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 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)!
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!
What does a soap factory, a hotel laundry, a cheese processing plant and a builder’s merchant have in common? They were all places that I learnt my ‘trade’, and somehow I became a CIO in the health service!
Yesterday was a great day for the digital team in Leeds, for the second year running the team interviewed for student placements for the summer. Six bright young things part way through their education in all things digital science came to meet the team and to work with us to decide if the digital team in Leeds is the right place to come and trial the skills they have been learning all year.
So over the next couple of weeks we will welcome; Daniel, Daniel, George, George, Alice and Reece to the team. A gang of Computer Sciences students who have a passion to do something good with their newly developed knowledge, to quench their thirst to try what they know in the ‘real world’! The exceptional thing that made me jump for joy though is that these 25ish year olds all wanted to be in Leeds for one key reason; they wanted to do good with the knowledge they have learned, they wanted to give back, the wanted to deliver return on the reputation that Leeds Teaching Hospitals Trust has built.
So much is written about the lack of faith that our future stars will have in the organisations they choose to work for and yet here I was faced with six stars of the future, all six of them looked ready to burst with enthusiasm. We delivered a presentation to them first, a bit of who we are and what we do, then another super star, Gareth Edwards one of our informatics nurses showed them what working here was going to be like. One of those age defining moments happened though as our amazing Informatics Nurse used a screen image of a computer game form the 80s and a computer game from now to show the difference in expectation that digital consumers have now. One of our candidates exclaimed; ‘My Dad used to play that game’, the sadness with a wry grin that swept over all of us in the room had to be seen to be believed as we realised just how fresh and ready for the challenge these new guys were going to be! But poor Gareth.
Much has been made of the Leeds Way, Davina Mcall has even explained it to Phil and Holly! When you see the Leeds Way ‘infecting’ new people into the organisation though is when you realise how well as a trust we have built this culture. After three hours with the team, in an assessment type scenario these guys were smiling, laughing and most importantly of all making amazing suggestions that we simply had not thought of. The assessment was a paper based affair, ‘think through how you would build the patient consent for surgery form?’ Remove the paper from the equation.
Now, lets just jump back a moment these are six students with no healthcare experience, the ideas they came up with, the references they were able to make to how people use technology, the way they really were appreciating the difference between digital transformation and IT really, truly blew my mind.
Thinking about colours, size of font, language, sensitivity about information recording, data protection, data ownership, access controls, the physicality of kit, the nature of the form; and most importantly the human nature of what was being considered. All came up in a 30 minute paired task!
So, we now have six new inductees into what we are and what we do; my promise is that their ‘summer job’ will not be like mine was; I won’t simply leave them to do the rubbish jobs, I will try to inspire them, I will try to send them back to their next year with a story to tell and if I can help influence a tiny little bit of the next generation of people who do what we do then crikey I am going to love this summer!
The #LeedsDigitalWay just started to create its next generation.
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
Seven predictions of trends in eHealth in Ireland in 2017
At the end of 2016 Boston Children’s Hospital in the USA published a blog describing the seven predictions for digital health in 2017. A focus of eHealth in Ireland in 2017 will be digital solutions to support the care of children, be that preparation for an EHR for the National Childrens Hospital or the continued implementation of the Maternity and New-born system. Ireland has, in 2016, delivered on so much of the promise it made, with this in mind we wanted to consider the predictions by one of the world’s leading children’s hospitals and apply them to what we think can be achieved in Ireland in 2017. eHealth Ireland has set its sights on being able to apply these trends to what it delivers in 2017, fully supporting the ‘building a better health service’ agenda of the HSE with digital solutions.
1 – Telehealth adoption by patients
We have seen the adoption of telehealth in other jurisdictions begin to make a difference to how care can be delivered, colleagues in Scotland have been making a success of telehealth in outreach regions for the last five years or more. Whether it is driven by the health system, special interest vehicles or the patient themselves it doesn’t matter in Ireland. The creation and adoption of design principles relating to telehealth and the digital identification of patients and clinicians will aid adoption. Three examples of success in 2016 that can be built on spring to mind. The wonderful work of the Heartbeat Trust in the connectivity of GPs for consultations prior to and after heart surgery has begun to change the model of care on offer and all at a price that is affordable from a technology point of view. The delivery of patient portals is something that will be at the forefront of care in 2017 with the go live of a patient portal for epilepsy and the initial go live of a patient portal for the viewing of a persons own elements of a summary care record will enable Ireland to understand better the impact of this information on the delivery of care away from the more traditional care centres. The final example is an Irish company called Web Doctor, a company that has gone from status as a start-up to truly delivering a platform for primary care that is centred around the patient and is built with the patient in mind.
