Mark Large has instigated and is pushing through the reshaping of infrastructure, systems and governance to deliver business-led innovation in ICT. Healthcare staff across all specialities have a say in how technology and systems should work for them, encouraging innovation that delivers real benefit to the organisation. Operational break/fix is now entirely outsourced while the recruitment to the ICT team of qualified nurses as well as enterprise architects has created a function that can engage using the language of our customer to truly understand their need.
Name and job title
Mark Large, director ICT, Central and North West London NHS Foundation Trust. Also chair of London CIO Council (a national strategy forum for around 35 CIOs from across all healthcare settings, including providers, commissioners and national bodies) and member of the executive steering board of the London Procurement Partnership.
How are you influencing the products, experience and services your organisation offers to its customers?
As director ICT, I have been responsible for multiple strategic programmes of work. Infrastructure transformation (including the introduction of unified communications, videoconferencing, mobility) coupled with new clinical systems (replacement of a disparate set of clinical systems with a single patient record system) to create a platform that gives access to a view of a single patient record from wherever you are. Early sites that have been transformed have shown that this dual approach is revolutionising the way staff at CNWL are able to work, leading to benefits for staff and service users alike.
The transformation is due to complete by the end of 2015. 130+ sites will have been transformed in terms of infrastructure, while four instances of the RiO clinical system were replaced by TPP SystmOne in October 2015, leaving one major legacy system to move. By the end of this financial year, new infrastructure and key clinical systems will have been delivered for circa 7,000 staff. All of this transformation offers a higher level of performance and resilience than previously experienced.
How as CIO have you driven cultural and behaviour change in your organisation and to what extent?
As well as the programmes mentioned above, I have completely reorganised the structure of ICT team. This team is now focused on delivering the needs of the business rather than the traditional operational break/fix, which is now fully outsourced. The creation of a chief clinical information officer post with a small team that can be the focus for business-led innovation means that, for the first time, staff across all specialities can have a say in how technology and systems should work for them, encouraging innovation that delivers real benefit to the service users and local organisation. In helping to create these governance structures, I have also sought to ensure that all parts of the business are working together seamlessly so that service redesign can deliver the maximum benefit.
Define the key business outcomes that you have delivered over the past 12 months and their impact on your organisation's performance
The programmes I am responsible for are delivering ongoing infrastructure transformation that is completely changing the way staff work. Early sites transformed have shown that this approach is revolutionising the way staff at CNWL are able to work. For example, the ability to access systems/information on the move will transform the working lives of community staff and the service users they visit. Staff in transformed sites now have the ability to access systems in service users' homes, enter information at the time, use videoconferencing/instant messaging to stay in touch with the team, and attend meetings remotely, all of which will let them spend more time delivering care.
Describe how you have used organisational and third-party information to provide insight that has benefited your organisation, its customers and products or services
We have worked with external suppliers to review our service, the way we work and to monitor the relevance/effectiveness of our key programmes of work. As a member of the London CIO Council, as well as working with local clinical commissioning group partnerships, NHS England and the Health and Social Care Information Centre (HSCIC), my team and I have gained many insights that have helped shape strategy to deliver the right outcomes for our service users and partners. The creation of a dedicated full-time CCIO post means we now have a CCIO leading a transformation team that is working across the clinical systems programme and BAU services to maximise efficiency and effectiveness of the care processes through development of better processes and better use of information.
Describe how you organise and operate IT and how this aligns effectively with business strategy and operations
The ICT team is now focused on business need rather than traditional break/fix. The new structure has 50% of staff engaging our customers directly to understand the problems/needs they have. One key qualification for this team is the ability to communicate clearly with our customers, so we have recruited registered nurses and other staff with frontline experience to ensure success in this area. The remainder of the teams have a focus on supplier engagement/management, programme/projects delivery and architecture/assurance.
A critical success factor has been the creation of a chief clinical information officer post with a small team that can be the focus for business-led innovation with the new highly configurable landscape being put in place. This lets staff across all specialities have a say in how technology and systems should work for them, encouraging innovation that delivers real benefit to the organisation. In creating these governance structures, I have also sought to ensure that all parts of the business are working together seamlessly so that service redesign can deliver the maximum benefit. With a dual reporting line between the COO and CFO, both operational delivery and strategic change are kept in focus.
Describe your role in the development of digital strategy in your organisation
I am currently engaged in writing the new CNWL ICT strategy, which has previously been focused on investing heavily to bring technology and systems up to date. The new focus is moving to a digital future – the way we can now use technology, systems, information, automation, alerting, etc, to bring a new level of automation, awareness and a new level of execution. Absolutely key as an NHS provider is working with our partners to deliver the NHS 2020 vision of being paperless at the point of care and devising/delivering new models of care, using NHS maturity models to monitor progress on the path to the digital future.
