A vast amount of paper in use in the organisation, far too many admin staff, an IT department that was seen as a cost centre rather than an enabler, and inefficient non-standard ad hoc processes everywhere – Tracey Scotter must have felt like she'd entered an IT nightmare when she joined Sheffield Teaching Hospital. Under her massive tech turnaround, all that is disappearing as she moves the hospital from a batch-processing organisation to one operating in real time and able to make operational decisions based on real data rather than no data at all.

When did you start your current role?
August 2012.

What is your reporting line?
I report to the medical director; he is the chief doctor, which ensures that IT is clinically led (or business-led).

Do you meet with and discuss business strategy with the CEO every week?
Every fortnight.

Are you a member of the board of directors?
Yes.

What other executive boards do you sit on?
Finance board, efficiency board, health economy board.

Does your organisation have a CDO?
No. I am responsible for the digital strategy.

What non-technology responsibilities do you have in the organisation?
• Medical records (3 million paper records, 280 staff)
• Information governance
• I am the SIRO (senior information risk owner) for the organisation

How many employees does your organisation have?
15,500.

How many users does your department supply services to? 
15,500.

How do you ensure that you have a good understanding of your business and how your customers use your business's products?
I joined the NHS from the private sector about 11 years ago as an executive with a seat on two boards (I was to set up a shared IT service for these two organisations). I had to learn fast how the NHS works, from the Department of Health down to a GP practice as I was expected to take part in all the board discussions and contribute to decisions about strategy, policy and tactics. Both boards welcomed my experience from the private sector and encouraged me to share this and lead on initiatives completely outside IT. For instance, one of the first jobs I did was to reorganise a committee that controlled the spending of the capital budget according to the principles I had learnt at Deloitte.

The business products from my organisation are health services and there are many opportunities for technology to change the way healthcare is delivered. In my current role, I attend board meetings on a regular basis, I am a member of a number of committees that make strategic decisions about finance, and I am a member of each of the key operational boards that effectively run the business (clinicians, nursing and management). My personal role at board level is to help the organization consider the future as well as identifying ways to improve the organization that exists today.

In addition, I have a number of senior clinical and nursing staff who work in my department (health informatics) to identify and introduce technology to improve healthcare. We meet on an almost daily basis to ensure this agenda is driven forward and our current portfolio is a mix of large transformational programmes down to small tactical decisions such as how to get the most out of a digital dictation system.
I also employ a number of business change managers who are not technical; they have been involved in delivering healthcare and their remit whilst working for me is to implement change and help departments realise the benefits.

Finally, I have a small team of relationship managers who bridge the gap between the business and IT. They look after specific business areas, helping them use technology effectively, gathering their requirements and helping them with business cases for change.  

Sheffield Teaching Hospital technology strategy and agenda

Is your organisation being disrupted by the internet, mobility or technology-oriented start-ups?
No.

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?
Before I worked in the NHS, I had fondly imagined it was one of the largest organisations in the world. It is actually a conglomerate of many different businesses, all with their own individual objectives, targets and drivers. There are still huge silos of data, which are often not shared at all, due to technology constraints, governance rules that have not kept pace with technology capability, or lack of trust and cooperation between different providers. A disruptive technology in healthcare can simply be the introduction of a system that allows the sharing of data, coupled with a programme manager determined to get over every obstacle and a few respected and enthusiastic clinicians to provide leadership in the clinical areas.

When I joined Sheffield Teaching Hospital, one of my first tasks was to lead on the creation of a technology strategy. The hospital had never had a proper IT or technology strategy and this was evident by the amount of paper in use in the organisation, the number of administration staff and the inefficient non-standardised ad hoc processes that existed everywhere.

One of the main components of the strategy was the introduction of a clinical portal that would pull information from various sources and share it between different health providers and social care. This was disruptive in that all the participating organisations had to buy into the idea, both at an executive level and an IT level. Data sharing agreements had to be created and clinicians and patients had to agree to this. I led on the creation of concept papers and presented these to a variety of audiences. There were a whole series of obstacles to be removed and eventually the concept was signed off as a project and is due to go live in April 2015.

