All posts tagged Leeds Teaching Hospital Trust

Don’t be salted about a problem, be marinated!

The digital revolution will not be televised! Its already here and televising a modern revolution simply will not be enough. The revolution will be live streamed in virtual reality for everybody to take part in!

Gil Scott Heron will be smiling from on high; to think that the immortal statement of wild abandon and a commentary on a somewhat dystopian future will never come true, largely because technology moves faster than the ‘humble’ human being can! The song and poem by Gil Scott Heron is said to be a reaction to the song “When the Revolution Comes” by The Last Poets, from their eponymous debut, which opens with the line “When the revolution comes some of us will probably catch it on TV”, how many of us are sitting by and waiting for the digital revolution to happen so we can watch it on TV.

In the last two weeks I have been stopped dead in my tracks whilst presenting with the same type of question;

… all this new-fangled technology stuff is all well and good but how do we manage inclusivity if so many services in healthcare become reliant on the digital platform we ‘all’ have?

As digital leaders, or in reality just as leaders, we need to humanise the issues we have if we are to truly achieve digital transformation then we need to discover a way to engage everyone, not just those involved in the revolution but those that want to watch from the side lines as it happens. Engage, engage, engage needs to be the phrase we use every day as we try to create a future that has a foundation in digital and is powered by digital capability. Whether building a new hospital here in Leeds or trying to delight a customer of a commercial organisation then humanising the digital change is imperative to success and engagement through digital will ensue once we have delight in digital channels, a truly omni-channel activity for all.

The urban myth or ‘trueism-research’ that suggests that waiting staff adding googly eyes to a tip jar will see the tips leap up by 6% is said to be because the customer in the café feels that it humanised the experience of tipping is something we can learn from with engagement of people in all that we do.

We need to marinate the problems that digital presents people with together rather pouring on salt.

I love that phrase, I heard it recently in a bar in reference to people being nice to others but it applies just as equally to the issue of digital transformation, let me try to explore and explain.

A plain steak, not a great steak just a plain one; by adding salt you can widen the flavour but you will never give it any depth, but, even a plain old steak marinated in spices and sauces chosen together by the chef and the customer will broaden the appeal and depth of flavour, lessen the harshness and achieve a better result for everyone involved. I think this works well for digital transformation, success will be achieved by working together on the flavours that we are trying to deliver. Digital leaders need to seek the advice, guidance, needs and desires of the ‘customer’ to ensure that the type of transformation works for all no matter the taste buds and previous culinary experiences.

Just a note here though, I’m not comparing the digital capability in the NHS to ‘any old steak’ I hasten to add!

Creating the right recipe for working together is a consideration for successful transformation. Agreeing on the desired outcome at the beginning of the project or deliverable and ensuring that everyone is clear what the outcome will be at the end is how success can be achieved. The same can be said for so many ways of working, in digital healthcare cross organisational teams, cultured networks of sharing have been created, but not everyone wants to join in even today in 2019. The accusation of not invented here still exists, the need to have the local flexibility needs to be in place but this cannot stop us all from marinating the issues we face today together and creating the best way forward for the whole system. In the most recent of years this has started to occur in digital health but perhaps not in other parts of healthcare delivery or even in single hospital teams. Things like Hello My Name Is… has created a framework that ensures that the patient is considered first and foremost but our cultural statements are still to fully impact on how we work together as one organisation with the right impact on each other all of the time.

The #PinkSocks world is a prime example of the wonder that can be achieved when people come together in new ways of sharing and supporting. Nick Adkins set about creating a way of connecting disparate people, people who traditionally were not empowered to share, in fact would often have been in competition with each other in reality. By gifting a pair of distinctive socks, by encouraging a hug as a greeting, by defining what ‘heart speak’ amongst peers should be like the movement has marinated the problems we shared rather than rubbing salt on them and the digital health world is way better for it.

Just be kind is the ethos of Ted Rubin as a leader in digital marketing. His theme extends into the realms of marinating the issue too. He suggests that ‘old’ marketing was dictation and ‘new’ marketing is communication and that we need to change from convince and convert to converse and convert. When we set about digital transformation this is what we need to use our Chief Clinical Information Officers (CCIO) in healthcare for. They have the immediate language skills to converse and convert that sometimes we don’t they also have something that digital is yet to create fully in the digital world, an even playing field of respect. We need to build the role of the CCIO as a forever role, a role of co-leadership and co-creation; the digital leader role is not to be sub-subservient to the CCIO in this new relationship, the role is now an equal, in leadership capability, in unique knowledge and experience and in position within the team. Getting that right is the new challenge of the CIO and CCIO. Ted offers some more words of wisdom in this;

You have to give to get. No relationship can survive without trust; simple in concept yet not always easy to see executed.

Ted’s # to follow is #RonR ‘Return on Reputation’, CIOs and CCIOs can together create the reputation that is needed to marinate not salt those problems that exist across a team.

If you haven’t read Humans by Matt Haig go and do so now, it will help with this issue too. Professor Andrew Martin the key character in the book has arrived; food sickens him, clothes confound him and he cannot understand relationships, the only person to ‘get’ him is Newton, and he is the family dog. Professor Martin is a human ‘possessed’ by an alien sent to earth to evaluate the who, the what and the why, and he falls in love with the Human race! Something that I think we all need to do again to be able to achieve the delightful transformation that drives us in so many ways.

If you read Haig’s book then have Professor Adam Rutherford’s The Book of Humans: The Story of How We Became Us and Mark Britnell’s new book Human: Solving the Global Workforce Crisis in Healthcare right next to it. We need to learn from how we got to where we are, we need to be able to see in to the future and we need to be able to laugh at our own naivety, silliness and stupidity that occur every day as we strive to be a better me. These three books will enable us to do just that!

If ever there were three flavours needed for the marinating of the issue then these three pieces of written thought leadership applied in different ways are it!

And that is it really I think, lets understand our past and learn, lets predict our future together and do something about it and lets laugh from both the silliness of the past and the possibility of the future, two different types of laughter but two types we can get right together.

 

Its time to get down and marinate!

 

 

 

Huge credit goes to my good friend Bolly for passing on the marinated Vs salted comment, with her permission it appears in a slightly changed manner. Originally the phrase was related to people, those that know how to marinate and those that simply salt everything, Bolly is an expert at marinating beyond anyone else I know.

 

The Long View of a Hero…

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;

  • Stop trying to know-it-all
  • Don’t worry about what others are thinking
  • Don’t think about what you want to be, but what you want to do.
  • Have a sense of humour and talk honestly.
  • Tomorrow’s heroes live on stage have been Feynman-esque in their approaches over the years.

 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)!

 

The Shades of Grey IT.

What is one of the most wicked problems in large organisations seriously adopting digital today? Many digital leaders would say it’s the challenge that Grey IT brings, and then some board members would turn to them and say what is Grey IT?

