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!
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 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;
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)!
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.
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.
Originally edited and published by www.digitalhealth.net reproduced here ahead of the Digital & Informatics Team at Leeds away day in July. Partnerships applies just as much to the team as it does to the age old ‘vendor’ relationship.
What do you need from the perfect dance partner? Someone with the same ear for a rhythm as you, someone that doesn’t tower over you, someone with strength and grace in awkward situations, someone who can stand up to a change in beat, or someone who will help when you miss a beat. All descriptions that a healthcare CIO needs to apply to building the perfect relationship with their commercial digital partners.
As an analogy does the search for the perfect ‘strictly’ partner help when picking the digital delivery partner, lets us look and see by considering the different ‘dances’ we have on offer:
Argentine Tango; is characterized by its hold embrace and complex leg and foot movements. It is an improvisational social dance that is truly a dance of leading and following.
Represented by a digital delivery partner that follows your every move no matter how complex the delivery is that you are trying to achieve. This type of partner, in the new agile environment of what is asked of digital in healthcare, needs to be able to improvise within a plan and deliver at a high speed, in a structured and planned manner. The risk with this kind of partner is that you as the digital leader either have to be leading the ‘dance’ at all times or if the partner wants to lead in this style of delivery they will be driving your organisation to their beat which comes with risk as your organisational goals and the digital benefits you are striving to achieve will have to be closely aligned to your partners throughout the relationship.
Ballroom Dancing; is a form of partnered dance that has pre-defined steps following strict tempo music, such as waltz, quickstep and foxtrot.
If your digital partner fits to this analogy then you have created a very structured but perhaps rigid partnership. Both you and your delivery partner know what is needed of you every step of the way; you are working closely on delivering against contractual elements that are clearly defined and well understood or at least a delivery plan that you have both worked hard on to ensure has wins for both parties included. The area of concern here would be the ability to react and work off plan together may take time. Creating the next steps in the new ways of working will not always meet the needs of a modern business change project, whilst that could be described as a failing the original plan will be delivered. This is ok if it is all that you need and therefore working in this way will be perfect for you both.
Contemporary dance; is not a specific dance form, but is a collection of methods and techniques developed from modern and post-modern dance
This style of partnership requires a true relationship to have been developed, one where a high level of trust has been put in place, after all you are about to embark on a journey that some will think is a little odd. Few digital delivery partnerships have been able to achieve the level of trust to work in this way, however if it can be put in place it will bring a surprising amount of success for both parties, a relationship that can be reaction driven and therefore drive an agile response to problems can be achieved through working in this way. The level of sceptism from the ‘audience’ though will be high for the success of the partnership and it is likely the partnership will be under constant observation from a governance point of view to test its validity as an ‘art form’. Conversations about delivery of digital in a post-modern world have been raised over the last couple of years a number of times, this way of working with partners perhaps is the way to see this come to a place where we, as digital leaders, can truly understand how this would work and indeed even what it means.
Jive; is a social dance that can be practiced to a broad range of popular music, making it highly versatile, which adds to its appeal. It is easy to learn and has simple footwork, making it accessible for beginners, but it is tricky to master.
Jive as an analogy for delivery partnership is perhaps best used for those quick partnerships that are only in place for the term of a single delivery focus. The partnership is easy enough to learn and create and is driven by the tempo of the delivery. No lasting commitment needs to be made to the partnership if all that is required is a successful and sharp delivery, but if this is to be maintained longer term and the pace of delivery kept up then a strict set of performance metrics need to be put in place to ensure the pace can be maintained longer term by both partners. A jive relationship will be tiring for all partners, a new level of contractual sustenance will need to be created to enable the relationship not to ‘flag’ as it gets tired of the pace.
Salsa; is in 4/4 time in two bar phrases with a pause on the 4th and 8th beats, which gives a quick-quick-slow rhythm. In classes a choreographed sequence is generally taught, but in practice it is an improvised dance.
Salsa can be described as a sales driven digital relationship. The initial excitement of the contract being signed and the new relationship created will give those early deliverables a focus; a shared impetus to deliver almost jive like, however without collective improvisation as the relationship matures the speed of delivery will slow down. This can be beneficial in creating quick wins and then moving to a more considered and managed relationship as long as the slowdown in delivery does not hit a stop. Improvisation of the relationship in after sales behaviour can ensure that this relationship continues to evolve and is successful.
