Originally written for and published by Horizon Business Innovation
The role of CIO is more and more about leading a team, and a team of diverse skills and capabilities at that. Healthcare CIOs are used to the term multidisciplinary team, it is intrinsic to integrated care delivery one of the key benefits of technology in healthcare, however the term can equally be applied to a team of IT professionals.
Leading a group of professionals with diverse backgrounds, motivators, knowledge and skill is one of the most important aspects of the CIO role I think. In December 2014 I was lucky to be given the opportunity to lead the digital healthcare function in Ireland. I inherited a team of around 290 directly employed staff and around 300 indirectly employed. As a team it was a group of people who cared passionately about the capacity, capability and function of IT at local levels but had not come together as a single function for many years.
One of the first tasks of the new role then was to bring together these local teams and build ownership of a national vision, a new operating model. By March 2015 the senior management team were able to unveil the route to the new operating model and begin transition, this was marked by the first ever all staff meeting. Bringing together all staff from across the country seemed like a simple but ambitious thing to do, particularly as the team had not done this ever before. The conversations for the day needed to be inspirational and we needed to use the team to make clear not just the new operating model but also the benefits of this. Bringing clinicians to the stage was the best way of doing this at this early stage and certainly the organisations national director for integrated care had the audience really understanding why the new operating model was necessary. The same event was also used to spark an interest in new technology with an Expo type area demoing diverse sets of technology from face recognition to drone tech to wearables.
By September of 2015 the route to a transitioned organisation had been completed, but in reality at this stage the most of what had happened had been a movement of the deck chairs on the deck of the big ship. Everyone now understood their new role but few people had moved to actually doing the new role. This led to the second all staff meeting being put in place, this time not just for staff directly employed but for all people working in healthcare technology across the country. The theme of the second meeting would be transformation and both the Director General and Secretary General of the Department of Health were able to open and close the event. The theme of transformation was illustrated by a number of conversations ranging from the new CIO of a major bank in Ireland talking about technology teams to the futurist view of a technology communicator and broadcaster. The engagement and enthusiasm created in the room was phenomenal and for the first time technology people in health were given ‘permission’ to go forward and innovate, to make mistakes on the way and to be more agile. The transformation process was really given a tremendous kick towards success.
So with transformation now underway it became clear that the engagement of the team throughout the country at a personal level would be of the utmost importance. With this in mind we altered the structure of the Senior Management Team Meetings making them fortnightly and moving them around the country so that as a team we were both visible and available to the organisation. We have a theory that if we can make the senior management team more accessible and more transparent in what it is trying to achieve then we will be able to take the team on the journey with us more easily, transformation to the new operating model was not going to be achieved overnight.
Motivation of a team that has delivered through the adversity of a huge financial downturn and crippling underinvestment in technology and personal development was never going to be straight forward. Meeting staff face to face and delivering open and transparent messages was to be a clear way to try to deliver for the team. Considering Maslow’s hierarchy of needs seemed to be a validation of the effort that needed to be applied. Taking an idea developed and evolved since the 1940’s and then applying this to a team of people in 2016 seemed uncomfortable at first but it has brought rewards and provided a framework for the change we need to make. Certainly we now feel we are trying to deliver on the top three elements of the hierarchy, provide belonging and reason, create an environment where staff can assert their own esteem and finally enable the process of self-actualisation to take place.
The use of social media as an engagement tool is not everyone’s ‘cup of tea’ (maybe that should be pint of Guinness after all I am in Ireland now not Yorkshire). For the very first all staff meeting we created a hashtag to be used internally for all team engagement, #ONEeHI. The SMT and speakers were asked and cajoled to engage on twitter using the hashtag and slowly but surely the identity of all engagement has moved to the hashtag, the latest all staff meeting has even simply become known as the hashtag itself. As we strive for the level of engagement and transparency that we need though we have been able to use social media to make each of the team real to those that want to engage in this way. Social media is not used ‘simply’ for these events but throughout the year as a way to ask questions at any time, as a way to see what thinking is happening where in the team and to simply make real the people that are involved in the changes.
We are a healthcare IT function and one of the next stages of the transformation was to begin the process of real clinical engagement at all levels. As a CIO and CEO of a health technology function I strongly believe that once the transformation has moved us to a platform that we can deliver upon more of what we do needs to be clinically led. So with this in mind as well as creating the single digital function for health we also started to create a clinical engagement function that became known as a Chief Clinical Information Officers council. We also appointed the lead role of this function to SMT to bring us the clinical diversity as part of the leadership team a decision that is bringing huge rewards to how the team functions and delivers.
With this in place and a promise in 2016 of bringing around 50 new resources into the team the next all staff meeting was in early March of this year. Over 300 people descended on Cork to hear conversations about connectivity, the need for us to make connections across the team to ensure that transformation really did become the way in which we worked. The first thing I had to do though was to apologise, we had made promises around new roles back at the September session that we had missed dates on which was a huge shame however being transparent and open around the process to get these roles into the team certainly gained us a level of understanding and engagement that we really needed. Again the Secretary General and Director General opened and closed the event with clear and exciting statements of support for what technology was doing in health and Director General urged the team to celebrate its success but be mindful that success brings more expectation, a powerful statement for a leader of such stature to make to the wider team.
