What do we turn to when the black dog pops on to our shoulders?
So many people go to a song, a poem, a book; solace in the repetitive patterns of something comforting, something sad, something happy. Me, I always turned to musical melancholy or a trusted battered American novel, (Nobody’s Fool by Richard Russo or The Hour I First Believed by Wally Lamb or The Art of Fielding by Chad Harbach) a story that I know I could open on any page and dive right into the life of someone else for a short period of time, comforting time that takes you away and gives the brain chance to find a new synapse to fire, a new spark that will help me find a different path to go head down.
Music and literature and art; ‘THE’ arts, the saviour of many a dark mood, the difference between falling down the long and deep tunnel and being able to perform a U turn that puts you (me) back in the moment, able to make a difference and care completely about the world around me.
There is no cure to depression, there is no cure to being sad, we need a way to cope, to ‘be’ something else. Everyone needs their own recipe to happiness or at least to that momentary difference that you can build on, something repetitive to distract you, to give you enough time to breath.
Music after all is a series of repeating patterns of varying complexity; eight notes to the octave for mere mortals and that sudden leap to twelve notes per octave for the seriously darker genres of Country, Blues and Jazz. There is nothing really stopping the number of octaves other than the physicality of the instrument and therefore there could (indeed should) be a song for every mood of every person on earth. The ‘free bar’ of Apple Music and Spotify have made it so much more possible to find that musical moment that you need, although sometimes that now is overwhelming when there is one ‘thing’ you know you need.
I’m Richard and I am addicted to miserable music when I am low, Red House Painters, Nick Drake, Radiohead, Cat Power, Sun Kil Moon, Low, Mojave 3 crikey the list could go on, there once was a time when this was my music and only now when I look back do I realise why, my world now is full of richer brighter colours more often but the complexity of those songs and the mood they could change is never lost on me in 2019 or 1999 or 1989.
What can we rely on though, I know that a glass of red and Down Colourful Hill or Ocean Beach and a little bit of solitary time will normally stop me in my tracks and remind me of what I can do, what I am here to do, and that’s ok for me, but no one who has been there can really ever ‘prescribe’ their cure for the next person. I have only ever met one other person who would listen to Red House Painters at their worst for example, and he was a fanatic Red House Painters fan anyway!
The sheer size of the ‘medicinal’ arsenal available to us when we turn to literature holds even less bounds than music. There are 26 letters in the alphabet, five vowels and twenty one consonants, making up the books of the world, all 130 million of them, each book has an impact on someone, somewhere, sometime. Languages hold no bounds other than the learning required to make sense of them which simply adds more and more to the arrangement that is available to you.
Once it comes to words to create stories the world become less and less random. The art in creating with the twenty six letters of the alphabet, the five letters as vowels; A, E, I, O, and U and the remaining twenty one as the consonants never cease to prove the human capability to be ‘artful’. In The Science of Story Telling by Will Storr he opens with the comment,
We know how this ends. You’re going to die and so will everyone you love. And then there will be heat death. All the change in the universe will cease, the stars will die, and there’ll be nothing left of anything but infinite, dead, freezing void.
I think I mentioned already I love a bit of melancholy! His point though is the human ability to tell stories needs to be boundless to give us all a moment of hope for every single new day, hope is derived from thinking about what tomorrow brings, we need to be convinced that tomorrow is new and brings something different, after all we are not living in the Matrix (are we?).
In the same way as the jazz men of old decided to begin to count the black keys as notes in an octave in their own right when we speak the words of a story in the form of a poem or spoken word performance art we again hear something different. The letter Y is sometimes considered a sixth vowel by poets and spoken word artists because it can sound like other vowels. Unlike consonants, each of the vowel letters has more than one type of sound or can even be silent with no sound at all extending again the beauty and curative medicine contained in the written word. But, if we did adopt this principle whole heartedly it would ruin the Cheshire Cat’s song in Alice wouldn’t it, a true happines finding song if ever there could be one!
The story of the sixth vowel and the inclusion of the black notes in an octave should teach us that what we have in this world is ours to be manipulated, even the most steadfast rules can be bent to create a new normal, a new way to help each other and perhaps most importantly to give us new tools to help ourselves.
