First published on www.digitalhealth.net
When you are on holiday do you play that ‘why?’ and ‘what if…’ game? For example in the USA on a recent holiday we were chatting about why foods are called different things in different countries. A quick poolside thumb poll had the list below as differences between the UK and USA, and we are sure there are more:
The only excuse we could come up with for why this happened was timing. These food stuffs were perhaps discovered at around the same time across the world and therefore no name was ever right or wrong, just more timely and geographically rich. The experience of being in a different country and seeing these new words for the same things adds a little nature of the exotic, particularly when the country speaks the same language (kind of).
But these differences speak to the single largest challenge that faces our digital health menu today: the challenge of interoperability and integration. When we talk about the delivery of a new healthcare paradigm we speak of the delivery of integrated care, a care delivery experience that places the patient at the centre and has no boundaries. But to achieve this requires information to mean the same thing to all those involved in its delivery. Where this isn’t possible we put in place a perpetually repeating health system; one where learning the parameters of a situation, of an illness, of a prescribed cure are repeated at each gateway to a different healthcare system. We don’t want an exotic patient experience we want an efficient and safe experience.
The journalist Geoffrey Williams once said, “You can’t understand one language until you understand at least two.” Goethe went even further claiming, “He who does not know foreign languages does not know anything about his own.” Moving healthcare delivery to a system-wide approach is the goal of over 50 (locally driven) digital initiatives in the NHS alone. The goal of an integrated health and care record is to provide access to, and translation of, multiple care languages. The pressure facing healthcare systems across the world today will only be resolved through integrated approaches that enable health and social care to work together to manage the front and back door to every major acute hospital in the system. A busy Accident and Emergency Department is no longer the problem that the acute hospital can resolve on its own, it is a system-wide issue that the geography has to resolve together. Access to information will unlock this resolution, but first we need to enable the way we refer to the healthcare to be shared.
For the last two decades sharing information between care settings has been a digital goal. In the late 1990s Hampshire became ‘famous’ for the delivery of an exemplar record sharing environment, linking access to information recorded in the ‘Exeter System’ to information in GP systems, to aid the delivery of healthcare regardless of the setting. The largest issue that stunted growth of this early pilot though was the quality of the data and the ability to index the information. The need for a common identifier across health systems was raised and the NHS Number mandated by a target date. It’s a shame that this would not be the last time the NHS number was mandated by a target date…
Jumping forward to 2017, the Irish health system delivered a unique EU-wide identifier for the delivery of healthcare to its citizens. Huge effort was put into delivering this in an agile manner at a limited cost, and today the number exists and is available but its actual implementation in healthcare delivery itself remains very patchy. We can also look at an example in Leeds today too. Having spoken to other healthcare jurisdictions, the Leeds Care Record has become well known throughout Europe as an example of local systems working together to achieve something quite remarkable. The Leeds Care Record is a platform that enables integration at a level beyond almost anywhere else in the NHS. Over 35 systems are able to share information in a controlled, secure and legitimate fashion. 111 GPs also benefit from having access to what is recorded about their patients’ hospital visit. They also share key elements of the GP record with the healthcare delivery system throughout the geography. And that word is where the Leeds Care Record does fail; it works for the geography of Leeds and so this isn’t integration, this is interoperability. In Leeds, information is shared through the same platform but the reference points for the delivery of care remain in the same ‘language’ of the originating care setting. The reliance is on the interpreter and their own understanding of the information.
Culture plays a huge part in how we create an interoperable health care system which digital supports. In his book Culture, Terry Eagleton tries to define what culture means to organisations. He has four areas that he believes are most relevant to creating the right culture: values, customs, beliefs and symbolic practices. None of these particularly speaks to a standardised way of operating and therefore, if we believe in culture being how we make things happen in an organisation, then interoperability will always be an area we strive to achieve.
In the same book Eagleton, who is from Ireland, notes that the postbox, an original integration tool, donates civilisation. However the fact that Ireland has painted its mailboxes the famous Ireland green denotes a culture, a difference to others. In Leeds we have many gold postboxes, a legacy of the London Olympics, when gold medal winners had the postbox closest to their home town painted gold as an honour. Again, culture flouting a standard.
As quickly as we can, we need to begin to agree nationally (and why not even globally) if we are to achieve integrated or interoperable healthcare systems. The standards to do this exist in so many ways already. Digital health doesn’t need changes to be made at the mega-vendor level, the systems need to adopt the standards and then innovate to exist in a ‘system of systems’ approach.
Maybe we need to use Eagleton’s four cultural reference points as starting points to creating a joint understanding of where we need to get to.
Values: The value of having integrated care has been made clear for decades. Digital leaders are still at the begging bowl though, seeking funding to deliver the necessary platforms that are required to enable information sharing. Information is now becoming more complex, faster in the way it changes and more encompassing of the healthcare experience and value needs to be placed on the innovation needed to achieve a truly interoperable healthcare system.
Customs: Local customs need to be protected but somehow we need to move from the clinical system paradigm. You know the one, where the clinician you have engaged loves the idea of a single system across the hospital, they feel it’s a great idea, but their additional one special system still needs to be protected as well. This has become known as the ‘one plus one’ clinical system and in a hospital it means we have one system, plus one for every adventurous clinician in the hospital.
Beliefs: We need the healthcare system to stand up for the belief it has in the delivery of integrated care. That belief will drive the ultimate understanding of what a system of systems digital solution can provide.
Symbolic practices: Perhaps in the NHS this is about to happen with the launch of the Local Health and Care Record Exemplars funding and a platform to enable lessons to be learned, standards to be tested at local levels (of five million population) and a real drive from the centre and from the ‘spokes’ to truly achieve this.
There has to be a hook to the original Bevan statement about the creation of the NHS, “Healthcare free at the point of contact”, so now we need data ‘free’ at the point of contact and this can only be achieved if we all have the same reference points.
Now, can I get some fries, I mean chips, I mean crisps, I mean home fries…
Originally published in the BJ-HC (British Journal of Healthcare Computing)
A change has to come to organisations perceptions of digital, not what it can do, not even that its focus has to be business change, no; the biggest change that needs to be considered and understood is that digital costs money.
In healthcare we seem sometimes terrified of the actual cost of digital. Digital failure is often related to the cost, the big headline figure is used to sensationalise a failed project. Have you ever seen a headline that describes the cost that going to digital has saved? Think back to the 1990s, booking a holiday, going to the bank, buying some music, all aspects of life that digital has changed for ever and clearly not only more convenient for ‘you’ the consumer but more efficient for the business delivering the consumer need. And then think how quickly that change has happened. The speed we now are at to get to the magic 50 million users is fed by the investment not just in the digital element but in the change that is required, 62 years to get to 50 million cars; 5 years for PayPal to achieve the same and only 2 years for Twitter to get there.
The political nature of so many healthcare systems means they loathe to invest in digital; after all the need to build a new hospital or recruit new nurses is far easier to explain to the citizen (the voter) than the promise of a more efficient and safer digital health system. And yet, show a patient the medical records room of a large hospital and then take out your phone and ask that patient which format they would prefer to see their care delivered on. I am guessing the answer will always be I want a digital system. A study conducted in Ireland in 2016 showed that if every citizen were to provide an additional 17 Euro a year to the healthcare system for the next 10 years then the system would move from a paper based system to an integrated and open data based provision. When asked over 60% of citizens wanted to vote for the project, one famously taking to the stage and asking why does an EHR even need a business case, surely it is like saying no to world peace to say no to a digital fabric for health.