The experience of physically bringing the team together in the days where technology connections are so powerful is still one I strongly believe has been hugely influential in the success of our transition and transformation. We have also used the technology available to make real connections through blogs, web-ex, podcasts, video, social media and animations but nothing has been more powerful than a room full of people who are enjoying the connectivity they are having so much that they are not even aware that lunch is being served and its time to go eat!
If you want to know more about the events have a look at the social media #ONEeHI or consider having a read of the three blogs that have been created ahead of each event at richardcorbridge.com or simply get in touch maybe even see if you can sneak in at the back of the next event in Galway in September!
Originally published via Horizon Business Innovation
The point in which the IT industry began to conflate the words innovation and entrepreneur bothers me as a CIO in the public sector. On a regular basis public sector technology picks up negative commentary on two fronts; firstly it is not innovative and agile enough and secondly that it is not managed well enough with good and clear governance that captures risky contractual issues and manages them appropriately.
The conflation of the two words though makes it even more difficult to achieve both of these key outcomes at the same time in the delivery of technology to national sized projects.
Why should it though?
Well if we are to believe that innovation can only be achieved by SMEs with an entrepreneur at the helm then the very nature of these two functions will make it very difficult for large public sector contracts to innovate. Public sector rules are designed to replace good, relationship based governance with a safety net that awards size and sue-ability of the organisation and despite many different attempts (for example G-Cloud in the UK) we have yet to see a framework in public sector that truly enables innovation rather than concentrating on the contractual framework that can be put in place.
As a public sector CIO for the last 10 years I am starting to form a theory though, maybe innovation is a state of mind rather than a contractually obliging function or something that can only be attained by having a cool hipster as the founder. Innovation from the CIO through the organisation requires a culture to be in place, not just the typical fail fast and learn lessons but a culture that allows the team to build a relationship with the supplier.
So many experienced delivery focused CIOs will say to keep suppliers at arm’s length, a single throat to choke and all the horrific imagery that goes with that. But what if we became collaborators, even friends, willing to put in all those extra miles for the shared good of an innovative outcome.
And what’s even more interesting is if we could do this then we would no longer be limiting ourselves to SMEs for innovation, you can build a relationship with the Oracle, Microsoft and IBMs just as easy as easily as you can with the bright young idea that just stepped into the office.
How? Well in my last two roles through using two key skills as a CIO that manifest themselves in one clear way. Mike Altendorf in the January issue of CIO UK lists the five things he learnt in 2015, and number five is communications. To see such an eminent thinker pull this out as a key skill in 2015 shows that at last our collective light is coming on.
The two key skills that I believe can be seen outwardly as communications that simply enable the innovation culture to brew are empathy and marketing. Perhaps marketing is a bit cold as a skill description but ultimately it is what it is, persuading the team, the organisation, the bright idea that just walked into your office that a collaboration should be reached is absolutely all about the marketing. You, your team and your organisation need to sell yourself to the idea as much as the idea needs to become your ‘supplier’. Then the empathy skill kicks in because this is where the new burgeoning relationship will build from.
For a public sector CIO to show empathy to a start-up organisation can sail close to either patronising or patriotism dependent on how far you go though. Someone shows you an idea, the germ of something you need, how much empathy do you show without over playing the card?. It is easy to grab the idea and try to support it through the whole system, becoming the champion but you then need to be careful not to have opened up a can of worms around a challenge for over enthusiasm for one supplier.
What is great though is all this applies regardless of who the organisation is. In 2015 we have had great ideas pitched to us from the biggest of organisations through to an idea from a one man organisation, all of which will in 2016 build that digital fabric for our large public sector organisation and all are seen by our customer base as innovative and yet simple. Maybe this is another key performance indicator that needs to be taken on board, customer or partner perceptions of innovation, they are not always the cutting (bleeding) edge of technology, innovation can often be the best re-sue of a current technology into a new setting, and these communications skills and in particular the ability to see and understand a customers perspective spring to mind so clearly here.
More and more often in my public sector area, health, we need to build a physical presence for this kind of engagement to be the most successful. An Innovation Centre where through a location where the culture described above will be encouraged and even taught to suppliers. Technology and business leaders from across health can come together as easily as possible to share in the building of solutions, no matter the size or age of the organisations working together.
There is a risk with all of this innovation styles hitting public sector though that if it is not joined up properly then there can be innovation lethargy. If you consider health alone in the UK and Ireland we have a plethora of tech funds, innovation hubs, accelerator programmes and commercial initiatives. So, now the CIO role is also to navigate the partnership they have created through this quagmire of opportunity.
In the process of creating this blog I feel I have persuaded myself maybe the conflated words were wrong, and we had in fact substituted entrepreneur for leader, if we put that ‘e’ word back in its box where it belongs and replace it with innovative leader then maybe we have the right solution.
