, standards and a reliance on the expected parts that are best done once nationally.

The EPIC Systems CEO Judy Faulkner told a meeting ahead of EPIC leaders just ahead of Christmas that

“If you want to keep patients well and you want to get paid, you’re going to have to have a comprehensive health record. You’ll need to use software as your central nervous system, and that’s how you standardise and manage your organisation.”

These words echo some of the content of the new direction published by the Secretary of State and his team.

As a digital leader I have always pushed back though on the statement that IT will help standardise the organisation. That needs to be a clinical pull for standard work not a technology led necessity. In Ireland in late 2014 the Department of Health pinned parts of the Electronic Health Record Case for Change on the standardisation that could be achieved through the implementation of technology. The CCIO community in Ireland understood what was meant here but still pushed back, they had built the understanding that clinical led change was the right way forward and insisted that change would come about only through collaboration and with digital as a foundation for standardisation. This is why it took two years from procurement of the Cerner Millennium system to go live in the first maternity hospital of the EHR system, the clinical team wanted to ensure that the standard work that the system helped them deliver was based on clinical best practice not how the software works.

Judy Faulkner told Healthcare IT News in December 2018,

“Because healthcare is now focusing on keeping people well rather than reacting to illness, we are focusing on factors outside the traditional walls.”

This makes sense, the delivery of Population Health is the new knowledge basis for what we as healthcare professionals (Note not digital leaders) need to focus upon, here in Leeds we need to deliver this as a city, as a citizen platform for good health and social care to exist. We need to protect our clinical, medical and healthcare professionals from a deluge of data and somehow find the right way to present the right data at the right time, not all the data some of the time. A move to ‘data is there for the asking, not the taking’ is what Ewan Davies chief executive of Inidus called out in his new year predictions recently, with permission and with the right tools the CEO of EPIC could be right, digital systems really could start to offer the delivery of healthcare the ability to consider how it can deliver healthcare ‘outside the traditional walls.

To kick off 2019 Simon Eccles, national CCIO for Health and Care revealed his predictions for 2019 to Digital Health;

I believe we’ll see a renewed vigour in digital health technology and I hope an end to the acceptance of ‘not-good-enough’ tech in the NHS, with NHS Boards across the country taking action to support their staff with good technology. 2019 will see the launch of the first NHS Interoperability Standards, with clear timescales for their adoption, and we’ll see the NHS App being taken up which will start to show us the true potential of the empowered consumer in health.”

However Ewan Davis the chief executive of Inidus had a less positive slant to add on the direction needed in his predictions for 2019;

Progress with interoperability will slow as vested interests and the sheer difficulty of making it work swamp efforts to get beyond the first few use cases and there will be growing recognition that we need a different approach to create the data fluidly we need.”

I believe the way to abort this gloomy direction will be moving to a learning from local approach, one where we come together as healthcare leaders and share what has been delivered and how, the Care Connect work in Bristol, GP Connect work in Leeds, Record Locator go live in various locations and an ask from One London to truly move forward with meaningful FIHR (Fast Healthcare Interoperability Resources) profiles all begin to truly ring a bell for interoperability to happen in earnest. Whether its new entrants into the GP market that deliver this or a renewed local relationship with the suppliers that exist now to my mind it doesn’t matter. What I do know though is that by working together the system can remove the frustration that our Secretary of State describes and offer a joined-up system that has digital at its foundation and data fluidity as its life force.

I am proud of being a digital leader but I think that in 2019, to truly deliver what EPIC have described as a CHR then we all need to become healthcare workers with digital expertise in the same way as a brain surgeon is a healthcare worker with surgical (and so much more) expertise!

2018 Review of the Year.

For the sixth year running I get to put ‘pen to paper’ and create my review of the year. A look back at the stuff I have done, the places I have been, the things I have learnt, the sounds I have heard and the things I have seen.

It’s become a tradition that I look forward to every year, it helps clear out my mind and gets me ready for the next years experiences; a bit like a disc de-frag, the consolidation of the years experiences captured as a memory of the year, to look back on and remind myself of all the good stuff in moments of challenge and to generally put some context to what was happening when the world changes around you.

It has been a busy year (all the reviews say that though), it’s been an impactful year with changes to so many parts of the life we live. The origins of this blog were a review of the music I had heard, a way of ‘formalising’ my playlist of the year but over the last three years I have used it more and more to reflect on the year gone and prepare for the year ahead.

Travel has played a bigger part in 2018 than ever before, I have had chance to talk about my passion, digital transformation in healthcare, on three continents this year, the air miles really have stacked up. With three very different trips to the USA my obsession with the American Way hasn’t waned at all. To see the way politics is impacting on life to such a degree in the US right now is fascinating and to see it in a few different places showed me that there isn’t any part of America that is generic and to think of it as one whole is just unbelievably wrong.

The big holiday of the year was a road trip through Florida, arriving in Orlando first and being able to visit Harry Potter World in all its fabulous glory was amazing. Walking around in lovely sunshine and on the last day in Orlando taking a 7 second drop into a zoom the flume at Volcano Bay was not something I expected to enjoy as much as I did, what a great start to the adventure.

The next part though, picking up the Ford Mustang and heading off down the Florida Keys was spectacular. The drive itself, the views, the next hotel in Fort Lauderdale was just amazing. By chance ending up at American Social on a Sunday afternoon on Las Olas was an eye opener, Drake pumping out of the most amazing sound system and every customer rapping and bouncing along was amazing and then the bike ride back to the hotel which was an adventure too.

The drive to Miami then was the thing of dreams, roof top off the car and a slow drive in to the city. Perhaps a little clichéd that we (I) insisted on Kendrick and Drake as the accompanying soundtrack. Miami is now first on my list of American cities to revisit, an amazing experience walking around seeing what I think could well be the best shopping experience in the world, the art and architecture, the food, drink, sounds and people really made it feel very special. It’s a bustle city and yet you can find a peaceful spot somewhere with such ease to watch the world go by, not to mention one of the most awesome book shops I have ever been in; Books and Books.