Some of the largest digital organisations in the world profess to be coming to the digital health market for philanthropic reasons, and the sentiments are always well described, none of these organisations has moved to giving away their solutions and intellectual property quite yet though. Global economists predict that by 2030 GDP in many countries needs to double to cope with the ever increasing healthcare costs. In 1955 there were 2.8 billion people in the world by 2025 six billion people will need a healthcare system of some sorts? In 2025 we expect the word to be around eight billion people and average life expectancy will have gone form 68 today to 73 in 2025, awesome figures and yet terrifying for those of us that work in healthcare. How will we cope, particularly with ‘crisis denial’ and a fear of investing in modernisation.
In the last 150 years, according to a Gartner presentation at this year’s CIO Symposium, the healthcare industry has created more value than any other business, if you push the outputs of healthcare through a cost and value system we really do deliver. But health costs money, it’s not free at the point of care! If we link the value that the system delivers back to Berwick’s triple aim of 2008; improve the patient experience, improve the clinical experience and create greater productivity and lower the per capita cost of care, then it becomes clear quickly that digital has to be a global investment point to achieve these grand aims. And yet digital is a separate business case time and time again.
If only IT were free? Or better still if only we could find a way to build the system perception of the value of digital. Even the promise of digital appears to cost money in so many jurisdictions, although I think we could track even that cost back to a lack of investment. To spend on digital requires not just the investment in the purchase itself but also the investment in proving the case before hand, and yet, how many digital healthcare business cases have come to fruition. Please do not misunderstand what I mean here, I am not suggestion a free for all, but, we insist that a digital decision should take a defined and obstructive amount of time, digital moves too fast for that to be the normal that we work to in 2018.
The return on investment needs to be clear for an investment in digital, but what of the new phenomena driven by Ted Rubin the American digital marketer, a return on relationship (RoR). A digital leader in healthcare needs to now push hard for the governance functions they are working with to begin to believe in a return on the relationship. A digital governance function needs to build trust in digital leadership to the point where the legacy of over engineering permission to invest is released to the digital leadership in a similar way to the HR Executive is empowered to deliver a talent solution for an organisation.
Investment in digital needs to be the catalyst for health system transition from ‘Repair Care’ to a truly transformed ability to deliver healthcare and it can only be empowered to become that catalyst through investment. As digital leaders we need to get better at expressing the way digital can move the system dial from simple enablement on to truly optimizing the system to one where digital will have some of the answers to huge issues like winter pressures and the healthcare system can transform through the presence of digital.
There could be a tactic to use, straight out of the Start-Up mentor handbook; ideation of the new value paradigm. A new digital value that we as digital leaders need to describe; a working value equation that can add to, in a different way, the understanding of the change that digital will make to the provision of healthcare. We as digital leaders need to identify and provide for the health risk cohort to prove our worth, oh, and of course save money. Digital creating value in healthcare could be as much to do with digital taking appropriate ownership of the description of the digital agenda and this can then aid in bridging the value gap that exists in our colleagues’ minds! This does rely on us getting right the clinical ownership, the business engagement, the change management and transformation agenda, hence the use of ideation, explain what it could look like when the investment delivers for the patient. Using ideation as a process will enable us take our systems through the thought process that gets it to an understanding of the future; moving from innovation to development to actualisation.
In the EU today we have 2.5 million doctors and 4.8 million nurses, the beating heart of our system and the delivery function of what we do! But, digital needs to not be considered as a back office to this. As we move to a place where the life expectancy goes form 83 years old (2017 in Japan) to an age that we struggle to compute then the equity of health care delivery needs to be built upon a digital way of working or the system can’t cope. Equity of service means we need to balance some hard numbers, the average 70 year old’s healthcare today cost $3,956 per person globally whereas in the USA the same person would cost $9982. Some of that investment (globally) has to be made in digital or we will stand still, and standing still in healthcare will mean failing whole populations of people.
So the ‘call to arms’ on this has to change. Digital in healthcare is the new utility, we need heating, water and light; we need digital too to deliver healthcare. The new ask is to move from the begging bowl; there for the scraps in the good times and a move on to the polite but considered statement of what cannot be done without digital. After all IT isn’t free!
Originally published by DigitalHealth.net
Since the publication of Robert Wachter’s book in the spring of 2015, the idea of clinical engagement in all that is digital health has been pervasive. But before ‘the’ book and over the last decade at least, I have seen a plethora of different styles adopted for the role of what we now call Chief Clinical Information Officer (CCIO).
The styles that can be adopted by CCIOs clearly work in different ways to match the culture and needs of the organisation alongside the benefits these digital projects are trying to achieve. The organisation in which I am now working, Leeds Teaching Hospitals Trust, has some amazingly talented clinicians with significant interests in many aspects of digital. As a Trust we are about to embark on the expansion of the CCIO role, creating a clinical leadership team of three, with individual responsibilities for:
The three CCIO roles will now be supported by nominated and clearly identified staff throughout the clinical service units (CSUs). The clinicians across the CSUs will act as the focal point for engagement in each of the CSUs throughout the trust. Also the creation of the office of the CCIO across Leeds Teaching Hospitals Trust will ensure promotion of the CCIO role in a way that facilitates a real width of clinical engagement, not just at the trust itself, but across what is becoming more and more referred to as the ‘place’.
Clinical engagement in digital is like pasta. There are so many different ‘flavours’ and ‘types’ and picking the right one is dependent on the digital ‘dish’ you are creating around your system. Many pasta types have regional variations and some have different names in different languages, for example ‘rotelle’ is called a ‘ruote’ in Italy and ‘wagon wheels’ in the USA. Let’s take three types of pasta and see if we can make this analogy work for the CCIO role:
In the last few years the model for clinical engagement in the digital agenda has transformed hugely. I remember discussing how to ensure that the initial delivery of the National Programme for IT’s Summary Care Record needed to be clinically led and this was way back in 2006. The amazingly driven Dr. Gillian Braunold pushed every part of the technology team so hard, often to the point of distraction as the need for clinical engagement was so new to us. But more than a decade later her style and her ideas for how clinical engagement can be achieved are really coming to the forefront as examples of the best ways of working. The concept of complete clinical ownership from an early stage of any digital project was something she championed way back in the early 00s.
The clinical engagement in place for the Summary Care Record was not seen as a CCIO role, more the twine that held the whole programme together. Certainly as the first sites went live the programme would have failed in its initial goals if it weren’t for the clinical engagement that had taken place. Clinical engagement in this case had to focus not on the benefit to the clinician impacted, the GP, but on the patient benefit and the longevity of the record of care, beyond system verticals. Dr. Braunold, even as far back as 2006, was talking about the fabric of information needed to offer the best care for patients, regardless of clinical setting, which is perhaps our earliest example of a digital fabric being raised.