Tap Dance; is an example of a non-partnered dance that is generally choreographed, with one or more participating dancers.
Going solo to deliver but in tandem with others is perhaps the best way to utilise this as a learning example. Maybe the Local Health and Care Record Exemplars (LHCRE) are a good example of five tap dances being performed around the country. Each of the cohorts will now be trying to create their own tap dance, the original choreography being provided by NHS England and the beat and shoes provided by NHS Digital and others. Each LHCRE cohort will be able to have an element of choice in the type of shoe and outfit they decide to wear but when the dance is the performance the music and choreography will have to be the same for the System of Systems approach to deliver across the country.
We need to be awake to the style of partner we are choosing for the dance, we need to be able to live with different ‘dance styles’ as part of our eco-system of partnerships as the same style will not work for each project nor each partner we choose. True success will come when we have picked the right partner for each type of dance we need to deliver and we know how to move seamlessly from style to style.
Grab your partners by the toe, let’s go do the Dozy Do, or as the legend that is Sir Bruce would say, Keep Dancing!
In 2001 AI was ‘just’ a Steven Spielberg film; in May 2018 it is being described by many as a solution too so many ills within the NHS.
On the 21st of May the Prime Minister provided the NHS with her view on the way Artificial Intelligence could revolutionise the delivery of care for patients with Cancer, Dementia, Diabetes and Heart Disease and by 2030 save 50,000 lives. Grand claims and grand plans and a new direction for government. One that focuses on a digital art of the possible although certainly to leap from paper records in vast wire cages and trolleys as an “ok” solution through to AI as an opportunity for the delivery of care is no mean feat, but a goal we can try to play our part in.
The following day Satya Nadella the Chief Executive Officer of Microsoft gathered CEOs and CIOs from digital business from across the UK to discuss what the team at Microsoft described as “Transformative AI”. The CEO used a quote by Mark Wesiser the prominent scientist of Xerox and the father of the term ubiquitous computing to open his presentation,
The most profound technologies are those that disappear. They weave themselves into the fabric of everyday life until they are indistinguishable from it.
This is where we want our EHR to get to!
The conversation continued to try to deliver the fundamentals in AI. Data is what feeds and teaches AI, it provides the fuel to grow to learn the what and the how.
Collecting more data therefore will educate AI more quickly; the next horizon is to make the nine billion micro-processors that are shipped every year become SMART devices. The micro-processor in your toaster, your alarm clock, your motion sensor light can become part of the data collection capability that will be responsible for our education of AI. The sheer growing size of data is something well documented, the creation of data will have reached a new horizon by 2020 and will look something like the figures below:
20 Billion SMART Devices will exist in the world
(8 bits to the byte, 1,024 bytes to the kilobyte, 1,024 kilobytes to the megabyte, 1,024 megabytes to the terabyte and 1,024 terabytes to the petabyte) The average mobile phone now has 128 gigabyte; the first man went to the moon on a computer that had less memory)
So much data to educate the AI of the world, the insights that could be gained are incredible.
The journey from what we know as an IT enabled world to a digital world sees the move from ubiquitous computing to Artificial Intelligence as a pervasive way of life and then on to a world where we live in a multi-sense and multi device experience.
The impact on the relationship between us and technology has evolved in how it is perceived; technology was ‘simply’ a tool, initially as AI evolved it worked for us as a subordinate and as AI evolves still further it will become more of a social peer in how we consider what it can offer us in healthcare. The most common Christmas present in the UK this year was one of the voice activated assistant, people all over the UK are now having chats with Alexa, Siri, Cortana or simply saying Hey Google to find out some fact that just alluded them or to ask for a simple task to be done.
The original concept of distributed computing (or cloud) gives us the ability to create the computer power and data storage that is needed to evolve AI capability. Distributed compute adds IT complexity, it is now our job to find ways to tame the complexity by ensuring consistency and a unification of experiences, this applies more to digital healthcare than any other ‘business’ as we try to utilise digital as a way to standardise the delivery of care as much as we possibly can.