Originally published by HIMSS Europe as a guest blog in December 2015.
No more than any other business or service area supported by technology health needs innovation.
Simply following the horizontal innovation path will not bring the type of different approaches needed to truly enable the health systems of the globe to be reformed so that they can meet the growing population needs. Health doesn’t have time for small incremental change, it needs a new approach.
At the Wired Health conference in the spring of 2015 this was termed Vertical Innovation. Some health IT commentators have referred to it as a need to ‘invest in magic’. No one said this would be easy to do though. Innovation in a public sector environment that comes with the defined need to ruthlessly standardise to enable more to be done for less is not an easy back drop to facilitate innovation.
The culture of technology teams in the health sector continues to fascinate academics and organisational development experts across the globe, why is health so much slower to adopt technology than other business verticals. The size argument is well made so organisations make the scale smaller, the engagement of clinicians is then levied and organisations now know this needs to happen (although this doesn’t always equate to a real engagement it has to be said). So what is slowing us down?
In Ireland we are aiming for a culture in the team that facilitates our ability to innovate. Firstly in creating a new operating model for technology delivery we have worked with Gartner to adopt the bi-modal principle they have been so fond of over the last 18 months or so. This focus gives us the opportunity to manage continued delivery and improvement whilst enabling innovation and new ways of working to be created within the system, all with relatively small resources. A great example of this is the implementation of the eReferral process, managed by just three people across the system but in 2015 now implemented into 50% of hospitals with a plan for the remainder by March 2016.
Hand in hand with the bi-modal approach though is a slow but obvious individual adoption of three ‘Rs’ – Resilience, Responsibility and Relentless. The eHealth Ireland team were presented with an overused management phrase in September, ask for ‘forgiveness not permission’ when considering how innovative technology approaches can begin to create integrated care. The team now have responsibilities that match the care pathways of health delivery in Ireland rather than technology delivery routes or geographies of the country and that enables them to take responsibility hand in hand with the clinician. The team are striving to be responsible for business change rather than technology implementation, and that comes from a partnership. Take some of the major projects this year (2015) as examples, the delivery of an Individual health Identifier for the population of Ireland has a clinical owner within the Primary Care field, the creation of a case for change and business case for the Electronic Health Record in Ireland is sponsored by the clinical director responsible for integrated care, even the eReferral success has been set up as a project by a Physiotherapist who had the vision to see the benefit and how it could be implemented.
So, Ireland now wants to build on this approach, it wants to facilitate access to innovation. There is simply not the funding or capacity in health to allow for the kind of tech-fund investment seen in the NHS, Ireland’s whole health IT budget is lower than some of the tech-funds launched there. So it has landed on a different approach.
In 2016 Ireland has created an innovation portfolio within its bi-modal capability. This innovation portfolio has three specific strands;
These three strands then become the innovation portfolio in 2016, the basis to allow Ireland to learn quickly, innovate vertically and continue to build upon the success of 2015, but learn in a way that immediately impacts upon the delivery of integrated care across the whole nation.
Considering the evolution from horizontal to vertical innovation though, this really does simply take us up the first rung of the ladder, but it feels better than sliding down the same path that has been tried and tested so frequently before.
This blog was originally published by http://businessvalueexchange.com/.
What does it mean to have a digital consumer experience? Probably the music industry has managed to make the most of the digital market for consumers in recent years. And even now the impact of consumer and artist continues to evolve what is delivered at a pace that could well be described as beyond agile. Take the Apple reaction o Taylor Swift’s demands on how the new service should be paid for, digital supply and demand at its most obvious.
I have loved the music of Prince since being a kid. I’ve put up with all the name changing nonsense and still enjoyed his music, as a digital experience and ability to work with the consumer the artist presents an interesting story board. In the late 80s I collected everything he put out on black plastic, loved it to bits, cared for it, taped it to make different compilation albums that were mobile based on my own analytics of what I wanted to hear and in what order. Then in the early 90s I collected the originals again on cassette as it was just so much easier, more ‘consumerable’ to have the ease of access. The late 90s saw me replace the cassettes with the high quality CD generation sounds, and then place these onto my own virtual private cloud so I could share them easily with my family through early versions of social media (Yahoo Groups anyone?). And now I stream his content from my phone, a new song thrown out without warning straight from the public cloud as a reaction to social issues in the US…
So, the Harvard Business review and some of the analysts at Gartner suggest that the make-up of Digital is something called SMAC-IT, Social, Mobile, Analytics and Cloud IT. Prince must have seen this coming and even added a few mega trends himself.
In reality though the digital consumer experience is the centre of the world for a CIO in 2015. The digital delivery mechanism is a key consideration for all elements of the business that the CIO is responsible for. Governments globe wide are creating digital strategies, the EU has the concept of a digital, boundary-less economy, and delivering to citizens on digital first platforms is the corner stone of the UK parliament and indeed the Irish government.
In health we are often faced with comparisons to banking and tourism, the comparison normally goes like this,‘If I can book my flight on line, even pick my seat then why can’t I book my appointment’ Or ‘I don’t have to actually go into my bank anymore so why do I need to be face to face with a clinician to get a repeat prescription or an initial consultation.’