Then back to earth with a bump, Las Vegas and the worlds largest health tech conference (HIMSS), the first of two visits to Las Vegas in 2018 proved to be an odd one, amazing food and the general Las Vegas experience was awesome as was seeing David Guetta at the Wynn but HIMSS itself felt like you were captured in a pin ball machine, just too big and too much at the end of the holiday to really cope with; although I did get chance to present as the MC for the conferences first International Stage and be a judge in the Canadian start-up of the year competition so perhaps need to reflect more favourably on the visit.

Particularly because two months later I got to have a return trip to Las Vegas for my little brothers stag do (bachelor party)! Pool parties, trips into the desert (in a Ford Mustang again) a zip line down the longest shopping mall in the world and shoe shopping in Tom Ford all highlights of a great occasion. Driving in the desert with a great friend with a play list built for the two of us was awesome, Hoover Dam, dust storms and the Grand Canyon were all highlights of the year, but getting time with my brother in such an extraordinary place meant the world to me.

Trips to Brussels, Barcelona, Berlin, Dublin, Sitges, Seattle and many trips to London; time in Oxford and Birmingham; a wonderful weekend in Scarborough with some of the best friends we could ask for all made up more of the travel too. I think Barcelona is still my favourite city on earth though, even after experiencing so much this year. Being able to spend time in Sitges and experience a different type of Barcelona highlighted the way that the Catalonian lifestyle permeates everything that happens, the food, music and diversity of people never ceases to amaze me. The political backdrop in Barcelona continues to sway the city, the country and perhaps the whole of Europe a little but it is still the most beautiful place to be in the heart of.

Films and TV continued to take over a little in 2018 from going to see live music, is it an age thing or a lazy thing I am not sure but I think there has been some awesome movies out this year that I have thoroughly enjoyed, although I do still worry I live in Marvel Land a little too much:

1 – Quiet Place 6 – First Man
2 – BlacKkKKlansman 7 – Leave No Trace
3 – Avengers: Infinity War 8 – Ant-Man and the Wasp
4 – Baby Driver 9 – Mission Impossible: Fallout
5 – Black Panther 10 – Annihilation

The world of TV continues to change and evolve and bring a different type of entertainment to us all, the list of TV has to be a list that has come to me to be watched this year rather than simply being released this year;

1 – Big Little Lies 6 – First
2 – Sinner S1 7 – Bodyguard
3 – Handmaid’s Tale S1 8 – Sharp Objects
4 – Killing Eve 9 – Handmaid’s Tale S2
5 – Westworld S1 10 – Jessica Jones S2

When I look at this list though there is a lot of quite down and miserable TV in there, I need to find something cheerful and life affirming for 2019 to watch maybe, although there is something to be said for disappearing into a dark world and trying to work out where it will go next.

Every year new sounds, new styles and new artists come to the fore bringing a new listening pleasure for me. This year has seen some great album releases; George Fitzgerald (Both Albums), Maribou State, Honey Dijon, Everything is Recorded, Tycho, Rufus du Sol to list just a couple of recommendations, seeing Neneh Cherry (also she is in Leeds in February and puts on an awesome show if you can make the date!) back on the list is heart warming too, what an album that is.

The Dekmantel best of 2018 is also one I now can’t get off the speaker too. The list as a whole is a bit different, some slightly more downbeat stuff in some ways but the disco influence keeps coming out strong to keep it mostly a head nodding experience…

1 – Love Is A Hurtin’ Thing (12” Mix) – Gloria Ann Taylor 17 – Leave A Light On – Tom Walker
2 – Look Ahead (Extended Mix) – Honey Dijon 18 – Roy Keane – Brame & Hamo
3 – Addison Lee – Not3s 19 – Water Baby – Tom Misch & Loyle Carner
4 – It Makes You Forget (Itgehane) – Peggy Gou 20 – At Night (Peggy Gou Remix) – Shakedown
5 – Young, Dumb & Broke – Khalid 21 – Turnmills (Club Mix) – Maribou State
6 – Half-Light (Night Version) – George Fitzgerald 22 – Shot Gun Shack – Neneh Cherry
7 – Bad Bad News – Leon Bridges 23 – In The Air – DMA’s
8 – Greasy Spoon – Sam Fender 24 – Horizon (Poolside Remix) – Tycho
9 – Techno Disco Tool – Mella Dee 25 – Girlfriend – Christine & the Queens
10 – Opal (Four Tet Remix) – Bicep 26 – Desert Night (Jesse Rose Mix) – Rufus Du Sol
11 – Everything Is Recorded – Everything Is Recorded 27 – Surprised By The Joy – Richard Ashcroft
12 – I Feel Joy (Feel The Spirit) – Nona Hendryx 28 – Beat 54 (Krystal Klear 12” Mix) – Jungle
13 – Vincent – James Blake 29 – Sincerity Is Scary – The 1975
14 – This Ain’t Freedom – Liife & Roland Clark 30 – Slow Disco (Piano Version) – St. Vincent
15 – Controller – Channel Tres 31 – Under the Moon – Claptone
16 – Perth (Dusky Remix) – KiNK 32 – Han Jan – Peggy Gou

Peggy Gou features three times in one list which shows the obsession with the music she has put out this year and the Gloria Ann Taylor song, whilst an old song, was such an amazing moment in the Black Madonna essential mix earlier in the year that it had to make the list. And like the ‘old days’ when I used to make copied of this as a CD and hand write the track listings I can now share this playlist by the wonders of Apple Music; click HERE to listen.

Having said we didn’t make many gigs this year we did make Hannah Wants in March at the Mint Warehouse in sunny Leeds, a great night in a proper dance club venue, we did feel old though, made a bit worse by being told on two occasions in one night that it was good to see two older, well dressed people enjoying themselves at a ‘proper’ night! When Bicep got played on the night and the place went a bit bonkers though it was good to see how music that you have fallen for really hit the audience in the spot it was made for.

A family trip to Centre Parks in Nottinghamshire was a lovely weekend, spending time with our nieces and seeing the joy that family time brings was super, I hope that 2019 gives me more time to spend with them, seeing them grow up so quickly and become little adults built on awesome experiences, even if that is riding ponies in Centre Parks, is a lovely thing to see.