2 – Increased engagement with patients for telehealth solutions
Boston Children’s describes the second trend for 2017 as increased engagement, in the UK Roy Lilley wrote a blog at the turn of the year asking the NHS to ban the word engagement, suggesting that it is a word that should only be used to describe the meshing of gears or the sound you hear when a phone line is busy! Taking his principles and applying it to this trend though, in Ireland we will see the interest from patients in accessing leap forward through digital solutions. The ‘dawn’ of the wearable and quantified self has occurred already and yet only as we move to 2017 will patients really be able to start to use telehealth that they define themselves, that they are in control of themselves and that the benefit is targeted for them.
3 – Innovative visualisation devices hit the clinic
The adage that health in Ireland has a great deal of data, not so much information and struggles to gain timely insights from the what it collects has been pointed out a great many times over the last two years. At the innovation showcase in November a number of amazing new solutions that enable visualisation were demonstrated, no matter whether it was a holographic anatomy or virtual reality anxiety training this type of technology can and will be adopted where appropriate in 2017. The idea of training clinicians through the use of virtual and augmented reality has become something that the RCSI is pushing ahead with, it is an exciting prospect. The eHealth Ireland team is now in the process of implementing Microsoft Surface Hubs into a number of maternity hospitals, a piece of hardware built to enable visualisation and interaction of data in a whole different way.
4 – Clinical experience software
The piece from Boston’s Childrens describes how the interoperability of information, a move away from data messaging and a move to information integration will change the way in which the clinical experience is delivered. Certainly when Ireland considers the change in the experience now possible in Cork University Maternity Hospital, Ireland’s first digital hospital, I would have to agree. The ability to have information live with the clinical team regarding the care of the patient in front of them, the ability to collect critical information and apply it to the clinical record as it happens clearly makes a difference to the care experience. When lab test results can also be automatically added to the record and algorithms can flag issues to clinical staff that can be linked to information collected in real time then at last digital will be making a difference to the delivery of patient care.
5 – Maturing market for digital health start-ups
The IrishCentral.com site published a review of digital start-ups in Dublin in late December 2016. According to the site there are 775 Irish digital start-ups that have decided to locate in Dublin, funding in 2016 to these start-ups was in the region of 734 million euro! Out of the top ten funded companies six were digital health start-ups, those top six attracted 164.54 million euro of funding in the last year alone. The eHealth Ireland eco-system and the initiatives put in place by the team to support innovation being adopted into the health care system will, in 2017, continue to grow this market, concentrating first and foremost on the health of the nation but allowing eHealth Ireland to meet is secondary challenge, to be a catalyst for the wealth of the nation too.
6 – Expanded offerings from insurers and pharma
The difference in healthcare systems between Boston and Ireland is significant. The relationship between big pharma and public health care systems globally is not always a comfortable one and yet at the same time as the issues of drug costs need to be resolved we are now seeing the role of pharma in digital health changing. For example the work that Pfizer has done with eHealth Ireland in 2016 to create a digital solution to support the medicines reconciliation process from acute to primary care has been extremely successful, so much so that eHealth Ireland will look to implement the solution country wide in 2017. The insurance companies in Ireland have led the way in providing access to telehealth solutions, offering solutions like Web Doctor mentioned above and the ubiquitous Babylon Health solutions to customers, changing the access model for customers to one that is less demanding on the health care system itself.
7 – Personalised care through voice enabled devices
Homes are now asking Siri, Cortana and Alexa for help, search YouTube to the video of all three in a perpetual loop seeking assistance from each other for a feel for how the battle of the virtual assistance is going to take off, one of the funniest things I have seen all year. We really can imagine these services coming to health quickly, voice recognition and dictation is already a key part of any radiologists ways of working for example. When an EHR for Ireland is specified there will need to be an ability not just for the capture of text and images but also voice recordings, a giant leap into new unchartered territory that will need to be managed carefully from a security and governance point of view.
Its great to consider the trends of the future, there is a whole career out there now as a futurist for many commentators on eHealth and where it is going. The difference for eHealth Ireland in 2017 is that because of the foundations created in 2016 each of these seven trends feels that bit more achievable.