We have tried hard for years, right back to when the then UK Prime Minister Tony Blair first used the comparison to say, ‘But, Health is different, it is more complex!’
The need for a digital consumer experience does not stem from the availability of technology to do each job though, it comes from customer expectation. Gone are the days when a real argument against a digital fabric for health could be the training and development of clinicians and how this would be such a significant piece of work that would slow digital adoption. A nurse really doesn’t put a mouse to a screen and ask what to do with it. Why, because the nurse is walking the wards with a personal computer in his or her pocket that is probably more powerful and is certainly more accessible than any system deployed by a health service.
This then becomes why the customer should have such an impact on what the digital delivery is.
A customer genuinely does know what is going to work best in their environment. The customer journey in health needs to be catered for in a different way, accuracy, safety and efficiency are the most important elements. At a recent event the key goal of health was discussed around a table, a sensible table that agreed that comparing health and the digital fabric that is required to support health is so very different to that of a commercial organisation. Consider the core function of health, drive customers away, keep them out of services as long as possible, cut down on interactions wherever possible and be as open and transparent as you can whilst maintaining privacy. The difference to say an insurance company is compelling; the digital customer journey for an insurance company is clearly more about retention of the customer, finding more ways to interact and ultimately taking something from them that they don’t really want to give, cold hard cash!
Trying to put a definition on the digital consumer experience in health may prove to be useful; I was recently presented with a time-bound definition of three waves of engagement:
1 – Patient Centred Care – A consumer wants to be partnered with to manage their health.
2 – Consumer Engagement – Enable the digital consumer to engage in and take charge of their health.
3 – Science of prevention – Empower the digital citizen to direct their life plan, cradle to grave.
By placing these goals at the centre of our eHealth journey and ensuring we set expectations of how long it will take to get there then we will be able to enable health to be as influenced as other consumer deliverables are in how they deliver, which surely will enable the patient to be at the centre of their care to the degree that they want to be.
So finally, in the words of our analogy creating artist, ‘I’ve seen the future and it will be!’ I wish I could but we can but try.
Delivering to a consumer base that is digitally aware, capable, and willing is changing the delivery focus of eHealth. It is not creating a one size fits all solution but one that is informed by the choice of the consumer and the outcomes and engagement the consumer desires.
Since the 4th millennium BC humans have been accessing and processing information about innovation and considering how to use what is in front of them! We call it reading! How many of you read at night? How many of you as children would get the torch under the covers and read just a little bit longer? For me it was Doctor Who books!
So, if reading is the route to innovative thinking and most of us love to do this at night, why oh why has the concept of reading in the dark been an obstacle for so many years that clever innovation hasn’t enabled it exponentially.
In 1800 if you wanted to read for one hour at night you would need to work an average 6 hours to earn enough money to buy the required amount of candle to do just that, and I wouldn’t have recommended anyone doing it under the covers either! However innovation was clearly hampered by the ability to read at night as the candle remained the main source of light to read by until the 1880s, when the oil lamp became the next innovation.
Horizontal innovation in action; 80 years to move from six hours hard labor to fund one hours learning to a new situation where you ‘only’ have to work for 15 minutes to fund enough oil for one hours reading. You would then assume that this vertical step would radically change the thinking for funding reading. Unfortunately not!
In 1950 the ability to read for one hour moved to a cost of eight seconds of work. The modern filament light bulb became the way in which we could gather knowledge to be able to innovate – another step change, but one that took just a little less than a century to reach. Again, more horizontal achievement rather than vertical change.
Today on average it costs less than a second to earn the funds to allow you to read for one hour in the dark. Now that’s an achievement. In over 200 years we go from spending all day working to be able to spend one hour learning and now it’s half second for the same! But, really if we were truly innovative in a vertical way, in a way that wasn’t an evolution of the same story, before the bright thinker makes a giant leap of faith, then perhaps we would already be in a position where technology allowed us to access energy for free, to create light that allows us to learn.
Innovation to deliver eHealth in Ireland requires different thinking. The concept of Research and Development needs to change, we can no longer ‘rip-off and duplicate’ what has been done elsewhere, for many reasons. Lessons learnt in eHealth globally show us that the transferal of technology from healthcare system to healthcare system has often caused so much upheaval that benefits are not released and clinical and patient engagement is made exponentially harder.
The Director General of the Health Service Executive in Ireland made a call to arms in the last week in February 2015. He suggested that health delivery in Ireland is now arriving in the information age. Two examples of that spring to mind, examples that have been delivered in different ways and ahead of any grand delivery model that my office will produce, showing me the will, the capability and the desire is absolutely there.
An electronic patient record (EPR) for Epilepsy has been in place throughout Ireland for more than a year. Delivering an integrated care pathway for patients suffering from a chronic illness that is cared for on a national basis to ensure that the best clinical minds are able to care for patients, offer them assistance in staying well and finding mechanisms to live a normal life with the illness.
