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Chapter 7 Contents
Chapters
1
Welcome and introduction
An introduction to the Health CIO Handbook, its aims, objectives and intended audience.
4
Transition guide to becoming a Health CIO
A transition guide to becoming a Health CIO, what should you expect, what mistakes should you try to avoid.
6
Partnering with CCIOs and other clinicians
How can CIOs most effectively partner with clinicians?
8
Future challenges
An examination of some of the ‘near future’ disruptive challenges that Health CIOs should think about preparing for; big data, genomics and the digital patient.
9
Breaking through the silicon ceiling
As a successful Health CIO, you have a lot of skills. How do you use them to secure the next step in your career? And what, exactly, do Health CIOs bring to the executive table?
The Role of the CIO in Innovation
By Catherine Dampney
Innovation is the buzz word in healthcare right now. We must be innovative in the way we deliver services, innovative to meet the challenges of the future, innovative in the way we empower patients.
Combine that with the fact that technology and innovation are synonymously linked in the minds of politicians, the public and national leaders, and you would think the golden age of the chief information officer had dawned.
But of the swirling melee leaps the CIO Superman (or Wonder Woman, if you are me) armed with an arsenal of technological solutions that will vanquish the dark spectres of shrinking budgets, demographic trends and chronic long term conditions.
Picture the scene: the executive team smiles benignly as present your strategy, nodding grateful assent to your requests for investment, as you create fully integrated virtual accountable care systems through the power of innovative technology.
All right, stop laughing. I know as well you do that this is about as close to reality as the last Marvel movie or anything by Hans Christian Andersen.
Three areas of focus
However, there are three key areas on which a CIO can - and should - focus in order to deliver innovation for their organisation and the patients it serves.
1. Innovation is about changing behaviour
Behaviour is about people, not technology. The key to introducing technology that will change behaviour is understanding what drives people’s behaviour now.
As a CIO, you need to be sensitive to what motivates and constrains people, not just in the boardroom but at all levels of the organisation. That means especially on the front line, where the technology will be used (and this includes managers and support staff, as well as clinicians).
Having skilled people on your team, who can champion technology and understand what problems everyone is facing and help to come up with solutions, is a key factor in successful innovation. These people don’t grow on trees, but they are there in your organisation somewhere; second them in to help out when you need them.
Remember, they may be lurking in your technical staff somewhere. I’m always fascinated to talk to our long-standing Service Desk team, whose members can be a font of knowledge on the different ways in which various teams work and what their challenges with technology look like.
Otherwise, poach them from other departments: there are a lot of radical thinkers out there ready to learn and embrace change. Or, if you do have pots of cash, buy in some consultants (I’ve never had the luxury and I’m also from Yorkshire so thriftiness is in my genes).
One way or another, build a rapport quickly with different staff groups who can understand the problem; get people to be open and honest about the issues; think laterally about ways to fix the problem.
The delivery of healthcare in the UK is now underpinned by technology. This means that, as the CIO, there are very few areas in which you are not asked to deliver solutions that will enable change and innovation; from HR to finance to radiology.
All these areas are an opportunity for you to understand what the organisation is trying to achieve, to deliver something that is cutting edge, and to make a significant difference to staff and patients. By really understanding the people and the issues, you will be able to drive and deliver the change.
2. Innovation is not always at the cutting edge
I always enjoy a good tech conference, and there is nothing better for revitalising the spirit and getting the creative juices flowing than playing with some of the latest gadgets.
I know many of our chief clinical information officer colleagues are in the same camp (I have just spent half an hour on email explaining why I will not be buying my CCIO a Google Glass) and it is vital that we do have this time to unleash our inner geek.
However, back at the coal face you are rarely, if ever, presenting cutting edge applications and gadgets to a room full of purring, appreciative tech heads.
Innovation needs to be sensitive to the context of the environment. As the CIO, if you are close to the organisation you can introduce technology that many of us think of as ubiquitous but can make a huge difference to what people do and how they do it.
For example, in Hampshire at the moment, we are currently moving our GP community onto a single domain.