First published by the NDRC as part of the #HealthTech event in the summer of 2016.
Ireland is the most personally connected country in the world. Or at least I am starting to believe that from the evidence I have seen over the last 18 months. I have been told on so many occasions that what we have in Ireland is the first real example of a global village mentality and in particular for technologists. I have been involved in a number of different forums to support start-ups and big ideas for health technology in the last few months and really I do now believe in the concept of connectivity being one of Ireland’s biggest assets.
The Hollywood concept of “Six degrees of Kevin Bacon” seems to apply even more in the world of the health technology start up in Ireland. If you don’t know someone who knows someone now, you soon will do! The willingness to help, to get the idea off the ground and at least the ability to bring it into the healthcare system is there.
One of the most reinforcing moments of my 20 year career in health technology happened a couple of weekends ago at the launch of the NDRC Health Tech event. Eleven teams were formed on the Friday around some amazing ideas for how technology can improve the delivery of healthcare in Ireland. As well as the idea generators in the room there were a number of volunteers from across many different sectors there to help turn the ideas into a real proposal that can be taken forward to be considered by the health system. The level of knowledge and commitment in the room around a number of great ideas was simply huge. The possibilities for health range, from the ability to provide assistance for Parkinson sufferers to walk with confidence again to an app that allows a mental health patient to step into the centre of the care they are involved in, to a new way of processing lab results nearer the patient and they are just three of eleven amazing ideas. However the magic is as much to do with the people in the room as it is to do with the ideas. Seventy people in a ‘competition’ and yet every one of them rooting for each other, connected in a new way to deliver a support network for new technology based ideas to change the way in which health is delivered. Teams of people working hard to support each other over that first weekend regardless of background, basis of knowledge or years of experience, all these amazing people are now connected to each other in a new way.
Slowly but surely a revolution is happening! The social media response to the RTE programme ‘Keeping Ireland Alive’ has started to open up the concept that the Irish healthcare system is not the issue with the delivery of care to the people of Ireland. The Irish healthcare system is full of heroes and connections to be made to transform the way in which care can be delivered. Truly the system is one going through a digital revolution a change that is having an impact on so much of the way in which care is delivered. The second of the Keeping Ireland Alive programmes had a telling digital moment as a senior clinician opened the paper records of the patient in front of him and exclaimed, as usual I can’t read the notes. Realisation that Ireland is running its healthcare system in the same paper based way that it has for the last 30 years is giving a strong impetus to the digital health agenda within the Future of Health objectives, no bad thing for the great technology organisations of Ireland.
With the type of innovations and connections made by the start-ups at the NDRC Health Tech event the problem the clinician faces can be fixed, removing yet another issue from the delivery of healthcare in Ireland is the desire of so many committed people. The NDRC is just one of many environments now supporting Irish companies movement in the health technology arena; the Health Innovation Hub, Portershed in Galway, ARCH, Insight, Health XL and the HSE’s very own eHealth Connects programme are now all there to support organisations in finding the connection and turning the bright idea into reality.
All this human networked connectivity can really bring about a change to healthcare delivery if we can harness it in the right way. The rallying call for Ireland from here though is simply get involved and help build a better healthcare system.
In November and December I was lucky enough to spend time with the IT leadership of the UK and Ireland, I collated the responses to a series of questions for an interview that HIMSS would then publish in two parts, here is the whole thing to give you a feel for how close the concepts of cross country collaboration are really coming along.
Some of the blog is written in the third person, it just felt a little odd interviewing your self without doing that, I hope you don’t mind.
Digital leadership in health in 2017 will have two crucial elements to handle, how to keep the ‘ship’ stable in times of change and how to deliver innovation in large, public sector organisations. In November the UK and Irish leaders of healthcare technology were face to face at a number of events that had these traditional pillars as the themes. Whilst they all accepted these had been at the heart of their focus for a few years now they still observed that 2017 would see a still further push to get these right or potentially fail to deliver for health in the countries they are responsible for.
The events where these leaders came together were, the Irish Innovation Showcase where Will Smart provided a key note that caused a pause in the IT leadership as they stopped to understand if they had the strategy right; the HIMSS Executive Leadership Summit where Andrew Griffiths provided an opening comment that got the whole crowd energised; Richard Corbridge then provided an opening statement with George Crookes at the Scottish Annual Digital Health and Care Conference that entertained and delivered a key message on the future and then finally Sean Donaghy who opened the first Island of Ireland collaborative Eco-System.