What is innovative is the approach taken to the delivery of what has been described by one of the leading clinical advocates as a ‘postmodern’ digital solution. A solution that makes the best of what has gone before so effectively it goes so far as to celebrate it within the delivery and specifciation of the new system.
The epilepsy EPR has been defined by clinicians against the care pathway requirements. It is a digital and mobile solution, and it enables access to the longitudinal record in the settings where care is provided. There is an inherent information governance capability within the system that protects the information within the system for clinical use.
This has been delivered against a local standardised solution set rather than a national governance model and shows the delivery team of eHeath Ireland how innovation can be adopted into clinical settings when it is clear what the benefit will be to patients first and the clinical outcomes and process second without the technology featuring on the list of priority considerations.
The other startling piece of disruptive innovation is an extremely successful eReferral pilot in Cork and Kerry. There isn’t anything that vertically innovative about digitizing the referral process itself, this has been done before in many countries and care settings. The innovation here is the way in which the project team has gone about the delivery, a model we will try to make re-use of throughout the eHealth Ireland implementations.
The team has built the technology in an unobtrusive way, delivering an integrated system into the GP solution through messaging capability. Then the team was able to work with individual clinicians to understand the personal benefit they could achieve from having a digital referral solution in their care setting. Visiting the Mercy hospital in Cork it is very clear to see the data benefits to them and the process change that the delivery of a digital solution has enabled them to undertake, creating an information age referral process throughout the hospital.
The change in attitude to innovation, to allow eHealth Ireland to be built is underway already in this country. We will support this as it develops more and find more and ways to inspire this behaviour change, after all we all want to read at night!
There are plenty of articles and books that give a great deal of advice about starting a new job. First 90 Days by Michael Watkins and the Gartner First 100 Days were great preparation reads for me moving to my new role in Ireland. Now I am more than 20% into that first period of time, and getting back to normal after Christmas.
So after taking a little time to reflect on what have I understood so far and what I need to focus on for the next period I thought it would be good to try and set it out here.
The Gartner report suggests after day five you start to chunk up the first 100 days into 15 day blocks, which was great for coming back after the holidays and being able to see where we are going next, but for this blog entry I wanted to try and reflect on where you can get to with just 20 percent of the time!
Coming into a new job will rock even the most solid CIO I would guess, and if it doesn’t then maybe there is something of an over-confidence element at play or the CIO is in the wrong role! Coming to the Health Service Executive in Ireland, I am continually reminded, is indeed a big challenge. There is some significant work to be done, but I knew that when I applied for the job. I wonder if suppliers and commentators sometimes miss the fact that a CIO will obviously have done their research before taking on a job and therefore will know key things like the investment to date and the attitude to business change; however I am sure all of these comments have a genuine point at the centre of them which is to offer advice, guidance and an access to what has gone before, all of which has been invaluable in setting the tone for that first 20% of the 100 days!
Creating intent for the year ahead was a goal I set myself over the Christmas period. As a senior management team for technology we created a document that describes what our key functions will be and how we will deliver on some early elements of the eHealth strategy itself. In true organisational development style we have then been able to start to think through some of the formation elements as well, putting in place a design that allows agility within the structure without predetermining the outcomes of a large piece of business analysis that is underway, that will inform what will become the ICT Strategy. (Although by the time the strategy does come out I hope it has a different name!)
The strategic intent also has defined the six interim but key programmes that we will apply resource to at least in the first part of 2015, to get some immediate traction and results. These programmes are:
Health Identifiers: The delivery of Individual Health Identifiers to the population in a single index database that can be accessed from integrated systems throughout the Irish health system is one of the key foundations of eHealth. A first phase of this will be designed, built, tested and delivered before the summer of 2015.
eReferral: A very successful eReferral pilot had been completed in two areas of Ireland. Whilst not being able to deliver on the whole healthcare system-wide benefits it has delivered significant benefit into GP surgeries and has been a platform for engagement on the subject of digital supporting business change. With this in mind, one of the programmes will work to both continue the piloted roll out and consider what referral solutions could be deployed in a tactical manner later in 2015, that will release additional benefit across the whole system.
Primary Care Technology Programme: At recent events I have been able to talk about the ‘stars aligning’ in the delivery of our goals. That is never more so than in the Primary Care area. Changes in the market place, advancements in technology, a desire to deliver integrated care and the will of the clinicians involved all point to the possibilities opening up significantly in this area. With this in mind we are creating a piece of work to evaluate the art of the possible and define the needs.
Cancer Technology Programme: The delivery of technology today is important to the delivery of care in this therapeutic area. A group of clinicians have created a hugely impressive body of work that describes how technology could support the therapeutic area that means so much to them. To read this piece of work and see the vision, capability and desire to move this area into the current decade for technology inspired the creation of the Cancer Technology programme. This work will concentrate on ensuring that what can be delivered in this area in the next 12 to 18 months is done so with a mindfulness of technology strategy such as the identifier but with a core goal of releasing benefits to patients and clinicians alike as quickly as possible.