This type of clinical engagement is epitomised, I think, by Spaghetti, due to the long twines of connectivity. In many ways the way spaghetti also has popularised the ‘dish’ also draws comparisons to what Dr. Braunold did in those early days.
To deliver business change in healthcare we need to engage our customers and they need to co-define the art of the digitally possible. At a recent presentation one of my CCIOs in Leeds put a statement up on a slide that I fell in love with:
“Dear clinical teams, please come to us with problems not solutions, then we can help fix your problem together!”
Clinical engagement in an acute hospital can often fall into the 1+1 story. The engaged clinician completely agrees that a single source of truth for clinical information is necessary throughout the organisation as long as their specialist and favourite application is also to be accommodated. That’s why in 2014, in Ireland, the health system had over 3,000 applications and in Leeds today I have over 300.
This influences my next example, which to this day I think is a brilliant illustration of not just engagement but full scale leadership. In 2014, the Cork region of Ireland decided to push forward with digital referrals from GP to hospitals. This project not only needed clinical engagement but clinical leadership of a kind, to that point, not seen in Ireland when it came to digital.
Joyce Healey, a physiotherapist, volunteered to lead the project and took it from the germ of an idea to a fully functioning solution, initially embedded in GP systems and then on to the possibility of integration into hospital systems across the whole country. The strength of the clinical leadership though is what is important here. Joyce not only took on ownership of the clinical engagement but the leadership of the project itself. It was agreed not to have a national project manager in its earliest days as the lead clinician suggested that the best way to truly ensure the project remained clinically focused was to actually be at the ‘coal face’ of the project.
The work here then calls back to the pasta analogy in that the sheer pervasive nature of the CCIO work in this project made sure that clinical engagement drove success. Lasagne delivers the meat filling with a layered approach to holding the dish together, maybe this is the best example we can use here, holding a superb dish together through a structure that worked well and ensured that the core elements of the ‘dish’ arrived where they needed to.
The development of the CCIO function in Ireland followed a similar path to the eReferral project. A council of clinicians was created under Joyce and then added to with successive and successful CCIOs. The initial style of ensuring that clinical leadership was apparent in everything the team did and this became a key part of the way of working for digital across the whole country. By the end of 2017, there were over 300 CCIOs in Ireland. This number has been criticised in some quarters as the vast majority of them did not have ring fenced time to act in this role, but, the nature of the way they were appointed into the roles has seen them enabled in being local clinical leaders for all things digital and they have become powerful and enabled as an influential voice for the digital health transformation across the country. The large group now created, and the way in which they line up to offer their expertise and advice, also works well with the Rigatoni pasta analogy, the sheer volume needed to create the dish!
I wonder who is the most influential CCIO in the business today? Who is the most famous pasta dish? For me it has to be the person described as ‘THE’ digital nurse: Anne Cooper. I worked with Anne for a while in the National Programme for IT and saw her vision for what clinical leadership should be, her vision of ‘card carrying’ NHS professionals ensuring that large digital programmes were successful, flows way back to the early 2000s. What Anne embodies different to so many CCIOs though, is her ability to not just represent the clinical need for digital inspired change but also her ability to translate from digital to clinical to citizen and patient speak. The Cavatelli pasta dish is known by 27 names throughout the world, let’s face it digital health and care programmes have so many different names for the same benefits that we are trying to deliver that perhaps Anne’s style is easily analogous to this type of pasta.
There are so many clinicians in the digital leadership business today and so many CIOs that truly now believe in the CCIO role; not as a nice to have but as an intrinsic element to achieving success. Professor Joe McDonald in his role as chair of the national CCIO leaders’ network in the NHS posted to social media in the run up to Christmas;
“A CIO isn’t just for Christmas, also without a CCIO a CIO is like one hand clapping.”
This new way of thinking reflects the views of almost every CIO I have spoken to in health and care recently. We are asked to collaborate as digital leaders but without a CCIO we will struggle and probably fail. The new ways of working that CCIOs bring to the digital agenda ensure that we are no longer moving to the digital bleeding edge without at least a clinician on hand to patch us up!
The NHS Digital Academy that Rachel Dunscombe is leading the creation of fits to this analogy too. What Rachel and the team are doing is setting up the Master Chef and cooking school for CIOs and CCIOs throughout the NHS. It feels like at last the opportunity is there for us all to learn from every Gennaro Contaldo there is and begin to truly build little Jamie’s Italians throughout the NHS!
All power and ragu to the CIO CCIO relationship!
Well folks, its that time of year again, a reflection of 365 days; things that have happened, things that that I’ve heard, things that I’ve watched things that I’ve learnt.
This is the fifth time I have been able to do a review of the year, take a little time and reflect on what has happened to me over 12 months. As I looked back on 2016 I commented that I thought it had been a quick one, where has the time gone, this year seems to have evaporated in front of my very eyes.
One change that has happened that I would never have predicted at the beginning of the year was that I would be writing this blog back in Leeds, back in my home county, my home city. The decision to leave Ireland was not an easy one, but I have written about that already on here. Being back in Yorkshire with family and friends is a heart-warming change. As part of the planning process for coming back to Yorkshire my wife commented how strange it is when you travel, how you can wake up on one day a member of a great team in Ireland and within 24 hours migrate to being part of something quite new. Well, we are a month into something quite new and indeed something we have done before; maybe it’s the best of both worlds, it doesn’t feel like going back but more a forward leap of faith to try and test the next part of tomorrow.
I certainly dare not even try to predict what 2018 holds for us. I was lucky enough to meet Gus Balbontin (of Lonely Planet fame) this year. Gus was adamant that every time we create a plan a fairy dies, so, 2018 will be my attempt to do less plans, more simply considering what to do next and less dead fairies! And, if you ever see Gus on a list of speakers at an event go see him, so inspirational in so many ways, energy, storytelling, sheer will of determination to make you understand his message, awesome!
Travel has played a huge part in 2017 for me, a dream holiday at what will now become a habitual holiday time for us happened in February. A few days in Bangkok followed by two amazing weeks on Phuket. I never did the whole backpack traveller thing; I was too ambitious to get my career started! Being in Bangkok blew my mind, probably in less than 10 minutes of being there. Temples, lady boys, practically free bear, live food choices, huge market places and the most expensive glass of wine I have ever had all featured in a very short time in Bangkok. We were then on to the relaxing part of the holiday on a very sunny Phuket. It really did allow my brain to recharge but after a few days of that learning the basics of Thai boxing, heading to Café Del Mar on Phuket and then following in the footsteps of Leonado De Caprio were all new adventures and highlights, experiences that made it the holiday of a life time.
2017 was also the year of some formal activities too, becoming a god father was an amazing experience, the fact that two wonderful friends and people I feel I have known forever want me to help in the upbringing of their very beautiful second daughter was amazing, and leading a reading at the service was a highlight of the year. Setting me up for another formal event in a few short months, my brother and his amazing fiancée decided that I would be the right person to be their best man in August 2018. I guess a prediction I can make is that the review of 2018 will feature some stories from the stag-do in Las Vegas and the wedding in August.
