In many ways IT is a perfect enabler of efficiencies in health services, and Joanna Smith has shown she can wield it to cut costs and enhance quality. Her digitisation of patient case notes (more than 50 million documents for more than 250,000 patients) freed up valuable hospital space for clinical use and cut the staffing requirement. Her introduction of a new system to manage admissions and outpatient clinics has helped avoid the fines levied for non-compliance, and is providing real-time information about in-patients and their pathways, which will drive operational efficiencies. While her implementation of a new system to support medicine prescription and administration is saving clinical time and protecting revenue.
Royal Brompton & Harefield NHS Foundation Trust
How are you influencing the products, customer experience and services your organisation offers to its customers?
I’m part of the leadership of the organisation and work closely and collaboratively with my colleagues. As a specialist NHS hospital we’re all about the patient. We care for complex patients from all over the UK and abroad, from pre-birth through to adulthood and rest of life. I actively seek to understand how we care for our patients, the challenges arising and how digital can make a positive difference.
I run and attend events, consult with experts and network extensively in order to understand what others are doing, to learn and be inspired. I encourage my team and colleagues to do the same to understand the art of the possible and see how we can innovate and apply new and best practices in our hospital. I frequently feed back on what I’ve learned and explore whether it is of interest to us. Patient participation and feedback is also included in the design of digital solutions where appropriate.
Define the key business outcomes that you have delivered over the last 12 months and their impact on your organisation’s performance
Skype for Business is supporting remote consultations, saving patients a long and tiring journey to the hospital and enabling the trust to carry out more consultations in a given period, potentially increasing revenue. We have recently completed implementation of three major new systems to help our clinicians provide better care to our patients and manage their pathways better. This includes:
- The digitisation of patient case notes (more than 50 million documents for more than 250,000 patients) giving back space for clinical use and releasing cash by reducing staffing requirements.
- A new system to manage admissions and outpatient clinics is helping us comply with national targets, avoid fines and manage attendance more effectively. It also provides real-time information about in-patients and their pathways, which will drive operational efficiencies.
- A new system to support prescribing and medicine administration is saving clinical time, improving compliance with national targets and protecting revenue.
What has been your involvement with innovation at your organisation – in particular, with products, business model and technology – over the last 12 months?
Our product is our research and patient care. Skype for Business has enabled the introduction of virtual clinics, and we’re piloting a new wayfinding service to help patients navigate around the hospital using an app on their smartphone. We continue to expand our informatics and analytics capabilities to better support our research activities.
Business model innovation
Skype for Business has improved cross-site working – teams no longer have to waste time travelling to meetings, and ad hoc SfB meetings reduce delays and solve problems faster. Our cystic fibrosis and transplant teams’ use of SfB has led to a reduction in bed stays. The digitisation of patient case notes means that clinicians have the information they need at the point of care, from any location, whenever they need them.
Our strategy is cloud first, and we’ve moved a number of systems to Azure, with more planned by March 2017. We’ve introduced DRaaS using Azure and StorSimple, meaning our digitised case notes system can be recovered back to full operation with an RPO of five minutes and an RTO of under 30 minutes. StorSimple has enabled us to address storage and performance issues with our fileshares, and provides seamless archiving of files over six months old direct to Azure. Our recently upgraded Wi-Fi is supporting the use of beacons to provide a new wayfinding service and will enable the introduction of RTLS this year. We’ve also recently introduced the WildFire cloud-based threat analysis service to reduce risk of cyber attacks; it follows the installation of new Palo Alto firewalls earlier in the year.
How have you delivered cultural and behavioural change as a CIO within the IT department and/or more broadly across the organisation?
In both cases change is achieved through exposure to suppliers, new technologies, digital solutions and different ways of working. I deliver it personally through openness, courage and consistency, and by being authentic and delivering on my promises. This has created trust and credibility, which is key when introducing change and for support with challenge.
For my own staff specifically, I have delivered it through changes to structure and roles, the introduction of standards, fairness, firmness and constancy and the use of third-party providers and expert advisers such as Gartner. The enforcement of appraisals, personal development plans and use of mentoring and coaching programmes has also contributed. We also invest in training and are introducing job shadowing across the department and in clinical areas to help my staff understand the importance and impacts of what they do, and expose them to different roles within the department. Changing an ingrained culture takes time and is challenging. While the majority of staff recognise the changes are for the better, there remain a few for whom it is still an unsettling and worrying experience.
How have you worked with your CEO and/or board to communicate whatever ‘digital’ and IT means to your organisation/sector and improve digital literacy at the highest levels of the organisation?
I report to the CEO and am part of the leadership of the organisation. I attend board meetings and provide updates on our digital progress and areas of concern such as cyber risk. I also talk directly to the chair and board members to brief them personally as required. I meet frequently with the CEO and other senior colleagues to talk about our challenges and the part digital can play.
How have you worked with the technology and IT vendor market to achieve your business goals? How have you been able to influence IT suppliers and successfully manage your partnerships/relationships with large IT companies, SMEs and startups?
My preferred style when working with suppliers is to partner and collaborate. Having previously worked in commercial organisations I understand the importance of revenue cycles and sales targets, and although my goal is always to achieve the best outcome for the trust I look for opportunities to support vendors through testimonials, PR, site visits and speaking at events. I believe a partnering and win-win approach has enabled me to secure some very good deals and has also turned around a previously very poor situation. I encourage suppliers to spend time with my team to understand our challenges, and I regularly support proof of concept and pilot opportunities.
