All posts tagged Clinical Research Network

C this Vs C that!

Recently at the IT Service Management 2014 conference I got into a debate via social media about the need for a Chief Digital Officer. The presentation was on cloud computing and service management and the presenter suggested that an organisation going down a cloud route ought to have a C suite person responsible for data.

I challenged this with the comment that if an organisation has a Chief Information Officer then they already have this in place! A little cheeky really as I guess I would protect the role of CIO, but the rise of Chief type roles relating to technology will at some point be unearthed as a cash cow for the IT executive. In some respects maybe we ought to come out now and be honest that at the executive level, if we can have one role responsible for technology generally then that is a great achievement and a leap forward in the last five years.

Chief Technology Officer, Chief Digital Officer, Chief Innovation Officer, Chief Information Security Officer, can we roll all of these into the CIO role? Surely this is just begging for the ‘too many chiefs and not enough Indians’ phrase to be used by someone. Even at the Information Security Forum Congress there was a whole workstream on ‘will the CISO be the new CIO?’. It seems everyone wants the CIO role to become something else.

Organisations want to place the release of benefits from technology at the centre of what is being delivered. I believe that the CIO is the right role to do this. Information is surely the most important phrase out of all the chief related roles, after all we don’t just want to collect date, we want to change data into information and put it too good use, and with that in mind surely the CIO is the role at the top of the technology chief-doms?

We have been using phrases centred on the collection of data to create insight for a couple of years now. Hearing it echoed back by some of the most senior people in our organisation makes me think that we have got the message right. The fact that our information is credited by our CEO as being our second most important asset tells me that the role of information is more solid in its foundations and we have matured from the need for a Chief Data Officer as we have a collective responsibility for information through a single point of responsibility at the top table.

The elaboration that the information strategy had to go through to reach the point where the organisation consistently considered information over data was quite a journey.

For us this journey started with creation of the Information Strategy in mid-2011. At the very core of the strategy we pinned our designs on a transformation where the systems that collect and manipulate the data are considered separate to the information the organisation lists as an asset. This separation would allow the organisation to have a clearer understanding and view of the value of its information rather than considering everything to be technology, wires and tin.

The team that volunteered for the delivery of technology across the organisation were the key authors for this strategy. However to ensure that the transformation from data as part of technology to information that delivers insight required the team to work at the core business end of the organisation. This would require far more understanding than had been seen before from a technology team, suddenly empathy became a skill for a technologist to have.

The engagement of research teams and executives from many speciality areas was actioned on the basis that they would ultimately then be able to influence the deliverables that ensured the implementation of the strategy.

So now several years later we are coming to the end of what the strategy prescribed, and as I said earlier we now hear the most senior parts of our organisation echoing back the information that delivers insight phrase rather than data collection. However we need to maintain this attitude, once there it doesn’t simply exist because it has been achieved.

So our organisation is sticking with the concept of one C suite role responsible for the delivery of business change and benefit through technology. The role will remain strategic in focus and be the voice at the board that is responsible for making the most from technology, but, they will be responsible for the data, its security and the innovation it brings as well.

Service management in 2030, an event horizon!

In preparation for presenting at this years ITSM14 I started to think about the future of service management. In 2030 we can guarantee the world will be very different and service management will have reacted to the changes, adapted, grown and evolved to be something incomparable to the service management we live and breath today. Service management has reached an event horizon moment, the point of no return where organisations at last believe in the benefit of the service management team and the process and would not consider trying to deliver their business without it.

ITSM14 asked me to gaze into my crystal ball and try to have a conversation about what service management would look like in 2030, rather than resort to the magic of a crystal ball I took to Siri and Google and the wealth of expertise that is out there to try to form a story.

One of the areas we have tried to impact upon within my organisation is to try to improve the understanding of service management and attempt to move it away from being always seen as an IT need and function. The concept of the service desk is perhaps the most prominent element of the service management discipline. So using the service desk as the hook for the organisation we are trying to push forward an understanding of what a service desk can do as a single point of contact for the organisation rather than as a help desk for IT. What will the service desk look like in 2030, we would want it to be the single way that anyone gets access to the organisation, but managing to deliver that in a world where concepts like the internet of things and the way in which technology has been consumerised will impact upon how the desk provides its service. A service desk that is always on and can react to any user will be a requirement of 2030, understanding who the consumer is will be more to do with if they are in contact then they must be a consumer of services rather than trying to validate every connection.

How will we provide service management for the Hoverboard? Seventeen years ago the director of Back to the Future announced that the Hoverboard would be on sale that Christmas, he was joking! But as we get 6 weeks away from Christmas 2014 the Hoverboard will be on sale and the concept of how to support it must be giving the development company a headache. You couldn’t really have a call centre with an IVR if you were on the board!

