Dr Johan Waktare, consultant cardiologist and clinical lead for IT, Liverpool Heart and Chest Hospital NHS Foundation Trust.
What is an “expert customer”? One who gets a good deal? One who doesn’t get duped? I would say these are givens, but if they are your sole strategy as a chief clinical information officer then you will struggle to get the best from your relationship with your suppliers.
The most valuable relationships with suppliers are partnerships rather than a customer/vendor setup. Of course, you must never lose sight of the fact that suppliers are a commercial enterprise, and that side of the relationship needs to be appropriately handled.
However, a high quality supplier in the healthcare field will share a passion for improving the quality of healthcare for the ultimate users of their wares - the patients.
If you want to be an expert customer, then realising your responsibilities in the relationship is vital. You aren’t actually a customer; your organisation is the commercial vendor’s partner just as much as they are yours. It is your organisation that has an accountability to deliver patient benefit and financial return on investment, not the vendor.
This chapter explores how to select a supplier with which you can build this kind of relationship, and how such a relationship is constructed.
Identifying potential suppliers and “visioning”
The first step is to identify potential suppliers. The procurement phase is a very formal one, bound by tight rules, codes and laws. But before entering that is a much freer period of examining the market. Indeed, scanning the market should be a continuous process – if you don’t have a continuous horizon-scanning approach, you will not know what benefits you are not planning on realising.
Sources of “intel” include, but are not restricted to:
- Conferences and meetings, be they major UK or even international ones, or courses where vendors have paid stands, such as EHI Live, e-Health Week, and HIMSS. The major shows are an excellent opportunity to both see multiple demos in short time, while also networking with colleagues
- Journals and e-media, such as Digital Health Intelligence
- Independent evaluation companies, such as KLAS
- Colleagues, whether local or national via the CCIO Network
- “Cold call” opportunities. These might seem inherently unattractive, but they can be a valuable source of ideas if used judiciously
- Your existing suppliers. Even if they can’t offer you the functionality you need, they will be able to tell you who they “rate” and, even more importantly, who they have successfully interfaced with previously.
After gaining some initial intelligence, then seeing the products in use is invaluable. There is nothing to prevent reference site visits during this phase, whether they are supported by a potential future supplier or brokered by yourself.
Bear in mind that “gathering intel” about potential suppliers is only part of what you are doing in this phase. It is as much about shaping your vision and increasing your insight into the possibilities of what IT-enabled healthcare holds.
You can only implement what already exists or can be developed out of what is available, and you are not an expert on that until you have gained the knowledge.
Getting the right contract, putting it in a drawer and not taking it out again
Your relationship with the supplier partner will inevitably be based upon a formal contract, and it is vital to get that right. How you get to that contract is very variable and will typically be driven significantly by processes external to your role as CCIO. These typically fall into either an OJEU tender or a framework-based procurement.
The EPR in my trust was procured via a QJEU tendering process, which is a drawn out, labour intensive and high risk procedure. Early on, the trust or other organisation going out to tender has to specify in great detail the expected functionality that it is contracting for; at a time when it may be relatively naïve about how such functionality would work best.
Treating this work with the respect it deserves is key, and having done your market surveillance, intelligence gathering and visioning well is central to doing that. The other key factor is approaching your specification in the right manner, which is underpinned by three priorities:
- Focus not on how something should be done, but on what needs to be done. The vendor is the expert on how to deliver that functionality for you and, indeed, they will usually have only one way of doing it in their product.
- Ensure that all requirements are specified, and that your needs will be met 100% of the time rather than 98%. Medicine and patients don’t follow the rules, and your electronic system needs to be able to be fit for purpose in all scenarios.
- Build your requirements around the real world requirements of frontline staff. Your electronic system needs to deliver the real world process that staff use, not what is specified in a dusty 15-year-old policy. Hopefully your policies are well aligned to real world practice but where they aren’t - as is inevitably true to some degree - then the priority is to allow safe and appropriate care delivery.
Once the contract is signed then it your hope that you never see it again. It needs to be there to formally underpin your relationship, but if you or your supplier find yourself referring to it regularly then you have both lost. The relationship should be built on your partnership, shared goals and objectives and strong personal relationships.
Are they the right supplier for you, and are you right for them?
Every organisation has a culture, and it is notoriously the most challenging thing to change about an organisation. Ensuring that you are culturally aligned to your supplier in terms of approach and values is therefore critical.
Some suppliers have a strong culture of getting you to adopt their workflows, which are based upon years of research, experience and hard fought learning.
While this is in some ways proscriptive, it has important advantages: you have less accountability for getting the design right; the workflow is tried, tested and proven; and almost as a byproduct you have delivered uniformity of process throughout your organisation.
The other extreme is the laissez faire approach of the supplier having a system that is fully adaptable to your requirements. That is obviously great and a huge advantage, until you realise that you don’t really know what your requirements are for optimal, electronically-based workflows.
Each of these extremes has advantages and disadvantages, and neither is intrinsically superior. The point is to try to find a supplier who fits to your organisation’s approach and requirements.
Bear in mind that the best approach may also depend on the solution you are implementing. You may wish to be able to design and customise your core systems heavily, but when looking at a specific task your needs may be best met by procuring an “off-the-shelf” solution that requires minimal input or maintenance from you.
One useful method of evaluating a supplier is to look at the organisations in which their solution has been deployed well. Were the culture and requirements of this organisation similar to your own?
Remember that you are looking to be a partner to your supplier. Do they share that aspiration, or are you just a potential revenue stream?
Maximising the value of your supplier relationship
As has been stressed, the key to success is to not be a customer but be a partner, with shared objectives, goals and values. This is a commercial relationship, but having strong personal relationships that underpin that is not “inappropriate” – it is a key feature of your partnership.
Not everything will always go right, and there is no issue in a strong partnership of holding each other to account. The requirement is to do that in a constructive manner, and to work in partnership to resolve matters.
A “customer plus”
Finally, consider the value that you deliver to your supplier partner. Could your relationship be strengthened by becoming a ‘customer plus’? And could you derive benefits from such a setup?
Being a ‘customer plus’ takes two principal forms:
- Reference site – If you successfully deploy and adopt software or a system, then you are exactly what the supplier is looking for in a reference site. Acting as a reference site involves work and commitment from the organisation, but brings rewards in terms of recognition, status and profile.
- Design input – As an active user, you rapidly come to recognise what works well in the system and what could be optimised. All high quality suppliers will take that feedback gratefully - in fact they crave it as they want to make their product better.
- Their means for doing this may vary, be it user groups or online communities but should exist. Your feedback, either personal or from others in the organisation result can and does result in a change in commercial products.
Conclusion
Building a strong and successful relationship to commercial suppliers is a key component of the CCIO role. The CCIO acts as a bridge between parties - in this case the supplier and the healthcare organisation - to deliver value from relationships.
Technically one might be a “customer”, but a truly successful delivery of this aspect of the CCIO role would be“strategic partner and liaison”.
About the author: Dr Johan Waktare is consultant cardiologist at Liverpool Heart and Chest Hospital NHS Foundation Trust.He has been the organisation’s clinical lead for IT for the past ten years, and has been closely involved in the implementation of an electronic patient record, which went live in 2013.