Before Joanna Smith arrived, the relationship between IS and the rest of the organisation had broken down. Today I&T (as the department is now known) has become embedded, accessible and approachable – consultants remark on an amazing transformation. The list of technology she has introduced is long and impressive. It includes newly upgraded Wi-Fi enabling patients recovering from major surgery to get out of bed while being continuously monitored using telemetry. Skype for Business lets clinicians interact remotely with patients, so they don't have to travel for routine check-ups. And wearable and IOT implementations are in full swing, the most recent being the use of a device implanted in the body that monitors the heart and transmits data back to consultants via a special pillow when the patient is at home sleeping.

Your name and job title
Joanna Smith, CIO, Royal Brompton & Harefield NHS Foundation Trust.

How are you influencing the products, experience and services your organisation offers to its customers?
It's all about the patient. Everything my department does is ultimately to enable our colleagues to do great things for patients and their families. I established an I&T committee, which oversees, prioritises and approves I&T strategy and associated spend and activity. The I&T committee comprises key stakeholders including the COO, finance director, general managers, CCIO, CNIO and the director of strategy.

I also established a new business relationship management team, which is dedicated to working with the business to ensure I&T understands and addresses its needs. The BRMs assist with developing business cases for submission to the I&T committee. We also run events for our clinical and operational colleagues to demonstrate the art of the possible and stimulate thinking.

How as CIO have you driven cultural and behaviour change in your organisation, and to what extent?
Before I joined, the relationship between IS (as it was known) and the rest of the organisation had broken down. Today I&T (as it is now known) has become more embedded, accessible and approachable. Consultants tell me the transformation is amazing, that they can see we are trying to help and deliver on our promises. A number of areas of shadow IT have moved to my department – at the request of the business – because they can see how this strengthens the service and is better for the individuals. Today we are included in their plans and they come to us for help; previously they felt there was no point in asking. I believe this is due, in part, to honesty and transparency. I am open about our shortcomings and passionate about the value I&T can bring and my aspirations for the future.

Define the key business outcomes that you have delivered over the past 12 months and their impact on your organisation's performance
By providing free, fast Wi-Fi, we help patients keep in touch with family and friends as well as relax by watching movies and listening to music. The newly upgraded Wi-Fi also enables patients recovering from major surgery to get out of bed and be mobile while being continuously monitored using telemetry. The introduction of Skype for Business means we can interact remotely with patients, effectively extending our hospital beyond its physical boundary, which saves our patients travelling for routine checkups and means they can keep in contact with their clinician.

We have also started the rollout of an electronic prescribing and medicine administration system, which is removing the need for paper prescriptions and provides automated alerts for drug interactions and allergies, thus increasing patient safety and freeing up clinical time.

The introduction of VDI is enabling remote access to the trust's services from any device, which helps our clinicians serve our patients better when not on site, as well as BYOD to make our clinicians more mobile. Single sign-on is being deployed to our wards, making it much easier for our clinical staff to access information quickly. Upgrades to our picture archiving communications system are making it easier for clinicians to access images such as scans and x-rays remotely and offsite, which is critical when operating and responding to emergencies.

Describe how you have used organisational and third-party information to provide insight that has benefited your organisation, its customers and products or services
I invest in services from Gartner and Advisory Board to keep abreast of who is doing what and new developments in technology and healthcare. I and my team regularly participate in analyst calls and attend events to learn from others. We have also run events with third parties for colleagues from clinical and operational departments to look at how technology and new techniques such as gamification can help us to improve our service to patients.

I recently took the COO, director of nursing, medical director and others to BT at Adastral Park to look at innovations and consider their application to health, and will be attending HIMSS16 in the US, plus visiting three US hospitals with another director and a senior manager.

Describe how you organise and operate IT and how this aligns effectively with business strategy and operations
I&T comprises the service delivery function, which is essentially the operational side of IT (and includes the service desk, infrastructure and telecoms teams), and demand and portfolio management, which is the more strategic business-facing part of IT (and includes the business relationship management team, who are aligned to the trust divisional structure).

I established a PMO and a change advisory board to apply rigour and structure, and ensure we follow best practice. The I&T strategy aligns with the trust's strategy and business plan, and the I&T committee meets monthly to review activity, spend and new proposals. We have created CCIO and lead nurse for IT roles to establish closer links and alignment between the clinical and I&T teams.