Digital functions the world over have adopted a multitude of phrases to describe a core issue that manifests in many ways and for many reasons. Grey IT is ultimately the organisation voting with its feet (or its projects) and buying and implementing technology without going through any digital function or digital governance. It’s a problem with its genesis in technology teams not meeting customer demands and the consumerisation of technology. There is an element of being careful what you wish for. In the 1990s technology leaders bemoaned their business functions for not being engaged in digital transformation, often the National Programme for IT and its perceived ‘failure’ within the NHS is accredited to the lack of business engagement; and now here we are a decade later complaining that the business is so engaged in digital solutions that they can deliver this stuff without digital teams getting involved.

The management training catch phrase of the 1980s, “Don’t bring my problems bring me solutions” needs to be turned on its head, when the business has an issue the ask now needs to be; “Come to me with your problem and lets together come to a solution for it.” This will be a first step to avoiding the Grey IT issue getting any worse, but once instigated the digital function now needs to be able to react to all the issues that are brought to the door, quickly, and in an agile manner that truly delivers on defined customer needs.

I propose that Grey IT is often so rife in large public-sector organisations because of two key reasons; a capacity to keep up with the now consumerised technology delivery that is possible and an often-backward view of innovation that comes from the business by digital professionals. The expectation that digital innovation can only come from those within technology rather than those at the cutting edge of business delivery has to be reconsidered by us, the digital leadership of any organisation! Sometimes the customer does truly know best!

We must combat these two root causes of this if we are to remove the negative outcomes of Grey IT’s existence. Technology outside of a decent governance capability is ultimately dangerous for business and healthcare delivery in particular. Grey IT does just that, delivers a layer of technology that does not have any governance to it. The real manifestation of Grey IT in the NHS today is often seen 12 months after the initial project go live, when the bill for the second year of the licence arrives or the need to upgrade becomes obvious and the technology professionals are called to assist. Worse still Grey IT becomes clear the day the system built, supported, procured and run outside of IT doesn’t work anymore, suddenly Grey IT falls back to its base colours, black and white, whose problem is it and who is going to fix it!

My organisation has been on the receiving end of one of the worst outcomes of Grey IT, many years ago we suffered a significant outage in the digital systems that were used in the Pathology Lab. Whilst the solution had been bought through a governed and appropriate manner it had not been taken into the technology team within the trust it had been developed, evolved and supported by keen and enthusiastic users, but a workforce that had moved on, had a higher priority (patient care) or simply had forgotten how to do stuff was left supporting a solution that was on legacy infrastructure. So when a server went pop, a disc array went AWOL and a back-up was missing disaster struck. This is all stuff the good book ITIL teaches digital professionals to avoid, but once the grey mist has descended upon it even the good book couldn’t help! All that the technology team could do in this case was take control of the recovery and work hard to ensure that the right lessons had been learnt and applied to the future.

I think we are looking at a plethora of different types of Grey IT that all need a different solution; Feral IT Guerrilla IT, Shadow IT and traditional Grey IT.

Feral IT for me starts as a digitally led project often a collaboration, an exciting chance for the digital team and the ‘business’ to work together to come up with a solution. It gains ground as it delivers benefit but slowly drifts away from good governance, often because the project is so successful. Over time though the project will grow and its delivery focus and the team will change, as that happens the digital governance of the organisation can break down and the project is then being delivered outside the parameters of good governance.

The key to making Feral IT work is to ensure that the governance of the project is grounded in the foundations of the digital agenda, organisations are often looking for agility and a start-up culture to enable innovation to happen, but innovation becomes scalable only when a rigour of governance is applied. As digital leaders we should try to encourage the agility that this type of project culture offers, but it is also our role to ensure that the foundations of decision making and corporate risk management are clearly understood. It is tricky in a new decade where digital is a consumerised product, building an understanding of why we the digital function of an organisation needs to be continually part of the decision making in this kind of project can only be achieved with the right style of engagement, one that at least can light a candle next to the consumer style digital capability now available to everyone.

Guerrilla  IT is a phrase that best describes the technology project that has been actively hidden from an organisations digital team, a project that has wilfully been created outside of governance for so many possible reasons. Guerrilla warfare was a phrase first coined in 1808 to describe the Spanish resistance to Napoleon, Guerrilla IT is an identified need that a team has understood and has been unable to get help with the delivery of, at this point the business function decides to go ‘rogue’ and deliver it anyway.

In the NHS today Guerrilla IT exists for many reasons but I would suggest the key reason is an inability to make the national solutions that have been delivered work in the way that locality needs them to. When we have Guerrilla IT projects we need to understand why they exist, much of the reason will often be traceable back to the nature of the solution being sought by the business to the problem and the digital functions inability to react in a way that achieves the desired outcome. The use of WhatsApp in the NHS is possibly the best example of a Guerrilla IT project, organisations have been saying for more than five years that this platform should not really be used inside a healthcare environment, and yet every day that I am in Leeds I see and hear of staff using it in ways we have actively said it shouldn’t be used. Why, because it achieves a need, it is easy to use and it’s a consumer product, and in reality, alternatives to its use are very new to the digital fabric of healthcare. The same could be said for ERS, there is a desperate need fro the NHS wide booking system to offer a ‘many to many’ booking capability, hospitals refer to hospitals! And yet it doesn’t and therefore department after department has its own growing digital solution to enable the digital transfer of information about patients moving from hospital to hospital, we have to fix this!

Shadow IT manifests often from the digital team, when disagreement exists in strategic direction, standards to be adopted or simply in the procurement of a system. Digital professionals can be a real pain, we all know best, we all know our subject matter and sometimes this can boil over into a Shadow IT project. A project that is delivered against the wishes of the governed decision and with an intention to compete with a decision made. Shadow IT will often be kicked off with good intentions; a project just in case the agreed and governed solution misses a deadline or as a risk mitigation to functionality delivery, but sometimes the project is started because it is a ‘pet project’ of a leader of the organisation, digital or otherwise. Shadow IT can be a useful mitigation to risk, but needs the same level of governance,  risk management and rigour applied, it needs to be managed as a project that has goal of being there just in case and should not be tolerated as a vanity project because someone with the digital function is unhappy with a technology decision that has been taken.

Grey IT becomes the collective term for these issues, all shades of grey, successful in some ways in delivering user defined need but with risks to the business that need to be quantified and mitigated against. Removing Grey IT has already become one of the wicked problems, maybe we should accept that we can’t remove Grey IT from what we do, but we should look to understand where it is, why it is and what the risks are to us. There is also an element now of learning from the collective Grey IT projects and understanding better how to avoid them starting up, and that I think is about understanding the investment decisions that are required to initiate a digital project and the engagement needed to enlighten everyone in decisions being taken.

Investment and the return it brings has to be part of the equation in the answer to the ever-present Grey IT problem. Investment in infrastructure for healthcare needs to have a digital element in the same way as the investment decision would call for electricity, heating and light. In 2015 KPMG Ireland called out the need for the fourth ‘utility’ for the building of the National Children’s hospital in Dublin to be digital, it wasn’t, and we now see a furore in the media as the whole digital backbone of a brand new hospital is going over budget because its digital element was expected by decision makers to be run as a Grey IT project. Misunderstanding or on purpose I am still not sure but I do know that the digital team across the project, the ‘centre’ and the department were clear that the hospital had to be a digital hospital and yet the return on that investment was not judged to be worthwhile capturing properly and openly, IT costs money, when will we learn!