What will service processes look like when change happens at the user level every moment of every day? We see now Google releasing four releases a day of some of the applications, our organisation is using these applications and is not impacted by this! The service process to manage that kind of change is huge if the service processes of yesteryear were applied, and yet already we see an organisation like Google cutting a new cloth for the future of service management, real time reactions to issues and the mobilization and close down of rapid support and development projects like never before seen.

Successful service management in 2030 will require us to remove the concept of users, maybe even the concept of customers – service management needs fans! And, as we define who those fans are we can start to use the same ideals to create the best profile for the service management professional, what character traits make up the best Service Delivery Manager compared to the Problem Manager. In 2030 you can imagine the change in these characters, but, by analyzing, watching and listening the team structures can evolve around the consumer and continue to create a fan base.

Change process to manage change – If Service Management is here to support more being done faster, seamless and instant access to systems what will that look like. Not just the commoditization of IT but also a ‘Digital Deluge’, when the number of devices outweighs the population 6 to 1 (A real prediction for some countries) then service delivery will need to accept the levels of control it can perhaps have need to be different and that education of the business will perhaps be the most cost effective way to protect the business.

All in all 2030 service management will be exciting that is for sure, and the event horizon has passed, there is no going back. I believe the key is to keep watching, allow service to evolve quickly and maintain core concepts throughout.

Internet of many things, research on the go…

The race for the truly smart home is on, when your fridge can create your shopping list on your phone. It can add to that list as your friend takes the last cold beer, advising you which supermarket to call at on the way home from work to pick up the best value replacement! Then the Internet of Things has become truly valuable.

This isn’t science fiction, this is here now, the Palo Alto company Nest Labs are now making the API behind this and other smart home solutions available ranging from kitchen appliances to the smoke detector and thermostat.

As your home starts to build an IQ what will the impact be on clinical research? I have been wearing the Jawbone Up since February, researching my own sleep versus activity and trying to hit the magic goal at least five in every seven days. The correlation between sleep and activity is clear, however I guess I didn’t need the Up to tell me that if I did lots then I needed more sleep! What is interesting is how that data can be added to with information about location and food consumed, the ease of keeping a food diary to understand the impact on sleep is now there and I now know to avoid cheese for a good nights sleep and that if I am away from home I can expect no more than four and a half hours sleep on the first night.

In a recent Gartner study it was reported that by 2020 there would be 30 billion connected devices worldwide. An IDC report indicates that there will be 212 billion ‘things’ connected to the Internet by 2020! McKinsey have been looking at the value that the size of this market could bring to the global economy, they have a suggested value today of $2.7 trillion against the market place that they define as the Internet of Things, by 2025 they suggest that this could grow to $6.2 trillion. All of these numbers make me shudder though, they seem to be equal in their impenetrable hugeness in a way to some of the big data numbers are.

Then you ‘throw in’ the iWatch in 2015, if it becomes as ubiquitous as the iPhone then many millions of people globally will be recording all manner of health information every day and perhaps making it available without the difficulties of consent to organisations that Apple believe are appropriate to be delivering research.

Tele-Health, eHealth, Tele-Medicine, terms that have been used interchangeably for years without a real leap forward in the beneficial impact they can make on the provision of health care. However as the Internet of Things truly takes hold these terms do come into their own and at last begin to put in place the building blocks to release benefits.

The concept of the Internet of Things breaks down an equally powerful social concept of the Digital Divide particularly for health and clinical research. After all ‘things’ is used as a definition largely to demonstrate how ubiquitous the internet will be, the digitisation and therefore connection of so much ‘stuff’ reducing if not removing the much maligned divide. As the next generation (and what will we go to after generation ‘Z’ I wonder?) takes to the digital world and the next generation of researchers and clinicians become qualified we will truly see an empowered citizen world wide.

Earlier this year I got involved in the creation of a piece of work called ‘The last train to Data-Topia’. In this we described a world in 2030 where research and health care went hand in hand. As the ‘Internet of Things’ moves from being part of the catch phrases of the famous consultancy firms and becomes more related to the reality of what can be done with technology the impact on clinical research can truly begin to be explored, not as science fiction, but as a reality.

eHealth and an easier path to clinical research really has become a possibility if the right ‘Things’ can act as the catalyst needed!

Solutions take second place to the story…

A headline caught my eye in a magazine in a hotel bar in Brussels, ‘ Solutions take second place to the story…’

This headline prompted me and another person from the UK to reach for the magazine and want to read further. This story is about both the application of the concept in the magazine title and what happened next between me and the gentleman, whom it turned out, was leading a mobile revolution in the delivery of applications to recipients of care across Western Europe.

