Rachel Dunscombe takes her credibility with the rest of the organisation very seriously – it's why she's diverted ambulances, and dealt with suicide and attacks on staff as part of her hospital director on call role. Even more impressively she has shown how IT and digital can play the central role in raising quality, lowering a financial deficit and delivering the second highest cost savings in the NHS.
Name and job title
Rachel Dunscombe, CIO, Salford Royal NHS Foundation Trust.
How are you influencing the products, experience and services your organisation offers to its customers?
By creating a digital ecosystem with SMEs and implementing a platform approach to electronic patient records.
How as CIO have you driven cultural and behaviour change in your organisation, and to what extent?
I have implemented the first substantive multidisciplinary team of clinical informaticians in the UK, embedding doctors, nurses and therapists within the CIO team and creating the true intelligent clinical client.
Define the key business outcomes that you have delivered over the past 12 months and their impact on your organisation's company performance
During the past year I have been CIO at two NHS organisations. At Bolton FT we became the first NHS organisation to turn around both quality and financial deficit while delivering the second highest cost savings in the NHS.
The turnaround of the organisation was enabled by the delivery of information and technology solutions which highlighted opportunities and revolutionised the way in which the organisation worked. Examples include reducing the systems nurses in A&E needed to log into from 26 to under five, and saving 20% of A&E time per nursing shift. All informatics projects with the organisation are now sponsored by a senior clinician who is Prince2, MSP, agile and ITIL-trained, leading to efficient and effective delivery of projects directly sponsored by the clinical community.
In my role at Salford which I have been in for just under two months I have already created a digital programme with an ecosystem of local digital SMEs who paper user experience for the likes of the BBC. Part of this programme is a course entitled commissioning digital, which teaches clinicians and managers what they need to know when commissioning and designing digital solutions. We have also partnered with a number of SMEs in Greater Manchester, including the Landing, to provide digital services on a government framework to other NHS organisations. These services focus heavily on user experience and we have an extensive laboratory setup.
Describe how you have used organisational and third-party information to provide insight that has benefited your organisation, its customers and products or services
As well as working for the NHS I work for the US research firm KLAS research. I am one of their four international CIOs who look at all aspects of digital health care solutions and benchmark them. This research has fed directly back into the large procurements I have led at both Salford and Bolton.
I am currently working with my business intelligence function at Salford on new research studies to follow the Salford lung study: the team power the data into North West E-Health, which has the world's first randomised phase III clinical trial. The new trials I am leading on include data sets never used before, including digital pathology and radiology.
Describe how you organise and operate IT and how this aligns effectively with business strategy and operations
In order to operate an organisation which can deliver safe and stable IT services that are life-critical while supporting innovative R&D, I actively work with my teams to be aware of their risk appetite in each situation. Using the Hitachi innovation model, I ensure that ideas are exposed, tested, triaged and then pipelined to operations in a consistent manner, stopping inappropriate noise in the system for those managing BAU. As part of the senior team at Salford, I ensure that all projects align with the organisational objectives and have benefits associated.
Describe your role in the development of digital strategy in your organisation
As part of my role at Salford I am delivering the digital hospital programme, which is part of the NHS Vanguards. This exciting programme has the aim of creating a template operating model for the ideal hospital, underpinned by digital workflows and optimal user experience. This digital strategy has led to a number of strategic partnership with large technology providers.
It has also led to the programme I thought up of creating an ecosystem of SMEs in Greater Manchester that can build applications on our platform. As part of the wider Devolution Manchester agenda, this will be rolled out further. As one of the two CIOs steering the health elements of Devolution Manchester, I have the ability to create a digital ecosystem for health.
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
My strategy to promote technology redesign is to recruit senior clinicians, train them in the art of the possible, and co-design the digital hospital and community with them. I have put a large number of clinicians in Greater Manchester through training in Prince2, agile, MSP and ITIL as well as master's in health informatics. When working with these teams of what we call CCIOs (clinical information officers), we use co-creation techniques to run small agile sprints for projects within a larger framework. These methodologies are balanced with the clinicians being trained in clinical risk management to ensure we consider all aspects of clinical informatics.
With the work on Devolution Manchester, I have split the technology elements into two: first, the single platform that removes the limitations for delivery of care, and second, the delivery of innovative care delivery models enabled by technology.
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 regularly talk to the board on subjects of current interest. The next session will be on cyber security and the increasing threat of cyber terrorism. In addition I regularly co-present sessions with my CCIO team on topical areas. At Bolton this may have been the digital journey to an electronic patient record; at Salford the next one is around commissioning digital.