I have had the great pleasure, as I have had every year, of working with some new amazing people, but in particular this year I properly got to know the team at Leading Social, a driven, aware, capable and unbelievably creative bunch, led by the ever up and ‘at’em’ Jamie White and the calmest and most considered side kick ever, Emma Klyne. When you meet an organisation like Leading Social and it becomes a partnership so quickly it always fills me with enthusiasm for what the future will hold.
Only one trip to Ibiza beats this years, and that one is unbeatable. But this year everything went so well, seeing Hot Since 82 and Purple Disco Machine, making it to some of the best day time dancing in beautiful sunshine with a lot fun scenery made for a great holiday, so much that the dates are booked straight away to repeat the experience.
When I first started writing this yearly review it focused on lists of music, the songs of the year, and yes I can’t not do that for my own piece of mind, but perhaps most interesting this year is the sudden re-emergence for me of albums, sets of music played in the order that the artist originally intended for the youngsters out there! New music by the likes of; Kolsch, Kink, Bicep, Terrence Parker, Jesse Rose, George Fitzgerald, LCD Soundsystem, Hercules and Love Affair, Honey Dijon, Anja Schneider, Maya Jane Coles, Purple Disco Machine and Emancipator have really given me something to look forward to when the release date came around, all recommendations for your listening pleasure.
Live music is still part of every month, and some of the best nights out have been gigs this year; James Vincent McMorrow in the grounds of Trinity University, Go Go Penguin, U2, The Happy Mondays, Loyle Carner, King Krule and Fatima Yamaha have all been part of the live experiences this year. Perhaps the best though was seeing Air at the Beatyard festival on a very very wet day in Ireland, one of those bucket list bands I had to see.
So one of the things I have done every year since 2003 is pick my songs of the year and keep them as a play list to go back to and enjoy, this years top 40 goes something like this:
The way taste changes, evolves and grows I find fascinating. Ireland changed my music taste, radio friendly pop music crept in, I am interested to see what being back home in Yorkshire does to it in 2018, certainly the gigs we are lining up would suggest a continued interest in those melody driven dance songs.
If we are going to do the songs list we may as well get the films (and TV Series) list up too;
|1 – Wonderwoman||6 – The Sinner (TV)|
|2 – La La Land||7 – Logan|
|3 – Stranger Things 2 (TV)||8 – 13 Hours|
|4 – Hacksaw Ridge||9 – Passengers|
|5 – Arrival||10 – American Gods (TV)|
I’m not always sure these were released truly this year but they landed on my screen this year and I enjoyed them a great deal. I stopped myself from adding Defenders and The Punisher and Luke Cage as well, that could have been a step too far. The second season of The Get Down did it for me as well but for some reason nobody else seemed to enjoy it the same, don’t you just hate that when your programme gets cancelled before it gets to some sort of fruition.
Being named as the number one CIO in the CIO100 was such a great moment in the year for me. The CIO100 is something I have been involved in for a few years now; being number 15 the very first year and the party that we threw the next day back at the organisation I worked for will stick with me forever. Being there at the front of the book was a wonderful recognition this year. I loved ‘giving’ the Oscar speech as well, making sure I didn’t forget the people that put me there, one day there will be a way of awarding the team of a digital organisation without so specifically calling out one person.
The after party that was arranged was pretty cool, one of the smallest clubs in London, in an old Gents loo with the most amazing dancing on stage, and me, in my celebratory state almost making it back-stage instead of outside will go down in my own stories of legend. The year kept being quite award driven though, a big surprise was a new category at the eGov Awards in Ireland, being announced by my Minister at the time as the winner of the Net-Visionary award was pretty cool.
Perhaps the best of the awards though was in early December at the Talent Unleashed awards. An award across the whole globe judged by Sir Richard Branson and Steve Wozniack, they decided to give me the award for the things that had been achieved in digital health in Ireland; most disruptive digital leader, it was such a great night in the museum of London and felt like a nice personal ‘round-off’ to three years in Ireland working with a wonderful team.
Meeting new people has an impact on all of us, in 2016 I met Fabian Bolin from War on Cancer, in 2017 I was able to invite him to a stage I was hosting, hearing his story touch people as it had done me a year earlier was a great moment. Disease and cancer in particular continues to touch so many people, we all have a story that makes an experience personal, to hear Fabian speak puts a new context on what we as individuals can do about it. In the job I do I try to talk to teams about being in it for the mission of making healthcare systems ‘right’, people like Fabien are the true inspiration for this as a way of being, a definite highlight of the year, a man who gave me so much courage through the year.
Talking of courage and teams; Wannacry as a highlight? Well in Ireland it was! Leaving Galway after a series of meetings a call came in from the NHS alerted us to the fact that something quite serious was about to happen. Those couple of hours gave Ireland the opportunity to get ahead of the curve and protect the boundaries of the system. I have never been prouder than on the Sunday hearing the roll call of people involved working so hard to do a job they did because they cared so much. It made for a busy weekend, TV and Radio and generally ensuring that everyone in health knew what to do when they touched a computer over those few days was something we now put down as a significant effect on the way Ireland came out of Wannacry. The team achieved the plaudits they deserved and for a short while the health system was seen as a leader in all things digital in Ireland.
Traveling for work became a part of the job in Ireland a part that was enjoyable although not always actually seeing much of the places I went to; Brussels, Malta, Barcelona, Estonia, London, Belfast, Richmond and Seattle all featured on the passport stamp in 2017. Perhaps the most fun travel though was the Maternity Digital Challenge; three cars in a challenge to visit every Maternity unit in Ireland (19 Units) in 24 hours and at the end of it publish a digital strategy for maternity services. The fastest piece of policy ever in Ireland and one that if acted upon fully will truly change the way maternity services are offered across the country.
The great thing about the travel side of what I do is obviously meeting people and the connections that then brings. Social media is a huge part of maintaining these connections, in 2017 a great many new connections have been made, the ones I continue to learn most from or truly inspire me on an almost daily basis include;
|1 – @MattHaig1||6 – @MrDanWalker|
|2 – @ValaAfshar||7 – @DrJessicaBarker|
|3 – @MuziekGeluk||8 – @Pnolan99|
|4 – @Nickisnpdx||9 – @Rosarii_mannion|
|5 – @TedRubin||10 – @evankirstel|
In 2018 there will be a new set of lists of the digital health leaders to follow coming out of Ireland and indeed HIMSS will be publishing their 50 global leaders, having featured in the Huffington Post social media lists I really think this is a great way of getting in touch with a different set of people that can expand what you know and what you want to learn. In the case of @Nickisnpdx and @MuziekGeluk I have met two people who genuinely have changed my life views. Two others in ‘the business’ that are also worth a follow are: @UKPenguin and @Andy_Kinnear, real digital health heros in a half-shell!
Life views get changed by events and people, Manchester and the impact the horrible events of that evening had on so many people will always now bare a mark on me. I love live events, and now they will always be a thought that goes out to those people that were harmed by the horrors of what happened in Manchester. I went to see Professor Brian Cox just days after Manchester, the odd calmness to the delays, the new acceptance of a normal that has come to us is quite scary. Professor Cox provided almost a eulogy for me in the way he delivered his ‘set’, how we are all human beings here on this planet for reasons unknown and yet so many people seem to be set here to destroy all that is good. In the wake of Manchester many people tried hard to stress the need to simply spread love not hate, I wish that would continue to hold strong in 2018.