The reach we have to help each other should hold no bounds. But, we do need to remember that my prescription will not be the answer to the person sitting next to me and their ailment, and with depression, with Mental Health, all we can do is offer help in a consistent, reliable and honest manner.
Ah, but a man’s reach should exceed his grasp, Or what’s heaven for?
Robert Browning (1812 – 1889)
Writing, sharing from our own experiences in as honest and open manner as possible gives us an opportunity to achieve a different outcome I think. In recent times I know that my world has changed a lot and that as I head further into 2019 it is the most unknowable of years, with the support that I have built though I am convinced that I can make the unknowable more exciting than scary and I can avoid heading down melancholy hill. Knowing change and knowing the support you need to enable change to happen around you is one of the keys to life I think, a lesson for 2019 though is best taken from an Instagram poet;
“From stardust we must come
to stardust we go
this is for certain
the rest is”
#AYearInPoems #29 “Sometimes its good just to know how small you actually are.”
….and enjoy being that!
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.
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!
Do you remember that school report moment, that evaluation and review of the academic year, the fear of what your teachers would say, or not say when your parents went to meet them? A year of hard work distilled to a 45 minute meeting with a bunch of teachers who, in some cases, were probably trying to provide feedback to maybe as many as 100 kids who had various degrees of motivation and ambition. It must have been a hard task for them and it was often a nerve wrecking experience for the pupil!
Key phrases from my school reports: ‘creative writing doesn’t always mean making it up as you go along!’; ‘Please follow the rules of emergency air supply on an aeroplane, secure your own work before turning to help others’; ‘Less communicating and more concentrating will bring more academic rewards, but will make the class a dull class’; ‘Richard’s passion for campanology outweighs any I have ever seen in any teenager’. The last one holds a dear memory for me as a retort from my Dad, who exclaimed he knew I liked camping but thought I wasn’t the only one in school in scouts!
So, a year into the role in sunny Leeds, a year in to concentrating in a new way on what a digital fabric can do for health and care across Leeds and I thought it would be good to try to put together my own school report. A progressive ‘school’ like Leeds would allow the pupils to put together their own review as long as it could be challenged in a fair and productive manner by teachers and peers, so here goes.
First subject to be graded has to be Delivery. I think the #LeedsDigitalWay deserves a B- for delivery in the last 12 months.
Delivery Grade – B-
The first 100 days saw a sea change in the way the team worked. The objectives of what we wanted to do were made clear and the team began to evolve. The ‘simple’ action of getting board approval to invest in the PPM+ solution as the Electronic Health Record (EHR) for Leeds until at least 2022 has seen a new concentration on the process for delivery. Leeds has delivered against an agile methodology for over five years but now delivers on a monthly release schedule; new functionality defined by the clinical team lands into live each month. A new focus on the release function and now the way that test, development and integration work together has brought about some immediately noticeable changes, largely the enthusiasm and engagement that the clinical team has for the solution has improved significantly.
Deliverables such as the A&E dashboard, flu reporting, tasks and jobs inside the EHR, the implementation of Forward, the delivery of the eRespect form, Nursing eObervations, single sign-on for all and even simple changes like the opening of the internet to ‘real’ use has seen a continuation of the acceptance that digital is a hugely important part of what a hospital needs in place every single day.
Scan for Safety and the mobile EHR solution are fast becoming a way of life in Leeds. Not new gizmos but a way to enable the understanding of patient flow and a way of capturing information without fingers being needed on a keyboard. Scan for Safety also is an illustration of LTHT-wide partnership working and what can be achieved when a delivery is led not by IT but by clinicians and key impacted departments.
The delivery of new infrastructure for PACS, Digital Pathology and the new Genomics service all considered to be that unfortunate term, ‘back office’ deliverables, but all crucial to the acceptable running of the digital fabric of the trust are well underway with a limited resource to make them happen.
A slow but steady reform of the way service management is delivered has started to take shape as has a new way of thinking for Information and Intelligence (I&I). The organisational change elements are now in place to enable a function within the I&I capability to focus ‘just’ on data within PPM+, something LTHT has been trying to make happen for some time.
