Royal Brompton NHS Trust CIO Joanna Smith is responsible for the technology at the largest specialist heart and lung centre in the UK, the 350-bed Royal Brompton Hospital in Kensington. Since Smith's arrival at the start of 2013, a number of 'Shadow IT teams' have since chosen to move to the CIO's organisation so they can collectively make the best decisions for the Trust.

Job Title
CIO

When did you start your current role?
January 2013

What is your reporting line?
CEO

Do you meet with and discuss business strategy with the CEO every week?
Not on a regualr or weekly basis but as required and bi-weekly as part of the Trust's Management Committee

Are you a member of the board of directors?
No

What other executive boards do you sit on?
Attend the Trust's Board and Governors' meetings.

Does your organisation have a CDO?
No

What non-technology responsibilities do you have in the organisation?
Information Governance and Clinical Engineering

How many employees does your organisation have?
Around 4000

Does your organisation carry out significant trade in the EU?
No

What number of users does your department supply services to?
All Trust users, approximately 4000

How do you ensure that you have a good understanding of your business and how your customers use your business's products?
I participate in a number of multi-disciplinary, non technology-specific committees. I also meet frequently with stakeholders across the Trust and observe clinical and operational activities such as ward rounds and theatre sessions. I have established a Business Relationship Management (BRM) function within my organisation and the BRMs are aligned to the Trust structure and are dedicated to working with their divisions to ensure I&T understands and addresses their needs. The BRMs assist with developing business cases for submission to the I&T Committee which oversees and prioritises all I&T spend and activity. The I&TC comprises key stakeholders including the COO, Chief Accountant, Divisional General Managers, the CCIO, CNIO and the Director of Strategy plus other clinical experts.

Royal Brompton NHS Trust technology strategy and agenda

Is your organisation being disrupted by the internet, mobility or technology oriented start-ups?
Yes

Are you empowered by your organisation to disrupt from the inside?
Yes

Describe a disruptive measure you’ve led or played a major part in?
I&T being visible and proactive and actively engaging the Trust in defining the I&T Strategy and 3-Year Plan has been quite disruptive culturally as this is very different from past behaviour.

The change in management style and operation has been and continues to be very disruptive for my own staff - they are not used to being challenged and encouraged to challenge each other. Nor are they used to thinking in terms of business outcomes rather than technical implementations. Technically we are poised on the cusp of delivering real change to how folk work by deploying (amongst other things) virtualised desktops that will dramatically improve mobility and enable remote working.

What major transformation project has been recently completed, or is underway at your organisation?
A Clinical Data Warehouse and analytics capability
Complete redesign and upgrade to the wired and wireless network - a fundamental enabler to everything else!
Introduction of an Electronic Prescribing & Medicines Administration (EPMA) system
Replacement of our Patient Administration system (PAS)
Introduction of an Electronic Document Management (EDM) system
Upgrade/replacement of the desktop estate including W7 and selective VDI(Clinical Desktop)
Virtualisation of server estate and Data Centre migration to cloud provider

What impact will the above transformation have on your organisation?
The infrastructure projects will deliver faster, reliable access to I&T services & systems whenever, wherever and however needed - improving patient safety and operational efficiency. Our new DW and BI tools are enabling rapid accurate identification of patients for research and helping clinicians make faster and more informed decisions about treatment and care. The EPMA system will improve patient safety and the EDM will facilitate our move to paper lite as well as improving patient care. The new PAS will improve the patient experience and our operational effectiveness and efficiency.

How has your leadership style contributed to the outcomes of the transformation project?
I'm a firm believer that no one person knows best and that the best outcomes are achieved by involving the right people at the right time. I also believe in transparency - good and bad. As such our successes so far and those we anticipate, are due to the engagement and contribution of key stakeholders, which I hope I have enabled through open and honest communication and inclusion.