The article was about a ‘start up’ film making team, or at least ’start up’ in concept back in 2007. Wong Fu are a group of film makers concentrating on their fans – people who love You Tube, love the short skits and the higher-than-average production quality feature films that they put out for free. Fans that don’t care about the product placement and lap-up the merchandising they now create. The success of Wong Fu has led to a company that the President of the United States of America put on his must meet list in 2011 and who now have over two million followers within social media.

So, how did this get two IT geeks in a bar in Brussels talking? Two things, the headline and the concept! I guess I am susceptible to anything where it talks about creating fans – it is becoming one of my watch phrases for 2014! In this case a small team of creative genius have allowed elements into their delivery that would sometimes turn off the purist, and yet unusually, this resonates well with their audience. In our organisation we have the Open Data Platform, and one of the reasons we landed on this different name was we didn’t want to be seen to openly promote one supplier of Business Intelligence tools over another, and yet we now find ourselves with Qlik and Google in product placement wonderland. I wanted to understand how Wong Fu had been able to drop into this place without harming the reputation they were building, and what was odd as I started up a conversation in the bar, so did the other reader of the same article.

We never worried that we were promoting Microsoft when we pushed out reports and statistics via Excel on SharePoint. That was the opening part to our conversation, and yet now we have invested in tools that are not Microsoft we tie ourselves in knots avoiding mentioning the systems that deliver for us. My peer for the evening went on to say that his product has the same issues. It is a recognisable household name making huge headway in Europe delivering mobile solutions for health, and yet the most common question he gets from customers is how to ‘de-brand’ the solution he offers.

Fans of our Open Data Platform often don’t understand the involvement of Qlik in its delivery, and that’s on purpose. We have gone some way to ensuring that the average customer of the tool doesn’t need to see the Qlik front end. In getting ready for the go-live of our new portfolio management system we are in conversations as to what degree the supplier will be branded on the system. And yet in this article we have Wong Fu making a success of product placement, making it acceptable, maybe even making it cool to place the product at the front of the solution or in their case the entertainment. The question in some ways then is, are we wasting our time? Maybe we don’t need to ‘hide’ the suppliers of our systems and badge them as our own, particularly when we are trying to get across the message that our strategy in the next five years is to procure off the shelf solutions far more than the bespoke solutions we have currently fallen for.

However back to the bar in Brussels … My fellow healthcare IT person asked an odd question during the debate about this subject, ‘how come in IT we strive to hide the brand, and yet many of our ‘dress down’ techies will have a name, be it band, film, comic or fashion house, on probably every item of clothing they wear. What makes what we wear so different in our minds to the IT we will deploy? I agreed that his point was valid, but, the individual with the brand emblazoned across the hoodie is buying into the culture or concept that the name offers, whereas an organisation is often of many minds and won’t want to dive for one representation of culture without significant care and consideration for the name they are getting in to bed with. I still agree with this in the cold light of day, but I really don’t know why we behave like this. If we want fans of the system, and we truly are building a strategy around this, then being clear what the product is maybe a way to create that culture.

The systems we deploy do now tell a story, one that shows the evolution of the industries attitude to IT. The legacy estate tends to be from the large, brand emblazoned across every screen solution type, the new innovations tend to be a little more about the product placement being inherent to the colours used or the look and feel of the product, to me a much better product placement solution.

We recently moved a great deal of our collaboration infrastructure to the Google platform, a decision that goes hand in hand with agreeing to product placement, but however large the clinical research capability in the UK is it is not going to get away with ‘de-branding’ a Google solution. So, we embraced it, we ran engagement days called G-Day, we sought out the Google promotional products and used them on the day to get the message across the organisation, and it really worked very well.

So the fear of product placement in the implementation of Information Systems is diminishing, that helps IT leaders move to a strategy where off the shelf products become a possibility and creating fans out of users is a reality.

There we were, still in the bar in Brussels as we came to this conclusion, two healthcare IT geeks wanting to change the world by learning from a film company in the US, maybe there is hope for us yet!


Reacting to the challenges of data analytics in research

Every modern healthcare system professes to use and need data analytics to provide care for patients. The acceptance and use of data and tools to support this is different dependent on geography and culture. Conversations with healthcare providers in Russia, Europe and the US in recent months have enabled a magnifying glass to be applied to these differences. What these differences reveal is that there could be a model that breaks down the known issues relating to healthcare provision through ‘magnificent use’ of information and that this can be learnt through an understanding of geographic or cultural differences to enable a data rich healthcare system based on access to information that delivers insight.