The chair of my organisation suggested a weekend at Oxford University in March as well, go and spend a weekend considering what the Automation of Business in 2022 should look like was the offer, and it was an amazing opportunity to mix with some wonderful brains and really see where this thing we do all day every day is taking us. The journey home though was when the second ‘dump’ of snow arrived, really quite an adventure as by the time we got to Sheffield everywhere was picture postcard beautiful and terrifyingly slippy in equal measure. Quite how we made it home I will never know, but then heading to the Cats Pyjamas on a craftily booked on line 9 o’clock dinner was quite the eye opener, watching the snow come down and the people of Headingly who had set out to celebrate St. Patricks day revel in the weather was hilarious.

Electronic Music in the City is a new Leeds city wide one day event that celebrates all elements of what makes up Electronic Music, for an inaugural event it was nothing short of amazing, venues all over the city with some of the best DJs and sound system you can see, perhaps the most astonishing though was seeing a hero of mine, KiNK take to the stage at Sheaf Street for a demonstration and conversation about making electronic music. He proceeded to make a melody based house music track with just a drum machine and loop as all his other kit had simply shut down on him, such amazing talent and a lovely friendly guy too. Talking of friendly dance music super stars, I also got to see Andy Butler of Hercules and Love Affair play in the sunshine on the roof of Headrow House after a big Saturday out, awesome experience even if I didn’t go and speak to him after and my friends did, what a DJ!

Ibiza this time was made brilliant by friends being there at the same time and some amazing repeat experiences, going to Ibiza though is like putting on a favourite pair of shoes, everything just fits nice, so sharing it with Tim and Rich this year was simply awesome, already looking forward to next year which we planned whilst there. Seeing the sun set from Mambo does two things to me nearly every time, it helps me remember all the times that went before and there have been some startling moments but it also makes me wish for people I have known in my life that ought to have seen that sun set, and that’s a sad edge to the experience.

Being able to get to a conversation with Matt Haig at Waterstones in Leeds was really interesting too. After a busy time at work and moving house and fitting back into life in Yorkshire it was great to hear from him and some of his interpretation of what we should try to consider and believe in to ensure that the light at the end of every day is bright, and if it isn’t then what he thinks we as humans should try to do. The audience that night was full of stories of beating the black feelings and sadness and what inspires them to set about on the war to beat mental health issues at every turn, truly inspiring stories for us all.

My top five book recommendations this year are as unconnected to each other in style and content as I think they have ever been on this blog, I know I enjoy the beauty of a book but in 2019 want to again try to promise myself to put Twitter down and pick up a real book more:

1 – Hit Refresh – Satya Nadella

2 – How To Stop Time – Matt Haig

3 – Annihilation – Jeff VanderMeer

4 – The Book of Humans – Adam Rutherford

5 – Out of My Tree (Midsummer House) – Daniel Clifford

My cook book collection doesn’t normally make the top 5 books I have read but Daniels Clifford’s story of how he made success happen is truly amazing, as are the recipes and the photographs, well worth a look. Satya’s book continues all year to be a point of reference and a source for great quotes.

The biggest event of the year though had to be the Corbridge-Carr wedding. An amazing day seeing my brother so happy, a day full of The Proclaimers, cardboard Gary Lineker and many many smiling faces. I was very proud to be asked to be best man and to give the speech a go, it seemed to mostly go down ok with laughs at the right moments and not too many fluffed words, still the most nervous I have ever been for giving a speech, give me 20,000 people in an auditorium any time over a group of family and friends who want you to be great, how odd is that! Standing at the front with the wedding party, holding the vicars book of words and seeing how the bride and groom were with each other filled me with joy for the future of two families linked together now over a very happy couple.

Trying new restaurants was one thing I spoke about in last years review, or rather looking forward to being back in Leeds and getting around to the many new places to eat that had sprung up; which we have done and really enjoyed but perhaps the real exploration has been looking at new restaurants in new cities. The Wilderness in Birmingham, American Social (On a Sunday) in Fort Lauderdale, Man Behind the Curtain in Leeds, Hide Above in London, Barnsley House in the Cotswolds, Bibendom in Kensington, Fera at Clarridges, Freak Scene in Soho, Harvest in the Bellagio in  Las Vegas, Mignonette in Miami, Reserve Roastery in Seattle, The Old Bookbinders in Oxford, Alfresco in Sitges, The Percy Arms in Chatton, Oddfellows Café & Bar in Seattle, White Bait in Wellington, Bodega 1900 in Barcelona, Tapas24 also in Barcelona, Nobu in London, The Ivy back in Leeds have all added to the pallet and the senses at different times in 2018. But the one place we keep going back to in the later part of 2018 is The Reliance in Leeds, I have truly fallen for that place, you can rely on the Reliance!

I have always wanted to see the Chilly Gonzales show, how does one man manage to pull off a show of classical piano, rap and classic interpretations of dance songs in one show with a comedic value added for good measure! Well he does, and at the Leeds show with some of the best seats in the house you could see the raised eye brow for each moment, the way he ‘conducted’ his fellow musicians and indeed how absolute genius like he is on the black and white keys.

We decided that one of the things we would do is get on board with the vinyl junky experience, getting help from the team at Richer Sounds in Leeds we picked a setup we are very proud of and set about the business of creating a collection, old stuff we loved, jazz stuff we hadn’t heard before and soundtracks. The original deal struck was all music had to be pre-1990 but I couldn’t resist hearing Portishead, Massive Attack, Mo Wax and Oasis on the set up so we are now heading down a simple yet diverse collection of sounds.

It’s a year since leaving Ireland and the most amazing team and wonderful experiences, in September a couple of the team got in touch to ask if I would be willing to accept the O’Moore Medal for services to Health Informatics in Ireland, a prestigious honour that I jumped at the chance of. It was huge for me to go over, see the team, reminisce about what we had been able to do and dedicate the medal to four people who made it possible, Kevin, Fran, Joyce and Tony, four parts to a team I will never ever forget. The medal sits pride of place in my new office in Leeds and I am so thrilled to have been part of that journey.