The definition of Artificial Intelligence is said to have been first coined in 1956 in Dartmouth, the journey from this definition now includes the term Machine Learning first applied to algorithms that are trained with data to learn autonomously and more recently since 2010 the term deep learning, where systems are enabled to go off and simply learn beyond a set of specific parameters. The art of clinical practice, the need to have a human touch though is well understood in healthcare. This is why more and more AI in healthcare is referred to as an ability to augment the delivery of care, AI does not deliver a solution to offer less clinicians in the service, what it does is remove the need to have clinical time spent on anything other than patient care, AI offers the opportunity to increase the human touch. A further quote reinforces this in the book The Future Computed;
In a sense, artificial intelligence will be the ultimate tool because it will help us build all possible tools.
Eric Drexler author of Nanosystems: Molecular Machinery Manufacturing and Computation (1992)
The journey to AI in our world is getting quicker. The journey to AI being successful is best measured when the different components of it reach parity with us humans;
The road to an AI augmented world though is about amplifying human ingenuity; AI can help us with reasoning and allow us to learn and form conclusions from imperfect data. It can now help us with understanding; interpret meanings from data including text, voice and images. It can also now interact with us in seemingly natural ways learning how to offer emotionally intelligent responses. A Chat Bot launched in China now has millions of friends on across multiple social media channels, it has learnt to offer help to its ‘friends’ that are demonstrating symptoms of depression, phoning up friends to wish them good night and offering advice and guidance on sleep patterns but in a very human way.
Gartner have reported that the ‘business opportunity’ associated to AI in 2018 is now worth $1.2 trillion! Suddenly AI is the new Big Data which was the new Cloud Computing, which was the new mobile first. All of these terms have had hype but have all in reality brought a new digital pitch to our business strategies and our lives.
Great Ormond Street Hospital in partnership with UCL is leading the way in AI application into healthcare with several projects delivering startlingly real results.
Project Basecode: Transcribing speech in real time and utilising AI capability to add information to spoken word dictation capture.
Project Heartstone: A device for passing messages, verbal and video to patients of GOSH that may be too young to have their own Smart Phone, the device can be expanded to offer services to children who may be deaf or blind.
Project Fizzyo: Puts in place gamification to the delivery of breathing physiotherapy for children with Cystic Fibrosis and captures the information for the clinical record offering analysis as it goes.
Sensor Fusion: Creates perhaps the most immersive AI elements in healthcare today, recording events throughout the hospital, offering machine learning developed advice and data driven descriptions of events as they occur.
At Leeds Teaching Hospitals Trust we have created a platform in the form of our Electronic Health Record (EHR). With this platform we can now begin to consider how this clinical push for AI and the difference it can make to patients lives and the way we work can be achieved in a carful and considered way.
This digital revolution can make a real impact on Leeds; the patients, clinicians and staff enabling us to provide the care we want to provide following the Leeds Way principles with digital as a supportive backbone.
If you want to know more or have an idea as to how you could help in this area get in touch with us via @DITLeeds
First published in CIO Magazine, November 2017.
In 1797 George Washington instigated the first handover period for the presidency of the USA, he handed his responsibilities to John Adams. Since the 1960s a 72 to 78 day handover period has featured in every transition of the presidential role, and yet in almost all other public sector and civil servant role changes a handover period simply doesn’t happen, in all the CIO roles I have had I have never had the opportunity to conduct a proper handover one that means you hit the ground running, rather than running to catch up.
In a few days time I will leave Ireland for Leeds after three years working in a country with a passion for what digital can do for healthcare. When I resigned from my post my boss, the director general of the health service here in Ireland could see that there was a need to have a careful, considered and informed handover process to maintain the pace of change that we have been working to. In a break from what would have been the easy decision it was decided to look outside of the Office of the CIO for an interim person to hold onto the digital healthcare business and to receive a handover. Appointing a progressive, digital business leader to the role of interim CIO eight weeks before my departure has meant we have been able to work through a handover of the business, we have been able to agree priorities for 2018 and at this time in the Irish political calendar we have needed to agree how the budget for next year should be spent.
CIOs need to get better at succession planning, I would suggest one of the reasons we have not been seen to be great at this so far is that we have very much an individual stamp on the businesses we run as CIOs. Our styles and how we work with the ‘business’ to achieve digital goals is one of our core values, handing that to another is always difficult.
With an interim CIO appointed we began to plan the handover, we broke the content down into areas that would make the most impact the quickest, what this did was highlight a prioritisation process for the work of the team and the office.
