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.
What does a soap factory, a hotel laundry, a cheese processing plant and a builder’s merchant have in common? They were all places that I learnt my ‘trade’, and somehow I became a CIO in the health service!
Yesterday was a great day for the digital team in Leeds, for the second year running the team interviewed for student placements for the summer. Six bright young things part way through their education in all things digital science came to meet the team and to work with us to decide if the digital team in Leeds is the right place to come and trial the skills they have been learning all year.
So over the next couple of weeks we will welcome; Daniel, Daniel, George, George, Alice and Reece to the team. A gang of Computer Sciences students who have a passion to do something good with their newly developed knowledge, to quench their thirst to try what they know in the ‘real world’! The exceptional thing that made me jump for joy though is that these 25ish year olds all wanted to be in Leeds for one key reason; they wanted to do good with the knowledge they have learned, they wanted to give back, the wanted to deliver return on the reputation that Leeds Teaching Hospitals Trust has built.
So much is written about the lack of faith that our future stars will have in the organisations they choose to work for and yet here I was faced with six stars of the future, all six of them looked ready to burst with enthusiasm. We delivered a presentation to them first, a bit of who we are and what we do, then another super star, Gareth Edwards one of our informatics nurses showed them what working here was going to be like. One of those age defining moments happened though as our amazing Informatics Nurse used a screen image of a computer game form the 80s and a computer game from now to show the difference in expectation that digital consumers have now. One of our candidates exclaimed; ‘My Dad used to play that game’, the sadness with a wry grin that swept over all of us in the room had to be seen to be believed as we realised just how fresh and ready for the challenge these new guys were going to be! But poor Gareth.
Much has been made of the Leeds Way, Davina Mcall has even explained it to Phil and Holly! When you see the Leeds Way ‘infecting’ new people into the organisation though is when you realise how well as a trust we have built this culture. After three hours with the team, in an assessment type scenario these guys were smiling, laughing and most importantly of all making amazing suggestions that we simply had not thought of. The assessment was a paper based affair, ‘think through how you would build the patient consent for surgery form?’ Remove the paper from the equation.
Now, lets just jump back a moment these are six students with no healthcare experience, the ideas they came up with, the references they were able to make to how people use technology, the way they really were appreciating the difference between digital transformation and IT really, truly blew my mind.
Thinking about colours, size of font, language, sensitivity about information recording, data protection, data ownership, access controls, the physicality of kit, the nature of the form; and most importantly the human nature of what was being considered. All came up in a 30 minute paired task!
So, we now have six new inductees into what we are and what we do; my promise is that their ‘summer job’ will not be like mine was; I won’t simply leave them to do the rubbish jobs, I will try to inspire them, I will try to send them back to their next year with a story to tell and if I can help influence a tiny little bit of the next generation of people who do what we do then crikey I am going to love this summer!
The #LeedsDigitalWay just started to create its next generation.
Originally published by DigitalHealth.net
Since the publication of Robert Wachter’s book in the spring of 2015, the idea of clinical engagement in all that is digital health has been pervasive. But before ‘the’ book and over the last decade at least, I have seen a plethora of different styles adopted for the role of what we now call Chief Clinical Information Officer (CCIO).
The styles that can be adopted by CCIOs clearly work in different ways to match the culture and needs of the organisation alongside the benefits these digital projects are trying to achieve. The organisation in which I am now working, Leeds Teaching Hospitals Trust, has some amazingly talented clinicians with significant interests in many aspects of digital. As a Trust we are about to embark on the expansion of the CCIO role, creating a clinical leadership team of three, with individual responsibilities for:
The three CCIO roles will now be supported by nominated and clearly identified staff throughout the clinical service units (CSUs). The clinicians across the CSUs will act as the focal point for engagement in each of the CSUs throughout the trust. Also the creation of the office of the CCIO across Leeds Teaching Hospitals Trust will ensure promotion of the CCIO role in a way that facilitates a real width of clinical engagement, not just at the trust itself, but across what is becoming more and more referred to as the ‘place’.
Clinical engagement in digital is like pasta. There are so many different ‘flavours’ and ‘types’ and picking the right one is dependent on the digital ‘dish’ you are creating around your system. Many pasta types have regional variations and some have different names in different languages, for example ‘rotelle’ is called a ‘ruote’ in Italy and ‘wagon wheels’ in the USA. Let’s take three types of pasta and see if we can make this analogy work for the CCIO role:
In the last few years the model for clinical engagement in the digital agenda has transformed hugely. I remember discussing how to ensure that the initial delivery of the National Programme for IT’s Summary Care Record needed to be clinically led and this was way back in 2006. The amazingly driven Dr. Gillian Braunold pushed every part of the technology team so hard, often to the point of distraction as the need for clinical engagement was so new to us. But more than a decade later her style and her ideas for how clinical engagement can be achieved are really coming to the forefront as examples of the best ways of working. The concept of complete clinical ownership from an early stage of any digital project was something she championed way back in the early 00s.
The clinical engagement in place for the Summary Care Record was not seen as a CCIO role, more the twine that held the whole programme together. Certainly as the first sites went live the programme would have failed in its initial goals if it weren’t for the clinical engagement that had taken place. Clinical engagement in this case had to focus not on the benefit to the clinician impacted, the GP, but on the patient benefit and the longevity of the record of care, beyond system verticals. Dr. Braunold, even as far back as 2006, was talking about the fabric of information needed to offer the best care for patients, regardless of clinical setting, which is perhaps our earliest example of a digital fabric being raised.