The field of analytics and big data (also considered a disruptive technology) will have a big influence on an individual’s health and Sheffield Teaching Hospital is aiming to become one of the genomic medicine centres that will be established to support the 100,000 Genomes Project. This ambitious national project intends to deliver the sequence of 100,000 whole human genomes by 2017, from patients with rare inherited diseases and patients with a range of cancers. If successful it will provide putative and confirmed diagnoses for some of those affected with rare inherited diseases and provide a huge resource for research into the genetic basis of disease. 

It is hoped that this initiative will put the UK at the forefront of genomic medicine internationally. For the hospital to participate in the project I have engaged a number of technology partners who will help us develop our technology infrastructure for the future delivery of genomic medicine. I selected the partners and convinced them of the great opportunity that exists in this field. This has required a number of companies to undertake quite a lot of work at their own cost, with an eye to the future. This has been successful so far in that Sheffield has been shortlisted as a possible centre.

We also have a project that fits under the disruptive technology trend of the internet of things. There is a trend in health for the convergence of medical devices and IT. Increasing numbers of devices require access to the internet to deliver a clinical service. When I joined Sheffield, they were in the process of completing a wireless network project. The plan was to link some laptops to the network and essentially make life easier for a relatively small number of clinicians and managers. I expanded this plan and recruited some business analysts to go out into the hospital and identify where connecting some devices to the wireless network could make a difference to patients. As a result of this we have created a plan to link a host of devices.

For example, functional electrical stimulation therapy (FES) is a rehabilitation technique where electrical current is applied to paralysed or weakened muscles. FES cycling involves coordinated electrical stimulation to create patterned movement of the legs to pedal a static cycle and exercise the muscles in the legs. The FES cycle is linked via the wireless network in the therapy department to the internet. The anonymous data can then be collected centrally on a website, which allows progress graphs to be viewed and analysed and objective measures of improvements recorded for use by the therapist. The bike can now be moved to anywhere within the therapy department thanks to the Wi-Fi internet connection, enabling it to be used in the shared gym or in a private treatment room. The new service has allowed the Sheffield spinal injuries unit to keep up to date with current evidence-based practice and offer this treatment, which is widely used within spinal cord injury rehabilitations worldwide, to our patients.

Finally, I have initiated a piece of work with some of the professors who have joint posts across the hospital and the university to create a digital strategy for the hospital. This will cover the more innovative trends in technology such as the introduction of disruptive technology and the use of predictive analytics. It will also look at the opportunities for improving the patient experience, gamification, remote monitoring, and we are talking to IBM about initiating a project with doctors from our hospital and IBM's AI computer; Watson.

The themes within our digital strategy are:
• Keeping patients out of hospital (this would include patient monitoring, interpretation of ‘personal’ data, predictive and alerting systems, self-management systems)
• Pre-hospital (anything, administrative or clinical, that a patient can do before their visit to hospital such as book tests, book appointments, ask questions, complete pre-op assessments)
• Hospital experience (patient entertainment, patient communication with the outside world, patient involvement in decision-making aided by digital systems, and potentially some form of ubiquitous monitoring for clinical alerts)
• Post-hospital (follow-up appointments, monitoring, patient feedback, monitoring and systems to support self-management and self-care)
• Teaching services (providing teaching and coaching services remotely)
• Support for primary care (providing information and advice to support primary care to deliver the best service to patients)

What major transformation project has been recently completed, or is underway at your organisation?
The trust has a history of high-quality care, clinical excellence and innovation in medical research but its IT and paper systems are no longer fit for purpose. I joined the organisation two and a half years ago and every single aspect of the IT service required a complete overhaul. The board knew this, but were not sure what they wanted, although they were very clear it was something completely different to what they had!

In addition, all the trends identify that technology will enable more efficient, effective clinical decisions as well as improve the overall quality of patient safety and care. The board have concluded that it will not be possible for this organisation to deliver the highest quality of compassionate care without deploying technology to transform clinical services.