The promise of data to support healthcare and clinical research is here. The European Commission believes that the mobile health market alone will reach a value of $6.9 billion by 2017. Imagine the data and the controls required to manage a market that buoyant. Also consider the data asset that the penetration of technology will bring and the disruptive improvement to healthcare.

However let us not let the obvious go unnoticed. The inefficiencies of two ‘IT Worlds’ become obvious at the interface between them. Inefficiencies between lifesciences delivery and care provision supported by information systems that have seen significant investment are quite profound, wherever you apply the magnifying glass. And the problem will become more impactful without a disruption that is the catalyst for a collaborative response across several care settings.

Countries, clinical research organisations and the life science industries all have a desire to change how they deliver clinical research. Each day that a drug is delayed from entering the market sponsors lose up to $8m1. Data collected comparing Europe wide statistics to the US puts only 18% of trials in Europe achieving time and target whilst in the US it is just 7%2. Everyday that a new drug is not on the market is another day that a person with an illness can not access the new innovative cure or drug that will ease the illness.

Take the sheer size of the diabetes population. There are 283 million people with diabetes, which makes diabetes the third most populous country in the world!3 In 2012 there were 212 new diabetes drugs in development4, innovations that with the right environment to trial are trying to expand treatment options that improve quality of life and provide value for money.

What does history tell us?

Healthcare professionals and business intelligence experts that were part of the conversations in the development of this piece from Russia have an eye on the NHS in England as an example of how to make this work. From an NHS perspective this concept probably makes the UK professional stop and think more carefully about the current situation within the NHS. It is, let’s face it, perceived to be controversial from inside the UK. The NHS has a cradle to grave clinical record. A healthcare system that is free at the point of care, and a system that the UK NHS should be proud of. It may not quite be a digital system and in recent times it has been portrayed as controversial in its approach; however it is the envy of other countries that would thrive on the opportunity to have the level of data available. Yet for many reasons the NHS is still to activate this asset to its full potential, which is something that the Russian participants in this research look at with incredulity.

The NHS is there for all to see, how it is structured, its coverage of the UK and its sheer size and volume. It has a rich history from which lessons can be learned in relation to information systems and access to data, and many organisations are looking here to understand how to do it. The NHS understands what its data asset is, but is still not quite able to release the asset appropriately.

The Russian perspective, they made clear, is very much based on culture and how their system has evolved over time. Perhaps the easiest way to illustrate this is to initially remove the healthcare element. Deploying business intelligence capability into Russian business arenas has been met with resistance. Whilst perhaps something of a stereotype, the average Russian business does not expect to have open data in any form, and would not expect to share business intelligence capability across the organisation, unlike in the UK and US where concepts of business intelligence have moved so close to open data initiatives that they often fall under the same executive responsibility. Therefore the application of business intelligence into the Russian environment initially met with resistance. This was until the implementers realised the ‘sales pitch’ for business intelligence should be to make it clear to the ‘coal face’ worker that access to data would help them do a better job for the good of their position.

With this in mind a conversation with healthcare professionals about how they share information with clinicians about patients with a specific focus on clinical research was enlightening. The starting point for research data in Russia is that if it is research that can be applied to the Russian healthcare economy then information would and should be provided freely based on the clinician’s approval. A patient could opt out, by talking to the specific clinician who was providing the information. However it would be a clinician- based decision that would be related to the healthcare outcome rather than the patient’s wishes.

Patients in Russia are said to be aware of research opportunities but are not likely to drive access to such research; this will often be prompted by the clinician. Quite a different model to other countries, which are moving to consent based models driven by patients.

The future

Industrial leadership, societal challenges and excellent science are the three key headlines for EU wide prioritisation of research. The 2020 programme within Europe is not disease centric; it has a goal of integrating research innovation into the care pathway and tries to ensure that the impact on the participant from an information point of view is kept to a minimum. However, the European programme is not about utilising any single data source or standard, it is about the integration and innovation of systems at the centre of care provision. Adopting the European 2020 approach however is a political decision that each country considers and interprets in a slightly different way. This European goal has an additional priority of international cooperation. Understanding why international collaboration has not yet been successful pan-EU or indeed between the UK and the US was also considered during the creation of this piece.

Delivery of care and access to clinical research from the patient perspective is different in each of the countries considered here. However the parallel industry- centric growth in IT and the delivery of trials is clear and yet significant benefit is still to be released. It is reported that over 40% of clinical trial data is entered into a health record or Electronic Data Capture (EDC) system of some type5, 57% of R&D spend is within clinical development and in some countries clinical records have been digitised to cover 90% of the population, and yet there is no real solution to make linkages in a seamless fashion that exploits technology and standards.