We are asked to consider the Return on Investment (ROI) that digital makes when we build a case for spend, perhaps the key to removing the plight that is Grey IT from digital health care could be to start to consider a different set of terms more strongly, what if we considered the Value on Investment (VOI) instead? Let’s not pretend anymore that investment in digital in healthcare anywhere in the world will ever return money back to anyone’s budget, capacity and demand are so ‘topsey turvey’ right now that no amount of digital innovation will return investment, what it will do though is increase efficiency to bring us closer to the demand need, increase quality to bring us closer to the required need and bring a new interest back to the daily roles to deliver a new enthusiasm for what we do. If we all consider the VOI together then just maybe no one would want to set up their own little Grey IT project anymore because we would all be heading towards the same increased value curve.

So we move from ROI to VOI and start to build the case for change in a different way, we still are missing a piece of the colourful puzzle that will be laid over the top of Grey IT though. Return on Reputation (ROR) was a phrase I first heard uttered by Ted Rubin a digital marketing expert and social media evangelist, Ted suggests that the way to building reputation is by building the network of believers and doing this by being ‘nice’. Quite an American ‘thing’ to want to do I guess but there is something in this I think. Digital functions all over the NHS have not adopted any form of ‘Del Monte’ attitude, we are quick to say no, we are quick to say get in line we have a prioritisation process you know! When we do this without listening, we do two things, we set the preference for our customers to understand that its quicker to ‘go elsewhere’ and that we are not part of the team, we are ‘another’ corporate function, maybe even an overhead, with our own benefit blocking agenda. If we adopt Ted’s principles then we should be more open to listen, more transparent in what we will do once we have listened and allow the ‘business’ to work with us to decide what to do first, second and third. The return we would all then get from this is an improvement in the reputation we have.

Grey IT is here now and no matter how big your One IT (insert other corporate programme name here!) is that you are instigating to remove it you won’t without attitude and aptitude change in the digital functions of healthcare. Change is hard to make happen but we have to make it happen, as a journey we are on not as a demand dictated to the system we can become one transformation function for the NHS.

Bring out the problems, let’s work together to create new ideas to solve them and then lets seek the right way of describing the investment and the way we are all going to deliver this together, let’s create joint solutions to problems we consider to be joint as well.

Somehow let’s make digital first be a way of working together that is about innovating for the future not simply concentrating on tomorrow.

 

 

NB If you ever see Ted Rubin on an agenda at an event you are at, go and see him speak, one of the most inspiring speakers I have ever had the joy of seeing, he changed my outlook and I still quote him years later, ‘just be nice!’

A ‘new’ trend, CHR, what is and how do we get there…

When arguably the largest digital health vendor in the world starts to consider how they move to a new terminology for what they deliver we need to prick up our ears and at least understand what the noise is about; a Community Health Record (CHR) is now the direction of travel for EPIC one of the worlds largest digital health care organisations. In the same period the Secretary of State for Health and Social Care has begun to add some flesh to the digital vision he published earlier in the year, particularly around the state of the GP System in the UK and the desperate need for interoperability of the systems, ie. enabling the creation of a CHR in the NHS on a national scale.

I remember a pre-NPfIT world where the NHS had a choice of GP Systems from a vibrant market, and even when you were with a single vendor there was often a plethora of systems with a multitude of functionality levels available to you; who remembers EMIS LV, GV, PCS and Web all being on the market at the same time. SeeTec, Microtest, TPP, InPS, Torex and iSOFT all with the ability to deliver new exciting functionality and at the same time support legacy and green screen solutions. The move that we all took as NPfIT to rationalise the market was meant to modernise what was available, was meant to support innovation and create a new market place one where a CHR would be delivered. It didn’t it created a duopoly that has stifled innovation removed any kind of ‘start-up’ culture within the market place and disempowered much of the ‘family business’ loyalty that existed between vendor and GP. The GP element of a CHR can now only be delivered by moving to a single supplier base across a region and even then only through the movement of information in ‘old technology ways’ in the most part. What were we thinking!

Matt Hancock Secretary of State said the week before Christmas,:

“Too often the IT used by GPs in the NHS – like other NHS technology – is out of date: it frustrates staff and patients alike, and doesn’t work well with other NHS systems. This must change.”

The move from the mega-vendors in this space to try to create systems that span acute, community and primary care will not alter this paradigm and we need to take care as a joined up health and social care system to not start to drink the cool-aid again. EPIC now ‘offering’ a CHR is not the solution to a GP market place that has shrunk in size and is currently slow to consider how interoperability can be achieved outside the walls of their own systems.

In the same week that the Secretary of State made these comments Sarah Wilkinson the Chief Executive Officer added,

“The next generation of IT services for primary care must give more patients easy access to all key aspects of their medical record and provide the highest quality technology for use by GPs. The suppliers must also comply with our technology standards to ensure that we can integrate patient records across primary care, secondary care and social care.”

The simple fact that our national body for digital followed up the Secretary of State’s comment with this is a good sign, an ask for vendors to integrate across the care setting that make up the NHS against an agreed and publicised set of standards is what NHS IT teams have been asking for since the demise of NPfIT. Enabling patient ‘easy access’ cannot be done at a national level, that has been proven when the centre’s attempt at Health Space and Microsoft’s cancelled Health Vault solution. What can be done though are elements of patient access; security layers, a unified front end and entry point, promotion of the solution, standardised sets of data and ways in which this is presented and access to national data sets and information; but access to local information is best managed at a local level!

The work done in Southampton and now in Leeds and now many other places is showing that elements of an open Person Held Record (openPHR) can be achieved with connectivity, standards and a reliance on the expected parts that are best done once nationally.

The EPIC Systems CEO Judy Faulkner told a meeting ahead of EPIC leaders just ahead of Christmas that

“If you want to keep patients well and you want to get paid, you’re going to have to have a comprehensive health record. You’ll need to use software as your central nervous system, and that’s how you standardise and manage your organisation.”

These words echo some of the content of the new direction published by the Secretary of State and his team.

As a digital leader I have always pushed back though on the statement that IT will help standardise the organisation. That needs to be a clinical pull for standard work not a technology led necessity. In Ireland in late 2014 the Department of Health pinned parts of the Electronic Health Record Case for Change on the standardisation that could be achieved through the implementation of technology. The CCIO community in Ireland understood what was meant here but still pushed back, they had built the understanding that clinical led change was the right way forward and insisted that change would come about only through collaboration and with digital as a foundation for standardisation. This is why it took two years from procurement of the Cerner Millennium system to go live in the first maternity hospital of the EHR system, the clinical team wanted to ensure that the standard work that the system helped them deliver was based on clinical best practice not how the software works.