This type of clinical engagement is epitomised, I think, by Spaghetti, due to the long twines of connectivity. In many ways the way spaghetti also has popularised the ‘dish’ also draws comparisons to what Dr. Braunold did in those early days.
To deliver business change in healthcare we need to engage our customers and they need to co-define the art of the digitally possible. At a recent presentation one of my CCIOs in Leeds put a statement up on a slide that I fell in love with:
“Dear clinical teams, please come to us with problems not solutions, then we can help fix your problem together!”
Clinical engagement in an acute hospital can often fall into the 1+1 story. The engaged clinician completely agrees that a single source of truth for clinical information is necessary throughout the organisation as long as their specialist and favourite application is also to be accommodated. That’s why in 2014, in Ireland, the health system had over 3,000 applications and in Leeds today I have over 300.
This influences my next example, which to this day I think is a brilliant illustration of not just engagement but full scale leadership. In 2014, the Cork region of Ireland decided to push forward with digital referrals from GP to hospitals. This project not only needed clinical engagement but clinical leadership of a kind, to that point, not seen in Ireland when it came to digital.
Joyce Healey, a physiotherapist, volunteered to lead the project and took it from the germ of an idea to a fully functioning solution, initially embedded in GP systems and then on to the possibility of integration into hospital systems across the whole country. The strength of the clinical leadership though is what is important here. Joyce not only took on ownership of the clinical engagement but the leadership of the project itself. It was agreed not to have a national project manager in its earliest days as the lead clinician suggested that the best way to truly ensure the project remained clinically focused was to actually be at the ‘coal face’ of the project.
The work here then calls back to the pasta analogy in that the sheer pervasive nature of the CCIO work in this project made sure that clinical engagement drove success. Lasagne delivers the meat filling with a layered approach to holding the dish together, maybe this is the best example we can use here, holding a superb dish together through a structure that worked well and ensured that the core elements of the ‘dish’ arrived where they needed to.
The development of the CCIO function in Ireland followed a similar path to the eReferral project. A council of clinicians was created under Joyce and then added to with successive and successful CCIOs. The initial style of ensuring that clinical leadership was apparent in everything the team did and this became a key part of the way of working for digital across the whole country. By the end of 2017, there were over 300 CCIOs in Ireland. This number has been criticised in some quarters as the vast majority of them did not have ring fenced time to act in this role, but, the nature of the way they were appointed into the roles has seen them enabled in being local clinical leaders for all things digital and they have become powerful and enabled as an influential voice for the digital health transformation across the country. The large group now created, and the way in which they line up to offer their expertise and advice, also works well with the Rigatoni pasta analogy, the sheer volume needed to create the dish!
I wonder who is the most influential CCIO in the business today? Who is the most famous pasta dish? For me it has to be the person described as ‘THE’ digital nurse: Anne Cooper. I worked with Anne for a while in the National Programme for IT and saw her vision for what clinical leadership should be, her vision of ‘card carrying’ NHS professionals ensuring that large digital programmes were successful, flows way back to the early 2000s. What Anne embodies different to so many CCIOs though, is her ability to not just represent the clinical need for digital inspired change but also her ability to translate from digital to clinical to citizen and patient speak. The Cavatelli pasta dish is known by 27 names throughout the world, let’s face it digital health and care programmes have so many different names for the same benefits that we are trying to deliver that perhaps Anne’s style is easily analogous to this type of pasta.
There are so many clinicians in the digital leadership business today and so many CIOs that truly now believe in the CCIO role; not as a nice to have but as an intrinsic element to achieving success. Professor Joe McDonald in his role as chair of the national CCIO leaders’ network in the NHS posted to social media in the run up to Christmas;
“A CIO isn’t just for Christmas, also without a CCIO a CIO is like one hand clapping.”
This new way of thinking reflects the views of almost every CIO I have spoken to in health and care recently. We are asked to collaborate as digital leaders but without a CCIO we will struggle and probably fail. The new ways of working that CCIOs bring to the digital agenda ensure that we are no longer moving to the digital bleeding edge without at least a clinician on hand to patch us up!
The NHS Digital Academy that Rachel Dunscombe is leading the creation of fits to this analogy too. What Rachel and the team are doing is setting up the Master Chef and cooking school for CIOs and CCIOs throughout the NHS. It feels like at last the opportunity is there for us all to learn from every Gennaro Contaldo there is and begin to truly build little Jamie’s Italians throughout the NHS!
All power and ragu to the CIO CCIO relationship!
Becoming the new boy again is always a nerve wracking event isn’t it? Remember the first day at school, new faces, new places and new ways of working? I am in week three of being the new boy in Leeds and I have never joined anywhere that worked so hard to make you feel welcome and part of the team as much as Leeds does; and at a pace that is quite extraordinary.
Induction would send the fear of dread into many a health IT person. Fire safety, manual handling, corporate values and orientation… ’Just let me get to the job,’ most of us would be screaming inside, after all we came here to do this job, we don’t need persuading anymore. But not one single new staff member can start within the organisation without attending, therefore induction it is.
So the Monday morning comes around and just like the first day at school I have my best new tie, my new note book, my new pen and I am ready for anything. Coming back to what you know, Leeds, the city, means that one of my best friends is there to meet me for a coffee before the induction begins. But straight away it feels different. New colleagues come up to say hello and welcome, before the (what I thought would be scripted) induction even begins and straight away it made me, the new inductee, realise, hang on, this isn’t a scripted event, this is real people with real values, and actually, OMG, everyone really does care!