Revisiting Seattle this year was a great learning experience, spending time with Virginia Mason for two days to understand what the way of Toyota has done for how they run a huge hospital was inspirational as was a whole day with the Microsoft team bringing colleagues up to speed with what the next digital leap will be in healthcare. I also had 8 hours to myself in Seattle, a great day exploring, the origins of Starbucks, the head offices of Amazon (Even the Amazon Go shop) the Jimi Hendrix statue, the oldest street, the Pike Market experience and the University campus all to a great soundtrack wherever you went. Three top picks for me for Seattle, go to the Amazon Go store to experience what shopping in the future will be like, take lunch at Oddfellows Café & Bar and see the stars of local film and fashion and spend an hour in the Elliott Bay Book Company, now one of my favourite places in the world.

More than 12 months ago I was asked to deliver the key note at the New Zealand health informatics gathering in Wellington in November, with our leave booked and our suitcases packed we set off on a 10 day trip to New Zealand in November. First stop off Singapore, with 10 hours to spare we headed into Singapore to wander around and get a feel for the city, we ended up at Marina Bay Sands and the Gardens by the Bay, a modern way to really celebrate an amazing natural environment. Then off to Wellington, we explored so much of Wellington, Cuba Street and the diversity on hand, Weta and the whole concept of Welliwood that has sprung up off the Peter Jackson films being based there. We saw where Hobbits would hide and where Hollywood stars took brunch and had an amazing time, although the 25-hour return journey was a real endurance test.

Being able to deliver the key note in New Zealand though was something special career wise. I bounced on stage and told a story of digital music, Singapore development, American jugglers, Magic engagement tools and the Twilight Zone. One of those moments I will always now remember; and as far as speeches goes it made me some new friends too.

Last year I continued a new tradition of also considering the people I had worked with or met over the year and the impact and memories they brought to what I do and who I am. Working with Molly Gilmartin and the Forward team was an inspiration to how the start-up ethos can and should impact on what we do; having Molly work with my team on what it means to be a disruptive leader and then later in the year see her inspire the whole department at the All Staff Meeting was a great experience, whatever Molly does next will be worth watching that much I am certain of. Bringing two speakers to meet the team in Leeds also had a huge impact, the same it did on me the first time I met them, Dr. Jessica Barker of Cygenta and Jamie White of Leading Social delivered inspiration for new ways of thinking and applying that thinking to what we do to the whole team and it was great to see them hear these inspirational voices for the first time and reflect on the impact they had on me the first time I heard them.

Kindness, sincerity and authenticity are three traits I want to model always, working with a hero of mine Gwyn Thomas on two occasions (and one planned for next year) was a great experience and one I cherish dearly. Meeting Wayne Dyson, not a supplier but the true embodiment of a partner was also exciting and I can’t wait to see where the partnership takes us next, when one ‘supplier’ cares so much about what we do it can only be a good year ahead! And reaffirming the relationship with a colleague like Andy Williams and then being able to so rely on one person to support you through some challenging actions has been brilliant.

Moving house meant we had new neighbours to meet, we had been very lucky in Ireland to have made some amazing friends, here in sunny Leeds though we have made the best of new friends in David and James, true gentlemen and scholars of everything they do.

What a year, so much happened, I haven’t even described what it was like to be at the CIO100 with an old friend, to have the secretary of state visit us and describe us as ‘mind blowing’, to work with a talented a team unlike any I have had the honour to call a peer before, to meet so many new people and create new relationships that I think are now more and more partnerships.

So as always a statement or rallying cry for 2019 needs to be created off the back of the year that was. In the past I spoken about bouncing out of bed every morning, about taking each day as a new opportunity and about how to create the right environment for change. As we head to 2019 for me my outlook needs to be that change will happen, in Leeds we have somewhat built a future on the Robert Frost quote,

Two roads diverged in a wood, and I took the one less travelled by, and that has made all the difference.

In 2019 I am committed to the development of what we do, who we are and how we do it, I want to use the Emily Dickinson quote as a mantra for why,

The brain is wider than the sky!

I guess my mantra for 2019 though will be to follow in the path of the ever wonderful Fatboy Slim and applying his vision of a good DJ to my life,

A good DJ is always looking at the crowd, seeing what they’re like, seeing whether it’s working, communicating with them. Smiling at them. And a bad DJ is always looking down at what they’re doing all the time and just doing their thing that they practiced in their bedroom.

2019, the year of looking up, smiling and being part of the team!

 

 

Twelve month school report…

Do you remember that school report moment, that evaluation and review of the academic year, the fear of what your teachers would say, or not say when your parents went to meet them? A year of hard work distilled to a 45 minute meeting with a bunch of teachers who, in some cases, were probably trying to provide feedback to maybe as many as 100 kids who had various degrees of motivation and ambition. It must have been a hard task for them and it was often a nerve wrecking experience for the pupil!

Key phrases from my school reports: ‘creative writing doesn’t always mean making it up as you go along!’; ‘Please follow the rules of emergency air supply on an aeroplane, secure your own work before turning to help others’; ‘Less communicating and more concentrating will bring more academic rewards, but will make the class a dull class’; ‘Richard’s passion for campanology outweighs any I have ever seen in any teenager’. The last one holds a dear memory for me as a retort from my Dad, who exclaimed he knew I liked camping but thought I wasn’t the only one in school in scouts!

So, a year into the role in sunny Leeds, a year in to concentrating in a new way on what a digital fabric can do for health and care across Leeds and I thought it would be good to try to put together my own school report. A progressive ‘school’ like Leeds would allow the pupils to put together their own review as long as it could be challenged in a fair and productive manner by teachers and peers, so here goes.

First subject to be graded has to be Delivery. I think the #LeedsDigitalWay deserves a B- for delivery in the last 12 months.