Judy Faulkner told Healthcare IT News in December 2018,

“Because healthcare is now focusing on keeping people well rather than reacting to illness, we are focusing on factors outside the traditional walls.”

This makes sense, the delivery of Population Health is the new knowledge basis for what we as healthcare professionals (Note not digital leaders) need to focus upon, here in Leeds we need to deliver this as a city, as a citizen platform for good health and social care to exist. We need to protect our clinical, medical and healthcare professionals from a deluge of data and somehow find the right way to present the right data at the right time, not all the data some of the time. A move to ‘data is there for the asking, not the taking’ is what Ewan Davies chief executive of Inidus called out in his new year predictions recently, with permission and with the right tools the CEO of EPIC could be right, digital systems really could start to offer the delivery of healthcare the ability to consider how it can deliver healthcare ‘outside the traditional walls.

To kick off 2019 Simon Eccles, national CCIO for Health and Care revealed his predictions for 2019 to Digital Health;

I believe we’ll see a renewed vigour in digital health technology and I hope an end to the acceptance of ‘not-good-enough’ tech in the NHS, with NHS Boards across the country taking action to support their staff with good technology. 2019 will see the launch of the first NHS Interoperability Standards, with clear timescales for their adoption, and we’ll see the NHS App being taken up which will start to show us the true potential of the empowered consumer in health.”

However Ewan Davis the chief executive of Inidus had a less positive slant to add on the direction needed in his predictions for 2019;

Progress with interoperability will slow as vested interests and the sheer difficulty of making it work swamp efforts to get beyond the first few use cases and there will be growing recognition that we need a different approach to create the data fluidly we need.”

I believe the way to abort this gloomy direction will be moving to a learning from local approach, one where we come together as healthcare leaders and share what has been delivered and how, the Care Connect work in Bristol, GP Connect work in Leeds, Record Locator go live in various locations and an ask from One London to truly move forward with meaningful FIHR (Fast Healthcare Interoperability Resources) profiles all begin to truly ring a bell for interoperability to happen in earnest. Whether its new entrants into the GP market that deliver this or a renewed local relationship with the suppliers that exist now to my mind it doesn’t matter. What I do know though is that by working together the system can remove the frustration that our Secretary of State describes and offer a joined-up system that has digital at its foundation and data fluidity as its life force.

I am proud of being a digital leader but I think that in 2019, to truly deliver what EPIC have described as a CHR then we all need to become healthcare workers with digital expertise in the same way as a brain surgeon is a healthcare worker with surgical (and so much more) expertise!

Twelve month school report…

Do you remember that school report moment, that evaluation and review of the academic year, the fear of what your teachers would say, or not say when your parents went to meet them? A year of hard work distilled to a 45 minute meeting with a bunch of teachers who, in some cases, were probably trying to provide feedback to maybe as many as 100 kids who had various degrees of motivation and ambition. It must have been a hard task for them and it was often a nerve wrecking experience for the pupil!

Key phrases from my school reports: ‘creative writing doesn’t always mean making it up as you go along!’; ‘Please follow the rules of emergency air supply on an aeroplane, secure your own work before turning to help others’; ‘Less communicating and more concentrating will bring more academic rewards, but will make the class a dull class’; ‘Richard’s passion for campanology outweighs any I have ever seen in any teenager’. The last one holds a dear memory for me as a retort from my Dad, who exclaimed he knew I liked camping but thought I wasn’t the only one in school in scouts!

So, a year into the role in sunny Leeds, a year in to concentrating in a new way on what a digital fabric can do for health and care across Leeds and I thought it would be good to try to put together my own school report. A progressive ‘school’ like Leeds would allow the pupils to put together their own review as long as it could be challenged in a fair and productive manner by teachers and peers, so here goes.

First subject to be graded has to be Delivery. I think the #LeedsDigitalWay deserves a B- for delivery in the last 12 months.

Delivery Grade – B-

The first 100 days saw a sea change in the way the team worked. The objectives of what we wanted to do were made clear and the team began to evolve. The ‘simple’ action of getting board approval to invest in the PPM+ solution as the Electronic Health Record (EHR) for Leeds until at least 2022 has seen a new concentration on the process for delivery. Leeds has delivered against an agile methodology for over five years but now delivers on a monthly release schedule; new functionality defined by the clinical team lands into live each month. A new focus on the release function and now the way that test, development and integration work together has brought about some immediately noticeable changes, largely the enthusiasm and engagement that the clinical team has for the solution has improved significantly.

Deliverables such as the A&E dashboard, flu reporting, tasks and jobs inside the EHR, the implementation of Forward, the delivery of the eRespect form, Nursing eObervations, single sign-on for all and even simple changes like the opening of the internet to ‘real’ use has seen a continuation of the acceptance that digital is a hugely important part of what a hospital needs in place every single day.

Scan for Safety and the mobile EHR solution are fast becoming a way of life in Leeds. Not new gizmos but a way to enable the understanding of patient flow and a way of capturing information without fingers being needed on a keyboard. Scan for Safety also is an illustration of LTHT-wide partnership working and what can be achieved when a delivery is led not by IT but by clinicians and key impacted departments.

The delivery of new infrastructure for PACS, Digital Pathology and the new Genomics service all considered to be that unfortunate term, ‘back office’ deliverables, but all crucial to the acceptable running of the digital fabric of the trust are well underway with a limited resource to make them happen.

A slow but steady reform of the way service management is delivered has started to take shape as has a new way of thinking for Information and Intelligence (I&I). The organisational change elements are now in place to enable a function within the I&I capability to focus ‘just’ on data within PPM+, something LTHT has been trying to make happen for some time.

Why the dropped marks in this area? Expectations have been set really very high and whilst the resource to deliver has been changed in its structure it hasn’t changed in its capacity in any dramatic manner. A phrase I think should be avoided has been used too often: ‘do more for less’. Outages have occurred on three occasions, all managed well with no patient impact but in all three cases these outages could have been avoided. On the positive side, key lessons have been learnt and business continuity lessons and disaster recovery plans are now well honed.

When in Ireland I was once challenged by a senior member of the team to spend a few months in the garden shed away from the team and the email. The meaning behind the comment was I was pushing at a speed that the team needed a rest from. I think I drop marks for not learning that lesson as well as I could have. We are going at a pace in LTHT that will tire the team out if I am not super careful in 2019 and therefore I do need to look around and be sure that the delivery ambition we have is met by the resource we can apply.

Culture Grade – B

Building the team I want to work in is always important to me in any leadership role that I have had. Putting in place weekly updates (Can you give me two minutes) and hitting these for 52 weeks in a row has been an important way to show the width of the team how we can act as one. The creation of the #LeedsDigitalWay and the associated goals, vision statement and key strategic plans have not been created in isolation by the senior management team but, following the ethos of the Leeds Way, these have been done through crowd sourcing and via the wonderful ‘Very Clear Ideas’ process.

I feel the team is engaged, not entirely, but better than many would be in the ideals of what we are here to deliver. That is largely because the LTHT culture, the Leeds Way, gives me a jump off point that I can simply add to, but this has to be seen as a great benefit.