During this period of time HIMSS caught up with each of these leaders to get their views on what 2017 holds for digital in health and what they thought of the statements being made by each other and how they could support each other into the new year.
We went first to Will Smart at the Innovation Showcase. Will, what do you believe is the key to innovation in healthcare in 2016?
“Strong collaboration between leaders, healthcare professionals and patients is of fundamental importance. We need to move away from a paternalistic view of healthcare to one which truly embraces engagement and co working. As well as fostering the trust that is vital to the data sharing innovations that put cutting edge insight in the hands of clinicians, collaboration has the potential to create a culture which encourages, accelerates and inspires technological excellence.
That is why, through our NHS Innovation Accelerator and Global Digital Exemplar initiatives, we are supporting the most technologically innovative people and acute trusts to help them connect with partners, make networks and accelerate their innovations. We want to enable these pioneers to inspire others by showing how information technology can deliver both improved patient outcomes and enhanced business effectiveness.
Our patient centred agenda, combined with this type of collaborative support and leadership gives us a once in a lifetime chance to innovatively set technology to work for a system that’s focused on patients and led by clinicians.”
The concept of no longer being able to stand still have become key to the delivery of healthcare, will digital innovation be the route to avoiding this do you think?
“Absolutely. The NHS is under real pressure. Not only is the occurrence of expensive to treat conditions such as obesity, diabetes, cancer and mental illness rising rapidly but we are all living longer and therefore need more care over the course of lives than ever before. So, to continue to deliver great care we must make our service as efficient as possible.
Innovation in information and technology is a critical part of almost all Sustainability and Transformation plans because it has immense potential ensure efficiency while making dramatic improvements to health and care provision, quality and outcomes.
Our planned new digital products and services will make health and care more accessible, more convenient and more effective for patients. As a result, patients will have more power to make better, more informed choices about their care which will also ultimately be more cost effective. Insight we can gain through shared information will also help us improve efficiency by ensuring that the right kind of care and treatment is given at the right time, from the start.
Standing still is not an option for the health and care system. Information and technology innovation has huge potential to help us provide more, and higher quality, care from the resources available to us at a time of increasing demand and this is an opportunity we must seize.”
Next to give us his views was Richard Corbridge from Ireland, Richard, this was Ireland’s first innovation week, what prompted Ireland to put such an event on? “First and foremost it was to bring the idea of Digital Health into the eye of the public. We have had over 3,200 individuals booked into the events in one week, all our events have been free and have garnered a significant level of interest from the people of Ireland. If the patient, the tax payer, wants to see digital in their health system to make it safer and more efficient then maybe an understanding of the level of investment that can be made can be got to. Secondly though the week of events has created a ‘platform’ to enable innovation in the Irish healthcare space to really begin to happen, and perhaps more importantly be supported, Ireland has an engaged clinical team, it is now starting to make the connections between clinicians and the technology leaders of the country.”
What do you see the blocker to innovation in healthcare being? “In Ireland it can be sheer resources, funding and time being the hardest to come by. More generally in healthcare I would say it is the concept of building the jumbo jet as it flies down the runway, as digital leaders we have to keep so many moving parts on the go, the temptation is to focus on these and we can’t, we have to keep an eye on the future. There is a story of a bridge built in Honduras I have been using in presentations recently, an amazing bridge, started in 1989, by the time it had finished due to environmental changes the river it was spanning had moved. We have to be mindful of this happening to our plans and enable innovation and new technologies to influence them.” We then caught up with Andrew from Wales at the HIMSS ELS; you spoke of ‘not checking the Daffodils too often’ which went down well as an analogy, can you explain what you meant? “First to explain the analogy, aside from playing to the Welsh stereotypes, if you keep digging up a plant in the garden because it’s not growing, the very act of checking everyday ensures the plant never grows. There can be a tendency in health IT to give up too quickly and declare the project a failure, spending all our energies on checking and explaining, when what’s needed are steady nerves, encouragement and the will to succeed.The most troublesome periods in any implementation can be the early days, people are not used to the system, support can take longer as training becomes practical knowledge and the IT hasn’t settled down. Inevitably the first period is also when most changes are happening and every change is an opportunity for a problem. Admittedly there are times when the plant is a weed and needs to be killed off quickly but in my experience more often it’s a plant that needs nurturing. If we “fail fast” at every perceived problem we might never achieve anything, some of the great achievements have needed great perseverance.” As digital leaders what do you think the key strategy for leading in these times of most unpredictable change can be? “I’m not sure there’s a simple answer to this and if there is, please someone tell me. However my thoughts for what they’re worth are that: we need to be clear about what we are trying to achieve and recognise that in achieving our goals “digital” is not an end in itself but the means to something greater.