Delivery Grade – B-

The first 100 days saw a sea change in the way the team worked. The objectives of what we wanted to do were made clear and the team began to evolve. The ‘simple’ action of getting board approval to invest in the PPM+ solution as the Electronic Health Record (EHR) for Leeds until at least 2022 has seen a new concentration on the process for delivery. Leeds has delivered against an agile methodology for over five years but now delivers on a monthly release schedule; new functionality defined by the clinical team lands into live each month. A new focus on the release function and now the way that test, development and integration work together has brought about some immediately noticeable changes, largely the enthusiasm and engagement that the clinical team has for the solution has improved significantly.

Deliverables such as the A&E dashboard, flu reporting, tasks and jobs inside the EHR, the implementation of Forward, the delivery of the eRespect form, Nursing eObervations, single sign-on for all and even simple changes like the opening of the internet to ‘real’ use has seen a continuation of the acceptance that digital is a hugely important part of what a hospital needs in place every single day.

Scan for Safety and the mobile EHR solution are fast becoming a way of life in Leeds. Not new gizmos but a way to enable the understanding of patient flow and a way of capturing information without fingers being needed on a keyboard. Scan for Safety also is an illustration of LTHT-wide partnership working and what can be achieved when a delivery is led not by IT but by clinicians and key impacted departments.

The delivery of new infrastructure for PACS, Digital Pathology and the new Genomics service all considered to be that unfortunate term, ‘back office’ deliverables, but all crucial to the acceptable running of the digital fabric of the trust are well underway with a limited resource to make them happen.

A slow but steady reform of the way service management is delivered has started to take shape as has a new way of thinking for Information and Intelligence (I&I). The organisational change elements are now in place to enable a function within the I&I capability to focus ‘just’ on data within PPM+, something LTHT has been trying to make happen for some time.

Why the dropped marks in this area? Expectations have been set really very high and whilst the resource to deliver has been changed in its structure it hasn’t changed in its capacity in any dramatic manner. A phrase I think should be avoided has been used too often: ‘do more for less’. Outages have occurred on three occasions, all managed well with no patient impact but in all three cases these outages could have been avoided. On the positive side, key lessons have been learnt and business continuity lessons and disaster recovery plans are now well honed.

When in Ireland I was once challenged by a senior member of the team to spend a few months in the garden shed away from the team and the email. The meaning behind the comment was I was pushing at a speed that the team needed a rest from. I think I drop marks for not learning that lesson as well as I could have. We are going at a pace in LTHT that will tire the team out if I am not super careful in 2019 and therefore I do need to look around and be sure that the delivery ambition we have is met by the resource we can apply.

Culture Grade – B

Building the team I want to work in is always important to me in any leadership role that I have had. Putting in place weekly updates (Can you give me two minutes) and hitting these for 52 weeks in a row has been an important way to show the width of the team how we can act as one. The creation of the #LeedsDigitalWay and the associated goals, vision statement and key strategic plans have not been created in isolation by the senior management team but, following the ethos of the Leeds Way, these have been done through crowd sourcing and via the wonderful ‘Very Clear Ideas’ process.

I feel the team is engaged, not entirely, but better than many would be in the ideals of what we are here to deliver. That is largely because the LTHT culture, the Leeds Way, gives me a jump off point that I can simply add to, but this has to be seen as a great benefit.

The whole team has had the opportunity to come together four times in 2017/18 as a digital team of leaders in the digital health environment. The meeting is not mandated (nor will it ever be) and has seen a steady increase in numbers for each gathering. One of the best moments of the year was the morning after the third All Staff Meeting being stopped by another early riser member of staff to be told they had put the next meeting in the diary already and would be telling all their colleagues how important the meeting was for working in the team – superb, immediate and honest feedback.

It is often joked that only those ‘great places to work’ organisations get IT and Communications right all the time. We have tried to get the level of communications right but in a recent staff survey the team wished for more, so now we move to consider all the different styles of communications we have and how they impact upon the culture.

To me the Leeds Way is our culture and our values with a digital ‘sheen’ applied to it. We have come some way in 12 months but I can see the gaps that we need to improve on.

The reason for some of the ‘dropped marks’? We are going through organisational change and are desperately trying to get that right at every juncture, but we haven’t always been as successfully as I would like us to be. As soon as we create an open culture which we have done then we have to have the capacity to listen and act on opinions that are made clear to us, we are trying to get that right but we are not quite there yet, could do better may be the school report language best used here.

I think we have been able to pick up extra marks though for team development opportunities. In 2018, we were able to be part of content delivered by HIMSS, KLAS, HSJ, CHIME, Digital Health and BCS. We have opened opportunities for staff to apply for the Digital Academy, a hugely important leap for us, and had 10 interns join the team, many of whom have stayed on in some way. Exciting learning prospects for all of us continue to be available across the team and will remain a high priority for us in 2019.

Engagement Grade – B+

The awareness of the LTHT digital journey at a national and international level has doubled in the last 12 months. We have been successful in ensuring that when somebody wants to understand how to deliver an EHR in the NHS then Leeds is one of the top five places they think of. Being able to take part in the Arch Collaborative and achieve the Net Experience score that we did showed the engagement the large proportion of our clinical staff feel for the systems we have deployed.

Leeds’ success has been represented on three continents this year and is synonymous with clinical engagement, an open attitude to delivery, an inclusive ability to resourcing and a willingness to share. If I were to write my own obituary these would be words I would want to see and therefor I think the B+ is justified.

We have been able to bring leaders from across the health and social care system to Leeds to show them how the front line of digital health is really working and I would like to think that has impacted on policy in some small way.

The reason for the dropped marks is, despite the geographic location working for us (Leeds is after all the home of over 20% of the health informatics staff of the NHS), we have yet to truly make the most of Leeds the place. With so many organisations in Leeds that focus on digital health, our own position in that eco-system still needs to be eked out.

Innovation & Technology Grade – C-

Next year I have to focus more on this. We have so many ideas and so many amazing offers of help to make those ideas come to life but time and resource has run away with us too many times. We have been able to get the infrastructure for Single Sign On in place and the migration has largely gone well. Piloting the linking of devices to this infrastructure, not just the software side, is a remarkable feat I think.