The whole team has had the opportunity to come together four times in 2017/18 as a digital team of leaders in the digital health environment. The meeting is not mandated (nor will it ever be) and has seen a steady increase in numbers for each gathering. One of the best moments of the year was the morning after the third All Staff Meeting being stopped by another early riser member of staff to be told they had put the next meeting in the diary already and would be telling all their colleagues how important the meeting was for working in the team – superb, immediate and honest feedback.

It is often joked that only those ‘great places to work’ organisations get IT and Communications right all the time. We have tried to get the level of communications right but in a recent staff survey the team wished for more, so now we move to consider all the different styles of communications we have and how they impact upon the culture.

To me the Leeds Way is our culture and our values with a digital ‘sheen’ applied to it. We have come some way in 12 months but I can see the gaps that we need to improve on.

The reason for some of the ‘dropped marks’? We are going through organisational change and are desperately trying to get that right at every juncture, but we haven’t always been as successfully as I would like us to be. As soon as we create an open culture which we have done then we have to have the capacity to listen and act on opinions that are made clear to us, we are trying to get that right but we are not quite there yet, could do better may be the school report language best used here.

I think we have been able to pick up extra marks though for team development opportunities. In 2018, we were able to be part of content delivered by HIMSS, KLAS, HSJ, CHIME, Digital Health and BCS. We have opened opportunities for staff to apply for the Digital Academy, a hugely important leap for us, and had 10 interns join the team, many of whom have stayed on in some way. Exciting learning prospects for all of us continue to be available across the team and will remain a high priority for us in 2019.

Engagement Grade – B+

The awareness of the LTHT digital journey at a national and international level has doubled in the last 12 months. We have been successful in ensuring that when somebody wants to understand how to deliver an EHR in the NHS then Leeds is one of the top five places they think of. Being able to take part in the Arch Collaborative and achieve the Net Experience score that we did showed the engagement the large proportion of our clinical staff feel for the systems we have deployed.

Leeds’ success has been represented on three continents this year and is synonymous with clinical engagement, an open attitude to delivery, an inclusive ability to resourcing and a willingness to share. If I were to write my own obituary these would be words I would want to see and therefor I think the B+ is justified.

We have been able to bring leaders from across the health and social care system to Leeds to show them how the front line of digital health is really working and I would like to think that has impacted on policy in some small way.

The reason for the dropped marks is, despite the geographic location working for us (Leeds is after all the home of over 20% of the health informatics staff of the NHS), we have yet to truly make the most of Leeds the place. With so many organisations in Leeds that focus on digital health, our own position in that eco-system still needs to be eked out.

Innovation & Technology Grade – C-

Next year I have to focus more on this. We have so many ideas and so many amazing offers of help to make those ideas come to life but time and resource has run away with us too many times. We have been able to get the infrastructure for Single Sign On in place and the migration has largely gone well. Piloting the linking of devices to this infrastructure, not just the software side, is a remarkable feat I think.

I would have loved us to have our first implementation of cloud in place in 2018 but we are still a little way away from that. We have well formed plans for AI access to some specific solutions which I believe will be transformational, but again they will be early next year.

The speed of the systems we have and the reliability of the solutions they are hosted on has improved ten-fold, but user expectation outstrips our current capability to keep up. The work done to make the regional integration capability ‘bomb proof’ is outstanding but took us longer than we thought.

We know how we want to innovate and even who with, but in some cases we have come unstuck as we try to find ways to create relationships. For us, the way we have worked with Forward in 2018 has been a real test of how an NHS organisation can create a true partnership with a new innovative company and really build benefit. Being able to ‘gift’ the content of the Axe the Fax toolkit to Silver Buck for them to industrialise and make available to the wider NHS is another great example of an innovative approach with a new partner.

If ever there was a category with the immortal school report words, ‘must try harder’, it would be this area. I need to consider how to deploy more resource here to give us more chance at being truly ground breaking in this arena in 2019.

Collaboration Grade – C+

Achieving the Local Health and Care record Exemplar (LHCRE) status was clearly done only by collaboration across Yorkshire and Humber and was a big moment in 2018 for all of the team. Collaboration across the city area on the Leeds Care Record remains a highlight of the job and being able to represent Leeds as the platform with my fellow Proclaimer is something that enthuses me every time we get the opportunity to do it.

The dropped marks though here are because I know we have not played the part we should play in the West Yorkshire collaborative to the same degree. Something that next year I will prioritise is ensuring that the blueprinting work we do can be shared first and as a priority with colleagues across West Yorkshire. I know that we have the basis for a great relationship and one that will enable a better platform for patient care if we can find the right projects to collaborate on.

Summary Comments

In the school report it was those summary words that always cut to the chase the most, the form teacher comment on the future challenges for the student and the head of year views on focus for the coming year.

I think if these words were being written about me after this year they would go something like this:

A successful start to the new school. Needs to keep a closer eye on the detail and avoid getting distracted by some of the wider picture, even though it is important to still see this and bring it back to the ‘school’ – we need to have all of our own foundations in place before truly looking to help so many others on the journey. The class (the Digital and Informatics Team) needs the focus to be slightly more on them than it has been on some occasions in the year. The key challenge for the next year is to keep moving at the current pace but with the whole class on the same journey. This will be difficult to achieve with the expectations that have been set but is entirely doable with the skills available.

 

… and if that was the summary I would sleep well at night.

Arch Collaborative

First published as a KLAS blog after Leeds teaching Hospitals NHS Trust received the analysis of the Arch Collaborative. If anyone wants access to the full Arch Collaborative results from Leeds then feel free to get in touch, happy to share.

The Arch Collaborative exists to ensure that we understand what the users of our systems really think of them!

The technology industry is one of only two industries[1] that describe their customers as users. Launching the Arch Collaborative locally ensures that each healthcare system that takes part can move further and further away from that ill-gotten term, user to a new paradigm where we have valued customers with opinions that matter, perceptions we should act upon, and innovations that we would be foolish not to consider.

The first time that my organisation, NHS Leeds Teaching Hospitals Trust (LTHT), considered the Arch Collaborative was in early 2018. We regularly share ideas and concepts with two NHS Trusts: The University Hospital Southampton and the Salford Royal Foundation. Those Trusts had taken part in the survey and were clear that it was a great way to really understand the clinical views of the Electronic Health Record (EHR) and the way it is implemented.

My organisation has risen to the EHR challenge in a different way than many. 15 years ago, our organisation decided to begin building its own EHR. We released new functionality in subsequent years until it became clear in 2017 that the organization had evolved the solution to the point where it was a clinically developed EHR.

Taking on the Arch Collaborative survey felt like the next step in understanding the direction we should head. It could be the basis for a strategic road map.

Standing up on such a public stage was a big decision for an organisation that has invested so personally in the creation of an EHR. For us, this wouldn’t be a comment on the vendor implementation or the partner development of the training materials; this would be a comment on what we had built, what we had prioritised and what we had invested our time in.