We need to keep that vision in our heads and keep doing things that gradually get us there. That will inevitably mean spotting opportunities that occur and changing the plans so that we can take the opportunity. It would be great to be able to stop the world, design it, then start again but the reality is that we have to make running repairs that are actually leading to a complete rebuild. We need to be developing great people who know the right things to do because they share the vision. Finally, somehow we need to summonses the courage to create certainty for others so that they, unburdened, can confidently get on with the doing.”
George was the next of the group we were able to speak to, the idea of the UK and Irish digital healthcare leaders being able to share more seems new, what do you think can happen if this is enabled?
“The days when we not only had to own the problem but also own the solution are over. It was wasteful in terms of time and money and we do not have the luxury of either! The benefits of sharing thoughts and ideas as well as good practices, lessons learned and solutions is mutually beneficial. The challenges our health and care systems face are the same, the largest part of any technology supported solution is generic. So, it is not rocket science to suggest that collaboration is the correct path to follow.”
The annual digital health and care conference in Scotland had a great selection of speakers, Richard spoke about different ways to engage stakeholders, how do you see that influencing the way we deliver digital health in 2017?
“The need to involve stakeholders from all communities of interest is fundamental to securing sustainable and scalable solutions to the wicked problems we face. The perceived effort it takes to engage the public can be reduced and the outcomes magnified by using innovative methods to support the process. The need to use multiple digital channels for engagement is going to become the norm going forward and will transform how we plan, develop and deliver services.”
The ability for countries to come together is highlighted through these leaders willingness to share, perhaps no more so will this make an immediate patient difference than between the Northern Ireland healthcare system and the healthcare delivery of the Republic of Ireland. Sean Donoghue opened the first whole Ireland Eco-System meeting in this same week with a rallying cry for collaboration on the delivery of standards and the ability to share key lessons learnt.
Sean, seeing the start of an Irish cross country collaboration at the Eco-System this week, do you see this model evolving across the EU?
“Inevitably it will, the key issue is whether it is driven forward by public and private health systems, or whether systems and leaders have to be pulled reluctantly to the table. Collaboration across systems is a key support to better sharing of citizen information and best digital care practice in to support better health and wellbeing across the EU.
We have that need right now, with a large land border that citizens of this island cross as part of their daily lives, including for health and social care. Too much of the approach up until now has had the feel of ‘make do and mend’, and that will not support our citizens to get the best from their own efforts and from health & social care resources. We have fantastic potential to build a shared digital fabric that can remove some of the worst impact of a land border on the experience of our citizens, and we’re determined to realise that potential. That means taking action now on shared citizen identification, and on shared standards.”
All of the leaders we have spoken to in the last week place the patient and clinician at the centre of the digital revolution, how does the Eco-System meeting do this and how do you ensure this is maintained beyond this initial coming together?
“The driver for sharing is the needs of citizens; that is very well recognised by health & social care staff, who voice their frustration at the barriers to communication, and thus to better care.
The Ecosystem meeting provides a place to check in, to celebrate successes, to remind us of what remains to be done, and to provide a public space for health and care systems and those who supply digital solutions to set out the agenda for further work. It is a visible and important signal of our intent to work together.
Sustaining this approach requires commitment from leaders, and of course, visible progress. The commitment is there, and the early signs of progress are encouraging. I am confident there is much more to come to inspire collaboration as the default way of working.”
In two weeks these five digital leaders have moved forward an agenda of collaboration, sharing and evolution in healthcare perhaps more than the UK and Ireland has seen in the last five years. The spirit of working together in times of change would often be described as the spirit of England, but, this collaboration shows that in digital health it has become a spirit of the five nations!
All of the leaders commented on the amount of change in 2016 being unprecedented, however they all spoke of ways in which they had built a strategy to cope, maybe what change will do is foster a degree of collaboration that the global healthcare system has not seen before. We asked a final question of the two leaders from the island of Ireland, what was their own predication for 2017 in digital health; the Republic of Ireland’s CIO said, ‘We will see the ability to deliver complicated care information digitally to the patients of Ireland and allow patients the ability to add information to their care record in such a way as to enable it to be useful to clinical staff.’