There were five themed areas that we agreed would be our area of focus:
1 – Delivery of Person Centred Care
2 – Trust and the Protection of the health systems assets
3 – Value add services – Patient focused innovation and proving the digital capability.
4 – Create Insight and Intelligence through data that is already collected.
5 – Connect the Care Delivery Network
The digital strategy has been in place since 2015 and the delivery plan for this was agreed in 2016. This means the interim CIO can move into the continued delivery of this, however what does need to be refreshed is a new operating model for the Digital team, an operating model that reflects changes in how service is delivered and how engagement can be brought from a digital responsibility to an organisational scalable way of working. This now becomes a priority for the new CIO, not always ideal, making changes in the early stages of taking on a new role but a necessity to continue to enable the evolution of the team.
Being able to instigate a proper handover has given the organisation the opportunity to really consider the way the team works as one function. In a recent Gartner presentation the idea of four digital accelerators was raised and how these are now being applied to the future of team working. These areas are; Digital Dexterity; Talent, Diversity, Skills and Goals; Network Effect Technologies and the Industrialised Digital Platform. The handover process with these as core values as to where and what is done next has helped hugely as we strive to put in place a robust way forward that continues to drive a new pace to digital in healthcare.
The handover process has included not just a new ownership of the digital agenda but a new face of the change being brought to healthcare through digital. Therefore involving the new interim CIO in all engagement events has been part of the process and one that has seen the new CIO move into the public eye. The handover has also been delivered in the public domain using social media as the platform to enable the team and our partners to see the process and to meet the new CIO in a virtual way. The #HandoverCIO has been used as a way for stakeholders to see the activities that are underway. The culmination of the handover process was a meeting of all partners to an open interview with me and the new interim CIO, the design of the session was to make it part of one of the quarterly Eco-System meetings but also to ensure that the partners could see that they were going to be able to continue to evolve the relationship they have from a traditional vendor relationship to one that continues to be described as a partnership.
The transition from Bill Clinton to George W. Bush in 2001 was a fraught process best epitomized by the Clinton prank of the removal of all of the ‘W’ keys from keyboards throughout the Whitehouse. The transition from CIO to CIO often does end up with a lack of knowledge of where ‘the bodies are buried’, a phrase used when I came to Ireland in 2015. A colleague offered his services on my first day to help me avoid digging up the bodies that had been carefully hid. By working on a handover process and a proper transition there can be no ‘buried bodies’, no surprises and no need to re-learn what has gone before.
Handover has been great, but now its time to let go as the quote suggests below…
Make yourself available for advice if they want it, but only if they ask for it – don’t stand in the shadows trying to hang on to something you’ve decided to stop doing. Professor Graham Moon
Giving up your ‘baby’ is hard to do but as a CIO in transition to a new role it has to be done smoothly and the new CIO empowered. As handover comes to an end please support a new CIO with advice and guidance, Jane Carolan is a digital leader that is now a CIO, she is excited to be in the role and can’t wait to engage with the wider CIO community, tweet Jane @janemcarolan
A simple pair of Pink Socks can change your world! Pair by pair pink socks have become the new paradigm in connectedness for healthcare IT professionals all over the world. To have a pair from Nick Adkins that you can gift on enables you to become the Network Effect Technology!
My first pair arrived from the Netherlands, from Ignar Rip, a simple gift of a few pairs to pass on, to create a little enclave of Pink Socks for an Irish health care conference, in this case the socks represented more than a new connection for technology people, they represented an awareness of improving Dementia care globally, they also created me a new friend who loves a variety of music and believes in the transformation of health care.
Being able to pass the socks on at the Future Health summit to such giants of the industry like Andy Kinnear and Rachel Dunscombe was a great pleasure, seeing the founders of One Health Tech Ireland in the socks as they began to formulate the plans for creating diversity in our industry was also a great thrill.
In just three connections the socks were making more difference than Block Chain is yet to make on health care!
Next came the wonderful Roy Lilley and Shane Tickell at the first Irish HealthChat, live from sunny Dun Laoghaire, Pink Socks times three now made it on to live TV and still represented partnerships and friendships coming from working together. Over the last three years we have worked hard with team in Dun Laoghaire to try to ensure there are ways that an Irish company with an amazing idea can be supported by the Irish health care system that needs their amazing ideas. Pinks Socks in action for another reason!