A suggested move to data citation when delivering clinical research could be a route to try to bring about an additional data standards based revolution without creating a rule book. If this were made a part of the pathway from a clinical trial then this could change thinking to such a degree that the barriers to the use of this technology asset could begin to be removed.

A revolution in waiting

The difference between countries is striking. The European 2020 programme is about putting the patient at the centre of any trial with information ‘floating’ out, whereas the Russian model appears, on initial analysis, to be about the excellence of the clinical researcher and supporting that learning with an outcome that can be applied locally. The model in the UK is about facilitating research conducted by the NHS as professionally and with as high a quality outcome as possible. In the US, the model seemed to be more akin to a hunting analogy. Researchers and scientists at the National Institute for Health in the US discussed how their current programmes of work are geared towards early stage research, before the patient is involved, the testing of ‘failed’ compounds to understand what failed means and where success may be grabbed from the jaws of failure.

European time to grant to be no more than eight months is the desire described by the senior team at the EHR4CR collaboration in Brussels in the first quarter of 2014. The median time taken from ethics approval to an NHS organisation having permission to run a trial and being open for recruitment was 21 days in quarter three of last year in the NHS. The focus on set-up times is bringing rewarding outcomes across EU countries.

General legal and ethical issues around the reuse of data for clinical research remain an issue for many countries worldwide. The World Health Organization Global eHealth Observatory survey in 2009 contained five legal questions. The questions were very general due to the nature of the audience, however the output indicated concerns around the legality of consent to take part in research and how it should be collected.

In Europe we are obliged to gain consent and apply it to the access of patient information; we treat this as one of the most important elements of the research pathway and yet this is probably the single largest barrier to the resolution of the problem. The need to ensure the patient has consented, record the consent, make it easy to change the consent, and the ability to access the information of the consented is the ‘golden fleece’ for clinical research.

At EHR4CR a change to the approach to data was suggested: to change the approach to be about who makes use of the information rather than who owns it. This was compared to the aboriginal concept of land ownership. Those that make use of it have control of it; they must take care of it and protect it at all times and if it is not useful to them they must, with permission, hand it to the next person who can make use of it. It’s a nice theory and may well be acceptable to the researcher and participant if a trust in this care could be built and applied, but the change to legislation, and global attitudes, would have to be significant to enable this to work.

Competing with the EU revolution: the US approach

Moving analysis to the US and its approach to the access of clinical information for the provision of care and clinical research provides an indication of even more differences, barriers and opportunities. In the US, data is without doubt an asset that is so prolific it is almost tangible. Organisations from tech start-ups through to large behemoth sized consultancies profess to be delivering something new, something that can revolutionise care at the point where the patient is directly impacted.

Data in the US has been collected for over 30 years based on inputs and outcomes. The concept of public and open data exists and yet until recently perhaps had not been latched upon. The expertise that exists in the technology market in the US is astounding and is starting to release benefits into the care pathway, often without the same consideration for privacy that certainly exists in the UK. This exposure of data is often from open data and the application of big data solutions that enable data linkage that generates insight.

Attitudes to the delivery of clinical research in the US are a key difference noted during the preparation of this article. In the UK a large proportion of clinicians are willing and able to deliver clinical research when their institution or patient asks, however in the US there appears to be a reluctance to take part in clinical research unless that is the role you have chosen. Whilst the number of open global trials is said to be increasing, the number of clinicians that consider research part of the ‘day job’ is decreasing and more so in the US. When asked why, several researchers cited a fear of the unknown and the quantification of the risk factor for them and their patients. A survey conducted by the Duke University in Durham, North Carolina, observed that patients taking part in a trial still consider themselves the equivalent of a guinea pig.

Despite the attitudes, and to some degree the missed chances to use the commercial care model to fuel the research model in the US, there is a success to be understood. The success is two-fold: the NIH who focus on the delivery of academic clinical research and who are starting to build infrastructure to be able to make use of each data set as it becomes available and Clinical Research Organisations (CRO) have realised that the data they have and the data they can get hold of is as strong an asset to them as a commercial relationship. Indeed several CROs are beginning to market themselves as data organisations. Will the CRO be the way that the global need to enable clinical research can reach a position where standardisation of systems is possible? If it is, it will be at a pound and dollar cost; CROs are after all commercial organisations, and yet it will be for the good of research delivery globally and will achieve a standardisation of sorts, even if that is driven to some degree by market forces.

What the world needs

There is a lot to learn from each other: large pharmaceutical companies are beginning to come together and share data and experiences. Europe has the EHR4CR group where nations are starting to share how to make the environment work, and yet there is still much to do. Delivery of high quality clinical research to a timescale and quantity required can be achieved through the use of analytics to support delivery. There are a number of different ways in which this can be achieved; in an ideal world all parties would work together and wherever the opportunity presents itself we will try to do just that.