Sean’s final comment perhaps is a shining example of how this group are starting to think when it comes to the transformation of healthcare; “The most exciting development is the sharing of information with citizens, and building shared workflow to provide more flexible, tailored care. I expect tangible progress with all of my colleagues on this in 2017.”
Richard Corbridge finished off a number of the presentations over this period of time with what is becoming almost a trademark phrase of his, Imagine A World, the conversations with these five digital leaders allow us to imagine a world where the much promised future can actually become a thing of reality, where integrated care can be delivered through a digital platform and patients will feel that the care they receive is within their own context, a huge leap forward for how these countries enable innovation in the health care system.
First published in HIMSS UK in November 2016.
Answers to questions can change the world, of course they can! When I fly I so rarely check a suit-case in that I had forgotten the words that you are asked before every flight until this year’s summer holiday. Did you pack this case yourself, are any of these (dramatic wave over picture) items in the case, could this case have been tampered with?
Western, male, childish human behaviour always, always makes me want to answer different to how the desk operator expects at this point, but I don’t, I behave and move along the line. But this summer holiday season these questions did get me thinking about the parallels to healthcare. Are the questions the right questions, are they based on enough background information, are they asked at the right time and does anyone really consider what the answer could be?
In Ireland we have three projects known as Light House projects, specific disease areas of focus where we have applied investment that has delivered learning and solutions for the healthcare system. Interesting in the context of question asking in particular is the Bipolar Light House project; one of its early deliverables is a solution that allows the person suffering with the disorder to record their feelings daily. In time and with the patient’s awareness the questions will be prompted by other data, for example has the person been outside today, exercised, and interacted with others. The question and the context of the question is just as important as the answer in these circumstance! And yet current ‘best practice’ is to ask at each consultation, how have you felt over the last month?
And to match the current best practice we also have human nature, where the obvious answer in Ireland in particular is, ‘Grand, thanks’.
Cause no fuss, almost regardless of disease type is the patient ethos when it comes to the sharing of information, and perhaps even more so in complex mental health areas. If a patient wants to share information then it is our role, maybe even our main reason for being in the digital health industry in the future to enable this to happen.
Are the questions the right questions to ask, clinical practice knows because of the wealth of knowledge that clinicians have what the right questions are and how they need to be asked. This is fundamentally why we need clinicians involved in the design, build and test of every system deployed into our healthcare system. Seeking clinical support from the design phase onwards is not a simple task though, design comes with personal perspective and opinion and therefore getting to a point of consensus is always going to be difficult. Maybe then the arbitration vote on the design of an information system that is asking questions should be the patient, to truly deliver contextualised care where the right questions drive a type of care that is infinitely safer, more efficient and makes the care delivery feel like the fast lane for baggage check in and the first class lounge at the airport!
Questions in health need to be based on enough background information to make a difference to the care that the patient is going to receive in a short space of time in the initial consultation. Systems need to inspire the right question.
The airport questions have to be asked at the right time, in health we need to consider are our questions asked at the right time and by the right people. One of the most common perceived benefits to an EHR in an acute hospital is to remove the need to keep asking the patient the same questions over and over again, not just because, lets face it, it doesn’t instil confidence in the patient or the delivery of care but because it is simply inefficient and unsafe. But really an EHR in an acute hospital can do so much more than fix this issue when it comes to asking the right questions.
As Ireland prepares to go live with it’s first EHR in the maternity hospitals of the country we can see a huge enthusiasm amongst clinicians because the system is going to prompt them, based on data, to ask questions against early warning algorithms. The questions will be prompted because the patient is at the centre of a new type of ‘network’ where devices that measure are plugged into data and where the two spheres of influence, the measure and the data, can come together to inform the intelligence of the clinicians so much more than simple observational charts allow us to do today. That’s is why we, the health technologists, got into this business really, the connectivity of technology that allows us to create an Internet of Things that has the patient at the centre, maybe a new name for IoT in health, the Internet of the Patient, IotP!
If you did decide to answer the airport questions differently to the expected answer what would happen? I would hazard a guess a serious double take would be the first thing as the clerk behind the desk has probably never had anyone answer in any way other than to confirm the answers they expected to hear.