How have you tried to develop the diversity of your team?
Through the introduction of staff from outside the NHS and from within clinical and operational areas of the trust. My department has a reasonable mix of age, ethnicity and gender, although females are still a minority overall. My senior management team is evenly balanced. We encourage apprenticeships, and I am a strong advocate and supporter of initiatives to encourage young people, and especially females, into a career in IT, and have given lectures to university students.
Describe how you organise and operate IT and how this aligns effectively with business strategy and operations
Our digital services and operations department includes all operational IT services: infrastructure, service desk, training, system support and project delivery. The governance, strategy and administration team provides support for strategy, governance and quality assurance, and includes business relationship management, PMO, supplier, contract, procurement and resource management. The BRM team lead on strategy, and are aligned with and work closely with divisional hospital leadership on a regular basis.
Our IT strategy and three-year plan was approved by the board, has been endorsed by our internal auditors and provides clear alignment with the trust’s vision and strategy. The chief clinical information officer and chief nursing information officer are part of my management team. Information governance, imaging IT services and clinical engineering are also part of my organisation.
What strategic technology deals have you made in the last year and who are your main suppliers and IT partners?
Recently awarded strategic contracts include:
- a new cloud-based VoIP, UC and contact centre solution from Maintel
- the upgrade of our Bleep platform, including introduction of an alert app for smartphones from Maintel
- redesign and installation of new AV equipment from BT and Cisco
- migration of Exchange to Microsoft Office 365.
Our main suppliers also include:
- Agfa, CSC, Kainos and Phillips – providers of critical/strategic hospital systems
- Alcatel Lucent Enterprise and Khipu – network and security solution providers.
What are your key strategic aims for next year?
- Improve collaboration and mobility through the introduction of VoIP, UC and new Bleep solutions.
- Transform how we manage front of house services and outpatient interaction through a new switchboard and contact centre platform.
- Continue to drive efficiencies through the deployment of RTLS to reduce time spent searching for clinical devices and lessen cost incurred through the loss or theft of high-value medical equipment.
- Improve clinical effectiveness by reducing time lost through kit failures and related support issues through the overhaul of the audiovisual estate supporting multidisciplinary meetings.
We also hope to transform how clinicians work through the introduction of a trust-wide electronic patient record, which will bring all clinical information into one place, accessible at the point of care. It will enable faster, more effective decision-making and support delivery of NHS England’s five-year forward view of a paperless NHS by 2020.
How are you preparing for any impacts Brexit might have on your organisation?
As a specialist NHS hospital we’re a national UK organisation, although we have many international customers. We also work with a number of international and European organisations. We hold sensitive and confidential patient data, and its security is paramount. Brexit is a key factor when we contract with vendors who may have access to or process patient data as we need to consider the impacts of the Data Protection Act and the privacy shield agreement once the UK is no longer part of the EU.
A secondary consideration is the cost of services. We’ve already seen significant increase in the cost of services from global providers following the Brexit decision, and we need to consider this when procuring new goods and services.
The most significant impact of Brexit on the hospital, however, is staff – many of our clinicians and healthcare workers come from across the EU and beyond. It’s vital that we can recruit and retain the best staff, and the Brexit decision is already having an adverse impact. Having good IT infrastructure and systems in place plays its part in attracting staff, and I’ve just got agreement to introduce a new salary sacrifice scheme for technology products to aid with recruitment and retention.
When did you start your current role?
What is your reporting line?
Direct to the CEO
Are you a member of the executive leadership?
Are you a member of the board of directors?
What other emerging roles does your organisation have and what is their relationship to you?
None at present
How often do you meet with your organisation’s CEO or equivalent?
At least forthnightly
How many people at your organisation does your function supply services to?
What is your annual IT budget, or your spend as a proportion of the organisation’s revenue?
This year my revenue budget was around £11m and my capital programme was just under £5m.
What percentage of your budget is operational spend (ie keeping the lights on) and how much new development (ie innovation, R&D, exploratory IT)?
Rank the following sources of advice/information in order of importance:
- Analyst houses
- CIO peers
- Industry bodies
Has your organisation detected a cyber intrusion in the last 12 months?
Are you expecting an increase in budget specific to security in order to tackle the cyber threat?
Does your organisation have a designated security professional – CISO or otherwise – and what is their relationship to you?
Yes, we take this as a service from a larger NHS trust. The service overall reports directly to me, but operationally to my digital serices and operations director.
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 or planning to bring skills and the ability to react to needs in-house?
Which technologies or areas are you expecting to be investing in over the next year?
- data analytics/business intelligence
- enterprise applications
- devices (mobile)
Which technologies or areas are you expecting to be investing in over the next one to three years?
- data analytics/business intelligence
- enterprise applications
- devices (mobile)
- machine learning/artificial intelligence
- 3D printing.
What emerging technologies are you investigating or expect to have a big impact on your sector or organisation?
AI will help us mine and understand our big data better. VR helps clinicians model and test clinical techniques before the operate. Expansion of IoT will further improve how we treat our patients and enable more remote care.
Does your organisation do a significant amount of trade with the EU?
Does your department include technology staff from the EU?
Are you or have you been looking to the EU to recruit key skills?