References – 1. Beasley ‘Recruiting’ 2008.
 2. State of the Clinical Trials Industry: A Sourcebook of Charts and Statistics, Centre Watch, 2008.
 3. EHR4CR Conference – Brussels 2014. 4. PhRMA 2012 – profile of the pharmaceutical industry.
 5. Integrating Electronic Health Records and Clinical Trials: An examination of Pragmatic issues. Michael Kahn, University of Colorado.


Led by the nose… Business led CIO!

Was it an insult I thought, being congratulated for not being technical? It felt like an insult! Of course it wasn’t but it got me thinking about what it means to be leading a technology team in a large organisation where the best way to get engagement is to take away all references to technology, to ensure that the business benefit is at the heart of all conversations relating to the delivery.

There is a risk though, every time we re-iterate to the team that we are delivering business change projects that use technology to assure the benefits, that it is potentially another nail in the coffin of technology as an expertise area. And, if we forget technology because we are busy ensuring benefits are related, then just maybe the technology won’t work. After all it will not look after itself! The role of ‘IT Professional’ has been a recognised role now for an unbelievable 80 years.

The role is now at a pinnacle position in the majority of global organisations, and as we all know, ‘with great power comes great responsibility’. The question though is where does that responsibility best sit, with the business change capability or with the delivery of technology?

So, the trick is where to draw the line. The CIO of any organisation needs to be technically capable and aware of technology and the innovation that can be delivered through its implementation. The need to innovate can only be limited by the organisation’s capacity for change and the business need to do so. The CIO must be able to facilitate change and lead change in some cases due to the disruption technology can bring. However being able to tell the difference between a CAT5 and CAT7 cable is still important! The CIO has to maintain credibility in his or her own peer groups and some of that comes from business drive and success but some will come from the technical battle scars and badges that the CIO has. Without these badges and scars a good manager with a bright mind could lead any technology team, and actually maybe they can!

Early in my career I worked in a team of four project managers. We were not like the IT Crowd, but the next sentence may call that into question. We argued, probably daily, who was the number one technically capable out of the four of us. The challenges ranged from identifying the CAT cable type to being the office Excel Wizard and master of the pivot table. The fact that as number three on a good day back then I am now CIO of an organisation, speaks volumes for the role of the modern CIO compared to the perceptions of the role maybe as recently as five years ago. And yet in the last couple of weeks I feel the need to try to revitalise the importance of technology knowledge and capability in the CIO role.

To be a good CIO requires the ability to translate technology into business delivery. Not to allow all projects to assume technology is business delivery with a wired layer above it. We have successfully migrated the provision of email in the last couple of weeks, but there were bumps on the way. The vast majority of those bumps were technology based, sizing servers for the migration process and replacement kit issues. School boy errors! How did we let this happen? We focused so much on the business benefit. This was not to be a technical project – the training delivery and business change element of this project was immaculate, but we missed two technical elements that, on day one, gave us a bump because we were concentrating on ensuring the business had everything it needed.

The team were great, spotted the issues and ensured that user impact was minimal, but, if we had run the technology part of the project as we would have in the past then we would not have been distracted and missed the elements that caused the bumps. The technology team can and should deliver for the business, it should talk the business talk, be useful for more than wires, but, it should never forget it is there to make the technology work for the customer.

Searching for the balance between technical capability and business focus is like looking for black cats in a dark room! So how to find the cat! In health the balance between technology and business capability is a fine line, and not even a straight line I would suggest. Each delivery project or service needs to be evaluated not just for the final delivery but against the stakeholders within it. With our email project we knew that the stakeholders needed to be ‘sold’ on the business benefit of the migration and that the words we used could not be technology based. Ultimately, migrating was a business imperative, but, the business needed to be taken on a journey.

What was once known as next practice with technology is now best practice and the role of the technology professional now needs to be multi-faceted more than ever before.

However I am now counselling the team to also remember we are here as technology professionals, and we must not forget the technology, let the ‘geek’ part of us be at peace and shine through. It makes sense as organisations flourish that they begin to look to technology to be innovative in the delivery of a disruptive change rather than fighting a rear-guard action to save money and we need to be there for that, but when a project is about delivering a technical change we have learnt we need to get the technology 100% right and support the business change, and in that order!

The butcher, the baker and the candlestick maker…

The butcher, the baker and the candlestick-maker – or in this case, the educator, the shop owner, the mechanic and the know-it-all – were in discussion at the recent UK CIO 100 event.

(As an aside no one has worked out what a collective noun for CIOs is, although suggestions have included a ‘wally’ of CIOs and an ‘agenda’ of CIOs!)