Entering a room with around 50 other new starters immediately creates something of a new collegiate group of professionals. We are in this together and in time to come we will remember starting on the same day. No matter what our role, the people in the room are connected to one new thing, the care of patients at Leeds and The Leeds Way.
A lesson in Leeds is the first part of induction: what is there to be proud of? Firstly you are already blown away by the sheer size of the hospital, and this is one of several sites. Then it turns out parts are over 250 years old. Remember the amazing work of Kate Granger. Personalising and making human the interaction with people who work in healthcare is also part of induction. Every one of the people on induction are using the ‘hello my name is…’ introduction line, instilling straight away the human nature of Leeds as an organisation.
The culture of the organisation is impressed upon a new person on day one. The brand of ‘#TheLeedsWay’ is distilled down to the key vision statements, not simply posters for all to see but real values that you quickly realise permeates everything that the team is here to do.
Leeds hospitals needs this team work, as the next realisation is just how busy the hospitals are. That week there had been between 550 to 600 discharges a day. If you didn’t realise before induction then it comes home quickly how important it is to every part of the organisation to be at the frontline of healthcare in the NHS, as Leeds is the centre for so many care initiatives, transplant scenarios and specialist care. As a new person working here you get the importance quickly of The Leeds Way and the Leeds Improvement Method in place across every job. Every ‘asset’ the trust has is asked to understand how to make the care journey of a patient a better experience.
Delivering care costs money, around £3m a day, and with over 1.5 million patients every year, you begin to build your own scale for the size and complexity of my new organisation.
Every induction group meets the CEO and gets to hear first-hand the vision for the future and understand how he believes every hand in the room is involved in building the Leeds Way. The leaders in the room also get to meet the Exec Team, truly making sure that the Exec Team is asked by every member of staff to model the values of the organisation.
I have worked in a number of health organisations over the last 20 years, yet never have I felt part of the team as quickly as I have at Leeds. The Leeds way of delivering induction means that I am a team member quickly and can help deliver the goals of the organisation as quickly as I possibly can.
Joining Leeds really does feel like joining a new way, #TheLeedsWay
The ladybird guide to explaining difficult things is something that as a parent I wish we all had a copy of, after all the word why and how are every three and six year olds favourite words!
In the last three months I have been involved in quite a few presentations. I was asked by manager to help him deliver a presentation as a ‘double-act’, a way to try to brighten up a message that doesn’t always excite everyone for some reason, the digitisation of healthcare!
Working in technology and healthcare at the same time means that we have twice the complexity, twice the TLAs (Three Letter Acronyms) and twice the very clever people to engage with.
Explaining complex messages to build engagement is all part of the job if we are to be successful digital professionals. This got me thinking what are the two most complex messages I need to explain; I think the ever-increasing size of data and the almost comical words the industry has adopted to describe these is one and the ever-increasing counting-horizon is another, but more on the second one later!
So, data sizes; what on earth is a Zettabyte other than something that is huge! Recently I heard data described using rice as an analogy, and at last I could begin, and I really do mean begin, to understand just how big, big-data was. Lets start at the beginning, if a BYTE of data is represented as a grain of rice then we can, loosely, get to a KILOBYTE being a cup of rice which in turn makes a MEGABYTE 8 bags of rice. To get us to the GIGABYTE then we would need three lorries full of rice! It just gets a little silly after this though, the exponential growth of data now starts being represented by 2 container ships equalling a TERABYTE the whole of Manhattan Island being a PETABYTE and the whole of the UK three times over being a EXABYTE. So back to the original question, a ZETTABYTE is the Pacific Ocean full of rice!
Whilst this is a loose story it puts a new perspective on a concept that has been perpetually hard to describe and understand, something that I now need to think of in every presentation I give, after all that question, ‘What is Genomic sequencing in two sentences please?’ is bound to happen soon and I don’t know the answer!
The second complex message comes back to what I have been heard called the counting-horizon. We now talk about millions and billions like we understand what they are, my son knows that soccer players are worth millions for some reason but doesn’t really understand the difference between that amount and the amount I pay for buying a packet of match attacks. Yet do we really understand that counting-horizon, there are six zeros in a million but what does that mean. Next time a football player is sold for 30 million I have a new trick to explain to my son what that ‘actually’ means.
There are a million seconds in 12 days! My sons favourite player is Messi, he is valued at $340 million or 4,080 days, which is older than my daughter!
There are a billion seconds in 31 years and a trillion seconds is 31,688 years, which almost becomes impossible to contemplate! The race is on for the first Trillion Dollar company but will they also have the longevity of their worth, I wonder, will Apple, Amazon and Alphabet be here in over 30,000 years from now!
One of the roles we have been talking about in the recent presentations is the role of story teller, good stories need good analogies, after all Captain Underpants, my sons latest bedtime read has been nearly banned in the USA for inciting disobedience in young adults, surely an analogy for the current political/media relationship over there!
Enjoy your ready in 60 seconds uncle Ben’s rice dinner!