National Children’s Hospital Delivery requirements: No matter what the opening date for the NCH will be it will be the most advanced hospital Ireland has ever seen: a truly digital care facility that will integrate the pathway of care for children and enable a quality of care to be reached beyond what we can see today. To do that will require a technical capability in the integration of systems and information and therefore it is important that one of the strategic programmes is to design the response to this wonderful opportunity for the country.
Industry Engagement: A member of the audience at a recent event I presented at asked the very pertinent question, ‘Ireland is the centre of technology innovation in Europe, what are we doing to leverage that?’ What was great was to be able to answer that question with a tangible reality not just intent and plans. The team began an industry engagement programme in the late summer of 2014, to discover what the technology industry thought could be done to support the delivery of eHealth for Ireland. As a programme this has delivered a huge amount of clarity to the thinking of the team. Discovering how technology can be applied, procured and deployed will inform the delivery of the strategy greatly. This in turn will mean industry will be engaged as they will have been involved in its formation thus creating a virtuous circle of belief and capability to deliver.
Added to these strategic programmes, the intent also goes on to establish the need to provide a focus and governance on technology decisions which will be enacted through the creation of a technical design authority and a renewed focus on the delivery of a HSE-wide virtual Business Intelligence capability. This will build on the amazingly powerful Health Atlas solutions and the work done within the HSE in 2014, to consider what Business Intelligence functions and system need to look like to support delivery into 2020.
So for 20% of my first 100 days I have been really pleased with what we have achieved. We feel like a team with a goal and an ambition and, most importantly I would suggest, is that in everything we do we can see the impact on the patient and the clinician and the overall care system in Ireland.
Exciting to see where the next 80% will land us!
It is widely acknowledged that there is a shortage of women in senior STEM roles across public and private sectors. Much has been written about how to engage with the next generation of IT leaders to encourage uptake of women into the tech industry, without many concrete ideas of what needs to change.
Increasingly the few female CIOs or tech leaders who do acknowledge their status as the minority gender represented at board level, have written books, articles and given interviews on their top tips for ‘surviving’ or ‘making it to the top’. The question is, do I want to simply ‘survive’ my career, or actively enjoy it?
The recent announcement by tech giant Facebook that they are offering to pay for female employees to freeze their eggs under the guise of being touted as a benefit for employees, sends a strong message that having a career and raising a family are mutually exclusive. Unfortunately, this doesn’t do much to dispel any fears the next generation of IT staff may have about choosing a career in tech.
As a Deputy CIO for a medium-sized public sector organisation, who recently returned from maternity leave, the pressure faced with the desire to start a family and balancing a demanding job is significant. With a high level of personal planning I am able to continue my job, but this is on a knife-edge; one late meeting or train sends a meticulously planned routine into freefall.
My desire to continue to progress in work as well as ensuring a happy home life is a conundrum. Increasingly I use mobile working applications such as Google Hub which assists with being able to have face-to-face meetings via video and offline access to documents which means I can sync between office and home seamlessly. This goes some way to easing the juggling act along with having the support of a proactive team who have their own busy schedules to manage.
The consumerisation of technology has enabled people to maximise efficiency of their time; technology which was formerly accessed via personal devices, such as smart phones has now blurred into working life. Bring Your Own Device policies are now commonplace in most organisations, all of which assists employees to balance their working lives, whether that’s working from home, using Bluetooth technology in their car to make phone calls on the move or remote access to work via a mobile device.
The proliferation of smart phone apps offers ways in which small scale technology products pushes the market on both at home and work. During pregnancy I tracked the growth and milestones of my baby using an app, I now use a video baby monitor which uses wireless technology to connect to a handset which offers colour video whilst monitoring the room temperature and breathing pattern of my (hopefully) sleeping baby on-screen. Whilst seemingly small scale in terms of function, the cumulative effect of these innovations saves me valuable time and offers peace of mind.
Reflecting this on to the lives of the next generation of technology leaders; does the increase in devices and apps offer a ‘helping hand’ which actually makes a career in technology a great choice for young women considering their career choices. From fridges being able to automatically re-order groceries online to synced calendars with other family members, technology may not be a panacea but it is certainly innovating quickly enough to make a real difference.
On balance, there is no silver bullet to ensuring women are equally represented in C-level jobs; naturally it should always be the best person for the job; employers may need to do more to acknowledge that when we get there we may have an ipad in one hand and wireless HD baby monitor in the other.
What is your Unique Selling Point (USP), even the Big Issue seller I pass on a regular basis now has a USP. Today he was playing a flute and shouting the catch phrase at the same time! Whilst it was a strange sight to behold it certainly grabbed my attention and I would imagine his sales were up on the next guy just doing the usual!
It got me thinking though, what is our USP? And that only got me asking questions of of all the different hierarchy’s of USP, personal, team, system and organisation. As an organisation we believe that the our USP is;
“The NHS is the most integrated research system in the world.”
As an organisation we ‘hang our coat’ on that USP a great deal, ensuring that it remains true is what translates into the system and teams objectives. If we were going to point to something as an overall mission for the implementation of our systems maybe supporting this statement would be it.