Why the dropped marks in this area? Expectations have been set really very high and whilst the resource to deliver has been changed in its structure it hasn’t changed in its capacity in any dramatic manner. A phrase I think should be avoided has been used too often: ‘do more for less’. Outages have occurred on three occasions, all managed well with no patient impact but in all three cases these outages could have been avoided. On the positive side, key lessons have been learnt and business continuity lessons and disaster recovery plans are now well honed.
When in Ireland I was once challenged by a senior member of the team to spend a few months in the garden shed away from the team and the email. The meaning behind the comment was I was pushing at a speed that the team needed a rest from. I think I drop marks for not learning that lesson as well as I could have. We are going at a pace in LTHT that will tire the team out if I am not super careful in 2019 and therefore I do need to look around and be sure that the delivery ambition we have is met by the resource we can apply.
Culture Grade – B
Building the team I want to work in is always important to me in any leadership role that I have had. Putting in place weekly updates (Can you give me two minutes) and hitting these for 52 weeks in a row has been an important way to show the width of the team how we can act as one. The creation of the #LeedsDigitalWay and the associated goals, vision statement and key strategic plans have not been created in isolation by the senior management team but, following the ethos of the Leeds Way, these have been done through crowd sourcing and via the wonderful ‘Very Clear Ideas’ process.
I feel the team is engaged, not entirely, but better than many would be in the ideals of what we are here to deliver. That is largely because the LTHT culture, the Leeds Way, gives me a jump off point that I can simply add to, but this has to be seen as a great benefit.
The whole team has had the opportunity to come together four times in 2017/18 as a digital team of leaders in the digital health environment. The meeting is not mandated (nor will it ever be) and has seen a steady increase in numbers for each gathering. One of the best moments of the year was the morning after the third All Staff Meeting being stopped by another early riser member of staff to be told they had put the next meeting in the diary already and would be telling all their colleagues how important the meeting was for working in the team – superb, immediate and honest feedback.
It is often joked that only those ‘great places to work’ organisations get IT and Communications right all the time. We have tried to get the level of communications right but in a recent staff survey the team wished for more, so now we move to consider all the different styles of communications we have and how they impact upon the culture.
To me the Leeds Way is our culture and our values with a digital ‘sheen’ applied to it. We have come some way in 12 months but I can see the gaps that we need to improve on.
The reason for some of the ‘dropped marks’? We are going through organisational change and are desperately trying to get that right at every juncture, but we haven’t always been as successfully as I would like us to be. As soon as we create an open culture which we have done then we have to have the capacity to listen and act on opinions that are made clear to us, we are trying to get that right but we are not quite there yet, could do better may be the school report language best used here.
I think we have been able to pick up extra marks though for team development opportunities. In 2018, we were able to be part of content delivered by HIMSS, KLAS, HSJ, CHIME, Digital Health and BCS. We have opened opportunities for staff to apply for the Digital Academy, a hugely important leap for us, and had 10 interns join the team, many of whom have stayed on in some way. Exciting learning prospects for all of us continue to be available across the team and will remain a high priority for us in 2019.
Engagement Grade – B+
The awareness of the LTHT digital journey at a national and international level has doubled in the last 12 months. We have been successful in ensuring that when somebody wants to understand how to deliver an EHR in the NHS then Leeds is one of the top five places they think of. Being able to take part in the Arch Collaborative and achieve the Net Experience score that we did showed the engagement the large proportion of our clinical staff feel for the systems we have deployed.
Leeds’ success has been represented on three continents this year and is synonymous with clinical engagement, an open attitude to delivery, an inclusive ability to resourcing and a willingness to share. If I were to write my own obituary these would be words I would want to see and therefor I think the B+ is justified.
We have been able to bring leaders from across the health and social care system to Leeds to show them how the front line of digital health is really working and I would like to think that has impacted on policy in some small way.
The reason for the dropped marks is, despite the geographic location working for us (Leeds is after all the home of over 20% of the health informatics staff of the NHS), we have yet to truly make the most of Leeds the place. With so many organisations in Leeds that focus on digital health, our own position in that eco-system still needs to be eked out.
Innovation & Technology Grade – C-
Next year I have to focus more on this. We have so many ideas and so many amazing offers of help to make those ideas come to life but time and resource has run away with us too many times. We have been able to get the infrastructure for Single Sign On in place and the migration has largely gone well. Piloting the linking of devices to this infrastructure, not just the software side, is a remarkable feat I think.