Seven predictions of trends in eHealth in Ireland in 2017
At the end of 2016 Boston Children’s Hospital in the USA published a blog describing the seven predictions for digital health in 2017. A focus of eHealth in Ireland in 2017 will be digital solutions to support the care of children, be that preparation for an EHR for the National Childrens Hospital or the continued implementation of the Maternity and New-born system. Ireland has, in 2016, delivered on so much of the promise it made, with this in mind we wanted to consider the predictions by one of the world’s leading children’s hospitals and apply them to what we think can be achieved in Ireland in 2017. eHealth Ireland has set its sights on being able to apply these trends to what it delivers in 2017, fully supporting the ‘building a better health service’ agenda of the HSE with digital solutions.
1 – Telehealth adoption by patients
We have seen the adoption of telehealth in other jurisdictions begin to make a difference to how care can be delivered, colleagues in Scotland have been making a success of telehealth in outreach regions for the last five years or more. Whether it is driven by the health system, special interest vehicles or the patient themselves it doesn’t matter in Ireland. The creation and adoption of design principles relating to telehealth and the digital identification of patients and clinicians will aid adoption. Three examples of success in 2016 that can be built on spring to mind. The wonderful work of the Heartbeat Trust in the connectivity of GPs for consultations prior to and after heart surgery has begun to change the model of care on offer and all at a price that is affordable from a technology point of view. The delivery of patient portals is something that will be at the forefront of care in 2017 with the go live of a patient portal for epilepsy and the initial go live of a patient portal for the viewing of a persons own elements of a summary care record will enable Ireland to understand better the impact of this information on the delivery of care away from the more traditional care centres. The final example is an Irish company called Web Doctor, a company that has gone from status as a start-up to truly delivering a platform for primary care that is centred around the patient and is built with the patient in mind.
2 – Increased engagement with patients for telehealth solutions
Boston Children’s describes the second trend for 2017 as increased engagement, in the UK Roy Lilley wrote a blog at the turn of the year asking the NHS to ban the word engagement, suggesting that it is a word that should only be used to describe the meshing of gears or the sound you hear when a phone line is busy! Taking his principles and applying it to this trend though, in Ireland we will see the interest from patients in accessing leap forward through digital solutions. The ‘dawn’ of the wearable and quantified self has occurred already and yet only as we move to 2017 will patients really be able to start to use telehealth that they define themselves, that they are in control of themselves and that the benefit is targeted for them.
3 – Innovative visualisation devices hit the clinic
The adage that health in Ireland has a great deal of data, not so much information and struggles to gain timely insights from the what it collects has been pointed out a great many times over the last two years. At the innovation showcase in November a number of amazing new solutions that enable visualisation were demonstrated, no matter whether it was a holographic anatomy or virtual reality anxiety training this type of technology can and will be adopted where appropriate in 2017. The idea of training clinicians through the use of virtual and augmented reality has become something that the RCSI is pushing ahead with, it is an exciting prospect. The eHealth Ireland team is now in the process of implementing Microsoft Surface Hubs into a number of maternity hospitals, a piece of hardware built to enable visualisation and interaction of data in a whole different way.
4 – Clinical experience software
The piece from Boston’s Childrens describes how the interoperability of information, a move away from data messaging and a move to information integration will change the way in which the clinical experience is delivered. Certainly when Ireland considers the change in the experience now possible in Cork University Maternity Hospital, Ireland’s first digital hospital, I would have to agree. The ability to have information live with the clinical team regarding the care of the patient in front of them, the ability to collect critical information and apply it to the clinical record as it happens clearly makes a difference to the care experience. When lab test results can also be automatically added to the record and algorithms can flag issues to clinical staff that can be linked to information collected in real time then at last digital will be making a difference to the delivery of patient care.
5 – Maturing market for digital health start-ups
The IrishCentral.com site published a review of digital start-ups in Dublin in late December 2016. According to the site there are 775 Irish digital start-ups that have decided to locate in Dublin, funding in 2016 to these start-ups was in the region of 734 million euro! Out of the top ten funded companies six were digital health start-ups, those top six attracted 164.54 million euro of funding in the last year alone. The eHealth Ireland eco-system and the initiatives put in place by the team to support innovation being adopted into the health care system will, in 2017, continue to grow this market, concentrating first and foremost on the health of the nation but allowing eHealth Ireland to meet is secondary challenge, to be a catalyst for the wealth of the nation too.
6 – Expanded offerings from insurers and pharma
The difference in healthcare systems between Boston and Ireland is significant. The relationship between big pharma and public health care systems globally is not always a comfortable one and yet at the same time as the issues of drug costs need to be resolved we are now seeing the role of pharma in digital health changing. For example the work that Pfizer has done with eHealth Ireland in 2016 to create a digital solution to support the medicines reconciliation process from acute to primary care has been extremely successful, so much so that eHealth Ireland will look to implement the solution country wide in 2017. The insurance companies in Ireland have led the way in providing access to telehealth solutions, offering solutions like Web Doctor mentioned above and the ubiquitous Babylon Health solutions to customers, changing the access model for customers to one that is less demanding on the health care system itself.
7 – Personalised care through voice enabled devices
Homes are now asking Siri, Cortana and Alexa for help, search YouTube to the video of all three in a perpetual loop seeking assistance from each other for a feel for how the battle of the virtual assistance is going to take off, one of the funniest things I have seen all year. We really can imagine these services coming to health quickly, voice recognition and dictation is already a key part of any radiologists ways of working for example. When an EHR for Ireland is specified there will need to be an ability not just for the capture of text and images but also voice recordings, a giant leap into new unchartered territory that will need to be managed carefully from a security and governance point of view.