Describe your role in the development of digital strategy in your organisation
I authored our I&T strategy and three-year plan. I did this in consultation with colleagues and staff and used Gartner and the Advisory Board to review and validate it. The I&T committee approved it prior to ratification by management committee and the board. It was reviewed by our internal auditors, who gave it the highest (green/satisfactory) rating.

Describe how you use and promote technology to redesign the processes, services and structures of your organisation to enable it to become more efficient and customer-focused
Skype for Business is being used to improve team working and collaboration across our two sites, reducing time spent travelling (up to an hour each way). The introduction of our new clinical data warehouse and analytical tools is enabling researchers to identify patient cohorts in days rather than months, significantly speeding up clinical trials, and visualisation tools assist clinicians to spot patterns in the data that can lead to improvements in patient care.

The introduction of an electronic document management solution and new patient administration system (part of our digital care transformation programme) this summer will dramatically alter how clinicians work by providing access to patient information on the go, and sophisticated tools for managing patient flow. Free, fast Wi-Fi helps patients keep in touch and relax as well as enabling those recovering from major surgery to get out of bed sooner.

Skype for Business also enables us to interact remotely with patients. The rollout of EPMA removes the need for paper prescriptions and provides automated alerts for drug interactions and allergies. VDI is enabling remote access to trust services from any device, and single sign-on is making it much easier for our clinical staff to access information quickly.

How do you engage regularly with your organisation about your team and the role of technology in the organisation, and what impact is this having?
I speak at a variety of internal meetings at all levels and do regular executive walk-rounds to talk to staff in all areas of the trust. I have also spent time in theatre observing procedures and talking to the clinicians, and I visit wards as often as I can to talk to nurses and patients. I also post updates on the trust's intranet. In all these instances I tell folk about what we're doing and how this will benefit them, as well as listening to their challenges – IT and otherwise. I encourage folk to escalate to me directly if they are not happy with our service.

How do you use social networks to engage in conversations across the industry about the opportunities and challenges technology is creating?
I use LinkedIn and Twitter to follow others and comment on items and events of interest. I am a member of several online networks and use these to communicate with others.

How do you bring the organisation together to explore and discuss technology and its challenges and to develop stronger alignment of the technology function with the full business?
We run events with vendors and analysts for colleagues to look at how technology can help us to improve our service to patients. This has included visits to BT and Apple, and onsite demos and workshops with Gartner and the Advisory Board. I also attend conferences and visits to other hospitals (UK and abroad) with senior clinical and operational colleagues.

Describe how you keep up to date with developments in technology and IT management
I am a big fan of networking and learning from others, and attend as many evening CIO events as I can. I also attend the annual Gartner symposium and several healthcare events and meetings including the London CIO Council and CIO Summer School, which are NHS-specific. I meet regularly with Gartner and the Advisory Board and participate in analyst calls on a regular basis.

Provide an example of how you have developed the diversity and improved the culture of your team
I have introduced new roles and recruited folk with differing skill sets using apprentices, Darzi fellows and nurses. I have taken on responsibility for the clinical engineering department and the technical imaging teams, and have integrated these into one directorate with a unified senior management team and quarterly directorate meetings where we bring everyone together. This year I will be launching a new L&D programme, initially for my direct reports and theirs, which will combine insights and coaching in order to develop a high-performance, customer-centric culture.

Describe how you collaborate and influence the organisation and its leadership team
I have developed close and trusting relationships with my peers and meet one to one with them on both a formal and informal basis. I focus on understanding their issues – not just those related to technology. I attend clinical and operational meetings on a regular basis and I also visit wards, theatres and diagnostic areas, where I talk to staff and encourage them to share their challenges and frustrations with me. I believe that by being approachable and keeping my promises, my colleagues have learnt to listen to me and trust my judgement. Certainly to date I have met very little resistance and am delighted with the support and feedback I receive.

Tell us how you have developed your own management, leadership and personal skills
I have been very fortunate that organisations have invested in me over the years through various leadership programmes. I also undertook a course in strategic leadership and Management, which encompassed a wide range of topics. In addition, I value learning from others through attendance at conferences and networking events, in particular roundtables and formal dinners, and I am an active member of a number of networks.