As an organisation we state that we provide
“…the infrastructure that allows high-quality clinical research to take place in the NHS, so that patients can benefit from new and better treatments, and we can learn how to improve NHS healthcare for the future.”
Often this statement is translated into the simple phrase, health and wealth of the nation. As an organisation USP its something great to get behind, and is something that a networked organisation of around 10,000 people can really understand, which is a credit to the team that developed it.
The term USP was ‘coined’ in the 1940s as a term to express successful TV advertising campaigns by Rosser Reeves of Ted Bates & Company. Theodore Levitt, a professor at Harvard Business School around the same time then suggested that, “Differentiation is one of the most important strategic and tactical activities in which companies must constantly engage.” USP for us means a lot more than the advertising differentiator, it is more a positioning statement that should occupy a consumers mind and enable them to compare one offering to a competitors. So, the USP now means the difference between the brand and it’s competitors.
So, apply that theory to Clinical Research globally. The NHS is the most integrated care system in the world, one of the few systems that is free at the point of care and offers the clinical record from cradle to grave. With that in mind we really do have an opportunity to be a global leader in the delivery of high quality clinical research.
The delivery of informatics to support clinical research then takes this in to account. How to ensure that we deploy systems as effectively as possible without distracting the clinician or researcher from the work they are here to do. This is becoming our USP in 2014, unobtrusive systems deployed to support the research journey, collect appropriate data at the point of care and enable an integrated clinical research journey. Not just rhetoric any more but a reality for the NHS.
At a meeting of the new Local Clinical Research Network senior staff last week there was a real understanding and positivity about the deployment of systems, how they will bring benefit and how experiences of the implementation of systems could be shared. Having been involved in Health Care IT for some time it was so refreshing to hear different organisations offering to share resource, best practice and even appropriate data. And this then, starts to be a further USP for clinical research in the UK. The new organisation structures are further enabling collaboration across formal organisational structures, truly allowing leadership to blossom that can continue to add to the NHS being not just the most integrated but also the most complete place to do clinical research in the world.
But what of that personal USP, as an organisation we are trying to facilitate the development of personal USP all the time, new, different knowledge, skills and experiences make the team a rounded function that can deliver for the organisation. It is the time of year when the annual planning round is in full swing and staff are all working together to agree what the team Values, Strategies, Aims and Measures are. My senior teams USP came to fore in the last week for me, as they were able to grab hold of this task and create our annual plan together in a collaborative way that really does set the bar at an achievable benefits driven level for the next twelve months. A description that hooks back to the USP of the organisation and the system.
Exciting times all round!
The world moves more and more quickly. The Stone Age lasted 48,000 years and came to an end with the innovation of how to create iron. The Iron Age and the Industrial Revolution changed the world at a rate so rapid that one could propose that it did as much damage as quickly as it delivered benefits. The Age of Plastic impacted on every element of the world! Now it is suggested that we are in the Age of Zeros and Ones.
The difference between the Plastic Age and today is as large a cosmic shift as there was between the Iron Age and Stone Age. Imagine a man of the mid Plastic Age jumping in his TARDIS and coming to see us in the early stages of the Age of Zeros and Ones, what would this Don Draper make of Google Glass? If you take the comparison still further, compare today’s innovation to the Industrial Revolution. I would suggest we are still playing with the early stage wheel in our new Age of Zeros and Ones!
The discussion about what is disruption and how it should be managed is one that is covered a great deal. What is considered to be the best leadership style for truly innovative organisations? Should we sustain innovation and continue to develop or land innovation in short sharp shocks and then allow organisations and business to catch up? What is interesting is the word that describes the innovation leadership style itself, the ‘disruptive’ leader. I certainly didn’t want to be described as disruptive in my school report back to my mum but now many people use this as an endorsable skill on Linkedin. Not to mention the term ‘dis’, how many other words with ‘dis’ as the leader phrase end up being a positive describer of a leadership style.
But change leaders and the modern CIO have to be disruptive to enable their organisations to survive; sometimes that disruption is uncomfortable but necessary. Take a look at the Fortune 500 today. Only 10 organisations in that list existed in 1955, and look at how many of the names on that list would then be considered to be untouchable then. Innovation and the disruption that this brings enable organisations to evolve with the ages, without it the organisation could be considered as a short sharp shock, maybe!
So, applying this to my organisation, we can’t afford the waiting, long game, as the business needs to continue to innovate and evolve to maintain its position in the global market place of clinical research. But it is only slowly investing in sustaining a leadership quality that delivers innovation in the most measured of ways. So what is our culture? ‘Unbounded innovation’ isn’t on the cards. We have a process for innovation in the informatics arena that works, but does it stifle innovation, as soon as you apply a process? I worry it does, ultimately, and that every organisation needs to let the unbounded out of the bag for a period of time every so often or else it doesn’t disrupt and therefore may well fall out of that Fortune 500.