Its great to consider the trends of the future, there is a whole career out there now as a futurist for many commentators on eHealth and where it is going. The difference for eHealth Ireland in 2017 is that because of the foundations created in 2016 each of these seven trends feels that bit more achievable.
First published by the NDRC as part of the #HealthTech event in the summer of 2016.
Ireland is the most personally connected country in the world. Or at least I am starting to believe that from the evidence I have seen over the last 18 months. I have been told on so many occasions that what we have in Ireland is the first real example of a global village mentality and in particular for technologists. I have been involved in a number of different forums to support start-ups and big ideas for health technology in the last few months and really I do now believe in the concept of connectivity being one of Ireland’s biggest assets.
The Hollywood concept of “Six degrees of Kevin Bacon” seems to apply even more in the world of the health technology start up in Ireland. If you don’t know someone who knows someone now, you soon will do! The willingness to help, to get the idea off the ground and at least the ability to bring it into the healthcare system is there.
One of the most reinforcing moments of my 20 year career in health technology happened a couple of weekends ago at the launch of the NDRC Health Tech event. Eleven teams were formed on the Friday around some amazing ideas for how technology can improve the delivery of healthcare in Ireland. As well as the idea generators in the room there were a number of volunteers from across many different sectors there to help turn the ideas into a real proposal that can be taken forward to be considered by the health system. The level of knowledge and commitment in the room around a number of great ideas was simply huge. The possibilities for health range, from the ability to provide assistance for Parkinson sufferers to walk with confidence again to an app that allows a mental health patient to step into the centre of the care they are involved in, to a new way of processing lab results nearer the patient and they are just three of eleven amazing ideas. However the magic is as much to do with the people in the room as it is to do with the ideas. Seventy people in a ‘competition’ and yet every one of them rooting for each other, connected in a new way to deliver a support network for new technology based ideas to change the way in which health is delivered. Teams of people working hard to support each other over that first weekend regardless of background, basis of knowledge or years of experience, all these amazing people are now connected to each other in a new way.
Slowly but surely a revolution is happening! The social media response to the RTE programme ‘Keeping Ireland Alive’ has started to open up the concept that the Irish healthcare system is not the issue with the delivery of care to the people of Ireland. The Irish healthcare system is full of heroes and connections to be made to transform the way in which care can be delivered. Truly the system is one going through a digital revolution a change that is having an impact on so much of the way in which care is delivered. The second of the Keeping Ireland Alive programmes had a telling digital moment as a senior clinician opened the paper records of the patient in front of him and exclaimed, as usual I can’t read the notes. Realisation that Ireland is running its healthcare system in the same paper based way that it has for the last 30 years is giving a strong impetus to the digital health agenda within the Future of Health objectives, no bad thing for the great technology organisations of Ireland.
With the type of innovations and connections made by the start-ups at the NDRC Health Tech event the problem the clinician faces can be fixed, removing yet another issue from the delivery of healthcare in Ireland is the desire of so many committed people. The NDRC is just one of many environments now supporting Irish companies movement in the health technology arena; the Health Innovation Hub, Portershed in Galway, ARCH, Insight, Health XL and the HSE’s very own eHealth Connects programme are now all there to support organisations in finding the connection and turning the bright idea into reality.
All this human networked connectivity can really bring about a change to healthcare delivery if we can harness it in the right way. The rallying call for Ireland from here though is simply get involved and help build a better healthcare system.
First published in CIO Magazine in August 2016. A collaboration with Elaine Naughton in the writing and development of this idea, a huge thanks to Elaine for this.
In the excellent Steve Jobs biography by Walter Isaacson, he describes a discussion between Jobs and Steve Wozniak where Jobs is explaining to Woz that the role he plays in Apple is that of an orchestra’s conductor, here to get the best out of the team, to ensure that they play in harmony and deliver to the listener the most inventive and yet classically rich vision of the original design. This conversation is said to have taken place after a strong ‘debate’ just before the launch of the iMac itself, Woz described by Isaacson had just exclaimed to Jobs that he was neither designer nor engineer and therefore did not really warrant or justify the recognition he was getting as the ‘re-saviour’ of Apple.
Is the creativity of the conductor the real line to success in IT leadership? After all the ‘band plays on’, or at least tries to, whether there is a conductor or not. Even as early as 1998 Jobs was describing, I think, what the modern CIO now needs to be, although maybe we now need an evolved model from conductor to DJ or rock and roll front man.
Why does the analogy and the model need to evolve? Well, in times gone by, the IT leader would have sought out the best in class people he needed. Much like creating an orchestra of around 30 talented artists, the Leader had to be the best that the orchestra could afford and then the conductor had to make them fit into the team, not always an easy job. The ‘prima donna’ persona of the highest calibre technologists is not always easy to integrate into a high-performing team after all. This then, perhaps, is where the evolved model comes in.
The leader of a rock band enables the band to “jam” develops a structure and order to remain in time, and chooses a rift as well as creating a tune as they play. Maybe this roll can be best described as the start-up innovator of the music scene. A band always needs a front man – someone with a vision for the sound they want to achieve and the charisma and charm to wow an audience, the band may play on if the front man leaves, but rarely as successfully; what would U2 be without Bono? or the Rolling Stones without Jagger? Queen without Freddie? Perhaps the best real world example of the rock star digital leader is Larry Ellison of Oracle, truly a front man if ever there was one to be seen in digital leadership. The owner, founder, creator and beating heart of the Oracle empire, whilst no longer leader in name still very much the charismatic front man of the brand and indeed, band!