What new technologies are you investigating, tracking or experimenting with?
We are looking at 3D printing as a way of creating bespoke equipment and artificial organs for training purposes. We are also discussing an initiative to develop virtual reality with touch (ultrahaptics) so a surgeon can practise rare and difficult procedures. We already utilise wearables and the IOT in a number of areas, the most recent being the use of a device implanted in the body that monitors the heart and transmits data back to our consultants via a special pillow when the patient is at home sleeping (a first in the UK last year). We are using analytics for clinical, research and operational purposes.

How do you decide where to apply the best technological approach?
Our strategy is off-premise, cloud-first, and to leverage managed and shared services. Space is at a premium and should be used for clinical rather than IT purposes. Not everything is suitable for cloud, particularly some of our legacy solutions, so we consider the risk versus the benefits on a case-by-case basis. Being public sector and based inside the M25 and London makes competing for skilled IT resource a challenge. As such we keep in-house development to a minimum and focus on a few highly niche solutions. I focus our teams on understanding the needs of our trust and how best to deliver them, which does not necessarily mean doing it ourselves.

Do you give yourself and your team time each month to assess or learn about technology vendors outside of the established providers?
Absolutely. I actively encourage attendance at external events, and we engage with analysts and the market in a managed way to understand new and emerging technologies and learn from others. We also talk with colleagues in other hospitals to learn from their experiences.

Describe your sourcing strategy and your strategic suppliers
We use Gartner to help identify market and emerging leaders and carry out market assessments in areas of particular interest. We have a number of strategic providers including Microsoft, BT, SAS, Alcatel-Lucent, CSC and Kainos.

Describe the technology innovations that you have introduced in the past year and what they have enabled
The newly upgraded Wi-Fi enables patients recovering from major surgery to get out of bed and mobile while being continuously monitored using telemetry; it also helps patients keep in touch with family and friends as well as relaxing watching movies and listening to music. The introduction of Skype for Business means we can interact remotely with patients, effectively extending our hospital beyond its physical boundary, which saves our patients travelling for routine check-ups and allows them to keep in contact with their clinician.

The rollout of the new electronic prescribing and medicines administration system is removing the need for paper prescriptions and provides automated alerts for drug interactions and allergies, thus increasing patient safety and freeing up clinical time. The introduction of VDI is enabling remote access to trust services from any device, which helps our clinicians serve our patients better when not on site, as well as limited BYOD, which makes our clinicians more mobile.

Single sign-on is being deployed to our wards, making it much easier for clinical staff to access information quickly. Upgrades to our picture archiving communications system are making it easier for clinicians to access images such as scans and x-rays remotely and off-site, which is critical when operating and responding to emergencies.

What strategic technology deals have been struck and with whom? What uniquely do they bring?
Our EPMA (Medchart) and PAS (Lorenzo) solutions were awarded to CSC, with Lorenzo being a fully managed hosted service, making it our first major off-premise solution. Lorenzo has the ability to become the trust's first fully integrated digital care record, which will enable us to meet NHS England's five-year forward view and aim of paper-lite by 2020. We have recently converged all our mobile and fixed voice and data services, awarded to BT, providing a scalable and cost-effective platform for future developments.

Rate how important your sources of innovative technology suppliers are

  • Always referred to: analyst houses, CIO peers.
  • Often use: industry body.
  • Occasionally use: consultants, media.

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

How is cyber security led and discussed by senior management?
The trust audit committee, which is chaired by a non-executive director, has periodic updates.

When did you start your current role?
January 2013.

What is your reporting line?
CEO.

Are you a member of the board of directors?
No.

What is the annual IT budget?
£15m.

How much of your IT budget is capital and how much revenue?
40% capital, 60% revenue.

What is your budget's operational/development split?
60%/40%.

How many users does your department supply services to?
4,000.

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.

Does your IT organisation operate an apprenticeship scheme?
Yes.

How many employees are there in your IT team?
80.

Are you increasing your headcount to bring skills and the ability to react to needs in-house?
Yes.

What is the split between in-house/outsourced staff?
70/30.