You can tell you are getting older, not just by the amount of grey hair but by a change in the what you love to do when you go out. For me this year new restaurants have played a huge part in my entertainment; Tickets, Social Eating House, Amuse, Hang Dai, Punch Room, Café Del Mar, Blind Pig, Mulberry Garden, Tattu, Cats PJs and Headrow House have all made a difference to the nights out I have enjoyed.
I have managed to get to the Café Del Mar on Ibiza, Barcelona, Thailand and Malta (Although Malta is a ‘fake’ version) and I am lucky enough to be adding Miami to the list in a couple of months, which just leaves Dubai. Amazing music, super food and normally some pretty cool entertainment make the Ibiza version of Café Del Mar still up there in the top places for me!
One of the last things I got to do in Ireland was a little dream come true, speaking at a literary festival. Something Wicked is a little crime writing festival in North Dublin and I had the great honour of speaking at it on the threats of Cyber Crime and how the world is changing through digital. It was a superb audience with a lot of smiling faces and great discussion and questions after. I would love to do it again in the future I enjoyed it so much.
Being back in the UK re-opens one of my other favourite pass times, shopping! With Vivian Westwood, Jeffery West, Pretty Green, Paul Smith, Jigsaw, Hip, Ok Comics, All Blues Co. and so many more wonderful shops in Leeds Saturdays (When Barnsley FC aren’t at home) are going to be fun and have been already since getting back here.
My last two memories of Ireland and 2017 are people based, my parting gift from Roisin Doherty was my very own certificate of my Individual Health Identifier, seeing that on paper and it being able to be used to aid in the delivery of my care is a great achievement for a small team of dedicated and inspiring leaders, none more so than Roisin who I can safely say is one of the most accomplished Project Managers I have come across and I know will go on to do amazing things in the digital health space, a definite highlight of 2017.
Last but not least was leaving Niamh, my trusted sidekick for only a couple of years but leaving someone who has helped you so much was difficult, we joked in those last few days about the importance Niamh has played in the success of eHealth Ireland, for those that are still involved on the Green Isle, it was no joke, Niamh is the centre of that world and intrinsic to its success. Working with someone who simply gets what you are doing was a great part of 2017, a lot of laughter was shared.
So here we are, on the verge of 2018. A new team, a new goal, a new environment and a new outlook, last year I leapt into 2017 with a new motto; ‘We can achieve, we truly can.’ I was full of vigour for not doing things like we always have, doing something different.
2018 is going to be the year that I work with my new team and try hard to;
‘… change what we do to change who we are.’
Small changes, small moves of the behaviour dial is all it takes to make a difference when the team you are part of is as good as what I have inherited here in Leeds. The culture I now work within can and will be our advantage in 2018 and I want to be part of the changes we each make more than anything else. After all as Bob Dylan says, ‘There is nothing so stable as change.’
We are in the year of the Rooster, so every morning I will try hard to wake up with the call of the Rooster ready for the next new challenge!
Becoming the new boy again is always a nerve wracking event isn’t it? Remember the first day at school, new faces, new places and new ways of working? I am in week three of being the new boy in Leeds and I have never joined anywhere that worked so hard to make you feel welcome and part of the team as much as Leeds does; and at a pace that is quite extraordinary.
Induction would send the fear of dread into many a health IT person. Fire safety, manual handling, corporate values and orientation… ’Just let me get to the job,’ most of us would be screaming inside, after all we came here to do this job, we don’t need persuading anymore. But not one single new staff member can start within the organisation without attending, therefore induction it is.
So the Monday morning comes around and just like the first day at school I have my best new tie, my new note book, my new pen and I am ready for anything. Coming back to what you know, Leeds, the city, means that one of my best friends is there to meet me for a coffee before the induction begins. But straight away it feels different. New colleagues come up to say hello and welcome, before the (what I thought would be scripted) induction even begins and straight away it made me, the new inductee, realise, hang on, this isn’t a scripted event, this is real people with real values, and actually, OMG, everyone really does care!
Entering a room with around 50 other new starters immediately creates something of a new collegiate group of professionals. We are in this together and in time to come we will remember starting on the same day. No matter what our role, the people in the room are connected to one new thing, the care of patients at Leeds and The Leeds Way.
A lesson in Leeds is the first part of induction: what is there to be proud of? Firstly you are already blown away by the sheer size of the hospital, and this is one of several sites. Then it turns out parts are over 250 years old. Remember the amazing work of Kate Granger. Personalising and making human the interaction with people who work in healthcare is also part of induction. Every one of the people on induction are using the ‘hello my name is…’ introduction line, instilling straight away the human nature of Leeds as an organisation.
The culture of the organisation is impressed upon a new person on day one. The brand of ‘#TheLeedsWay’ is distilled down to the key vision statements, not simply posters for all to see but real values that you quickly realise permeates everything that the team is here to do.
Leeds hospitals needs this team work, as the next realisation is just how busy the hospitals are. That week there had been between 550 to 600 discharges a day. If you didn’t realise before induction then it comes home quickly how important it is to every part of the organisation to be at the frontline of healthcare in the NHS, as Leeds is the centre for so many care initiatives, transplant scenarios and specialist care. As a new person working here you get the importance quickly of The Leeds Way and the Leeds Improvement Method in place across every job. Every ‘asset’ the trust has is asked to understand how to make the care journey of a patient a better experience.
Delivering care costs money, around £3m a day, and with over 1.5 million patients every year, you begin to build your own scale for the size and complexity of my new organisation.
Every induction group meets the CEO and gets to hear first-hand the vision for the future and understand how he believes every hand in the room is involved in building the Leeds Way. The leaders in the room also get to meet the Exec Team, truly making sure that the Exec Team is asked by every member of staff to model the values of the organisation.
I have worked in a number of health organisations over the last 20 years, yet never have I felt part of the team as quickly as I have at Leeds. The Leeds way of delivering induction means that I am a team member quickly and can help deliver the goals of the organisation as quickly as I possibly can.
Joining Leeds really does feel like joining a new way, #TheLeedsWay
First published in CIO Magazine, November 2017.
In 1797 George Washington instigated the first handover period for the presidency of the USA, he handed his responsibilities to John Adams. Since the 1960s a 72 to 78 day handover period has featured in every transition of the presidential role, and yet in almost all other public sector and civil servant role changes a handover period simply doesn’t happen, in all the CIO roles I have had I have never had the opportunity to conduct a proper handover one that means you hit the ground running, rather than running to catch up.
In a few days time I will leave Ireland for Leeds after three years working in a country with a passion for what digital can do for healthcare. When I resigned from my post my boss, the director general of the health service here in Ireland could see that there was a need to have a careful, considered and informed handover process to maintain the pace of change that we have been working to. In a break from what would have been the easy decision it was decided to look outside of the Office of the CIO for an interim person to hold onto the digital healthcare business and to receive a handover. Appointing a progressive, digital business leader to the role of interim CIO eight weeks before my departure has meant we have been able to work through a handover of the business, we have been able to agree priorities for 2018 and at this time in the Irish political calendar we have needed to agree how the budget for next year should be spent.