An orchestra, on the other hand, follows a very strict plan and each of the upwards of 30 members (over 50 for a symphonic orchestra) knows exactly what they need to play and when, whether it is solo or synchronised with their team (by virtue of the score). Only the conductor knows the full score and reads all lines simultaneously, knowing who to call on and who to bring in exactly when they are needed for the orchestra to continue playing in harmony and in time, and for soloists to have their moment to shine. A digital leader in the style of the conductor does just this. The danger here though, is if only they know the full picture, keeping everyone focussed takes a huge amount of energy and enthusiasm. Many public sector digital leaders are of this style (often by necessity) as the full picture is in reality always being altered and reconfigured a small amount by the political leaders and paymasters.
The conductor’s role is an art form and a talent, while being a very technical job. Take the conductor from this and time signatures slip, the musicians become discordant and eventually chaos ensues. Just as with Jobs and his temporary departure from Apple, as conductor of that orchestra he was never truly replaced and therefore for a time the music was not what the audience needed to hear. The creativity, in the sense of innovation of the music, belongs to the composer rather than the orchestra or conductor; with this in mind maybe we need to see the digital leader as composer and conductor more often!
A DJ, unlike the conductor or rock band front man, can take the best work of a much wider variety of stars, mould them together until they find the right mix and then play it for the audience. The DJ doesn’t have to integrate the full character of the artist just that moment of excellence where the beat fits or as the very wonderful NetFlix original puts it, ‘When the Get Down arrives’! A modern successful digital leader then is going to be a DJ! If we consider the ‘gig economy’ to be the future in digital then this kind of character and behaviour is likely to become even more prevalent when building successful teams. The magpie-type ability to bring all the best bits together for one moment of excellence that then can be repeated.
We believe the skills of a DJ are also key traits of a transformational leader: someone who motivates and energises their employees to get behind a transformation strategy, creates something that has been written about many times before, the creation of a fan base if you will!
The styles of these three analogies allow us to consider the nature of digital leadership. There is a mix of two key styles here, one is transactional the other transformational. The conductor is transactional, planning, organising and controlling. The DJ is transformational challenging and changing organisational culture, coaching and developing people, creating a climate of trust, establishing a long-term vision. The front man perhaps mixes both styles dependent on the need of the audience or band members, an ambidextrous style that is agile and responsive as startups require to be.
The analogy can continue in a number of ways beyond just the parts of the mix. A DJ brings with them the theme and the end point they are trying to get to, much like a high performing digital leader needs to, they start with the end in mind. Also, the DJ needs to be aware of the change in trends, evaluate them and consider how to adopt them into their fabric, so much learning of how this is done from both professions; I would love a temporary job swap!
The Jobs autobiography also describes the moment that Woz and Jobs first met from Woz’s point of view, “We first met in 1971 during my college years, while he was in high school. A friend said, ‘you should meet Steve Jobs, because he likes electronics and he also plays pranks,’ so he introduced us”
Jobs and Woz learnt they had so much in common, and yet were so different. The wonderful “Small Data” book by Martin Lindstrom references a Harvard Business Review article by de Swaan Arons, van den Driest and Weed called “The Ultimate Marketing Machine”. The article suggested that there are three types of people needed to make a marketing company successful, they are:
Think people – Who focus on data and analytics
Do people – Who have responsibility for content, design and production development
Feel people – Who are all about consumer engagement and interaction
I wonder if the modern digital organisation can apply this exact same logic as has been done here for the marketing team. The types of people the IT leader needs to bring together are defined less by their technology specialty and more by the person type they act when they are in a delivery focused team. Back to Jobs and the Apple empire, the success of the original swathe of ‘i’ products has always been put down to two elements, one, Jobs own meticulous eye for detail and two, the design standards of the team under Sir Jonathan Ive. If we overlay the commentary from the article in the Harvard Business Review referenced above and the conclusions that Lindstrom himself makes on this article we start to see that the way this team has been successful is by ‘minding the small things’ by being a team that is led by a digital orchestrator but exists as a team that can deliver empathy together, to the benefit that is trying to be attained.
A modern, successful leader needs to be a strategist, a “front-man (or woman)” AND be able to conduct a complex set of teams in a harmonious way – or at least empower capable section leaders (upper strings, lower strings, woodwind, brass, percussion) to do so on his or her behalf.
The theories of Lindstrom in Small Data will blow your mind, you regularly turn a page and laugh at the conclusion he has made and how it applies so completely not just to modern marketing ways of working but to how the right digital function needs to deliver. Whether as leaders we are badged as CIOs, CDOs, Conductors or DJs we don’t care, we just want to be able to make IT work.
…… as a post script we really do care! Two IT leaders were involved in the creation of this article, one of us wishes they had taken the path of enlightenment and become the superstar DJ of their dreams the other is progressing from playing second fiddle in a growing orchestra to becoming a conductor and leader of a great band.
When a member of staff offers to put you in a shed at the bottom of the garden for the next 12 months, what does it mean I wonder? So far my time in Ireland has taught me so many new phrases. Most hilarious was learning what being ‘put on the long finger’ meant, however today on the eve of our all staff meeting the concept of asking the leader of an organisation to go and hide in the shed at the bottom of the garden for a little while I thought was uniquely Irish, turns out its not. It’s perhaps a bit unique to the style of CIO I aspire to be.