Last but by no means least is the Pink Socks feature at Health Innovation week, a pair of the Pink Socks 2.0 gifted to every speaker at the main event ensured that they then featured in the whole week of events. It didn’t matter if you were the newest digital engagement expert from Samsung, the CEO of CHIME or the Minister for Health, in that week Pink Socks became the way to connect.
Nick finishes his recent TEDX in San Francisco by asking everyone in the audience to turn to someone they don’t know and with intent say, “I See You!” Three words that can make a connection.
So for me Pinks Socks is…
…a new connection, a new way of seeing people, not roles, not prejudices, not functions, not end game goals, but real people, who, if we truly make the connection we will be able to have help in everything we do.
I want to be seen because I want to help.
I loved that song, Bobby McFerrin 1988 when the world was a much simpler place. No matter what we do we have days when we are up and cope with anything and days when we are down and the world gets on top of us all. What are the tricks of the trade you use when you are struggling to ‘turn that frown upside down?’ In the world of social media so many people turn to the ‘hive-mind’ for support, what can seem like a random note to Facebook can actually be a cry for help, and so often they go un-responded to or worse become derided for seeking attention.
No matter what people tell you, words and ideas can change the world!
What makes us glum? I am returning from teaching at the Next Gen CIO school in Brussels, a great experience, one of the teachers was there to convince the next generation of CIOs that they really need to look after themselves an awful lot more if they are to have the energy they need to be truly great CIOs. He advised on diet, sleep patterns and ways to manage stressful situations, all clearly impactful in the health and wellbeing of what we do. What percentage of CIOs have stress symptoms I wonder, my guess its very high.
But tomorrow, the 10th of October, is world Mental Health day, I for one will be remembering a good friend, a friend that couldn’t get the help he needed at the time when he needed it the most. Despite being loved deeply by everyone around him stopping worrying and trying to be happy was no longer an option.
So on the day that you read this extra short blog post at some point give a friend a second glance and consider do you know how they are feeling, do they need a little more support, can you be, just a little bit nicer to them. Even better, consider a colleague, a member of your team, a manager, a leader and ask yourself could I do something today to show them that I care, because for some people that will be the giant leap they need to not worry and be happy.
After all it is the little things in life that make us smile, and smiling is infectious.
What’s right is what’s left if you do everything else wrong!
First published for KLAS research, republished here for completeness…
Liquid healthcare systems.
I was discussing a way to describe how eHealth can change the way in which hospitals deliver care recently with a learned colleague. He has come up with the phrase, the ‘Liquid Hospital’, which I have to say has grabbed my imagination completely. The concept of a Liquid Hospital is very much one not just supported by technology but actually made possible through technology and innovative ways of working. Its not that much of a stretch of the imagination to see it being possible but it will require a large amount of business managed change and can’t be made so ‘just’ through the implementation of technology. The thinking is starting to mature here and in November Ireland’s minister for health began to use the phrase a health system without boundaries, after all digital doesn’t recognise the ‘physical’ boundaries of a hospital or GP Practice.
Moving away from concepts of episode centric care will be a significant challenge for all considerations within any health care system worldwide. Let’s not forget even the concept of an Electronic Health Record (EHR) is based around recording the episodes of care that occur rather than around the patient. Breaking down the systemised walls for the provision of care will be key to the innovation that we describe here as the Liquid Hospital. Although as the concept evolves, we note a flaw in the name. The Liquid Hospital does not refer to one institution or hospital – the concept really is around the delivery of seamless care and wellbeing support to people (not just patients), however for the purposes of this article let’s stick with the name as a term.
The idea is quite simple really; once the patient is in hospital the technology allows the episodes of care that the patient requires to come to them, rather than the patient being shipped around the hospital for different treatments and the risks that come with that. In other words, the system becomes clinical centric. I know from a stay in hospital in 2016 that being moved from ward to treatment room and back again is at the least uncomfortable and at worst darn right scary. The concept doesn’t just stop there though. It does also propose to achieve that panacea of eHealth – a truly paperless environment, as not only do treatments flow around the patient, so does information.
Imagine an outpatient visit to a liquid hospital. You arrive in reception and check in with a clinician who takes your identification and confirms back to you some details to allow you to confirm to them the reason for your visit. As a patient you have elected to collect information on your condition at home so you quickly synchronise the smart device you have with the hospital systems. This shares your medication record and real time recordings of how your condition makes you feel.
