"There's no way that anyone can ever say this is down to me as a CIO, it's down to all levels being aligned," explains Salford Royal NHS Foundation Trust CIO Rachel Dunscombe after the hospital picked up an award recognising it as the most digitally mature organisation in the NHS.
Salford Royal was named Digital NHS Trust of the Year under Dunscombe, who has a joint role as CIO of other hospitals in the Pennine region within the Salford Royal Group. The organisation had been named one of four high performing foundation trusts in the country to be accredited by NHS Improvement to lead other institutions as a vanguard of a programme to champion new models of care in response to challenges faced by the NHS.
Dunscombe said that from the board down, there was a commitment to change through investing in technology and digital initiatives.
"We have succeeded because there's a combination of stable board leadership, a board that understands digital and gives us our delegated authority to get on with it," Dunscombe said.
"The board gets it. Within a month I'd taken a paper on cyber security and enhancing it here to them, and they passed it instantly with some sensible questions. Then I took a major business case to the board, the execs and the non-execs, and they were asking me quite advanced questions around behavioural change of the citizen which was facilitated by digital and how we were going to leverage that and expedite it.
"They can see their way through the material, and I think that's the strength of a very good board."
The skilling up of boards is important so projects are not stalled and transformation can take place, Dunscombe said, with the danger that a board which does not confidently know how to engage with something outside of their area of expertise "will either slow proceedings, or stop them and throw a spanner in the works".
A board fit for digital
Dunscombe said that CIOs may need to take boards on that journey to have the greatest chance of success since digital transformation is something for the whole organisation and not a silo that exists - whether that is within or outside of IT.
"It's very possible for a CIO to be unsuccessful but a good CIO if they land in an organisation where their level of maturity and the aspiration that they've been recruited to is a mismatch for the board," Dunscombe said.
"If the board are recruiting somebody to digitise them, that's never going to work. If they recruit somebody to work with them along that journey and recognise that it's not going to happen instantly it's more successful, but boards are an interesting thing for me. Here we have got the most amazing board."
Dunscombe said that Salford Royal is a textbook example of great leadership from the top, with a Chief Executive who "has a way of supporting and nurturing people to a position where they are very, very effective".
Indeed, Chief Executive Sir David Dalton is fully behind the organisation's digital agenda saying Salford Royal had a particular interest in "utilising digital solutions" to support staff in clinical decision making, improve patient pathways and help better utilise resources.
For Dunscombe, their award as "the most digitally mature organisation in the NHS" was an acknowledgement of various strands of change - from app development to vendor management - which she was delighted to share with her diverse and hard-working team.
"The award recognised that overall we're the most forward organisation in the NHS and not just in terms of the electronic patient record, because Cambridge have done a great job for that and I've got to give them a huge nod, because they've done amazing things at Cambridge," she said. "It's all the stuff we put around it, it's the governance, clinical leadership, the mobile apps, the work we do with the university, our supplier relationships - it's basically the whole package. It's what they were giving us a huge nod for.
"I've taken the award to the team and the feedback is great. It's really interesting when a bunch of down-to-earth northerners win an award, because the one thing I would say about my team is they are consistently 'northernly' humorous.
"Very dry, very down to earth. Very northern. While they're really, really excited, there are no big egos in my teams, they're absolutely fantastic. They work together, they're a really diverse bunch, and they just get on with it."
As a digital exemplar organisation whose technology executive is the CIO representative for Health Education England, Dunscombe is also working with local universities to ensure there is a digital element to the workforce programmes of nurses, doctors, therapists and other care workings as part of their education and training.
"As they're being pipelined through now, they know what this technology looks like; that's part of their training," she said.
"It's not just about CIOs and informatics staff, but it's actually how we put digitisation into every member of our workforce's training programme, and their job description."
With an NHS England grant to become a global centre of digital excellence, Salford Royal and Dunscombe will be building a digital academy, working with the BCS, Health Education England, and local tech bodies - running programmes for everyone from 16-year-old apprentices, gap year students and PhD postgrads to experienced health professionals.
A high-flyer in the 2016 CIO 100, Dunscombe was also a 2016 CIO Summit speaker where she discussed harnessing startups and local digital ecosystems. A Liverpudlian in Manchester, Dunscombe is passionate about embracing the talent of the north west as a way of supporting the local digital economy and increasing employment rates while helping improve the health and wellbeing in the area.
Rachel Dunscombe at the 2016 CIO Summit
"We need to be digital - you get more people into jobs, you get them being healthier and they are less of a burden on the system," Dunscombe said. "If I'm going to summarise that as a long term objective, digital and creating an ecosystem is actually a wellness creation measure. Basically you are changing the microeconomics of the community."
Manchester startup ecosystem
Dunscombe also believes the Manchester digital scene has much to offer, and fares well compared to London's pseudo-hip Shoreditch - often cited as the heart of the UK's digital and entrepreneurial innovation economy but for Dunscombe with too much emphasis on the PR, marketing and digital agency side.