The all staff meeting occurs twice a year. It has become traditional to try to pull together a blog post for each of these on the eve of the event that sets some of the tone or theme for the day, gives us something to reflect back on and adds a bit to the conversation as the day progresses. The theme for the staff event this time is quite simply ‘Delivery’. We have had ‘Transition’, ‘Transformation’ and ‘Connectivity’ and now we move on to the ‘pointy end’ – delivery as a theme!
Delivery style applies nicely to the concept of the leader of any organisation being put at the bottom of the garden for a little while it would seem. In just under two years the team has moved mountains, to completely re-structure a function and put in place a national focus that organisations like the World Health Organisation are giving Ireland credit for. The credit for making this happen goes to every member of the team though.
But, when the team offer a ‘deluxe shed’ for a few months to the leader it is time to stop and ask why. Strategy and delivery go hand in hand. A CIO needs to be able to do both simultaneously, Grand plans badly executed will not change the way healthcare is delivered in Ireland nor will rushing at a problem head long without a vision in mind. It is well documented and in the public domain the distance Ireland has to travel with digital health. It has become a little too easy to move quickly without always the consideration needed for keeping the whole team on the same path.
One of the key principles as we moved to transition and transformation of the team was ‘don’t break anything’. We haven’t, but maybe on some days it feels like we have come really close. We are currently operating a resourcing style probably best described as robbing Peter to pay Paul. Not ideal and maybe one of the reasons why a proportion of the team wish I was away in the garden shed for a short while. A further principle though when we started this journey was to keep delivering new things, not to go away with a long term plan that had no new early benefits to the delivery of health. That requires a balance of strategy and operational delivery that isn’t always there for technology teams in health but Ireland has been able to make this work better than I have seen anywhere else.
The most successful of teams are really hard to create. They certainly do not come together ready formed and need a plethora of different elements to make them work. Sport is littered with examples where teams do not equal the sum of their parts and the results simply are not there. Take the difference in commitment from this year’s soccer Euros. The most telling moment of sport TV for me over the summer was a comparison of the Ireland and England team getting off their team bus. The England team exit in ones, big Beats headphones on, no interaction, and no conversation just 12 super stars in perfect isolation. Cut to the Ireland team, talking to each other, gesturing at the stadium, practically hand in hand ready to meet the challenge. The team in white had one of the worst sporting performances ever and the team in green one of the best ever, in my view. Certainly as we head to the qualifiers for the World Cup I am hoping my adopted home allows me to be one of the #BIG rather than a miserable man in white.
The leaders of these two teams had very different sheds. England seemed to have a shed that was strongly built, just a small window and an appointment system to come in for a look with edicts passed under the door every couple of hours about what to do. The analogy for me of the Ireland shed was more of a gazebo, open access, everyone able to see what was happening, to share ideas and move the whole structure easily moved around.
The need to deliver is a pressure the team has to try to handle daily, and that pressure comes from an unwavering pride in what is being attempted. The team has embraced the concepts of the new operating model and is trying hard to make it work often in the face of some adverse conditions, but each small success moves us one notch further towards creating a digital solution that can tangibly make a difference to the way health care is delivered in Ireland. The need to keep delivering, to prove what eHealth Ireland can do, is with us all the time. No matter each success, the media will always find a story that does not play the positive element of digital health. Whether it’s the fact that the wider eHealth Ireland eco-system has sought guidance from an organisation that is globally recognised as a ‘digital-first’ organisation (and for writing about restaurants on that platform) or that eHealth Ireland has pushed hard to be part of the NHS CCIO/CIO councils, these elements do not serve the organisation well in the width of the Irish conscious and perceptions of what is being delivered. And yet they do serve the ability to deliver well!
Camaraderie has to be a big part of how the team works, and that can’t be forced to occur. We are trying lots of different ways to create small eco-systems of support. The amazing initiative from the team around eHealth Moments starts to really put new and exciting opportunities in place. A safe place where the team can share experiences, ask for support, get to know each other or simply understand the many projects and services that are delivered, all on one platform where staff are able to introduce themselves with this now world changing words…
Hello my name is…
I can’t wait to see the way this will bring the team together, and after all, as a digital organisation dispersed across the country, we should absolutely use the tools to hand to achieve improvements to the team culture.
Dare we ever try to emulate the three musketeers’ motto in eHealth Ireland I wonder? It is cheesy but a very good friend used to have it on his email signature, ‘All for one and one for all’. We are trying to get there. I know there will be some of the team who read this who are not sure if they really fit into this, and yet I am committed to get everyone in that shed with me, that’s the style of CIO I want to be!
Times continue to be exciting. An old boss of mine in the National Programme for IT was fond of saying to staff as she passed them in the corridor, she speed walked everywhere,
‘No one said it would be easy, everyone said it would be worth it.’
So rather than just putting the leadership (or worse just me, I need some help) in the shed at the bottom of the garden, who wants to join me, we can break the rules, change the rules and support each other in being committed to delivering, we can strive to keep the positivity and sometimes ignore the negativity.
First published to CIO.CO.UK
Just when you thought every conversation would be about Trump this summer someone decided to press a big button that didn’t say Brexit on it, it said ‘stick it to the man’ and very few people thought that meant leave Europe! Or certainly after the event that is what it feels like. As I have caught up with colleagues, friends and peers I have only found two people who are proud to have voted leave, admittedly one was resplendent in union jack cuff links and belt buckle so maybe shouldn’t count due to crimes against fashion! So much has been written from within the UK about what it could mean for this role we all love, the CIO role post Brexit will change, we have no doubt about that. I am no longer living or working in the UK, whilst only 50 minutes with Ryanair away Ireland is very much a different country, and I love it for that.