CIOs need to get better at succession planning, I would suggest one of the reasons we have not been seen to be great at this so far is that we have very much an individual stamp on the businesses we run as CIOs. Our styles and how we work with the ‘business’ to achieve digital goals is one of our core values, handing that to another is always difficult.
With an interim CIO appointed we began to plan the handover, we broke the content down into areas that would make the most impact the quickest, what this did was highlight a prioritisation process for the work of the team and the office.
There were five themed areas that we agreed would be our area of focus:
1 – Delivery of Person Centred Care
2 – Trust and the Protection of the health systems assets
3 – Value add services – Patient focused innovation and proving the digital capability.
4 – Create Insight and Intelligence through data that is already collected.
5 – Connect the Care Delivery Network
The digital strategy has been in place since 2015 and the delivery plan for this was agreed in 2016. This means the interim CIO can move into the continued delivery of this, however what does need to be refreshed is a new operating model for the Digital team, an operating model that reflects changes in how service is delivered and how engagement can be brought from a digital responsibility to an organisational scalable way of working. This now becomes a priority for the new CIO, not always ideal, making changes in the early stages of taking on a new role but a necessity to continue to enable the evolution of the team.
Being able to instigate a proper handover has given the organisation the opportunity to really consider the way the team works as one function. In a recent Gartner presentation the idea of four digital accelerators was raised and how these are now being applied to the future of team working. These areas are; Digital Dexterity; Talent, Diversity, Skills and Goals; Network Effect Technologies and the Industrialised Digital Platform. The handover process with these as core values as to where and what is done next has helped hugely as we strive to put in place a robust way forward that continues to drive a new pace to digital in healthcare.
The handover process has included not just a new ownership of the digital agenda but a new face of the change being brought to healthcare through digital. Therefore involving the new interim CIO in all engagement events has been part of the process and one that has seen the new CIO move into the public eye. The handover has also been delivered in the public domain using social media as the platform to enable the team and our partners to see the process and to meet the new CIO in a virtual way. The #HandoverCIO has been used as a way for stakeholders to see the activities that are underway. The culmination of the handover process was a meeting of all partners to an open interview with me and the new interim CIO, the design of the session was to make it part of one of the quarterly Eco-System meetings but also to ensure that the partners could see that they were going to be able to continue to evolve the relationship they have from a traditional vendor relationship to one that continues to be described as a partnership.
The transition from Bill Clinton to George W. Bush in 2001 was a fraught process best epitomized by the Clinton prank of the removal of all of the ‘W’ keys from keyboards throughout the Whitehouse. The transition from CIO to CIO often does end up with a lack of knowledge of where ‘the bodies are buried’, a phrase used when I came to Ireland in 2015. A colleague offered his services on my first day to help me avoid digging up the bodies that had been carefully hid. By working on a handover process and a proper transition there can be no ‘buried bodies’, no surprises and no need to re-learn what has gone before.
Handover has been great, but now its time to let go as the quote suggests below…
Make yourself available for advice if they want it, but only if they ask for it – don’t stand in the shadows trying to hang on to something you’ve decided to stop doing. Professor Graham Moon
Giving up your ‘baby’ is hard to do but as a CIO in transition to a new role it has to be done smoothly and the new CIO empowered. As handover comes to an end please support a new CIO with advice and guidance, Jane Carolan is a digital leader that is now a CIO, she is excited to be in the role and can’t wait to engage with the wider CIO community, tweet Jane @janemcarolan
A simple pair of Pink Socks can change your world! Pair by pair pink socks have become the new paradigm in connectedness for healthcare IT professionals all over the world. To have a pair from Nick Adkins that you can gift on enables you to become the Network Effect Technology!
My first pair arrived from the Netherlands, from Ignar Rip, a simple gift of a few pairs to pass on, to create a little enclave of Pink Socks for an Irish health care conference, in this case the socks represented more than a new connection for technology people, they represented an awareness of improving Dementia care globally, they also created me a new friend who loves a variety of music and believes in the transformation of health care.
Being able to pass the socks on at the Future Health summit to such giants of the industry like Andy Kinnear and Rachel Dunscombe was a great pleasure, seeing the founders of One Health Tech Ireland in the socks as they began to formulate the plans for creating diversity in our industry was also a great thrill.
In just three connections the socks were making more difference than Block Chain is yet to make on health care!
Next came the wonderful Roy Lilley and Shane Tickell at the first Irish HealthChat, live from sunny Dun Laoghaire, Pink Socks times three now made it on to live TV and still represented partnerships and friendships coming from working together. Over the last three years we have worked hard with team in Dun Laoghaire to try to ensure there are ways that an Irish company with an amazing idea can be supported by the Irish health care system that needs their amazing ideas. Pinks Socks in action for another reason!
Last but by no means least is the Pink Socks feature at Health Innovation week, a pair of the Pink Socks 2.0 gifted to every speaker at the main event ensured that they then featured in the whole week of events. It didn’t matter if you were the newest digital engagement expert from Samsung, the CEO of CHIME or the Minister for Health, in that week Pink Socks became the way to connect.
Nick finishes his recent TEDX in San Francisco by asking everyone in the audience to turn to someone they don’t know and with intent say, “I See You!” Three words that can make a connection.
So for me Pinks Socks is…
…a new connection, a new way of seeing people, not roles, not prejudices, not functions, not end game goals, but real people, who, if we truly make the connection we will be able to have help in everything we do.
I want to be seen because I want to help.
The 31st of July was a very sad day for me, it was the day I had to sit down with the Director General and say those words, ‘I resign as CIO of the HSE.’ Nearly three years in Ireland has been amazing. In the following week one of the team asked me, ‘was it a hard decision?’ Yes it was, one of the hardest I have ever had to make, over the last three years I have met some of the most committed and talented people I have ever had the pleasure to work with, a team of people who truly, with the right support, can change the face of a country!
Some of you will have heard me tell this story before, so please forgive me; my second day in Ireland, I grabbed a taxi, the Dublin driver turned to me and did the usual, where are you from etc, and then asked what brings you here? I replied without hesitation, somewhat green to Ireland and the culture, that I was working for the health service. The taxi driver stopped in his tracks and said, “You have a lot to learn, you have joined the second most hated organisation in Ireland, after water Irish people hate the health service the second most!”
I assumed he was joking, but no he was kind of right. The health system of Ireland is not a loved system, its not cherished, its described as bloated, regularly someone has a ‘pop’ at it being top heavy, or spending money wrongly, or deploying resources in the wrong places. Yet, here we are with a health system that every day saves hundreds of lives, a system that has a workforce like I have never seen before, a committed one that knows how to deliver care with compassion and often against adversity.
Let me take my own crisis management experience in Ireland, Wannacry, as an illustration. On the Friday evening the team identified the global impacting issue was heading our way, without any consideration for the plans for the weekend the team mobilised, created a defence strategy and set about working all weekend, all hours of the weekend, to protect the systems that delivers care to the Irish citizen. Nobody was paid to do this, no one received any bonus, time off in lieu or really any kind of recognition other than a heartfelt thanks from the system. In fact some ‘friendly’ people on social media suggested that the strategy adopted was even wrong, and that the focus should never have been needed if the HSE had been more prepared. I was so proud when on the following Tuesday we returned all systems back to normal and were able to say we had protected Ireland when others across the world had not been able to achieve the same.