"It's pretentious, some of it in the extreme. We're real - this is the north," she said.
While having a buoyant local economy, digital and otherwise, is beneficial to healthcare and reduces stress on the NHS, Dunscombe said that the biggest challenges for Salford Royal and the NHS was nudging and encouraging citizens to care enough about their own wellbeing.
"What's our biggest challenge? Our biggest challenge is getting the citizen to self-care to enable wellness," she said. "The challenge is how do we do that and dovetail in technology with social change.
"It's the biggest challenge we've got. The NHS is not sustainable until everyone who's walking past these windows starts caring for themselves and interacting with the system to care for themselves.
"There are some interesting pieces there around what the social contract is with the citizen around health and wellness, and how we contract with the citizen to keep themselves well."
In the absence of the extra £350 million a week funding for the NHS materialising in the near future as promised by those campaigning for the UK to leave the European Union, Dunscombe said that wearables and remote care will play an important part in making the NHS more viable even if the biggest gain to be made is in the general populace taking better care of themselves.
"I think technology could save the NHS," Dunscombe said. "We use telehealth and we're going to extend telehealth.
"It's the prevention of admission, but it doesn't really change the citizen's behaviour majorly. It's more about the economics of the NHS and making it more economically viable with the prevention of admission, reducing infection risk and things like that."
The former music teacher who is also an advisory board member of KLAS research, a Utah-based healthcare network, Dunscombe is always looking to learn more and become better in her role to aid the people of Salford Royal and beyond. When she sat down with CIO UK Dunscombe had recently completed Certified Healthcare CIO qualification, a programme run by CHIME - the College of Healthcare Information Management Executives - over in the US and the first healthcare industry credential developed by CIOs for CIOs.
As well as this study and accreditation and trips to Utah to engage with KLAS, Dunscombe looks to Europe and beyond to take part in personal fact-finding missions to seek out inspiration and best practice about how healthcare provision can be improved.
Even on holiday or family trips, Dunscombe explains she will steal the opportunity to make a connection where one does not already exist in order to learn more about CIOs in the health sector all over the world.
Austria was next on the list, while praise was reserved for Slovenia and Estonia as countries at the leading edge.
"Slovenia is amazing, one of the best, and Tallinn in Estonia is the most digital city in Europe," she said. "They just blow us away, and in Ljubljana they have done some great stuff."
Perhaps related to the stint teaching music, Dunscombe sees the new CIO role as one not dissimilar to that of an orchestrator and conductor.
"I'm a curator," she said. "You get the right people in the room, so you curate that group, and you facilitate that group.
"That's what the CIO job is about. Most of my time is getting the right people in the room, persuading them they need to be there, and then guiding that conversation to a positive outcome."
This applies as much internally in a hospital and occasionally political environment as it does when working with key technology and IT suppliers to support Salford Royal. While the CIO role has evolved to take on these new skills, on the vendor side some are responding better than others to the new ways of working.
A supporter of digital organisations in Manchester, Dunscombe is keen to make sure a quarter of digital spending goes to local companies, a figure which is possibly helped by a lack of change and flexibility among some of the traditional big IT vendors.
"Some of them are doing a great job of partnering with us, others are still telling us what to do," Dunscombe said. "Regardless of size, I'm happy to work with anyone as long as they're a good partner.
"That is back to open and honest dialogue. Actually we've got part of the answer, they've got part of the answer and it is about creating something together."
As well as the digital and traditional IT space, Dunscombe has set up a healthcare UX lab at Salford Royal and is excited by emerging technologies, particularly artificial intelligence and deep learning, and the opportunities they will provide.
The CIO said that she thought IBM supercomputer Watson's time "is yet to come" and that her organisation was in some discussions with Google and DeepMind which she found "really exciting".
Despite her belief that "technology could save the NHS", it's the team behind the CIO at Salford Royal that Dunscombe sees as one of the biggest factors in trying to transform the hospital and help it to becoming named most digitally mature health organisation in the NHS.
NHS Digital and Rachel Dunscombe, Salford Royal CIO, at a CIO UK event at Old Trafford in October 2016
Dunscombe lavishes praise on her CTO who has "every qualification under the book", has been winning gongs for technology projects and "is an award-winning cake maker", her Deputy CIO, director of informatics and business intelligence lead Emma Birchall - as well as a Citrix genius who happens to play in the official Thin Lizzy tribute band - as examples of those helping drive transformation at Salford Royal.
The current focus therefore is to drive forward the changes in digital health at Salford Royal Group, leading the way with its new status and grant from NHS England to help other organisations improve supported by digital technology.
"There is so much stuff happening - at Salford Royal there is more going on that you can ever imagine," she said. "It's utterly brilliant and utterly stimulating, and some world leading stuff is coming out."