I would have loved us to have our first implementation of cloud in place in 2018 but we are still a little way away from that. We have well formed plans for AI access to some specific solutions which I believe will be transformational, but again they will be early next year.
The speed of the systems we have and the reliability of the solutions they are hosted on has improved ten-fold, but user expectation outstrips our current capability to keep up. The work done to make the regional integration capability ‘bomb proof’ is outstanding but took us longer than we thought.
We know how we want to innovate and even who with, but in some cases we have come unstuck as we try to find ways to create relationships. For us, the way we have worked with Forward in 2018 has been a real test of how an NHS organisation can create a true partnership with a new innovative company and really build benefit. Being able to ‘gift’ the content of the Axe the Fax toolkit to Silver Buck for them to industrialise and make available to the wider NHS is another great example of an innovative approach with a new partner.
If ever there was a category with the immortal school report words, ‘must try harder’, it would be this area. I need to consider how to deploy more resource here to give us more chance at being truly ground breaking in this arena in 2019.
Collaboration Grade – C+
Achieving the Local Health and Care record Exemplar (LHCRE) status was clearly done only by collaboration across Yorkshire and Humber and was a big moment in 2018 for all of the team. Collaboration across the city area on the Leeds Care Record remains a highlight of the job and being able to represent Leeds as the platform with my fellow Proclaimer is something that enthuses me every time we get the opportunity to do it.
The dropped marks though here are because I know we have not played the part we should play in the West Yorkshire collaborative to the same degree. Something that next year I will prioritise is ensuring that the blueprinting work we do can be shared first and as a priority with colleagues across West Yorkshire. I know that we have the basis for a great relationship and one that will enable a better platform for patient care if we can find the right projects to collaborate on.
In the school report it was those summary words that always cut to the chase the most, the form teacher comment on the future challenges for the student and the head of year views on focus for the coming year.
I think if these words were being written about me after this year they would go something like this:
A successful start to the new school. Needs to keep a closer eye on the detail and avoid getting distracted by some of the wider picture, even though it is important to still see this and bring it back to the ‘school’ – we need to have all of our own foundations in place before truly looking to help so many others on the journey. The class (the Digital and Informatics Team) needs the focus to be slightly more on them than it has been on some occasions in the year. The key challenge for the next year is to keep moving at the current pace but with the whole class on the same journey. This will be difficult to achieve with the expectations that have been set but is entirely doable with the skills available.
… and if that was the summary I would sleep well at night.
Originally edited and published by www.digitalhealth.net reproduced here ahead of the Digital & Informatics Team at Leeds away day in July. Partnerships applies just as much to the team as it does to the age old ‘vendor’ relationship.
What do you need from the perfect dance partner? Someone with the same ear for a rhythm as you, someone that doesn’t tower over you, someone with strength and grace in awkward situations, someone who can stand up to a change in beat, or someone who will help when you miss a beat. All descriptions that a healthcare CIO needs to apply to building the perfect relationship with their commercial digital partners.
As an analogy does the search for the perfect ‘strictly’ partner help when picking the digital delivery partner, lets us look and see by considering the different ‘dances’ we have on offer:
Argentine Tango; is characterized by its hold embrace and complex leg and foot movements. It is an improvisational social dance that is truly a dance of leading and following.
Represented by a digital delivery partner that follows your every move no matter how complex the delivery is that you are trying to achieve. This type of partner, in the new agile environment of what is asked of digital in healthcare, needs to be able to improvise within a plan and deliver at a high speed, in a structured and planned manner. The risk with this kind of partner is that you as the digital leader either have to be leading the ‘dance’ at all times or if the partner wants to lead in this style of delivery they will be driving your organisation to their beat which comes with risk as your organisational goals and the digital benefits you are striving to achieve will have to be closely aligned to your partners throughout the relationship.
Ballroom Dancing; is a form of partnered dance that has pre-defined steps following strict tempo music, such as waltz, quickstep and foxtrot.