One of the first actions I had to take when I joined the organisation was to engage the board in understanding what a strategic asset a good IT service could be and then to complete a rapid assessment of the existing IT service, producing a plan with options on how to improve this. The plan was quickly regarded as a transformation plan and covered four main areas:
• Governance
• Developing a technology strategy and roadmap
• Organisational development – creating capability and capacity in IT
• Creating a realistic managed portfolio of work

Improving the governance involved setting up the right groups to oversee all aspects of the technology agenda: governance, strategy, finances and communications. Previously there had been no clinical involvement in IT, and the department was regarded as a cost overhead rather than a strategic enabler. I established a clinically led technology board that owns the technology strategy and a high-level set of technology principles against which all technology development requests can be evaluated. This allows a federated model of governance for the hospital with centralised oversight, a core budget and an overarching technology strategy while still allowing directorates some freedom to operate as long as their proposals meet the technology principles and can be funded. The board has invested considerable time creating a clinical technology vision (which I facilitated) and this provides the guiding principle for everything we do.

In developing the technology strategy and roadmap, I persuaded the board it needed to be a high-quality piece of work executed quickly and drawing on knowledge and expertise from all sectors, not just health. I engaged PA Consulting to facilitate this. The team interviewed over 700 people and produced the first comprehensive set of IT requirements the trust had ever had. I was then involved in the creation of the strategy and the roadmap to deliver this. Once it had been agreed I presented and explained this to various boards and committees, and communicated it throughout the whole organisation (using presentations, workshops, podcasts and social media).

The technology strategy is all about transformation and the organisation is using this unique opportunity not just to update but to transform ourselves into a hospital with the cutting-edge systems to support the transformation in care we want and need to deliver over coming years.

A programme has been created called ‘Transformation Through Technology’ to implement three major IT systems in a very short time frame and redesign hundreds of processes. I personally worked on the creation of the business cases for these, the removal of the many obstacles, the financial planning and the setup of the programme, including the recruitment of staff, the establishment of the board, and the proposals to recruit clinical, nursing and operational staff to lead it.

The implementation plan is fast-paced and ambitious and I have had to address a number of cultural issues to convince people to ‘move at pace’. While people accepted the logic that the transformation is required, they found it more difficult to believe the urgency.

One of the key messages has been that this is not an IT project – it is about improving what the hospital does by taking advantage of what technology can now offer. 

Alongside this work, I have been progressing the complete overhaul of the existing IT team. The existing senior team departed and a new team was recruited. A target operating model has been created and a new structure implemented. Business plans have been created and approved to recruit additional staff. A vision, mission and set of values have been created for the new service and a new service management system has been implemented.

Finally, it was necessary to review all the ‘inflight’ IT projects that had existed for years and were still not delivered and in many instances were undeliverable. I organised a clinical review and over half the projects were stopped as a result. We now have a prioritised book of work for IT that consists of projects with business owners that will be delivered in the next year.

What impact will the above transformation have on your organisation?
The ‘Transformation Through Technology’ project will totally change the way the hospital operates, it will move from a batch-processing organisation to one operating in real time and being able to make operational decisions based on real data rather than no data at all.

The introduction of the clinical portal will deliver a single sign-on and the ability to pull data from the existing 280 systems into a bespoke clinical view.

The electronic document management system will digitise a million paper records, release physical space, save money (in staffing costs) and give 24/7 access to patient records (not available today using paper) and improve patient safety.

Finally, the most significant system in the transformation programme is the electronic patient record, which will deliver standardised processes, improved A&E performance, electronic prescribing, improved patient safety, reduction in hospital running costs, real-time bed management (we have over 2,000 beds and they are currently managed on paper) and real-time performance data.

The transformation of the Informatics service will deliver a fit-for-purpose IT service that is owned by the business (clinicians).  

The IT investment budget has been increased by 700% per annum and the ‘keep the lights on’ budget increased by 200%. This reflects the board’s confidence in the technology strategy and the improvements to the operation of the hospital already achieved by an improved IT service.