The morning of the 24th of June will be one that the modern CIO will remember for years and years to come. It has become the where were you moment of the ‘teenies’, so many people describe the story of turning to their partner and saying, crikey it happened, we are leaving Europe and the look and squeak of complete and utter astonishment from the other person whose twitter feed hadn’t woken them up first. I wonder if Boris and Farage were as shocked as the rest of the globe was.
The google search for how to get an Irish passport over that day is said to have been the most common search in Dublin and then the need to continue the conversation with digital leaders throughout Dublin really began to happen. It has now become the conversation at every meeting of CIOs and IT professionals in this bustling digital city and not having an opinion or a new piece of gossip about the impact is simply not allowed!
The good it will do for Dublin in the short to medium term seems to be huge as more and more companies are said to be looking to have a location in the city, after all it is English speaking, in the EU and with the Euro, not to mention the amazing digital eco-system that has sprung up already. But will it be for the good of the wider Ireland? My own opinion is possibly not; there is a huge risk that Dublin becomes more and more like the London of Harry Enfield’s imagination, where Dublin is the place ‘with’ and much of Ireland becomes the place of aspirations, and that I think could be an Irish outcome of Brexit without very carefully national leadership.
The immediate impact on a CIO delivering digital solutions to health in Ireland has been significant. For example data sharing agreements for the island of Ireland will need to be looked at from a different point of view once article 50 is triggered. The delivery of health care if you are a patient living on the boarder suddenly could be a very different prospect for a non-EU Northern Ireland. The technology to support this will need to have a very different plan to that being considered pre-Brexit.
The 8th of June saw the Republic of Ireland announce an EU member state first, a Health Cloud First policy. Brexit now will mean that a wider consideration of where data goes from a disaster recovery point of view needs to be had, if data is leaving the EU what does that mean and what will the UK data agreements be with a USA. More open and free movement of data between Uncle Sam and the May state is quite a scary prospect to manage with the privacy concerned of Ireland. Certainly a Brexiting UK with May at the helm is already building up a worrying record of a willingness to downgrade digital privacy considerations.
The advisory and consultancy firms that Ireland’s health sector has been working with as it moves towards its full Electronic Health Record programme moved from conversations about NHS expertise and knowledge to different countries overnight, suddenly Canadian knowledge and experience is de rigueur amongst the partners seeking to impress the eHealth Ireland function. Why though, is it because an NHS post Brexit would be less willing to share or simply because the sheer amount of work to now do in the NHS will be simply too big to offer up guidance to Ireland. Personally I don’t believe it is anything to do with the NHS really and more to do with the large consultancy firms trying to stop the conversation being ‘just’ about Brexit and wanting it to remain on topic.
The Brexit promise to the NHS of 350 million a week more in funding was withdrawn by the morning of the vote, the NHS is heading to a deficit that is eye watering and will impact upon the priorities of a minister for health who never really jumped one way or the other when it came to Brexit. In Ireland we have a minister who is insisting that the country needs a ten year plan, or at least a five year plan to reform the health system. The optimism in health in Ireland in a post Brexit world is quite significant, the number of Irish citizens working for the NHS is huge and Brexit just became another leaver to try to persuade them to return home. Around 5,000 of the health staff of Ireland are English though, the thought of not being able to do the job here in Ireland is a nightmare scenario but one that now needs to be on the risk register.
The one thing that as a CIO with a penchant for social media I did come to realise more and more during the run up to Brexit was the concept of a the social media influence bubble. So few people ever seemed to be talking about voting to leave and yet somebody somewhere clearly did make that choice. The dawning thought as social media became awash with despair was that the influence that the social media format has on you is way more to do with the bubble that you are in than a truly independent view of the world. A great many have complained they simply couldn’t get good media facts and knowledge to build up an opinion; maybe there is something in the fact that we are now using social media as a news outlet that hugely influenced that. Brexiters were compared somewhat to an extreme political view, racist with lack of global view. And yet in a post Brexit world clearly that simply cannot be true!
A recent Irish Times article rather tongue in cheek suggested a coming together of Scotland, Ireland and Northern Ireland as an EU state. Whilst done in a mischievous way it grew legs and in less than 24 hours people were discussing this as if it were a real possibility. The desperation to find a way to maintain some of the status quo in the digital world we are trying to live within is having a huge impact on what we think of as the art of the possible. The conversation now needs to shift, away from desperate plans like the ‘Scotireland’ and move towards what needs to be done to make each of our areas of concern work in a new world. Every EU state now needs to have a digital consideration of Brexit and build policy and solutions on how to make this work, the EU of a shared digital future has changed forever and each one of us now has a part to play in understanding what it will look like next.
As something of a post script to this piece, there is a town in county Tipperary called Twomileborris, the name Borris is generally thought to be a Norman word for stronghold or district, maybe, just maybe the work of Boris to deliver a Brexited UK could end up creating an even stronger digital stronghold for Dublin, and with the right considerations and policies the whole of Ireland, certainly the opportunity seems to be stronger than the threat. I had three adoption offers and the passport application process explained to me in detail within 24 hours of Brexit, I hope that means I am going to be in Ireland for some time to come, but I really do hope that the CIO fraternity of the UK can make Brexit work for digital, the whole of the EU still needs it to, in or out!