At the London CIO Council, part of each meeting is devoted to discussing digital strategy and how organisations will successfully interoperate to the benefit of patients.
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
The infrastructure and systems transformation, coupled with a newly designed ICT structure with a team devoted to process/change mean that service redesign initiatives can and will deliver profound change to the way staff are able to operate with service users. Add to this the new CCIO post and creation of a clinical action group (CAG), the close working relationships between CAG and the programme/ICT management supports better process analysis/redesign and delivery of subsequent changes to practices. Working with the CAG led by our CCIO and the service redesign programme led by the CNWL medical director, far greater levels of service redesign will be enabled by the programmes of work we are delivering.
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?
ICT engages the workforce regularly using various media – intranet pages, direct email news about specific topics and attending local team meetings. Our service engagement staff work with the local teams (CNWL runs service from Berkshire up to Milton Keynes and south as far as Dover). The intention is that there is a bidirectional flow of information at all levels, allowing us to disseminate information as well as listen and hear messages from our customers.
In addition, the new ICT is working with the new CCIO to help run innovation days, where we listen as well as demonstrate new services that we are developing/about to release. My management team work with clinical commissioning groups on programmes focused on delivery around data sharing, whilst the local programme team is working with systems suppliers, CCGs, and other providers to develop higher levels of interoperability and data sharing.
How do you use social networks to engage in conversations across the industry about the opportunities and challenges technology is creating?
The social network I use most is LinkedIn to stay in contact with specialists and suppliers/market disrupters across all industries. I also focus heavily on direct contact, using networks such as the London CIO Council (the largest network of CIOs in healthcare) as well as attending conferences/summer schools to engage in face-to-face debate with a wide range of CIOs. CIO magazine/events are a key resource in this respect!
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?
Around 400 staff from across CNWL were brought together in each of the major programmes (infrastructure and clinical systems) to ensure that these procurements resulted in something the business chose, not ICT. This has resulted in an outcome-based approach to allow flexibility, a contract that can flex with time.
This has not been without its difficulties as CNWL and our suppliers test the boundaries of what can be achieved, but with a spirit of partnership and hard work, stunning progress is now being made to deliver the outcomes our staff identified as being most important. In particular, the use of Skype for Business on a robust new always-on infrastructure is delivering both immediate change and the expectation of further service redesign, leading to real benefit.
All of this is being achieved through engagement with staff both with the service redesign programme, the newly created CCIO post and the CAG created by the CCIO. The need to bring clinicians together to drive innovation and change has long needed to be resolved – the CAG provides the ideal vehicle.
Describe how you keep up to date with developments in technology and IT management
Chairing the London CIO Council gives me the unique advantage of hosting a large forum of peers, all of whom are in their own ways keeping up and, critically, sharing. At each meeting we have talks from among the membership as well as an external talk feeding the latest thinking into the group. I also try to attend as many industry events as I can, in addition to sessions with strategic technology/systems partners to allow my team and me to scan the horizon.
Provide an example of how you have developed the diversity and improved the culture of your team
Moving to a fully managed service and allowing staff to migrate to the new supplier, offering a much more diverse range of opportunity for development while ensuring that the organisation has a wider pool of expertise available. Those who have remained at CNWL are more focused on user experience and service delivery, alongside the new structure. This has changed the whole dynamic of the team.
Recruitment to the team has ranged from qualified nurses to enterprise architects. We now have a team that can engage using the language of our customer to truly understand their need. Our staff can take those insights and convert them to accurate service requests or projects that deliver what was actually requested, or better. I would also mention here that, through the difficulties of working through an outcome-based contract, we have now moved from a discordant approach to having a truly one-team culture with our supplier. This has not only transformed the working lives of our staff, but also led to the breakthrough in delivery that our teams, but even more importantly, staff across CNWL needed us to achieve.
Describe how you collaborate and influence the organisation and its leadership team
I work closely with the leadership team to ensure that they know that I am someone who understands their needs and can deliver change that makes a difference, given the many years of experience I have both in the public and private sector. A collaborative and open style helps, as well as ensuring that my team and I communicate clearly. Allowing your team to be the best they can by encouraging them to take the lead builds strength and depth that the organisation then knows it can rely on.
Being part of the London CIO Council and the backup network that provides is a definite benefit. You have a fall-back for the questions you cannot answer yourself, and the experience that you have yet to gain, avoiding the pitfalls that others have discovered. This means that I can do my best for CNWL. Above all, you need to demonstrate strength and a steady pair of hands on the tiller.