There were no gimmicks, backing tracks, or staged production; the Arch Collaborative just asked for an evaluation of our raw digital ability.

By the time we agreed to get involved in the Arch Collaborative, there had been a number of departmental changes in our organisation. We brought together individual teams and elements in the hope that we could form a super group.

We were so nervous about what would happen next that a colleague compared this process to an audition for the a cappella singing team at university, but we were resolute to know how our voice fit into the digital health mix.

The Arch Collaborative involves getting the broadest clinical input possible to a series of questions about the functionality and implementation of the EHR solution within the organisation. The survey is quite in-depth and requires time and energy to work through. We asked one of our Chief Clinical Information Officers (CCIO) to take on the project. The CCIO worked with our digital engagement team to ensure that the survey terminology was anglicized and then to widely promote the survey. In the first week, over 400 members of the hospital team had completed the survey; by the time we closed the survey, over 980 members of the workforce[2] had completed it.

We were so proud that so many clinicians had come to our gig. We were not playing to an empty stadium—they had come to join in and sing about the EHR they used every day.

Our organisation uses the EHR for point-of-care delivery; over 19,000 unique users accessed the system in September of 2018. In the same month, there were over 74 million interactions with the system. An average nurse is now collecting over 100,000 data items a year!

When we consider the size of the audience that the Arch Collaborative response will reach, the throughput of the system feels huge. That comparison to the a cappella sing-off is more like the national sing-offs at the Kennedy Centre in the film Pitch Perfect.

When organisations and senior staff members look at the success of EHR implementations in the NHS, it is easy to focus on the traditional project management triumvirate of cost, time, and quality. That is understandable—these are important aspects of a large-scale procurement project.

But a lesson hard learned and seemingly relearned many times over in digital healthcare is that an EHR project is not just a procurement project. The Arch Collaborative was the perfect way for us to test the pitch and tone of our EHR.

We believe we have an approach worthy of blueprinting for reuse but not a specific system, although that is possible. We are more keen to consider the approach we have taken—an approach that includes the following: open standards; the concept of the geography as a platform for care rather than separate healthcare systems trying to interact and integrate; and the clinical focus we have placed in the prioritization of developments.

Each of these methods has been a major part of how we developed the #LeedsDigitalWay, and we believe it is worthy of blueprinting and digital implementation in healthcare across the world.

Ultimately the Arch Collaborative at LTHT would be a comment on the concept of the #LeedsDigitalWay as much as it would be about the actual EHR.

In discussions with KLAS about the decision to take part in the Arch Collaborative, they stressed that our taking part showed humility, a strong word that meant a great deal to us. Around the same time, a tweet from Damian Hughes (@LiquidThinker) resonated particularly with our reaction to the Arch Collaborative results:

Ego is often a roadblock to your development. Humility is a key to a new pathway.

Taking the ego out of delivery means that we can adapt and learn more quickly and ensure that the silos that so easily spring up between clinicians and digital leaders can be avoided.

The results from the Arch Collaborative are not for the faint of heart. They deliver a complex, true, and statistically sound message that will shine a very powerful light on the weaknesses of the work that you have done and specifically highlight the areas that you can change to improve your “Net EMR Experience score” with minimal effort. Unlike a HIMSS score, the Arch Collaborative is based not on what is in the “box” but how the box is used and the success of its functionality.

The headline score for Leeds Teaching Hospitals Trust was a 41% Net EMR Experience score. This is the macro score that sits front and centre on the report. The score ranges from -100% to +100% and is built up from the entire survey. We were pleased with our score.

60% of our staff members described themselves as “pleased with the experience” that the EHR offers, while 19% are frustrated daily. The detail of the Arch Collaborative report allows you to investigate how to improve each evaluated area as well as the headline figures.

By offering just four hours of training every year to every staff member that uses the EHR (that’s over 19,000 people, remember), we could improve our Net EMR Experience score by a further 10%.

That final statistic makes a digital leader in the NHS pause for thought; the cost-to-impact revenue on that 10% Net EMR Experience change is not insignificant, and the debate about where the cost sits would be a long one to resolve. Is it the digital team’s job to continue to deliver business changes? If the digital solution has been embedded in everyday life, should it be a cost of ownership?

35% of our team members that use the EHR daily would describe themselves as proficient in the use of the solution. That seemed immediately positive. However, 8% of our staff members indicated that they struggle every day.

The Arch Collaborative shines a light on what you need to do and the evolution that you need to inspire. Being on the receiving end of a complex statistical readout of your digital agenda enables you as a digital leader to take a breath, look around you, and consider how you move to the next stage.

Computer Weekly refers to the CIO role and its responsibility for the transformation of a system for driving business outcomes. It suggests that the CIO role is the “third leg of the stool” of modern “business” evolution, the other legs being marketing and sales. In healthcare, we are also in a modern evolution, made clear in the following quadruple aims:

  • Purpose
  • Productivity
  • Efficiency
  • Better health and better care

The Arch Collaborative provides an opportunity to focus on the aims of the quadruple claims, but it doesn’t provide the means.

The Collaborative is grounded in the quadruple aims by accident rather than by design, but it does expose how necessary EHR capabilities needs to be implemented with the aims in mind. The Collaborative does not pass judgement on the EHR, though—it offers the statistical vision of how to improve.

If we consider the Virginia Mason Institute improvement method that was based on the Toyota Production System management methodology, we can understand how to innovate and improve using the Arch Collaborative as a baseline measure and the evolutionary plans as the rapid-improvement plans.

To ensure that what we deliver is received better, we need to find a way to offer 19,000 extremely busy people a way to not do what they do for four hours of the year! (I picked those words carefully.)

We can offer the opportunity to do the training and learning relatively easily. It is a great deal more challenging to find four spare hours for each professional who needs to use the EHR to devote to the digital agenda. It feels like a budget issue at first; who is going to pay for this? However, it soon becomes clear that it is an organisational culture issue.

The statistics from the Arch Collaborative allow you to dive into perceptions from different parts of the clinical team. The definitions need a little work to map with NHS language, but they work well at a rough-order view. For LTHT, the Collaborative highlighted a difference that we already knew, but the existence of the analysis reinforces where to focus. Clinical roles placed the LTHT EHR in different percentiles of approval, and they map as follows:

  • All clinicians – 72nd percentile
  • Physicians – 41st percentile
  • Nurses – 63rd percentile
  • Allied Health Professionals – 59th percentile

The results also include sophisticated symptom analysis to distil some key phrases for us to work with:

  • Enhance initial EHR training and follow-up education to focus on supporting efficient clinician/speciality-specific workflows using personalization tools.
  • EHR personalisation tools for shortcuts, filters, and report views have the highest impact on satisfaction. The use of these tools should be a focus in initial training and follow-up education.
  • Timely, helpful support for clinicians’ EHR requests will improve the clinicians’ trust in leadership and the wider digital agenda. Trust will be further built as clinicians are solicited for their input into workflow designs and personalisation tools and as those enhancements are delivered as communicated.
  • Engaging clinicians in ongoing enhancement of the EHR will support a culture of teamwork at Leeds that will ensure that the group coalesces around the digital agenda.