At both organisations I have not had a separate newsletter but have committed to regularly contributing to all corporate communications.
The impact in all cases has been further engagement. Each time I speak I ask for people to contact me with ideas, questions or even for a chat. The most valuable outcome is relationships built within the organisation. The impact is a feeling that IT is part of the team and excellent customer satisfaction scores.
How do you use social networks to engage in conversations across the industry about the opportunities and challenges technology is creating?
Many of the NHS health social networks are held behind closed doors due to the nature of the conversation. I am part of the CIO/CCIO health organising committee, which have their own social space on discourse for CIOs and CCIOs. I also support the Yammer communities for Greater Manchester. In addition I use the likes of Storify to document and tweet – examples include the following examples here and here used to document the Mobilise events I created.
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?
By running events such as Mobilise, commissioning digital and cyber security, I stimulate conversation with the business units, board and clinicians. My aim is to increase the confidence in the art of the possible from informatics and non-informatics staff alike. Use of co-creation groups with a task and finish theme with members from various areas of the trust enable us to create solutions together. A great example of this is the community redesign group at Bolton, which included community doctors and nurses. They had a special lab space I commissioned where they could real-time test and feed back on the solutions, enabling them to feel like they owned the future state.
Describe how you keep up to date with developments in technology and IT management
I have an extensive network and participate in many external organisations. These include my work for KLAS research – the global lead in digital medical benchmarking. I am an adviser and examiner for APMG, Axelos for ITIL, Prince2 and MSP. I am part of the national CIO/CCIO organising group. I sit on the NHS England Open Source Board.
I am also a board member for the ISD network – the north-west professional network for informatics. I am a member of US organisation Chime, which is the professional body for CIOs, and take part in their educational programme. I am currently setting up Chime UK to bring their professional development to the UK. In essence I will support and join anything that is of educational development to the informatics community.
Provide an example of how you have developed the diversity and improved the culture of your team
I am proud to have led teams with a great mix of age, race, gender, sexuality and health challenges. My aim has been to celebrate diversity in all of its forms and create a safe environment. The NHS by its nature is a great place for diversity. Having teams where people feel ok to talk about their HIV status or prayer times as part of flexible work patterns is what I have created.
I have actively supported ladies in stepping forward and mentored them. I have also actively supported fathers in taking time to be with their children. Overall it's about each person being seen and heard and acknowledged, being able to voice their needs and being heard. This is not one single action but the result of many interactions.
Describe how you collaborate and influence the organisation and its leadership team
Being part of the exec team in a healthcare organisation means you only have credibility if you can understand their perspective. In order to gain this credibility I agreed to be part of the organisational operational team. This means that one week in nine, I was the director on call for the hospital managing the A&E and all other departments through the hardest winter yet in the NHS. Diverting ambulances, dealing with suicide and attacks on staff – I was standing in their shoes, and this enabled me to relate to the staff and patients. These shared experiences and understanding have given me the status to build the trust to collaborate and influence the directors who stand alongside me. Influencing is about building strong relationships over time, and trust. Nothing could build this trust better than me taking on a clinical management role.
Tell us how you have developed your own management, leadership and personal skills
For a number of years I have had weekly mentoring from a senior HR manager in a large technology company. She is a wonderful reflection point and keeps me focused on the commercial aspects of what we do. I also regularly undertake 360 appraisals to reflect on these.
Outside of work I have taken time to learn coaching skills in order to get the best from my teams. I also am a member of leadership networks such as Chime, CIO/CCIO network and ISD network, which provide me with leadership training.
What new technologies are you investigating, tracking or experimenting with?
My teams are working on machine learning to pick up early signals of ill health – for instance, feedback loops on the early signs of sepsis, which flag before any detectable signs to the clinician. My current role is to ensure that this is implemented in line with national recording guidance which does not cover machine learning. This is currently in pilot phase in the A&E in Salford.
With data analytics I am working with the Trafford health economy, which is one of our main commissioners, to power its command centre using data feeds on patients. Further details can be found here.
I have managed the implementation of data feeds at Salford in the last two months and I led a workshop with Trafford on the use of advanced data sets for real-time analytics. In addition I am also in the early stages with my team of setting up a similar care co-ordination centre for the population of Salford.
As for wearable technology, currently I manage an electronic patient record taking feeds from wearable medical devices that provide the observations. I have also run in Bolton (and plan to at Salford) a limited pilot of sensium patches giving observations wirelessly. This enabled patients to walk around and the Wi-Fi will monitor their vital signs. The patches last five days and I am working on a future case for home use under hospital at home.