Tell us how you have developed your own management, leadership and personal skills
Over the past five years, I have been fortunate enough to have the services of an executive coach to help provide targeted independent input to help me progress. In addition, the opportunity to chair the London CIO Council has helped me develop. Being part of such a large peer group, each with their own experience and view has been a humbling experience from which I have learned so much.
I have always had a collaborative and open style, yet leading such major programmes has also taught me a great deal about leadership in complex and sometimes fraught situations, and the need to take a strong position when clarity and direction need resolving. Observing others and growing with those experiences mean you never stop learning.
What new technologies are you investigating, tracking or experimenting with?
I see internet of things as increasingly important as we move towards telemedicine and an increasing focus on home monitoring to reduce/prevent unnecessary admissions. The use of wearables will increase to enable just-in-time interventions to respond to changes in service user conditions, sparking a visit in the community rather than a more serious intervention if not responded to. A more digital NHS will allow more innovative approaches to service provision. These sorts of changes must happen if the increasing levels of demand are to be met by the NHS.
How do you decide where to apply the best technological approach?
My focus in the NHS has always been to remember that the core business is providing services to patients. Becoming more virtual, using VDI for remote connectivity and utilising the compute power in a supplier-hosted datacentre with the economies of scale that provides mean that we are now moving to provide the same good service wherever our users need to operate. CNWL has so far chosen specifically not to have an in-house development team in favour of commercially available systems that can promote interoperability and standards. Given this approach, our team design is now more heavily focused on customer experience and service.
Do you give yourself and your team time each month to assess or learn about technology vendors outside of the established providers?
Our CEO encourages time to be taken out to work on strategy and research new technology, in addition to the natural feed of end user and clinical innovation being generated by the CAG and office of the CCIO. As a result, I and my team work with end users and the governance structures mentioned previously as well as our outsource partners to continually review what benefits can be derived from new advances, and how quickly.
Describe your sourcing strategy and your strategic suppliers
CNWL has over 130 locations, so outsourcing is clearly the sensible answer to gain economies of scale in an environment where nearly 100% of the organisation will remotely connect in any case. We have moved to a complete infrastructure outsource with CGI (datacentres in Wales, new network connectivity to all buildings, new desktop and capacity to be mobile) and are moving to TPP SystmOne to provide a single patient record system hosted by the supplier and accessible to all healthcare providers with a legitimate relationship to the patient, given the right patient consent. CNWL also uses Ascribe for pharmacy. We maintain strategic relationships with both Cisco and Microsoft in partnership with CGI.
Describe the technology innovations that you have introduced in the last year and what they have enabled
This year has been all about infrastructure renewal from a very low base. As part of the outsource with CGI, CNWL is moving all applications to the CGI datacentres, deploying a VDI solution, unified communications (Skype for Business) including soft phones, higher performance MPLS links and far more capacity to be mobile, able to access systems from where ever you need to be. CNWL is also trialling Visimeet to enable remote consultations, meetings and more complex multiparticipant MDT sessions.
What strategic technology deals have been struck and with whom? What uniquely do they bring?
Outsourcing of all infrastructure to CGI is bringing the technology listed (and more) to CNWL. This, coupled with the clinical systems replacement with TPP and Ascribe, will cause a step-change in efficiency, allowing access to service user records on the go. Efficiency has till now been limited by round-trips to the office for meetings or to drop off/pick up records.
Rate how important your sources of innovative technology suppliers are
- Always referred to: CIO peers.
- Often use: analyst houses, consultants.
- Occasionally use: industry body.
- Of little importance: media.
Has your organisation detected a cyber intrusion in the last 12 months?
How is cyber security led and discussed by senior management?
CNWL has an information governance executive lead and an information governance board that ICT attends, while ICT has a specific post for security and governance.
When did you start your current role?
What is your reporting line?
Joint to CFO and COO.
Are you a member of the board of directors?
What is the annual IT budget?
How much of your IT budget is capital and how much revenue?
£10m capital, £12m revenue.
What is your budget's operational/development split?
How many users does your department supply services to?
Are you finding it difficult to recruit the talent you need to drive transformation?
Has recruitment and retention risen up your agenda as a CIO?
Does your IT organisation operate an apprenticeship scheme?
How many employees are there in your IT team?
59 FTE (excluding contract staff working on capital programmes).
Are you increasing your headcount to bring skills and the ability to react to needs in-house?
What is the split between in-house/outsourced staff?
Currently approximately 50:50 given the large capital projects we currently have in progress.