As your consultant comes to you they are fed this information to their tablet computer and are analysing the outputs in the lift as they come to meet you in your own personalised consultation room. As the consultant comes into your room your records are shared on the display on the wall for both you and the consultant to consider. You have also elected to share the consultation output with your primary care professional and therefore the actions the two of you now collectively take are recorded and made available to them digitally and directly into their system ready for next time you the patient are with them.
You elect to have a procedure related to your long term condition. Whilst with your consultant you choose when and where that procedure will take place and you are electronically introduced to the clinician who will be your key point of contact when you return for the procedure. Your consultant is then able to provide advice on what you need to do before coming in to hospital for the procedure and download this advice to your smart device for you to consider with your family when you are home.
You also consider a slight change to your medication. The consultant is able to provide you with advice and guidance from around the world and connect you to patients like you with a similar condition via a secure social media outlet. This allows you to consider the impact of a change in medication with a peer group over the coming weeks and access some key support.
Your clinician can provide you with a new prescription directly to the pharmacist of your choice and you can call there on the way home knowing your drugs will be ready for you. A copy of your prescription and your summary notes are also made available to you for your own health record as you have elected to keep this information in your own health vault solution in addition to the electronic record in the hospital.
A few days later your long-term condition takes a turn for the worse and you decide to drop into the primary care centre, which is in your village. You ring the centre and are asked to provide the information you have collected over the last few days via your smart device, which you can do whilst you are on the phone. The primary care centre advises you to up the dose of medication ever so slightly and alter the time you are taking your prescription and within one day your illness settles down and you don’t need to go in to the centre.
The time of your procedure and your short stay in hospital draws ever nearer. Rather than have to attend the hospital for a pre-op meeting you have decided to share your own collected data with your key contact in the week leading up to your visit and have a brief video conference with the clinician. All is looking well and the clinician does not need to see you face to face. Although you are a little anxious, the hospital has arranged for you to be part of a secure group on a social media site and you are able to communicate with patients from around the world who have been through a similar experience, and this goes some way to settling your fears.
On the day of your attendance at hospital you check in comfortably with very little fuss. You are provided with a secure tablet PC that is linked to the hospital’s WiFi, and all of your notes and updates will be on this device during your stay so that you have the comfort of seeing them as well as them always being with you during your stay. It’s your choice throughout your stay as to who you additionally share the information with, electronically. You elect to send all information to your own personal record and some of the key facts to your primary care centre. You also decide to email your nearest and dearest a summary of each day to help them feel less worried about your time in the hospital’s care.
After the procedure you are out of hospital very quickly. Your after care is already arranged and as you hand back the hospital tablet computer with your information on you can already see it has arrived both in your own personal record and at the primary care centre.
The social care provision you require in the first few days is arranged on line and again, as the patient, you have decided what information to share and with who. The social care clinician visiting you at home asks if they can view your record in more detail and you grant them access there and then. The information they are able to get from this satisfies any initial concerns they had and they are able to discharge you within three visits.
How much of a stretch of the imagination do you feel this is?
The technology is there to facilitate this. It has been available the last five years at least if not longer. The big change is perhaps twofold; investment in the aspects of technology to drive this (including training and development) and the change in how care is delivered at a business and service level. Healthcare provision and change related to it is often compared to changing the direction of a sea bound oil tanker, but, if the description of this kind of benefit can be brought to a wider audience (and bought into) by clinician and patient alike maybe this could be an innovation we can make reality, its certainly describes a system that puts the patient at the centre and yet is only just beyond our own reach. A tangible view, just over the horizon of eHealth in action.
Some countries across Europe are starting to put in place the building blocks to enable this change: in Scotland, a change to the commissioning model, facilitating health boards across all care delivery to allow the holistic delivery of care and here in Ireland, the HSE’s own integrated care programme and reform programmes beginning the concepts of change, the creation of the Individual Health Identifier and concepts like ‘money follows the patient’ will all start to enable this dream to become reality.
Technology and a business change programme truly can break down the physical walls of the care institutions of the country and allow care to flow around the patient in a manner as transparent as H2O. Our 2020 vision sees health without walls made possible by digital.