If your digital partner fits to this analogy then you have created a very structured but perhaps rigid partnership. Both you and your delivery partner know what is needed of you every step of the way; you are working closely on delivering against contractual elements that are clearly defined and well understood or at least a delivery plan that you have both worked hard on to ensure has wins for both parties included. The area of concern here would be the ability to react and work off plan together may take time. Creating the next steps in the new ways of working will not always meet the needs of a modern business change project, whilst that could be described as a failing the original plan will be delivered. This is ok if it is all that you need and therefore working in this way will be perfect for you both.
Contemporary dance; is not a specific dance form, but is a collection of methods and techniques developed from modern and post-modern dance
This style of partnership requires a true relationship to have been developed, one where a high level of trust has been put in place, after all you are about to embark on a journey that some will think is a little odd. Few digital delivery partnerships have been able to achieve the level of trust to work in this way, however if it can be put in place it will bring a surprising amount of success for both parties, a relationship that can be reaction driven and therefore drive an agile response to problems can be achieved through working in this way. The level of sceptism from the ‘audience’ though will be high for the success of the partnership and it is likely the partnership will be under constant observation from a governance point of view to test its validity as an ‘art form’. Conversations about delivery of digital in a post-modern world have been raised over the last couple of years a number of times, this way of working with partners perhaps is the way to see this come to a place where we, as digital leaders, can truly understand how this would work and indeed even what it means.
Jive; is a social dance that can be practiced to a broad range of popular music, making it highly versatile, which adds to its appeal. It is easy to learn and has simple footwork, making it accessible for beginners, but it is tricky to master.
Jive as an analogy for delivery partnership is perhaps best used for those quick partnerships that are only in place for the term of a single delivery focus. The partnership is easy enough to learn and create and is driven by the tempo of the delivery. No lasting commitment needs to be made to the partnership if all that is required is a successful and sharp delivery, but if this is to be maintained longer term and the pace of delivery kept up then a strict set of performance metrics need to be put in place to ensure the pace can be maintained longer term by both partners. A jive relationship will be tiring for all partners, a new level of contractual sustenance will need to be created to enable the relationship not to ‘flag’ as it gets tired of the pace.
Salsa; is in 4/4 time in two bar phrases with a pause on the 4th and 8th beats, which gives a quick-quick-slow rhythm. In classes a choreographed sequence is generally taught, but in practice it is an improvised dance.
Salsa can be described as a sales driven digital relationship. The initial excitement of the contract being signed and the new relationship created will give those early deliverables a focus; a shared impetus to deliver almost jive like, however without collective improvisation as the relationship matures the speed of delivery will slow down. This can be beneficial in creating quick wins and then moving to a more considered and managed relationship as long as the slowdown in delivery does not hit a stop. Improvisation of the relationship in after sales behaviour can ensure that this relationship continues to evolve and is successful.
Tap Dance; is an example of a non-partnered dance that is generally choreographed, with one or more participating dancers.
Going solo to deliver but in tandem with others is perhaps the best way to utilise this as a learning example. Maybe the Local Health and Care Record Exemplars (LHCRE) are a good example of five tap dances being performed around the country. Each of the cohorts will now be trying to create their own tap dance, the original choreography being provided by NHS England and the beat and shoes provided by NHS Digital and others. Each LHCRE cohort will be able to have an element of choice in the type of shoe and outfit they decide to wear but when the dance is the performance the music and choreography will have to be the same for the System of Systems approach to deliver across the country.
We need to be awake to the style of partner we are choosing for the dance, we need to be able to live with different ‘dance styles’ as part of our eco-system of partnerships as the same style will not work for each project nor each partner we choose. True success will come when we have picked the right partner for each type of dance we need to deliver and we know how to move seamlessly from style to style.
Grab your partners by the toe, let’s go do the Dozy Do, or as the legend that is Sir Bruce would say, Keep Dancing!
So there we were, three lads at the back of Mr. Carter’s British History class, Richard H, Richard C (me) and Gary. This was going to be a two year support friendship to ensure we passed a GCSE that to me was important as at that stage in my life I thought I was going to be a teacher, and a teacher of history to younger kids no less!
What was odd then is the debate that would start once a week about which band was best, Richard H was U2 (Cheering at the back I assume), Gary was Queen and I was Simple Minds. The back cover of our History books at the age of 15 would have the co-joined S and M for Simple Minds on mine, a crudely drawn Claddagh was on Richard H’s and poor Gary had to make do with trying to draw the iconic Freddie pointing to the sky from Live Aid.