What key technologies do you consider enable transformation?
Virtualisation (server and desktop), mobile (devices & apps), cloud, unified communications

Are you increasing the number of cloud applications or infrastructure in use at your organisation?
Yes

What is your information and data analytics vision for the organisation?
A "single source of the truth" that is accessible by whoever needs it, whenever they need it and however they need it. We are already delivering this through a single repository currently holding over 80% of our clinical data which is analysed using SAS tools and includes anonymised data accessible via public cloud.

How is mobile and social networking impacting operations and customer experience?
Patients, quite rightly, expect to interact with us as they do with retailers, banks and other service providers. This means we must enable them to communicate with us via any channel. More importantly we need to take out-patient services to them whenever possible rather than have them travel to us. As in-patients we need to keep them connected with their friends, family and teachers and we need to get them out of bed and safely mobile (and monitored) as quickly as possible.

Describe your strategic vision towards shadow IT and BYOD. How do you influence and engage executives and employees around choice?
It's less about BYOD and more about choose and use your own devices. We have to enable "UYOD" for remote access and for 3rd parties but our environment and lack of 3rd party clinical solutions that are device or OS agnostic mean we expect to provide Trust supported devices for some time and we therefore aim to provide a range of devices to enable "CYOD". Shadow IT exists and is not an issue - it's about visibility, collaboration and appropriate governance. I include all shadow IT leads in my extended organisation and include them in strategic and operational design as well as key procurements as relevant. Interestingly since I arrived several shadow IT teams have chosen to move to my organisation. I'm here to support the Trust deliver its objectives for the good of patients, not tell the Trust what to do. My job is to advise the Trust of the options and implications so we collectively make the best informed decisions. The I&T Committee ensures that senior Trust stakeholders share ownership for the Trust's investment in IT and all major projects have a non IT Accountable Exec and Senior Responsible Officer and multi disciplinary project board. The BRMs engage with users across the Trust to ensure their needs are understood and that they are aware and engaged with what I&T is doing.

What strategic technology deals have been struck and with whom?
BI/Analytics solution from SAS
Refresh of the wired/wireless network (Alcatel-Lucent via Khipu) which will enable VOIP and UC
New Patient Administration and Electronic Prescribing & Medicines Administration systems from CSC
New Electronic Document Management system and scanning service from Kainos

Who are your main suppliers?
SAS, Alcatel Lucent/Khipu, Lenovo, CSC, BT, Microsoft, Kainos, Citrix

Royal Brompton NHS Trust IT security and budget

Has your organisation detected a cyber intrusion in the last 12 months?
Yes

Has cyber-security risen up your management agenda?
Yes

Does your organisation understand the potential cyber-security threats it faces?
No

Has this led to an increase in your security budget?
No

What is the IT budget?
£20 million

How much is the IT operational spend compared to the revenue as a percentage?
2%

What is the strategic aim of the CIO and IT operations for the next financial year?
CIO strategic aim: Transform how the hospital operates through the innovative and appropriate use of Information & Technology.
IT operations: Standardise, stabilise and improve I&T services.

Are you finding it difficult to recruit the talent you need to drive transformation?
Yes

Has recruitment and retention risen up your agenda as a CIO?
Yes

Are you looking for recruits in the EU to fill the skills shortage you have?
No

Does your IT organisation operate an apprenticeship scheme
No

Royal Brompton NHS Trust technology department

How would you describe your leadership style?
Primarily visionary, inclusive, collaborative, consultative and fair. I vary my style according to the situation and who I'm dealing with, as necessary.

Explain how you've supported and developed your senior leadership team to support your overall objectives and vision?
This is still work in progress - my SLT are a mix of permanent and interim folk and are all new to the Trust (since I joined). I have defined (with their input) and communicated our Mission, Vision and strategy and will be setting formal goals for all of them in January. I personally invest time coaching them as well as providing 3rd party support and training as necessary. We meet regularly 1:2:1 and as a team.

How many employees are in your IT team?
Around 80 for pure I&T (excludes Information Governance and Clinical Engineering)

What is the split between in-house/outsourced staff?
currently up to 50/50 due to in-flight projects

Does your team include key skilled workers from the EU?
No