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.
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!