The quiet debate when we were supposed to be doing small group work on whether the Archduke Franz Ferdinand’s assassination had caused world war one would often turn to which band was best, and which would stand the test of time.
Bands could transition but could they transform.
Our team comes together today (17th of September) for the second time in 2015. The key themes are the completion of our organisational transition and the move to a transformed organisation, as well as an exciting look at the art of the technologically possible in healthcare.
So what lessons can we learn from Bono, Jim and Freddie and the debate that we had on the back row of History class?
Transition is the easier of the two tasks that ensure a reformed approach to IT delivery is in place. Transition can be as simple as moving the ‘deck chairs’ on the ship deck, but truly transforming the way the team delivers requires a whole lot more. I have to now concede to Richard H, U2 are the only one of the three bands that has stood the test of time and transformed themselves time and time again. How has Bono, the Edge and the other two pulled that off, where Jim in particular simply didn’t? By looking at the whole picture I would suggest U2 have understood the change in taste, adapted and continued to deliver. They have understood how technology impacts on what they do and have embraced it, gaining the benefit and only rarely getting it wrong, and when they do get it wrong, correcting the mistakes and continuing to transform.
What is the goal of transformation? For me, first and foremost it is to create enthusiasm. If you think of the elements as an equation:
Transition/Transformation X Development = Enthusiasm
I guess we can say the square root of this equation is improved delivery capability! We now embark on transformation though in reality.
The new teams are in place and the route through those teams to ensure safe and agile delivery is mostly designed. The challenge we now face is how to move from our very own Rattle and Hum stage to Achtung Baby and onwards, and the journey we need to take our fans on with us.
The journey as always is grounded in the concept of not breaking anything on the way. This has been written in red marker on our transition plan since January of this year, and we know it is a challenge. In the reforming of a team with such a significant responsibility as well as new important and innovative tasks to complete, it is clear we have to protect the service we have put in place. Unlike U2, we can’t afford the controversy and perhaps publicly perceived failure of Songs of Innocence.
The protection from this then is our new Service Management function. Much is written about the function of service management in the delivery of technology. When the NHS embarked upon its huge transformational National Programme for IT it invested heavily in service management before the first system even went live. A criticism from the delivery team inside this programme was often that the service delivery function did anything but deliver, and we must be mindful of learning from this, creating a relationship that facilitates interaction between the programme functions and service management that will not only support delivery but drive it forward.
My own ambition is to perhaps to take the best of Queen, Simple Minds and U2 and create a new super group. The super group will have the drama, captivation and live capability of Queen, the brutal honesty and life lessons of Simple Minds and the ambition, creativity and intelligence of U2.
If Simple Minds could start life as Johnny and the Self Abusers and U2 came together first as The Hype then I am certain it will be acceptable for us to initially come together as HSE IT then transform in to eHealth Ireland with a new culture created, not by the positioning of a new name in a new font but by a vision, plan and the enthusiasm of a great set of band members!
We are still creating that fan base of what we do after all, and transformation is a tool for keeping an audience interested, but at some point the transition has to reach its culmination and the delivery of the product needs to be complete. At this point we need an answer to a key question that the record companies of our three analogy setting bands must often ask, “What next?”.
The delivery of technology into health needs to be less about technology and more about business change. We talk a great talk on the subject of business ownership of projects. I have said as CIO that I do not want us to own any projects by 2020 and that we should not even be seen as anything other than a function of healthcare delivery in Ireland by this time. That then gives us a raison d’etre for transformation:
‘Commodity providers to business change champions’
This then becomes the super group’s album title!
The three of us at the back of history never did settle the debate. I would hazard a guess if we came together again now we would probably allow nostalgia to colour history and empower us to think that at a snap shot in time we were the ones that were right. I do know all three of us moved on. As tastes changed, evolved and transformation of what we needed occurred then we looked for different solutions.
If we define success in any way through, it is what the fans want, and U2 still can sell out any tour anywhere in the world in minutes. I hope everyone who needed a ticket got one for November’s excitement here in Dublin!