This kind of commentary was very powerful for LTHT for two key reasons: first, it wasn’t particular commentary on missing functionality—it concentrated on additional ways for system use; second, it refocused on the engagement piece as an area for improvement. We took these statements as suggestions for how we can do better.

The distance we have to travel on the journey of improvement is not to be underestimated. KLAS and the Arch Collaborative may have hit on something important. If the rest of the NHS spent the time to consider their suggestions, the wealth of comparison data that would become available could bring about the change in attitude and aptitude that digital healthcare needs so badly. Southampton has completed their Arch Collaborative research, too.

The CIO in Southampton, Adrian Byrne, commented, “I think it’s hard to come up with a set of measures to get a good evaluation report. We want to have some things we change and refine and some things we keep the same, so we can measure improvement. I like the Arch Collaborative’s ability to measure across peers. That is its main benefit. We can measure improvement ourselves, but it’s all arbitrary. KLAS has a great record in research and tends to provide real insight.”

That is the key. The Arch Collaborative today, in its full glory, enables LTHT to build its strategic direction for the continued evolution of the EHR. As more NHS organisations take part in the survey, more souls are bared, and more agreement is reached for sharing the report’s details, then we will build a platform that can inspire the next phase in the NHS digital revolution where the stars align. We will ensure that digital healthcare is about collaboration between CIOs and digital leaders who lean into the challenge together.

My last comment is from many years ago:

Forgetfulness is in the learners’ souls because they will not use their memories… they will be hearers of many things and will have learned nothing; they will appear to be omniscient and will generally know nothing; they will be tiresome company, having the show of wisdom without the reality.

Socrates (5th Century BC)

Let us prove the genius wrong. Let us learn from each other by remembering the past and noting the opportunities of the future with a humility that allows us to continuously learn and collaborate. As David Amerland says;

Collaboration is the new competition!

 

 

[1] The illegal drug trade has used the term since the 1960s and yet the technology industry has remained the only other business to maintain this reference.

[2] 530 clinicians, 147 Advance practice clinicians, 153 nurses, 154 allied health professionals

Digital & Mental Health

I love technology and how it has transformed the way we live today; so sitting in a Matt Haig event last week in sunny Leeds I began to feel like an interloper, an enemy of the ‘people’, like at any moment I would be found out and the audience would rise up against me and swing me from ‘the wall’ very much Handmaid’s Tale-esque.

Matt’s opening comments were very much about the speed of life today and the impact it has on us all. There is no denying what the speed that not just digital brings but the speed of change more generally. We now witness fast paced change in the political scene, the way in which social media impacts upon us all, even the instant gratification of things like Uber, Amazon Prime and Deliveroo, the effect these have on our lives is unrealised day to day.

We spend very little time simply waiting for something without distraction. A friend, an avid Twitter poster, recently commented that he was on the family summer holiday and camping. There were queues everywhere and little mobile signal, so people were actually talking to each other, although the irony wasn’t lost on others, that he was still posting this on Twitter!

Mental health (or rather a lack of it) is the biggest killer of men under 50 years of age! We call the collective for illnesses in this pandemic ‘health’ even though this is a misnomer that we hide behind. People die through a lack of understanding, a lack of support, a lack of diagnosis; they don’t die because they have ‘mental health’, that’s what we need to strive for, we want people to be mentally healthy!

No one would think you should only get treatment for a physical illness if you’re on the point of death

The political mighty have taken it upon themselves to remove sugary drinks from most of the market place to attempt to remove the obesity issue threatening the kids of today. Yet what has the same intelligencer done about the support for the mental health of the same children? Very little yet! Anti-depressants are the fastest growing prescription drug in boys aged 11 to 14 in 2018, this figure floored me!

The pressure on the young of today outweighs anything anyone my age would have ever felt. Matt pointed out in his talk that when we were kids the need to fit in, the need to hide from the bully or even the annoying friendly chap, ceased to be there at four o’clock because we could go home and close our bedroom doors with only our parents and siblings to handle. Now the school and the peer groups’, friendly and unfriendly, follow children home. Social media brings us ever closer, so close that time away, time alone, is becoming the most treasured position. That unique opportunity we chased used to be connectivity and sharing, now it’s time unplugged and chance to breathe without so much connectivity a chance to just be.

When you interact with the next generation now how does it make you feel? What is the generation gap when it comes to mental health I wonder? A member of Matt’s audience asked about the definition and difference between nervousness and anxiety. He quickly compared the difference being the equivalent to hungry and starvation! For me nearing 45 years old, I thought that was quite an amazing way of considering the difference in how the younger generation will define the impacts on mental health – worlds apart. How many people under the age of 30 will exclaim that they are stressed, and how often will the ‘elderly statesman’ retort that they have nothing to be stressed about.

The way we consider mental health of people in the UK needs a fresh pair of eyes. We need to get to impacts and causes somehow.

My boss in Ireland used to talk eloquently about the health care system being a system of the sick not a health care system because it doesn’t do (isn’t able to do) prevention. The ‘shift left’ change to health care much talked up all over Europe now needs to be applied to the mental health of the people of the UK more than ever before. Matt gave a great example of Fiji in the mid-1990s, when they started to air US TV shows, ahead of doing this there were no eating disorders in Fiji. Anxiety was almost unheard of, but within five years, eating disorders grew to the ‘norms’ of the US and anxiety was at one point described as a pandemic. There are no official studies linking the two events, and as I have said already the world is changing at a high speed, but, it does make you pause for thought.

But there has to be hope, doesn’t there? When do we become aware of what makes us better? When do we apply that to the next generation of young people, harmed by the pressure the system applies to them to such a degree that society becomes malformed and somehow changes in how it treats the disease are never quite impactful. We have now accepted the term mental health as a phrase that is ok to use as an everyday description for a reason for school exclusion.

Matt asked the audience to ‘hear their own advice’, ‘it’s ok to be well one bit at a time’, ‘you can be a bit better’. We need a new acceptance, it’s ok to be at work with a cold, just don’t give it to me, and therefore it needs to be ok and supported to be at work or involved in activities with some mental health issues. How do we accept, understand and support mental health illness in the work place, in the school system, in the street in the same way as the common cold I wonder?

We have to do something, the speed of life isn’t going to slow down, I don’t want the speed of digital innovation to slow, which means it will continue to have an impact on our lives. I took another great little anecdote from Matt: digital and social is like ice cream! We can have a bit of what we love, and I love dearly chocolate and vanilla in the same bowl, but staying in bed on Saturday morning for four hours with a bath of chocolate and vanilla would not do any of us any good, the same goes for digital and social media I guess.