I would have loved us to have our first implementation of cloud in place in 2018 but we are still a little way away from that. We have well formed plans for AI access to some specific solutions which I believe will be transformational, but again they will be early next year.

The speed of the systems we have and the reliability of the solutions they are hosted on has improved ten-fold, but user expectation outstrips our current capability to keep up. The work done to make the regional integration capability ‘bomb proof’ is outstanding but took us longer than we thought.

We know how we want to innovate and even who with, but in some cases we have come unstuck as we try to find ways to create relationships. For us, the way we have worked with Forward in 2018 has been a real test of how an NHS organisation can create a true partnership with a new innovative company and really build benefit. Being able to ‘gift’ the content of the Axe the Fax toolkit to Silver Buck for them to industrialise and make available to the wider NHS is another great example of an innovative approach with a new partner.

If ever there was a category with the immortal school report words, ‘must try harder’, it would be this area. I need to consider how to deploy more resource here to give us more chance at being truly ground breaking in this arena in 2019.

Collaboration Grade – C+

Achieving the Local Health and Care record Exemplar (LHCRE) status was clearly done only by collaboration across Yorkshire and Humber and was a big moment in 2018 for all of the team. Collaboration across the city area on the Leeds Care Record remains a highlight of the job and being able to represent Leeds as the platform with my fellow Proclaimer is something that enthuses me every time we get the opportunity to do it.

The dropped marks though here are because I know we have not played the part we should play in the West Yorkshire collaborative to the same degree. Something that next year I will prioritise is ensuring that the blueprinting work we do can be shared first and as a priority with colleagues across West Yorkshire. I know that we have the basis for a great relationship and one that will enable a better platform for patient care if we can find the right projects to collaborate on.

Summary Comments

In the school report it was those summary words that always cut to the chase the most, the form teacher comment on the future challenges for the student and the head of year views on focus for the coming year.

I think if these words were being written about me after this year they would go something like this:

A successful start to the new school. Needs to keep a closer eye on the detail and avoid getting distracted by some of the wider picture, even though it is important to still see this and bring it back to the ‘school’ – we need to have all of our own foundations in place before truly looking to help so many others on the journey. The class (the Digital and Informatics Team) needs the focus to be slightly more on them than it has been on some occasions in the year. The key challenge for the next year is to keep moving at the current pace but with the whole class on the same journey. This will be difficult to achieve with the expectations that have been set but is entirely doable with the skills available.

 

… and if that was the summary I would sleep well at night.

Arch Collaborative

First published as a KLAS blog after Leeds teaching Hospitals NHS Trust received the analysis of the Arch Collaborative. If anyone wants access to the full Arch Collaborative results from Leeds then feel free to get in touch, happy to share.

The Arch Collaborative exists to ensure that we understand what the users of our systems really think of them!

The technology industry is one of only two industries[1] that describe their customers as users. Launching the Arch Collaborative locally ensures that each healthcare system that takes part can move further and further away from that ill-gotten term, user to a new paradigm where we have valued customers with opinions that matter, perceptions we should act upon, and innovations that we would be foolish not to consider.

The first time that my organisation, NHS Leeds Teaching Hospitals Trust (LTHT), considered the Arch Collaborative was in early 2018. We regularly share ideas and concepts with two NHS Trusts: The University Hospital Southampton and the Salford Royal Foundation. Those Trusts had taken part in the survey and were clear that it was a great way to really understand the clinical views of the Electronic Health Record (EHR) and the way it is implemented.

My organisation has risen to the EHR challenge in a different way than many. 15 years ago, our organisation decided to begin building its own EHR. We released new functionality in subsequent years until it became clear in 2017 that the organization had evolved the solution to the point where it was a clinically developed EHR.

Taking on the Arch Collaborative survey felt like the next step in understanding the direction we should head. It could be the basis for a strategic road map.

Standing up on such a public stage was a big decision for an organisation that has invested so personally in the creation of an EHR. For us, this wouldn’t be a comment on the vendor implementation or the partner development of the training materials; this would be a comment on what we had built, what we had prioritised and what we had invested our time in.

There were no gimmicks, backing tracks, or staged production; the Arch Collaborative just asked for an evaluation of our raw digital ability.

By the time we agreed to get involved in the Arch Collaborative, there had been a number of departmental changes in our organisation. We brought together individual teams and elements in the hope that we could form a super group.

We were so nervous about what would happen next that a colleague compared this process to an audition for the a cappella singing team at university, but we were resolute to know how our voice fit into the digital health mix.

The Arch Collaborative involves getting the broadest clinical input possible to a series of questions about the functionality and implementation of the EHR solution within the organisation. The survey is quite in-depth and requires time and energy to work through. We asked one of our Chief Clinical Information Officers (CCIO) to take on the project. The CCIO worked with our digital engagement team to ensure that the survey terminology was anglicized and then to widely promote the survey. In the first week, over 400 members of the hospital team had completed the survey; by the time we closed the survey, over 980 members of the workforce[2] had completed it.

We were so proud that so many clinicians had come to our gig. We were not playing to an empty stadium—they had come to join in and sing about the EHR they used every day.

Our organisation uses the EHR for point-of-care delivery; over 19,000 unique users accessed the system in September of 2018. In the same month, there were over 74 million interactions with the system. An average nurse is now collecting over 100,000 data items a year!

When we consider the size of the audience that the Arch Collaborative response will reach, the throughput of the system feels huge. That comparison to the a cappella sing-off is more like the national sing-offs at the Kennedy Centre in the film Pitch Perfect.

When organisations and senior staff members look at the success of EHR implementations in the NHS, it is easy to focus on the traditional project management triumvirate of cost, time, and quality. That is understandable—these are important aspects of a large-scale procurement project.

But a lesson hard learned and seemingly relearned many times over in digital healthcare is that an EHR project is not just a procurement project. The Arch Collaborative was the perfect way for us to test the pitch and tone of our EHR.

We believe we have an approach worthy of blueprinting for reuse but not a specific system, although that is possible. We are more keen to consider the approach we have taken—an approach that includes the following: open standards; the concept of the geography as a platform for care rather than separate healthcare systems trying to interact and integrate; and the clinical focus we have placed in the prioritization of developments.

