The Long View is a Radio Four programme hosted by Jonathan Freedland where he uses stories from the past to increase understanding of current affairs and events. At Rewired tomorrow (25th of March) we are reusing some of the format, bringing heroes of past digital healthcare to the stage to shed a light on the lessons we can learn from the past and ensure we stop making the same mistakes time and time again. Why do we study history? I remember a teacher once saying to me, of course the answer was to do things better in the future!
Are we looking at heroes of digital as an example of the changes in the digital market place for health care today? If we are maybe it’s not an Alan Turing type hero we need (full genius style) but in-fact a mind more akin to Professor Richard Feynman, his famous four productivity strategies included;
The Feynman way of working may be the best approach for leadership in the digital health and care arena that we could adopt.
“The only way to deep happiness is to do something you love to the best of your ability.”
And the heroes of digital health that take to the stage with me tomorrow are the embodiment of that quote. Professor Gwyn Thomas, Andy Williams and Beverley Bryant all overachieved (and continue to be huge parts of) the grand digital healthcare plan. They also applied the Feynman further principles of trusting in knowledge through teaching and taking others on a journey with them and trusting in people as friends and colleagues, not as competitors and antagonists.
Trying to shape the face of the next hero of digital health care is a challenge. We could try to use the Hasbro game Guess Who to create the ‘picture’ of the new hero we all need to step up to the front. Does it feel like the change is just about to come over the hill though with NHS X and a minister and team that seem to ‘get it’ so maybe we don’t need a Guess Who, more a guess how!
Although a hill that today has hidden Brexit shaped traps that could scupper all of our ideas and plans. We need that Long View vision of the future enabled by the lessons of the past to truly give us the blueprint we strive for. When we came up with the game we had a long list of the digital heroes of the past that we wanted on stage, Richard Grainger, Katie Davies, Nigel Bell, Gordon Hextall and Tim Kelsey all made that long list, but hero is a strong word and not everyone could agree to be on stage described as a hero.
“… but we’ve always done it like that!”
In Ireland, as Chief Information Officer I pushed hard for the removal of the culture of not trying something new. I even asked that the council of Chief Clinical Information Officers adopt the famous quote from US Navy Rear Admiral Grace Murray Hopper’s as their vision statement in year one,
“The most dangerous phrase in the English language; we’ve always done it that way!” became a way of trying every day to change the paradigm, a way of simply pushing harder to do something differently, sometimes simply because it is different it worked.
Looking to the past does not mean do it like that again, it means consider what happened, learn what needed to be done to get it right and avoid the mistakes that were made. We are rightly so concentrating on blueprinting the success at the moment, we do need to be careful not create one size will automatically fit all environment. My heroes of the past in digital and business didn’t simply take the blueprint and press copy, they tried hard to reapply with the lessons they learnt and make sure others could see how to apply and learn next.
My heroes from my reality today include; Tony O’Brien for his calm considered leadership. Jonathan Sheffield for his vision and steadfast refusal to take second best. Russ Branzell for demonstrating compassion as a leadership trait in the face of global influence. Kevin Holland for showing that expertise is a leadership trait best served shared. Gwyn Thomas for delivering the most inclusive organisational change a person could experience. Carrie Armitage for ensuring that the team around the leader is the most important. Phil Randles for never guarding his knowledge. Rachel Dunscombe for being all of our Messi. Andy Kinnear for leading us from the dark ages to the light. Molly Gilmartin for bringing an approach to innovation that others are just too frightened of. Gary Venchuk for teaching me when to swear appropriately. Ted Rubin for inspiring magical thinking on reputational importance. Amy Freeman for taking knowledge and constantly learning more with a goal of doing better. Sarah Moorhead for caring so much about the next person in the queue and frantically finding a way to take them with her. Dan and Chip Heath for delivering the most amazing stories and Frank Buyendijk for being my own stage presence inspiration.
Then I consider the Leeds team I am part of now and know as I look around we have a group of people that embody the long view in everything they do, a Chief Executive, an Exec, a Chair a team of digital professionals like none I have been able to work with before supporting a clinical team who learn lessons and apply them every day and can and will deliver with the patient at the centre of every moment of the day.
Heroes from a different reality and how the impact on our style is interesting as we head to London for two days of being Rewired. Seeing old faces is always a new inspiration and that’s whether we are laughing together in a social environment or listening intently to the latest story Rewired will bring us together for the first time in 2019 as a group of professionals who know how to do this, we just need to collectively move the blockers out of the way. The nations CCIO Dr Simon Eccles will undoubtedly remind us why we need to do this and why we need to do it in a better way, no jam for tomorrow but the reality of today.
Heroes of tomorrow, aspirational people who we know we can follow, stand up at Rewired and be counted because inspiring the next generation should be all of our most important job!
We could be heroes, just for one day, (or maybe at least the two days of Rewired)!
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!
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.
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!
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