How has your leadership style contributed to the outcomes of the transformation project?
My leadership style is collaborative and inclusive, and this tends to be my approach to getting things done. I have recruited a new team who are truly excellent and together we are starting to get results. They describe me as determined, passionate, fair and a decision-maker who gets results.

I believe in trying to understand what motivates different people and then creating some of what they need. The values of the NHS are very compelling and many people have a strong desire to make a difference and improve things. We don’t offer the highest salaries but I have given my team a fantastic opportunity to do something really worthwhile.

My personal contribution has been to meet every challenge head-on, to actively remove all the blockers, to paint a clear vision of where the hospital needs to be and how it's going to get there.  

What key technologies do you consider enable transformation?
My answer to this depends on the type of transformation being considered. Sometimes it can be disruptive technologies, sometimes innovative niche-type products are required, and sometimes it can be simple technology but huge culture change that brings about a transformation.

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?
• To enable a data-informed decision-making culture.
• We are developing a BI strategy that will use our own clinical and operational data to manage performance, improve patient outcomes and support the strategic objectives.
• We are setting up an infrastructure and adopting national standards that will allow us to tap into advanced analytics and big data projects.

How is mobile and social networking impacting operations and customer experience?
Traditionally, hospitals have been viewed as fairly static environments with fixed points of working. Most of our wards had one or two desktops when I joined. The reality is that our hospital site is the largest in northern Europe and our clinicians look after many patients spread across a number of wards. Since joining the hospital I commissioned a mobile working strategy and introduced devices of choice for the clinicians to roam with and care for their patients. Some prefer a small laptop, some a tablet and others a smartphone. The essence of our strategy is that they can choose what works for them and we support this. Mobile working is improving clinical efficiency, allowing doctors and nurses to see more patients and have better information to hand.

Social networking is supporting patients to be more empowered. They are able to set up or join communities to share information and manage their conditions better. We have also had instances of where patients have tweeted about a dreadful experience in the hospital while it has been happening and we have been able to take immediate action to turn the situation around.

Describe your strategic vision towards shadow IT and BYOD. How do you influence and engage executives and employees around choice?
Our approach to shadow IT and BYOD is to understand the use case and requirements through executive (and employee) engagement to provide a solution in a safe, secure and supportable manner. We offer choice, rather than restrictive, non-agile standardisation.

The strategic vision is driven by initial small-scale, proof of concept solutions to help drive the business case and ensure it is financially viable, improves efficiency and provides real business value rather than just a 'nice to have' benefit for employees.

What strategic technology deals have been struck and with whom?
Our most recent strategic technology deals have been with CSC (electronic patient record), HP (clinical portal and infrastructure), Orion (integration and portal), ANS (infrastructure), Agfa (imaging) and CCube (electronic document management).

Who are your main suppliers?
CSC, HP, ANS, Agfa.

Sheffield Teaching Hospital IT security and budget

Has your organisation detected a cyber intrusion in the last 12 months?
No.

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?
Currently £20m per annum.

How much is the IT operational spend compared to the revenue as a percentage?
4%.

What is the strategic aim of the CIO and IT operations for the next financial year?
• To deliver the transformation programme
• To address our failing infrastructure
• To continue to deliver the improvements to the IT service
• To develop a digital strategy
• To complete our BI strategy
• To integrate 1,500 community staff (who will work outside the hospital, mostly in patients' homes)

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?
Yes.

Does your IT organisation operate an apprenticeship scheme?
No.

Sheffield Teaching Hospital technology department

Explain how you’ve supported and developed your senior leadership team to support your overall objectives and vision
I set objectives, I meet with them weekly (some of them daily) and discuss what is going on, progress they have made, issues they face. They all have personal development plans and I ensure they spend time on these and I have set aside a senior management development budget to support their development.

How many employees are in your IT team?
Around 300.

What is the split between in-house/outsourced staff?
60% are permanent, 40% contractors. We currently outsource very little.

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