Each of these methods has been a major part of how we developed the #LeedsDigitalWay, and we believe it is worthy of blueprinting and digital implementation in healthcare across the world.

Ultimately the Arch Collaborative at LTHT would be a comment on the concept of the #LeedsDigitalWay as much as it would be about the actual EHR.

In discussions with KLAS about the decision to take part in the Arch Collaborative, they stressed that our taking part showed humility, a strong word that meant a great deal to us. Around the same time, a tweet from Damian Hughes (@LiquidThinker) resonated particularly with our reaction to the Arch Collaborative results:

Ego is often a roadblock to your development. Humility is a key to a new pathway.

Taking the ego out of delivery means that we can adapt and learn more quickly and ensure that the silos that so easily spring up between clinicians and digital leaders can be avoided.

The results from the Arch Collaborative are not for the faint of heart. They deliver a complex, true, and statistically sound message that will shine a very powerful light on the weaknesses of the work that you have done and specifically highlight the areas that you can change to improve your “Net EMR Experience score” with minimal effort. Unlike a HIMSS score, the Arch Collaborative is based not on what is in the “box” but how the box is used and the success of its functionality.

The headline score for Leeds Teaching Hospitals Trust was a 41% Net EMR Experience score. This is the macro score that sits front and centre on the report. The score ranges from -100% to +100% and is built up from the entire survey. We were pleased with our score.

60% of our staff members described themselves as “pleased with the experience” that the EHR offers, while 19% are frustrated daily. The detail of the Arch Collaborative report allows you to investigate how to improve each evaluated area as well as the headline figures.

By offering just four hours of training every year to every staff member that uses the EHR (that’s over 19,000 people, remember), we could improve our Net EMR Experience score by a further 10%.

That final statistic makes a digital leader in the NHS pause for thought; the cost-to-impact revenue on that 10% Net EMR Experience change is not insignificant, and the debate about where the cost sits would be a long one to resolve. Is it the digital team’s job to continue to deliver business changes? If the digital solution has been embedded in everyday life, should it be a cost of ownership?

35% of our team members that use the EHR daily would describe themselves as proficient in the use of the solution. That seemed immediately positive. However, 8% of our staff members indicated that they struggle every day.

The Arch Collaborative shines a light on what you need to do and the evolution that you need to inspire. Being on the receiving end of a complex statistical readout of your digital agenda enables you as a digital leader to take a breath, look around you, and consider how you move to the next stage.

Computer Weekly refers to the CIO role and its responsibility for the transformation of a system for driving business outcomes. It suggests that the CIO role is the “third leg of the stool” of modern “business” evolution, the other legs being marketing and sales. In healthcare, we are also in a modern evolution, made clear in the following quadruple aims:

  • Purpose
  • Productivity
  • Efficiency
  • Better health and better care

The Arch Collaborative provides an opportunity to focus on the aims of the quadruple claims, but it doesn’t provide the means.

The Collaborative is grounded in the quadruple aims by accident rather than by design, but it does expose how necessary EHR capabilities needs to be implemented with the aims in mind. The Collaborative does not pass judgement on the EHR, though—it offers the statistical vision of how to improve.

If we consider the Virginia Mason Institute improvement method that was based on the Toyota Production System management methodology, we can understand how to innovate and improve using the Arch Collaborative as a baseline measure and the evolutionary plans as the rapid-improvement plans.

To ensure that what we deliver is received better, we need to find a way to offer 19,000 extremely busy people a way to not do what they do for four hours of the year! (I picked those words carefully.)

We can offer the opportunity to do the training and learning relatively easily. It is a great deal more challenging to find four spare hours for each professional who needs to use the EHR to devote to the digital agenda. It feels like a budget issue at first; who is going to pay for this? However, it soon becomes clear that it is an organisational culture issue.

The statistics from the Arch Collaborative allow you to dive into perceptions from different parts of the clinical team. The definitions need a little work to map with NHS language, but they work well at a rough-order view. For LTHT, the Collaborative highlighted a difference that we already knew, but the existence of the analysis reinforces where to focus. Clinical roles placed the LTHT EHR in different percentiles of approval, and they map as follows:

  • All clinicians – 72nd percentile
  • Physicians – 41st percentile
  • Nurses – 63rd percentile
  • Allied Health Professionals – 59th percentile

The results also include sophisticated symptom analysis to distil some key phrases for us to work with:

  • Enhance initial EHR training and follow-up education to focus on supporting efficient clinician/speciality-specific workflows using personalization tools.
  • EHR personalisation tools for shortcuts, filters, and report views have the highest impact on satisfaction. The use of these tools should be a focus in initial training and follow-up education.
  • Timely, helpful support for clinicians’ EHR requests will improve the clinicians’ trust in leadership and the wider digital agenda. Trust will be further built as clinicians are solicited for their input into workflow designs and personalisation tools and as those enhancements are delivered as communicated.
  • Engaging clinicians in ongoing enhancement of the EHR will support a culture of teamwork at Leeds that will ensure that the group coalesces around the digital agenda.

This kind of commentary was very powerful for LTHT for two key reasons: first, it wasn’t particular commentary on missing functionality—it concentrated on additional ways for system use; second, it refocused on the engagement piece as an area for improvement. We took these statements as suggestions for how we can do better.

The distance we have to travel on the journey of improvement is not to be underestimated. KLAS and the Arch Collaborative may have hit on something important. If the rest of the NHS spent the time to consider their suggestions, the wealth of comparison data that would become available could bring about the change in attitude and aptitude that digital healthcare needs so badly. Southampton has completed their Arch Collaborative research, too.

The CIO in Southampton, Adrian Byrne, commented, “I think it’s hard to come up with a set of measures to get a good evaluation report. We want to have some things we change and refine and some things we keep the same, so we can measure improvement. I like the Arch Collaborative’s ability to measure across peers. That is its main benefit. We can measure improvement ourselves, but it’s all arbitrary. KLAS has a great record in research and tends to provide real insight.”