As a group we were discussing whether a CIO of mechanics in the manufacturing industry can become a CIO in the health sector, primarily dealing with patients, doctors and nurses? My starting point was absolutely yes, be aware of the learning curve in doing so, but every CIO starts the response with the idiosyncrasies of their industry. “Yeah sorry, we are a complicated organisation, what it really means is…” they say, and therefore the learning curve is universal.

At the CIO 100 event we also heard how certain themes are the focus of so many CIO minds at the moment, when thought leaders speak and so many people sit and sagely nod you know that you have a group of people in the room who are ‘like minded’.

Or are they? My entire tenure as a CIO has been in the health sector. Is that because I am appropriately skilled for that arena or because I am worried about which side my toast will land on if I move out of my comfort zone? The group of CIOs were convinced that the CIO skill set is transferable, and yet the definition of what that skill set is was considered to be different dependent on the market area and the culture of the organisation.

So as a group this was pondered for a little while, very much from a positive point of view. We all wanted to do a job swap for a week at one point just to understand the differences. Key messages that came through though were:

Everyone wants to innovate – If an organisation has invested in the concept of a CIO then they are likely to be doing so because they need to utilise the disruption of information systems and technology to alter the business in some way, i.e. the power to innovate and manage innovation is a core competency.

Influencing up, down and sideways is essential – The ability to see the message at all levels and then influence its delivery is essential. The CIO role is as a friendly manager, stiff message deliverer, honest broker and executive, often all at the same time.

Translation of focus from technology to benefits – The CIO’s skill of technical balance is essential to success. A CIO needs to be excited by technology but not blind to benefits, simply wanting the new shiny thing will not deliver benefits.

Responsibility – The organisation wants a ‘go-to’ face for all things thrown in the bucket as technology: information, data, mobile, digitisation and a plethora of new exciting words that were picked up in a conversation that now need to be looked at.

So, taking the initial nursery rhyme analogy a little further, if our group CIOs were all in a tub and were about to set out to sea, what did that group think was the single skill that would keep the tub a float. The conversation seemed to lead us to that the key skills really all fall under one overarching banner, LEADERSHIP. The key skill that is both transferable and allows the CIO to be transferred, is the quality of the leadership.

In so many ways many of the examples above are simple subsets of leadership. They are skill sets that are transferable, it’s the context and relationships that need to be picked up, when, as a CIO the person moves from retail to health to automotive and still has to keep the tub afloat.

By the end of the evening we came to the conclusion that the transfer from one CIO role to another could be even easier with a community of support, and therefore if we all really were in a tub together about to set out to sea and between us we would know the life skills needed to get it to land again!

Originally published at –

Guest Blog – The elegant solution

Where Does Improvement Begin?

In February 2014, I was at the Lean Healthcare Awards, presenting as a finalist in the Lean Champion category when I was asked how I had started on my improvement journey? I suddenly remembered a chance conversation from the start of my career that had inspired me for more than 15 years. Perhaps it can inspire you too.

Putting the Customer or the Patient First

Since 2006, I have worked on various assignments as a Senior Manager in the National Institute of Health Research Networks, increasingly specialising in service and systems improvement. But, for eight years before that, I worked in the software industry for companies like Hewlett-Packard (France) and Micromuse Inc., a specialist in network management.

I worked as a usability specialist, designing user interfaces, writing online help and user manuals. My job was to make the systems we built as simple as possible for our customers, hiding complexity and enabling efficient use. I now channel the same desire to improve to ensuring patients get the best possible service from the organisations I run.

I had Kaizen ( in my bones long before I knew what it was.

How Developers Can Inspire

At HP, I worked with one of the best programmers I have ever met. Not your typical programmer of cliché; he was dapper, eloquent and had arrived in software via a classical education and a passion for mathematics. We shared a drive to make things simple for our customers.

One day our team was struggling with a seemingly intractable coding problem, when a fix emerged. It looked like we could all go home, but my colleague was not satisfied. He stayed back to work on it some more. When I asked him why, he gave a simple, powerful reply:

“Because we have yet to find an elegant solution.”

When he found that solution a few days later, he solved a thousand problems in one, because the code flowed perfectly. Ingenious simplicity.

So, whatever problems you face today, look for the elegant solution and you may just inspire yourself.

One week after deadline day…

The 1st of April meant so much to our organisation this year! A complete change in how we manage the delivery of clinical research in the NHS goes ‘live’. No fuss, no trumpets, it simply comes into being: a change from over 100 contracts across the NHS to just 15, a change that sees a network of organisations empowered to deliver and take ownership of clinical research  delivery still further.