If we move our world forward just five years we need to be able to give ourselves some assurance that the digital world we create does good without causing harm. In my professional area we talk of patient centred design and portable data owned by the citizen but we also need to consider inclusivity and the bias associated to what digital brings. I am still excited for the future, our awareness is improving and I hope that this means we can get it right, evolve in a direction that is safe but also considerate of the wider impacts. Just maybe digital can be part of the cure not the problem.

Partnerships and dancing…

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!

Leeds Digital Interns

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.

AI a shiny thing or the next loop in the evolution of digital healthcare.

In 2001 AI was ‘just’ a Steven Spielberg film; in May 2018 it is being described by many as a solution too so many ills within the NHS.

On the 21st of May the Prime Minister provided the NHS with her view on the way Artificial Intelligence could revolutionise the delivery of care for patients with Cancer, Dementia, Diabetes and Heart Disease and by 2030 save 50,000 lives. Grand claims and grand plans and a new direction for government. One that focuses on a digital art of the possible although certainly to leap from paper records in vast wire cages and trolleys as an “ok” solution through to AI as an opportunity for the delivery of care is no mean feat, but a goal we can try to play our part in.

The following day Satya Nadella the Chief Executive Officer of Microsoft gathered CEOs and CIOs from digital business from across the UK to discuss what the team at Microsoft described as “Transformative AI”. The CEO used a quote by Mark Wesiser the prominent scientist of Xerox and the father of the term ubiquitous computing to open his presentation,

The most profound technologies are those that disappear. They weave themselves into the fabric of everyday life until they are indistinguishable from it.

This is where we want our EHR to get to!

The conversation continued to try to deliver the fundamentals in AI. Data is what feeds and teaches AI, it provides the fuel to grow to learn the what and the how.

Collecting more data therefore will educate AI more quickly; the next horizon is to make the nine billion micro-processors that are shipped every year become SMART devices. The micro-processor in your toaster, your alarm clock, your motion sensor light can become part of the data collection capability that will be responsible for our education of AI. The sheer growing size of data is something well documented, the creation of data will have reached a new horizon by 2020 and will look something like the figures below:

  • A SMART City – 250 Petabytes a day
  • SMART Stadium – 1 Petabytes a day
  • SMART Office 150 Gigabytes a day
  • A SMART Car 5 Terabytes a day
  • Your Home 50 Gigabytes a day
  • You 1.5 Gigabytes a day

20 Billion SMART Devices will exist in the world

(8 bits to the byte, 1,024 bytes to the kilobyte, 1,024 kilobytes to the megabyte, 1,024 megabytes to the terabyte and 1,024 terabytes to the petabyte) The average mobile phone now has 128 gigabyte; the first man went to the moon on a computer that had less memory)

So much data to educate the AI of the world, the insights that could be gained are incredible.

The journey from what we know as an IT enabled world to a digital world sees the move from ubiquitous computing to Artificial Intelligence as a pervasive way of life and then on to a world where we live in a multi-sense and multi device experience.

The impact on the relationship between us and technology has evolved in how it is perceived; technology was ‘simply’ a tool, initially as AI evolved it worked for us as a subordinate and as AI evolves still further it will become more of a social peer in how we consider what it can offer us in healthcare. The most common Christmas present in the UK this year was one of the voice activated assistant, people all over the UK are now having chats with Alexa, Siri, Cortana or simply saying Hey Google to find out some fact that just alluded them or to ask for a simple task to be done.

The original concept of distributed computing (or cloud) gives us the ability to create the computer power and data storage that is needed to evolve AI capability. Distributed compute adds IT complexity, it is now our job to find ways to tame the complexity by ensuring consistency and a unification of experiences, this applies more to digital healthcare than any other ‘business’ as we try to utilise digital as a way to standardise the delivery of care as much as we possibly can.

The definition of Artificial Intelligence is said to have been first coined in 1956 in Dartmouth, the journey from this definition now includes the term Machine Learning first applied to algorithms that are trained with data to learn autonomously and more recently since 2010 the term deep learning, where systems are enabled to go off and simply learn beyond a set of specific parameters. The art of clinical practice, the need to have a human touch though is well understood in healthcare. This is why more and more AI in healthcare is referred to as an ability to augment the delivery of care, AI does not deliver a solution to offer less clinicians in the service, what it does is remove the need to have clinical time spent on anything other than patient care, AI offers the opportunity to increase the human touch. A further quote reinforces this in the book The Future Computed;

In a sense, artificial intelligence will be the ultimate tool because it will help us build all possible tools.

Eric Drexler author of Nanosystems: Molecular Machinery Manufacturing and Computation (1992)

The journey to AI in our world is getting quicker. The journey to AI being successful is best measured when the different components of it reach parity with us humans;

  • In 2016 AI became able to see to the power of us, and passed the RESNET vision test with 96% able to see 152 layers of complexity.
  • In 2017 AI became able to understand speech to the same degree we can the 5.1% switchboard speech recognition test.
  • In January 2018 AI was able to read and comprehend to the same degree as a human passing the SQuAD comprehension test with 88.5%.
  • In March 2018 AI became better than a human at translation, now able to translate in real time successfully to an MIT measure of 69.9%.

The road to an AI augmented world though is about amplifying human ingenuity; AI can help us with reasoning and allow us to learn and form conclusions from imperfect data. It can now help us with understanding; interpret meanings from data including text, voice and images. It can also now interact with us in seemingly natural ways learning how to offer emotionally intelligent responses. A Chat Bot launched in China now has millions of friends on across multiple social media channels, it has learnt to offer help to its ‘friends’ that are demonstrating symptoms of depression, phoning up friends to wish them good night and offering advice and guidance on sleep patterns but in a very human way.

Gartner have reported that the ‘business opportunity’ associated to AI in 2018 is now worth $1.2 trillion! Suddenly AI is the new Big Data which was the new Cloud Computing, which was the new mobile first. All of these terms have had hype but have all in reality brought a new digital pitch to our business strategies and our lives.

Great Ormond Street Hospital in partnership with UCL is leading the way in AI application into healthcare with several projects delivering startlingly real results.

Project Basecode: Transcribing speech in real time and utilising AI capability to add information to spoken word dictation capture.

Project Heartstone: A device for passing messages, verbal and video to patients of GOSH that may be too young to have their own Smart Phone, the device can be expanded to offer services to children who may be deaf or blind.

Project Fizzyo: Puts in place gamification to the delivery of breathing physiotherapy for children with Cystic Fibrosis and captures the information for the clinical record offering analysis as it goes.

Sensor Fusion: Creates perhaps the most immersive AI elements in healthcare today, recording events throughout the hospital, offering machine learning developed advice and data driven descriptions of events as they occur.

At Leeds Teaching Hospitals Trust we have created a platform in the form of our Electronic Health Record (EHR). With this platform we can now begin to consider how this clinical push for AI and the difference it can make to patients lives and the way we work can be achieved in a carful and considered way.

This digital revolution can make a real impact on Leeds; the patients, clinicians and staff enabling us to provide the care we want to provide following the Leeds Way principles with digital as a supportive backbone.

If you want to know more or have an idea as to how you could help in this area get in touch with us via @DITLeeds

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