Nothing there that I would call ‘innovative’ in the technology or what we’re doing: but on the back of that we’re enabling GP federations, offering better access for social care across the region, and providing a platform for merged back office functions and easier movement of staff from community care organisations. In short, a platform that will support the development of integrated care alliances.
Most people using technology tend to want to make their lives at work easier, quicker and faster, so they can concentrate on patients.
No one expects technology to be overly complicated and slow things down, especially at work. Let’s face it, in real life that’s exactly what we all do with our phones or tablets: we shop faster, we keep in touch with friends more easily, and so on.
Sometimes you can innovate on very little indeed. A few years ago, we gave an integrated care team BlackBerry devices, just so they could access their Outlook diaries on the go and move off the paper version.
Our change lead worked with them for six weeks, and at the end of the pilot the interim report was fascinating. In short, they hadn’t quite got the diaries sorted - because they had become much more interested in emailing scripted voice notes to their admin team.
The admin team was now in charge of transcribing and uploading the notes onto the patient record, along with the pictures they were taking where appropriate.
So, our nurses had given up driving in and out of the office each week to input their information. They’d started recording more detail about all their patients, their DNA rates plummeted, and productivity went up by 40%. Staff satisfaction rocketed, as they felt that someone was listening to them and helping them achieve their goals. It was real innovation, driven by fitting the right technology in the right environment.
So, as a successful CIO, you will be giving people the right tools to enable them to change and innovate; and these will not always be the Apple Watch (or Google Glass, sorry).
3. Innovation is about disruptive technology
This one is music to the ears of Apple and Google and so forth; but speaking as a patient I’m personally more interested in high quality care in a safe environment.
So I get slightly wary about this phrase, because I also associate ‘disruptive technology’ with risk - and as we know clinicians and patients are a (rightly) risk averse group. Let’s face it, if we’re honest here not a lot of us are up for some major risk taking if we’ve just convinced everyone to invest heavily in a new electronic patient record or suchlike.
We have to bear in mind that some of the ‘disruptive’ technology out there has had a very high failure rate. So, yes, it’s true that iPads, smartphones and phablets are phenomenally successful, and have fundamentally changed our lives as well as major aspects of the economy.
But for all the success stories there has been a lot of failure. Just have a look on the app store: for each Facebook how many Beebos and MySpaces have there been? If we’re going to do something radical, we need to be very careful about how we assess the risk and potential impacts.
While the example of the integrated care team and BlackBerries is a great illustration of innovative change and the unintended consequences of technology, the essential objective of the programme - electronic diaries – failed.
What was the impact? Well, the team members were no worse off than they had been before, but if I was going to introduce a major system (such as picture archiving and communications) into an acute environment, I’d avoid that sort of risk.
How do we avoid it? I echo a recent article in HSJ: planning, planning and more planning. Plan the implementation, plan the ongoing management of the system, plan the monitoring of it, plan the contractual arrangements.
Have a great project management office. If your organisation does not have one, build it yourself from within your team.
Good PMOs within the CIO’s portfolio are starting to be recognised as powerhouses for delivering change across the wider organisation. Drive the best practice in implementation from here, and you will be able to start moving them into a role to support wider service transformation across the organisation.
As easy as one, two, three
So what conclusions can be drawn? Firstly: know your organisation’s business and the way it operates; know its challenges at all levels, know the way its people work and what makes them tick.
Then, use that knowledge to introduce innovative technology that will make the change, and understand that it will not always be the shiniest toy in the box.
Finally, when you do introduce it, make it a successful implementation: plan for the full lifecycle. Don’t just unpack it and plug it in. Support your frontline staff or patients who are using it, so that they understand what they are doing with it.
Be ready for the ‘disruptive’ change when it happens, and embrace the benefits and manage the issues.
And then… Once you’ve achieved all this and your glittering career as a CIO has reached its pinnacle, what next? At a Gartner seminar a couple of years ago, I was introduced to the phrase ‘silicon ceiling’.
If we’re so embedded with an organisation and critical to its day to day operations, if we’re close to or leading the transformation, what other roles could we do? In the best comic book tradition, this is an idea that is to be continued…