Leaving this role, not being part of the team in the HSE leaves me with so much trepidation; the personal focus that so many people have put into the changes that we have made over the last three years is significant, I wonder if this ‘perfect storm’ of personalities will ever be created again. One of the first programmes of work I ever owned in healthcare was the delivery of a system called the Data Transfer Service (DTS). The solution was a new way for primary care and acute and administrative functions to share information securely and in a timely fashion and we had to deliver this in thirteen months, this was back in the late 1990s. I thought that was the best team I had ever worked with until I came to Ireland.
The team make-up is a happy accident that has evolved to be one that I will look to emulate elsewhere. The team is a mixture of evangelists, sceptics and pragmatists, after a couple of years in the role that mixture hit the right balance. The team has a group of people who believe in being open and a sub-set who understand the need to be closed. The creativity in some has been astounding and the sheer dogged focus to keep going in others has given us a drive that has seen us get to the finish line on so many projects.
What I have learnt is best described by a Yorkshire phrase; “It takes all sorts!”
Handing the team to a respected, committed and digitally enthused leader has given me a new reflection on what can be achieved. The team are gathering around my interim replacement ready to support her and help her continue the success, not just of the last 3 years but the building success that the team has been trying to achieve for the last decade. There are some new tools now; a ‘brand’ that is synonymous with success and openness is in place in the form of eHealth Ireland. The health identifier is a foundation for information stored digitally, enabling a leap forward in patient safety initiatives with a data flavour. Ireland and its health system has a renewed vigour for what can be achieved in healthcare through the foundations of a digital system. Its first examples of digital hospitals are live and are a success, the programme to sequence the genome of patients with suspected epilepsy is changing the lives of many people this year, people with a disease that is often not considered high enough up the agenda. The readiness to consider innovation, how to work with the new, the fresh, the different ideas is also now part of the way the Irish healthcare system is changing and delivering benefit. In the last 12 months alone there have been over 50 new digital solutions deployed into the health system, each of these implementations requires the unwavering commitment of a team to make the system live and support the system going forward.
Perhaps the biggest ‘thing’ that we have achieved though in the last three years is to place the possibility of digital in health on to the agenda. We have a minister who says that digital is no longer a nice to have, we have a HSE leadership team that has embraced the concepts of digital into the way it works and the way it considers reform. The representation of all of this is the passion of the team that deliver this though, as my goodbye reflection I want to pause here and call out, maybe even embarrass a few of them, “live” on this blog site, to be remembered here and learnt from in the future.
First and foremost, an often unsung hero of the team is Joyce Shaw, the driving force in how we have transformed as a team, a lady with a passion for the team, how It works and perhaps most importantly the reality of people working hard together. Joyce is the conscience of the team!
The most considered, calm and truly gentlemanly Fran Thompson would be next on my list of essential elements to any team of the future. Without Fran being there through thick, thin, muddy and clear so much of what has been achieved in the last three years would have got absolutely nowhere.
When I consider the team that we were in December 2014 and think about the difference people have personally made I have to call out Michael Redmond as well. Michael is a true example of a leader building through engagement. Working with Michael and seeing him go from sceptic to optimist over a three year period of time has been one of my own personal highlights.
The eHealth Ireland committee has been a joy to work with, and is a group of people I now call friends, Eibhlin Mulroe, Derick Mitchell, Andrew Griffiths and the ever committed Mark Ferguson have ensured that the path we have walked has been supported. The success of the eHealth brand can be put down to these people and others in the committee who work hard in the background ensuring that we can make a success of what we do.
I have been lucky in that I have worked for two ministers who have wanted to engage with the digital element of health in a different way, they have taken a personal interest in what we do as a team, supported us and been there for us. eHealth Ireland has been able to enjoy an open door to both ministers over the last three years an acceptance and realisation that the team here in health is a high performing team of committed and capable staff is a great by product of that engagement.
A wise old colleague of mine said to me once that those of us that want to evolve and change simply need a good manager, once that person is in place we will be able to achieve anything. It felt a little like a piece of Jedi advice at the time but working for the DG of the health service here in Ireland I now understand. The DG has empowered us to get on with it, insisted we stay calm in the most stressful of situations and supported all that we have tried to do in a way that ensures success, certainly without this support we would still be thinking through how to make some of what we have achieved happen.
There is space for just two more names on this list for fear of it turning into a gushing speech that no one will read.
Niamh Falconer is my conscience, where Joyce ensures the team has a voice in everything Niamh reminds me of my voice in everything, caring for me and reminding me that successful change needs time to happen and time can’t be magically created; although she has had a magic wand in her hand for the last two years doing Tinkerbell like tricks to make sure we can do what we need to do.
Last but not least is Maria O’Loughlin, when grey clouds appear Maria has blown them away for so many parts of the team. She has a unique ability to translate ideas into reality whilst adding a shiny creative style to them, if we adopt Pareto’s rule Maria is the way to achieve the last 20% in all that we do.
Calling out individuals is dangerous, I know that, the reality is that in every single case of every person I have worked with over the last three years they have touched what we have done and indeed who I have become in some way, I would love to simply list everyone here now but no one would find that an interesting final comment from me.
A vision of the future has to be my final comment, I came to Ireland in October 2014 to present at the HISI conference what my vision of the future would be, I think much of that vision is still valid! The purpose of eHealth in Ireland is to create digital as a platform for change, a platform for a health service that has every citizen’s health and wellbeing at the heart of what it does.
If I could have a final wish it would be;
… be ‘nice’ to the system that is there, help it continue to evolve.
It needs to find a new way to celebrate what it is, the Health Service Executive is the life blood of this country, treat it as that, realise what is limiting its capability and focus on fixing that rather than damaging and attacking the resource that is at its disposal. The HSE is an organisation that is committed, it is an organisation that is caring and it is an organisation that is capable, treat it as that and it will deliver the best healthcare system for the population of this great country.
What can digital health learn from the biggest trend in Hollywood block busters, the Re-Boot.
In the last 15 years Spiderman has been through three ‘re-boots’, Tobey Maguire, Andrew Garfield and now Tom Holland. Batman has managed even more changes that have brought various degrees of success (personally I thought Michael Keaton did a great job!). Digital health can learn from this trend, a re-boot or two of how digital health is ‘sold’ to the public, the tax payer and the media is perhaps a little overdue.
The cynic amongst us though would be worried of the PR agency spin at this point, but I would disagree. Earlier this week I was being taken on a high-speed car chase through the streets of Leeds, otherwise known as a taxi ride from the train station to St. James. The usual conversation, what do you do and where do you come from ensued (does anyone else feel they are on a game show sometimes when they are in a taxi?) What was surprising was how much the taxi driver knew about the digital reform of the UK health system, but here is the issue; “Was that the disastrous IT project that failed”, says the taxi driver. No matter where you go the National Programme for IT (NPfIT) is almost universally hailed as a failure, and yet the programme put in place foundations for digital health to rival any country in the world, it put in the ground work to engage the customer whether that’s the clinician or the patient. I guess much as Michael Keaton put in the ground work for the plethora of super hero movies that have become de ’rigour as the summer hit movies!