For us the next ‘Age” is the Delivery Age! We have lots of new systems, processes and cultural changes to apply and ensure benefit is gained, but personally I am already looking forward to letting it out of the bag and allow the off-process innovation to happen again and enable the ‘next practice’ not just support the ‘best practice’.
However, what is the answer to the question? Well I think that it is entirely reliant on the culture of the organisation and the will of the leader. Innovation can and will happen in the most unsuspecting of circumstances, if the organisation has a stable back bone then let it happen in as many elements of the benefit life cycle as possible and reap the rewards as an individual, a team and an organisation.
I have been asked to present at a summit of CIOs (http://www.ciouksummit.com/) later this week on the subject above and therefore thought it would be of use, and hopefully of interest to get some of the ideas down on here.
What our organisation needs is the ability to provide interoperable systems, link legacy systems to new shiny systems, and utilise open data standards and capabilities. We have tried to use that word open in a different way by opening up our data to information managers across the research eco-system, allowing them to create open queries that can be shared across the organisation, and therefore providing the catalyst for service improvement.
For those that visit here often you will know something about the systems we are deploying and the legacy we are trying to improve upon, but for new readers and to allow us to take stock of where we are I wanted to try to gather my thoughts on where we are going and what we are starting to achieve.
First a note, this is not an advert for our suppliers, we have however gathered a selection of suppliers around our delivery that are today helping us to make a difference. We have a strategy of not having an enterprise wide supplier and trying to seek out the best systems for each need we have. Our critical infrastructure is a mixture of Oracle and Microsoft and recent additions of Linux, which whilst giving the infrastructure team a headache it does mean we have the most appropriate solution for each of our systems.
We have effectively created our own private cloud solution that is scaled appropriately, it is not the size and capability of going to Amazon or Google but provides us what we need and allows our hosts the University of Leeds to provide a high level of support to the business and provides our system suppliers the ability to deploy systems on to our own infrastructure.
The information systems themselves are a series of integrated modules rather than one solution size that fits all. The entry point into our systems is a solution known as CSP. This is a bespoke system using Oracle platforms. As a solution it provides workflow and reporting support to the NHS as it works through the process of achieving permission to deliver clinical research at a local level. However there is no way we could describe CSP as ‘cutting edge’, when it was built the horrible phrase bleeding edge probably applied as the team tried to shoe horn the most benefit out of new Oracle sub systems, whereas now, two years later, it delivers what it needs to but doesn’t utilise all of the possibilities of the infrastructure it is landed upon.
The next module along the work flow is our new Central Portfolio Management System (CPMS). CPMS acts a central spine for all data collected about clinical research, it has work flow elements integrated to CSP and our other sub systems and will, once live in late January, be the central system for performance management data of clinical research. It is this system that we are changing our Information Systems strategy around, changing users into fans and ensuring that we achieve an organisation that can make the most of its data and the volume of capable users.
Underpinning these two systems is the Reference Data Service (RDS). The RDS is a simple idea realised, the ability to master and expose reference data relating to clinical research in the UK. What has been fascinating about the development of the RDS though has been the external interest in having system to system access to it. This is an interest that has caught us all on the hop a little but one that we can satisfy through the industrialisation of the RDS. Having large organisations from the Life Sciences industry building connectors to the RDS so that they can consume data about structures of the NHS, researchers, resources and even the UK terminology will make it easier for research to be done in the UK, making this truly ‘cutting edge’ in our world.
The system that started us on the path to innovation and the one we pin any conversations about ‘cutting edge’ development and the ‘open organisation’ to the most is the Open Data Platform (ODP). ODP is a series of Apps available from the new NIHR CRN App Centre, the apps associated to ODP are those that allow varying levels of access to the information we collect and enable the user to apply business intelligence tools to the data to develop insight that is gathered from the information we hold.
The infrastructure in place for the ODP enables the organisation to utilise a dispersed capability to develop new apps that can then be used across the UK, delivering specific data based insight into research and enabling the work force to build solutions that meet needs as quickly as the technology can be adopted.
The App Centre itself will, in 2014, become the front door to the tools the organisation has deployed and enable SMEs involved in research in the UK to surface their innovations to clinical researchers, business intelligence leads and perhaps most importantly public and patients interested in clinical research.
A development in pilot today is the ability to surface disease specific trials directly into clinical systems and disease pathways within these systems. Doing this will prompt and enable the clinician to offer access to the clinical trial at the point of care directly to the patient, in theory this will enable a change to the landscape of access to clinical trials, the pilot will provide us with the evidence and therefore the impetus to do this across a wider care setting.
We are becoming an open organisation through the systems we have developed and how they facilitate a change to our culture, information systems are a facilitator or supporting agent to culture change, if they are the catalysts then I would not be sure that they will become imbedded in our business. Information Systems shouldn’t be the reason for cultural change to occur, becoming an open organisation is the need of the organisation, the innovation of systems merely facilities this being possible.
The speed we build and adopt new systems has improved significantly over the last two years and that enables the reaction times of the organisation to adopt new technology where there is an identified business need that brings about an improvement to the service we offer, in other words business led change using technology to adopt change at speed.
Exactly where we want to be!