The internet of things is already with me. I have over 200 medical devices piping data, ambulances sending GPS, MRI scanners, CT scanners, x-ray machines, etc, all piping information into the electronic patient record. More of these come on board every week, most recently ophthalmology systems that measure and photograph the eye.
I also have the delight of starting work with Watson. As the host of and first pilot for the Academic Health Science Network and its Datawell project we are just starting to use Watson to analyse pathology results. This is a very exciting project.
In the 3D printing space we are partners with Sectra and CIMI at the University of Linkoring (www.liu.se/cmiv?l=en). They have implemented 3D printing of bone from 3D scan data. I have visited the centre with my colleagues and we are looking at bringing their technology to the UK as part of our partnership.
As part of the sharing economy I have been working with Intermountain Health in the US and the open source community in the UK as well as Marand in Slovenia to promote open data archetypes for health.
Other new technologies include the first UK digital pathology implementation and MDT, genomics and much more.
How do you decide where to apply the best technological approach?
The best way to choose an approach is to work with the best people. I use my own knowledge, experts from our partners, my CTO, and experts from suppliers to co-create a solution to a problem. My principles are that we need cloud: our business is not to manage boxes and wires if they are not needed. However, cloud is not suitable for the huge data and bandwidth needs of pathology or genomics.
Do you give yourself and your team time each month to assess or learn about technology vendors outside of the established providers?
Yes I give my team time and themes to research. My CTO is currently looking at Open Stack. My CCIOs are currently looking at digital imaging. Staff may suggest a theme. With our pressures I will never get to 20% Google time, but a day or two a month is possible for staff.
My electronic patient record team have been out visiting other hospitals to look at their approaches to see what they can learn, and my patient administration team have been out on other sites looking at systems and processes to optimise bed utilisation. I have taken one of my clinicians to the US on a trip I paid for to see how US hospital systems have digitised.
Describe your sourcing strategy and your strategic suppliers
In the NHS we must stick to strict procurement legislation. However, if you create the right procurement, you will get the right strategic partners. The first rule is to be good at procurement: understand how to weight and score in order to get the best. For me a lot of the weight needs to be on the partnership, delivery and satisfaction elements. I have seen many suppliers with a good product but the wrong approach fail, but the more agile company with the maturing product and a great mindset succeed. It's also a bit like a marriage: there needs to be give and take, dialogue and a need to understand each other's business and pressure points.
Describe the technology innovations that you have introduced in the last year and what they have enabled
98% virtualisation of servers allowing capacity to be allocated based on date time and requirements, resulting in no performance issues for clinicians. 100% virtualisation of desktop with thin client, including the virtualisation of over 300 apps that cover imaging, 3D and all patient-facing systems, allowing any app any place for any clinician. Implementation of sensium patches allowing recording of vital signs for patients without wires. Implementation of digital pathology and the first UK multidisciplinary pathology conferencing setup.
What strategic technology deals have been struck and with whom? What uniquely do they bring?
A strategic partnership with Sectra that let us achieve the first UK digital pathology system with multidisciplinary conferencing. They bring the world's best approach to imaging and have the world-leading imaging research centre at Linkoping University. They have passion, honesty, drive and integrity.
A strategic partnership with Allscripts EPR; as one of the UK's most digitally mature NHS organisations, our patient record vendor Allscripts is key to our success. We have a strategic partnership, which mean we are their exemplar UK site. They bring us the best of US innovation with a wonderful organisation with many clinicians in leadership.
App Sense and Imprivata have powered out virtualisation technology stack, and I have provided testimonials and agreed to be a reference site. They have both gone the extra mile in ensuring we have single sign-in and the ability to stream complex and legacy applications, such as those with interaction with peripherals or smart cards. Both have brought great knowledge, great working and the ethos of going the extra mile.
Rank in order of importance your sources for innovative technology suppliers
1 Industry body. 2 CIO peers. 3 Media. 4 Analyst houses. 5 Consultants.
Has your organisation detected a cyber intrusion in the last 12 months?
Is cyber security led and discussed by senior management?
When did you start your current role?
I started at Bolton in 2012; I have been working at Salford and Bolton for most of 2015. This is likely to officially become a joint role in 2016, although my contract formally moved to Salford in November 2015.
What is your reporting line?
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?
£11.5m revenue, £0.5m capital.
What is your budget's operational/development split?
80% on keeping the lights on, 20% on new projects.
What number of users does your department supply services to?
7,000 staff, 400,000 patients.
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?
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?
Too complex to unpick as we contract resource as part of many contracts.