For the area of the organisation that is tasked with delivering information systems to support research what does this mean? Well, firstly ‘big bang’ go live, something you are ‘taught’ to avoid at all costs needs to be done across multiple integrated systems for go live of the new structures, all at the same time on the same day! Changes to the data models, reference data, workflow, user based access controls, task labels, reporting infrastructures, web site addresses, you name it there is an IS component in there that needs to be changed as the clock ticks over into midnight plus one on the 1st of April.

Protecting ‘the business’ capability through this transition was something the team were tasked with managing, and rightly so. In a business where information is the foundation to what we do, this is a clear priority, the delivery of what we do needs to continue and performance needs to be maintained through any change.

The team has a strategy that by and large sees best of class solutions deployed across the infrastructure and therefore maintaining integration whilst delivering new systems is no easy ask. The control the team have applied to this is through the sharing of resource and a single model of understanding of the changes, not to mention some well placed business understanding and support. We are very lucky in that we have a development team that have an in-depth understanding of our business, our data structures and business needs. As a team the developers were able to get close to the business and the change programme to build a series of specifications in conjunction with the Business Analysis team. Not quite Agile but a hybrid model where the developer was able to translate the requirements directly with the business.

The 1st of April came and went, not completely smooth but the impact of many changes to the systems deployed was kept to as bare minimum as possible. The project and service wrap around the systems deployment was effective and we got to the 3rd of April with the ability to say all systems are live and functional for the new structures. Lessons learnt were how the team worked, how it got close to the business, and maintained that level of interaction throughout and also the level of interaction during go live, keeping all the key stakeholders informed and able to support and react if and when any issues came up.

All in all not an April fools day trick, just a really good result that will continue to be built upon over the next few weeks as any issues are reported, understood and fixed with cutover satisfaction at the heart of the delivery.

What is natural analytics…

Do I want red wine or a beer? What system do I use to make that decision? Recent studies reveal that in so many decisions the human brain actually doesn’t make many choices based on rational though but on instinct. So if it’s a cold evening and I want to have a nice meal with my loved one then a glass of red wine will be a choice I don’t need any additional ability to make. If it’s a warm day and there is a garden to sit in then, again, no rational decision with tools to help is needed.

But with the implementation of the next generation of business intelligence tools we are able to move to a state of ‘natural analytics’. But what does this mean? Having recently been in Moscow I can say I could have done with a state of natural visualisation at the airport; as soon as you remove the modern English alphabet everything seems just a little more difficult to understand and you become paralysed to make decisions.

The concept of allowing space to think rather than know has been used to describe what natural analytics will bring, but even that doesn’t quite get to the ‘nub’ of what it means. To our organisation natural analytics will see the advent of a number of things. First and foremost, an increase in the number of people that systems will enable to become ‘data enthusiasts’ across our organisation. The concept of natural analytics to our organisation includes easy access to large data sets and the ability to wander through the data to create your own insight. The natural analytics concept applied to our Open Data Platform is new functionality we will look to deploy that will allow any user with any analytical competency to feel that they can access information easily, making connections, comparisons and creating insight that informs how they go about their ‘day job’. Natural analytics will extend the capability of everyone’s day job!

Doing things naturally should mean they are easy to do. Take the iPhone. Who would have thought when that disruption landed that the average human being would be happy with a phone with just 4 buttons. Previous to the iPhone the business leading solution for work had probably been the Blackberry, with its 40 plus buttons to access a lesser amount of functionality. It is now natural for us to know that different combinations of key depressions of those four buttons will achieve different outcomes, doing it comes naturally! Our desire for the next generation of Open Data Platform apps is to embrace this concept and apply it to them.

Also fitting in with the concept of natural analytics for us is personalisation. In a world where you personalise your teddy bear on the high street, your shoes on the internet and your musical recommendations at your favourite online store, we need to be able to embrace this commercialisation of personalisation within the creation of applications for business intelligence.

One of the regular questions from users of our business intelligence apps is the desire to make them be specific to their needs. You can currently do this but it’s a bit ‘clunky’ and involves bookmarking rather than truly setting up a dashboard for your own ‘personal’ use. The second phase of implementing elements of natural analytics will be two fold, firstly the further development of some additional skills to aid the creation of these personalised dashboards and then the functionality to do just that. Learning from some of the best delivery strategies for business intelligence out there we intend to ‘invest’ one to three in favour of usability over new analytics capabilities, safe in the belief that data can be turned into insight that can deliver intelligence.

Clearly that rational thought process on the difference between red wine and beer is all a little miss guided, the day before British Summer Time and I am in the sunny garden with a glass of red wine, rather than expected cold beer!

Older Entries