That is the key. The Arch Collaborative today, in its full glory, enables LTHT to build its strategic direction for the continued evolution of the EHR. As more NHS organisations take part in the survey, more souls are bared, and more agreement is reached for sharing the report’s details, then we will build a platform that can inspire the next phase in the NHS digital revolution where the stars align. We will ensure that digital healthcare is about collaboration between CIOs and digital leaders who lean into the challenge together.

My last comment is from many years ago:

Forgetfulness is in the learners’ souls because they will not use their memories… they will be hearers of many things and will have learned nothing; they will appear to be omniscient and will generally know nothing; they will be tiresome company, having the show of wisdom without the reality.

Socrates (5th Century BC)

Let us prove the genius wrong. Let us learn from each other by remembering the past and noting the opportunities of the future with a humility that allows us to continuously learn and collaborate. As David Amerland says;

Collaboration is the new competition!

 

 

[1] The illegal drug trade has used the term since the 1960s and yet the technology industry has remained the only other business to maintain this reference.

[2] 530 clinicians, 147 Advance practice clinicians, 153 nurses, 154 allied health professionals

Digital & Mental Health

I love technology and how it has transformed the way we live today; so sitting in a Matt Haig event last week in sunny Leeds I began to feel like an interloper, an enemy of the ‘people’, like at any moment I would be found out and the audience would rise up against me and swing me from ‘the wall’ very much Handmaid’s Tale-esque.

Matt’s opening comments were very much about the speed of life today and the impact it has on us all. There is no denying what the speed that not just digital brings but the speed of change more generally. We now witness fast paced change in the political scene, the way in which social media impacts upon us all, even the instant gratification of things like Uber, Amazon Prime and Deliveroo, the effect these have on our lives is unrealised day to day.

We spend very little time simply waiting for something without distraction. A friend, an avid Twitter poster, recently commented that he was on the family summer holiday and camping. There were queues everywhere and little mobile signal, so people were actually talking to each other, although the irony wasn’t lost on others, that he was still posting this on Twitter!

Mental health (or rather a lack of it) is the biggest killer of men under 50 years of age! We call the collective for illnesses in this pandemic ‘health’ even though this is a misnomer that we hide behind. People die through a lack of understanding, a lack of support, a lack of diagnosis; they don’t die because they have ‘mental health’, that’s what we need to strive for, we want people to be mentally healthy!

No one would think you should only get treatment for a physical illness if you’re on the point of death

The political mighty have taken it upon themselves to remove sugary drinks from most of the market place to attempt to remove the obesity issue threatening the kids of today. Yet what has the same intelligencer done about the support for the mental health of the same children? Very little yet! Anti-depressants are the fastest growing prescription drug in boys aged 11 to 14 in 2018, this figure floored me!

The pressure on the young of today outweighs anything anyone my age would have ever felt. Matt pointed out in his talk that when we were kids the need to fit in, the need to hide from the bully or even the annoying friendly chap, ceased to be there at four o’clock because we could go home and close our bedroom doors with only our parents and siblings to handle. Now the school and the peer groups’, friendly and unfriendly, follow children home. Social media brings us ever closer, so close that time away, time alone, is becoming the most treasured position. That unique opportunity we chased used to be connectivity and sharing, now it’s time unplugged and chance to breathe without so much connectivity a chance to just be.

When you interact with the next generation now how does it make you feel? What is the generation gap when it comes to mental health I wonder? A member of Matt’s audience asked about the definition and difference between nervousness and anxiety. He quickly compared the difference being the equivalent to hungry and starvation! For me nearing 45 years old, I thought that was quite an amazing way of considering the difference in how the younger generation will define the impacts on mental health – worlds apart. How many people under the age of 30 will exclaim that they are stressed, and how often will the ‘elderly statesman’ retort that they have nothing to be stressed about.

The way we consider mental health of people in the UK needs a fresh pair of eyes. We need to get to impacts and causes somehow.

My boss in Ireland used to talk eloquently about the health care system being a system of the sick not a health care system because it doesn’t do (isn’t able to do) prevention. The ‘shift left’ change to health care much talked up all over Europe now needs to be applied to the mental health of the people of the UK more than ever before. Matt gave a great example of Fiji in the mid-1990s, when they started to air US TV shows, ahead of doing this there were no eating disorders in Fiji. Anxiety was almost unheard of, but within five years, eating disorders grew to the ‘norms’ of the US and anxiety was at one point described as a pandemic. There are no official studies linking the two events, and as I have said already the world is changing at a high speed, but, it does make you pause for thought.

But there has to be hope, doesn’t there? When do we become aware of what makes us better? When do we apply that to the next generation of young people, harmed by the pressure the system applies to them to such a degree that society becomes malformed and somehow changes in how it treats the disease are never quite impactful. We have now accepted the term mental health as a phrase that is ok to use as an everyday description for a reason for school exclusion.

Matt asked the audience to ‘hear their own advice’, ‘it’s ok to be well one bit at a time’, ‘you can be a bit better’. We need a new acceptance, it’s ok to be at work with a cold, just don’t give it to me, and therefore it needs to be ok and supported to be at work or involved in activities with some mental health issues. How do we accept, understand and support mental health illness in the work place, in the school system, in the street in the same way as the common cold I wonder?

We have to do something, the speed of life isn’t going to slow down, I don’t want the speed of digital innovation to slow, which means it will continue to have an impact on our lives. I took another great little anecdote from Matt: digital and social is like ice cream! We can have a bit of what we love, and I love dearly chocolate and vanilla in the same bowl, but staying in bed on Saturday morning for four hours with a bath of chocolate and vanilla would not do any of us any good, the same goes for digital and social media I guess.

If we move our world forward just five years we need to be able to give ourselves some assurance that the digital world we create does good without causing harm. In my professional area we talk of patient centred design and portable data owned by the citizen but we also need to consider inclusivity and the bias associated to what digital brings. I am still excited for the future, our awareness is improving and I hope that this means we can get it right, evolve in a direction that is safe but also considerate of the wider impacts. Just maybe digital can be part of the cure not the problem.

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