But when formulating the questions does anyone really consider what the answer could be? Imagine if a patient answered differently to expected, how much would it throw the care process. In 2006 I was seriously ill in hospital, no one knew why, no matter what questions were asked the team couldn’t get to bottom of it, so they put me in ICU and wired me up to every possible machine, turned down the lights and observed, when the questions fail observation and time are the only keys to unveiling the true nature of disease and illness. Questions answered can come from so many different quarters, in my case the fact I had travelled overseas was the key to unlocking what was wrong, but that took a more casual conversation than how are you feeling and could only be got to once I was stabilised. Somehow the ability to unlock that information needs to be a new focus for health if we are to deliver contextualised care. However the care that needs to be taken in unlocking the data and delivering it to the clinician needs to be significant, as Frank Buytendijk, a Gartner researcher has been describing for several years this could be considered to be ‘crossing the scary line’. The impact on care that data can have is phenomenal, but, two key actions need to be considered, firstly can the clinician handle the volume of data and second what privacy elements is the patient willing to give up to enable the clinician to have this information.
Imagine if we could give an answer that could cause a different question to be formulated! In so many other sectors digital information has already enabled business disruption to occur. If we can get to the point in health care where the question of the patient could actually move from how have you been for the last month to one where the clinician and patient already have the core data shared between them, the conversation can then move away from how to why and then to prevention. A clinician recently told me that the outpatient appoint for him, a psychiatrist, was as much a reminder to review the notes of key patients as it was an actual face to face appointment, with the right systems delivering the right information to all parties then that can become a shared responsibility and the mantra from the UK of no decision about me without me can be taken up even more strongly.
Next time I check a bag in at the airport I think I will have a little more time for the person asking the question, really they have an important job to do in simply asking the most simple of questions.
First published in CIO Magazine in August 2016. A collaboration with Elaine Naughton in the writing and development of this idea, a huge thanks to Elaine for this.
In the excellent Steve Jobs biography by Walter Isaacson, he describes a discussion between Jobs and Steve Wozniak where Jobs is explaining to Woz that the role he plays in Apple is that of an orchestra’s conductor, here to get the best out of the team, to ensure that they play in harmony and deliver to the listener the most inventive and yet classically rich vision of the original design. This conversation is said to have taken place after a strong ‘debate’ just before the launch of the iMac itself, Woz described by Isaacson had just exclaimed to Jobs that he was neither designer nor engineer and therefore did not really warrant or justify the recognition he was getting as the ‘re-saviour’ of Apple.
Is the creativity of the conductor the real line to success in IT leadership? After all the ‘band plays on’, or at least tries to, whether there is a conductor or not. Even as early as 1998 Jobs was describing, I think, what the modern CIO now needs to be, although maybe we now need an evolved model from conductor to DJ or rock and roll front man.
Why does the analogy and the model need to evolve? Well, in times gone by, the IT leader would have sought out the best in class people he needed. Much like creating an orchestra of around 30 talented artists, the Leader had to be the best that the orchestra could afford and then the conductor had to make them fit into the team, not always an easy job. The ‘prima donna’ persona of the highest calibre technologists is not always easy to integrate into a high-performing team after all. This then, perhaps, is where the evolved model comes in.
The leader of a rock band enables the band to “jam” develops a structure and order to remain in time, and chooses a rift as well as creating a tune as they play. Maybe this roll can be best described as the start-up innovator of the music scene. A band always needs a front man – someone with a vision for the sound they want to achieve and the charisma and charm to wow an audience, the band may play on if the front man leaves, but rarely as successfully; what would U2 be without Bono? or the Rolling Stones without Jagger? Queen without Freddie? Perhaps the best real world example of the rock star digital leader is Larry Ellison of Oracle, truly a front man if ever there was one to be seen in digital leadership. The owner, founder, creator and beating heart of the Oracle empire, whilst no longer leader in name still very much the charismatic front man of the brand and indeed, band!
An orchestra, on the other hand, follows a very strict plan and each of the upwards of 30 members (over 50 for a symphonic orchestra) knows exactly what they need to play and when, whether it is solo or synchronised with their team (by virtue of the score). Only the conductor knows the full score and reads all lines simultaneously, knowing who to call on and who to bring in exactly when they are needed for the orchestra to continue playing in harmony and in time, and for soloists to have their moment to shine. A digital leader in the style of the conductor does just this. The danger here though, is if only they know the full picture, keeping everyone focussed takes a huge amount of energy and enthusiasm. Many public sector digital leaders are of this style (often by necessity) as the full picture is in reality always being altered and reconfigured a small amount by the political leaders and paymasters.