Ireland still has its own NPfIT. PPARS is still described by the Irish media as a ‘comedy of errors’, and just as NPfIT it has its failings, PPARS today is a success that can be built on! To go back to the superhero movie analogy, PPARS and NPfIT are best linked to the Daredevil and Elektra movies, Ben Affleck and Jennifer Garner vehicles of 2003, fans know these were ‘great’ films, the critics were convinced they were rotten tomatoes, but, they now have influenced some of the best Netflix superhero fodder ever to be made!
The culture and leadership of the digital team is significant in a judgement of success.
Building a team is a trick that every digital leader should accept as their number one priority. Without the team the priorities, the governance, the customer at the centre, any of the benefits of digital will not be delivered! Across the world the delivery of healthcare is under financial pressure and this in turn means that the immortal words, ‘do more for less’ are likely to be uttered to you as a digital leader.
When you then look at what you can do less of there is a risk that the things that ‘could’ be seen as not digital’s responsibility are the first to go. If your mind lands on this as a decision please, please think again!
All over the world organisations are being told digital fails without business change resource, and yet as fast as this is becoming a key message for many business areas health systems are trying to cut the business change element from the budget of digital. In Ireland, we have spent the last three years trying to reinforce the message that the projects we have set as priority projects will fail without proper business change elements. The success Ireland made of the first digital maternity hospitals was a success of the business change functions and the clinical leadership. The need to have 9,500 hours training in one of the hospitals is described in some of the Irish media as a failure, what a shame that is. Business change perhaps shouldn’t be labelled as training, I guess that’s where we went wrong in Ireland, the ‘brand’ of business change resources within the team needs to be clearer, they are the engineers of success!
In my move to Leeds I was recently asked what sort of a CIO I am? One that focuses on technology or one that focuses on information? I think I confused the person asking the question when I said I am a CIO that focuses on the people. The need to create a team that cares most about the business change we are trying to achieve; I hope is part of the legacy I leave in Ireland as I begin the handover of what I do to the next digital leader for healthcare, a team that has moved from one that delivers digital to one that helps create business change through digital innovation.
Resourcing any organisation to be able to achieve a business change is difficult, trying to ‘re-boot’ the view of the team at the same time really does require an engaged and enthused leadership team.
How will we find the right people for the right job at the right time is a tricky question for any digital leader trying to create a cultural change. It’s a challenge that we have worked hard on in Ireland. In November 2015 the department of health gave us permission to recruit 49 new members of staff to the team. An exciting time being able to consider how we could now truly begin to move the ‘dial’ on the ratio of staff available to the business and how we really could begin to focus on the delivery of business change. The trick though was what sort of staff did we need. We were pleased with permission to recruit 49, we had asked for 150 new staff which meant a prioritisation exercise and a structural alignment that matched the resource we were now allocated, a re-boot with a limited budget. Not all of the re-boots require the superstar actors and huge budgets though, think of the collection of superhero TV series now gracing the screens of Netflix, nowhere near the super budgets of Batman Vs Superman, nor do they have the big name actors and yet they are probably making a bigger dent in the film buff psyche than the most recent Batman film ever will, sorry Ben Affleck!
How do we professionalise the digital health function though, how do we become recognised as the go to function to achieve change in healthcare. First and foremost, the logic of success building on success is key. Pick the projects that can be successful, not the easy projects or the quick wins, but the projects that will make a difference and that you know can be achieved. Professionalising the digital role in health is influenced from the outside in to some degree, the clinical engagement in the success of digital will build an organisational ally to help in the consideration of what a professional digital workforce can bring.
The re-boot of digital health needs some tools as well as the new actors. The SAMR ladder has worked well for us in understanding where our focus needs to be. Are we Substituting, Augmenting, Modifying or Redefining the delivery of healthcare. Are the terms mutually exclusive or are they an innovation journey that digital healthcare is on?
Dr. Ruben Puentedura’s model gives any digital leader an opportunity not to just re boot the organisation but a model to re boot projects as well.
Lets look at PPARS in Ireland, its original premise using SAMR was to simply Substitute what was currently in use with a digital platform, what went wrong according to the general consensus is that a simple substitution wasn’t enough. The human process was exactly that, not a logical process that digital could be a substitute for but an emotional and geographically different process that actually needed a redefining re boot. The success of eReferral in the last 18 months is because the process has been augmented, and the project team set about the re boot of the process knowing that was the case.
As we move to the EHR programme here in Ireland we know that the whole programme of work has to be about redefining, that is why the business change resource is so important and its why Ireland’s EHR business case insists on the budget and resource allocation for the business change elements,
Einstein’s definition of insanity is perhaps over used, but it fits so neatly here; ‘doing the same things over and over but expecting different results’ is his tried and tested definition. Without a re boot digital health is not going to succeed and we need it to be the next Avengers re boot not the best forgotten Nicholas Cage classic, Ghost Rider.
Consider the re boot theme, build the business change resource and lets get this movie started!
What makes the world go around? What connects people more than anything else? I think its music!
In the last short period of time going to hear live music is now a target for evil. Those people making this happen do not care for music, they do not care for people, they do not care, not at all, not ever!
Music transcends all of this though. A love of music is no longer a matter of taste, it is no longer a matter of being in a certain gang, it’s a connector that takes us all, people of every age, gender, creed, persuasion, away from staring at a screen, away from the pace of life in 2017. Music is escapism, hope, solace a vision of the future and a window to the past.
Last night’s events in Manchester, to me the home of English music, well my English music anyway, is like targeting the future of us all. A love of music from that city, that aspirational city, that baggy city, that ‘mad-for-it’ city can begin to give any of us a platform for forgiveness, for hope, for us staying connected to each other as humans, not as religions, not through technology but through love, hope, consideration and a will, a will to be there for one another.
So in the words of a few of ‘my’ Manchester bands rather than my own thoughts, I take a new meaning from these lyrics and they help me sleep tonight…
Press your lips,
To my eyes,
Taste my tears,
On your tongue,
Pull the blinds,
Play our song.
Get out of bed,
Come out and sing,
Blue skies ahead,
The man who told everything.
Do what you`re doing,
say what you`re saying.
Go where you’re going,
Think what you`re thinking,
Sounds good to me.
So this is how it feels to be lonely,
This is how it feels to be small,
This is how it feels when your word means nothing at all.
The road is long,
With many a winding turn,
That leads us to who knows where,
Who knows where.
Up, down, turn around,
Please don’t let me hit the ground,
Tonight I think I’ll walk alone,
I’ll find my soul as I go home,
Up, down, turn around
Too much to take,
Some cross to bear.
I’m hiding in the trees with a picnic.
And all the roads that we have to walk are winding,
And all the lights that lead the way are blinding,
There are many things that I would like to say to you,
But I don’t know how.
Thanks be to; The Doves, The Happy Mondays, The Inspiral Carpets, The Hollies, New Order, The Stone Roses, Oasis, and lets face it so many more.
Love Manchester, love people, connect to one another, stop the violence.