The conductor’s role is an art form and a talent, while being a very technical job. Take the conductor from this and time signatures slip, the musicians become discordant and eventually chaos ensues. Just as with Jobs and his temporary departure from Apple, as conductor of that orchestra he was never truly replaced and therefore for a time the music was not what the audience needed to hear. The creativity, in the sense of innovation of the music, belongs to the composer rather than the orchestra or conductor; with this in mind maybe we need to see the digital leader as composer and conductor more often!
A DJ, unlike the conductor or rock band front man, can take the best work of a much wider variety of stars, mould them together until they find the right mix and then play it for the audience. The DJ doesn’t have to integrate the full character of the artist just that moment of excellence where the beat fits or as the very wonderful NetFlix original puts it, ‘When the Get Down arrives’! A modern successful digital leader then is going to be a DJ! If we consider the ‘gig economy’ to be the future in digital then this kind of character and behaviour is likely to become even more prevalent when building successful teams. The magpie-type ability to bring all the best bits together for one moment of excellence that then can be repeated.
We believe the skills of a DJ are also key traits of a transformational leader: someone who motivates and energises their employees to get behind a transformation strategy, creates something that has been written about many times before, the creation of a fan base if you will!
The styles of these three analogies allow us to consider the nature of digital leadership. There is a mix of two key styles here, one is transactional the other transformational. The conductor is transactional, planning, organising and controlling. The DJ is transformational challenging and changing organisational culture, coaching and developing people, creating a climate of trust, establishing a long-term vision. The front man perhaps mixes both styles dependent on the need of the audience or band members, an ambidextrous style that is agile and responsive as startups require to be.
The analogy can continue in a number of ways beyond just the parts of the mix. A DJ brings with them the theme and the end point they are trying to get to, much like a high performing digital leader needs to, they start with the end in mind. Also, the DJ needs to be aware of the change in trends, evaluate them and consider how to adopt them into their fabric, so much learning of how this is done from both professions; I would love a temporary job swap!
The Jobs autobiography also describes the moment that Woz and Jobs first met from Woz’s point of view, “We first met in 1971 during my college years, while he was in high school. A friend said, ‘you should meet Steve Jobs, because he likes electronics and he also plays pranks,’ so he introduced us”
Jobs and Woz learnt they had so much in common, and yet were so different. The wonderful “Small Data” book by Martin Lindstrom references a Harvard Business Review article by de Swaan Arons, van den Driest and Weed called “The Ultimate Marketing Machine”. The article suggested that there are three types of people needed to make a marketing company successful, they are:
Think people – Who focus on data and analytics
Do people – Who have responsibility for content, design and production development
Feel people – Who are all about consumer engagement and interaction
I wonder if the modern digital organisation can apply this exact same logic as has been done here for the marketing team. The types of people the IT leader needs to bring together are defined less by their technology specialty and more by the person type they act when they are in a delivery focused team. Back to Jobs and the Apple empire, the success of the original swathe of ‘i’ products has always been put down to two elements, one, Jobs own meticulous eye for detail and two, the design standards of the team under Sir Jonathan Ive. If we overlay the commentary from the article in the Harvard Business Review referenced above and the conclusions that Lindstrom himself makes on this article we start to see that the way this team has been successful is by ‘minding the small things’ by being a team that is led by a digital orchestrator but exists as a team that can deliver empathy together, to the benefit that is trying to be attained.
A modern, successful leader needs to be a strategist, a “front-man (or woman)” AND be able to conduct a complex set of teams in a harmonious way – or at least empower capable section leaders (upper strings, lower strings, woodwind, brass, percussion) to do so on his or her behalf.
The theories of Lindstrom in Small Data will blow your mind, you regularly turn a page and laugh at the conclusion he has made and how it applies so completely not just to modern marketing ways of working but to how the right digital function needs to deliver. Whether as leaders we are badged as CIOs, CDOs, Conductors or DJs we don’t care, we just want to be able to make IT work.
…… as a post script we really do care! Two IT leaders were involved in the creation of this article, one of us wishes they had taken the path of enlightenment and become the superstar DJ of their dreams the other is progressing from playing second fiddle in a growing orchestra to becoming a conductor and leader of a great band.