Stephen Docherty has taken a failing department that provided extremely poor service and turned it one that has been asked to submit a bid to become a global digital exemplar (GDE) for mental health. The way services are delivered has been transformed by allowing staff to become mobile. Staff now have access to the clinical system offsite and collaboration tools so they can deliver services more in the community, and less in the hospital environment.
Chief information officer
South London and Maudsley NHS Trust
How are you influencing the products, customer experience and services your organisation offers to its customers?
In two years since agreeing the IT strategy at South London and Maudsley (SLaM), we have taken the IT service through major transformation, from a failing department and extremely poor service, through to being recognised by NHS England and being asked to submit a bid to become a global digital exemplar (GDE) for mental health. We are changing the way we deliver services by allowing staff to become mobile, giving them access to the clinical system offsite and Office365 collaboration tools so they can deliver services in the community, and less in the hospital environment.
By working in collaboration with the medical director, chief clinical information officer and director of nursing, we are developing new digital services such as:
- Digital ward observation service on an open source platform (with algorithms to auto-alert consultants when certain scores are recorded). It is now in operation in wards and being rolled out, which helps with health management of our patients and achieving paper-free at point of care.
- A new personal health record (PHR) has been developed using agile methodology, co-produced with service users, carers, clinicians and researchers, following a user-led design ethos, working with an SME to develop the service. This will have a huge impact on our service users (and carers), who will be given the ability to self-monitor conditions, have access to and contribute towards their clinical record, and share their data with their circle. This will allow for personalisation of care based on digital triage of records and captured data from patients and carers through the use of wearables and surveys, mood tracking, etc.
- Business intelligence is now in UK Azure and providing data visualisation as well as the ability for the execs to drill down the data from ‘board to ward’. This is of massive benefit to the organisation, allowing for better performance management and the identification of capacity issues with bed management and patterns across the four London boroughs we serve.
All NHS organisations and primary care (GPs) are involved in sustainability and transformation plans (STPs) which bring the local/regional health economies together to develop new models of care, which will be underpinned/enabled by local digital roadmaps (LDRs). I have dedicated a lot of time to work with our local organisations to ensure we have created an excellent LDR that will deliver universal capabilities through the use of technology and information.
As the chair of the London CIO Council (elected September 2016), we have a collective voice and can influence the direction of technology in healthcare. One of my immediate aims in my role of chair is campaigning across the health economy (and social care) to obtain collective agreement towards the vision of a pan-London connected health and social care. This will be a truly connected city where citizens can access health or government services through a single Wi-Fi and identity service, and staff can roam between any NHS or local authority site and access internal or national resourced provided by NHS Digital.
Define the key business outcomes that you have delivered over the last 12 months and their impact on your organisation’s performance
I think that the transformation of IT services and adoption of cloud platforms has been critical to laying the foundations for the trust to develop and enhance its capabilities and the services we provide to the population, including new BI platform, allowing for better activity and capacity planning, and contract discussions with the clinical commissioning groups (CCGs). This new platform is also enabling the data to be used in the quality improvement (QI) programme, which is about standardising clinical practice and measuring and reducing variation.
Allowing more staff to access resources and clinical information in the community, not having to take paper notes and return to base to enter them into the clinical system, is another key outcome and a strategic objective.
Enhancing our research capabilities; we have re-engineered part of our research pipeline for anonymisation of clinical records in UK Azure, allowing for researchers and clinicians to derive insight from our patient database.
What has been your involvement with innovation at your organisation – in particular, with products, business model and technology – over the last 12 months?
- Development of a new PHR (mentioned earlier), which will allow service users to access their record and have self-management of their conditions, with the ability to share their data with carers, GPs, family, etc. Digital ward observations will be another service to manage patient health and remove paper.
- My IT (digital services) department has enabled the organisation, through dashboards and the use of information from the clinical record, to enhance bed management across the trust.
- Our Centre for Translational Informatics (CTI) was officially launched in June 2016, providing the environment for clinicians, service users, data scientists and researchers to come together with tech industry to collectively solve problems in healthcare. We now have many exciting projects under way and are working with partners in industry.
How have you delivered cultural and behavioural change as a CIO within the IT department and/or more broadly across the organisation?
When we set out the IT strategy in March 2015, the key objectives were to change from a command and control IT department which managed bits of tin to one that embraces cloud first. The value add is coming from helping trust staff to adopt the technology.
Across the organisation, we still have perception issues around the service as well as a difficult culture in terms of tech adoption. To change this I asked the team to take digital to the staff rather than expect staff to come to us. The team rose to the challenge and developed pit stops – a programme of visiting every one of our 90 or so sites, showing a presence, fixing problems and showing staff how to utilise Office365 collaboration tools. We are also piloting Skype for Business to allow for remote consultation, allowing services to be delivered through different channels.
We have rebranded from ICT (old NHS term) to SLaM Digital Services. I have asked the IT senior management team to think with more of a marketing mindset, delivering IT bulletins and programmes to engage trust staff.
When I came on board we ran an IT survey in December 2014 as I wanted to establish a baseline and get an understanding of the satisfaction levels across the trust, which were shocking. We recently ran the survey again (December 2016); the results were great and really pleasing for the IT department to show that the hard work and achieving the vision was paying off.
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?
Similar points to those mentioned above.
Having clinical leadership endorsement is also important, as everything we do is ultimately for the benefit of the people we serve. Working closely with the medical director, director of nursing and the chief clinical information officer, we ensure that what we do is of benefit to staff and our service users – not tech projects.
Our CEO has been very supportive of the IT strategy and we are now considered to be one of the leading mental health trusts in the UK in our use of digital and the electronic health record for research and insight. We also utilise natural language processing (NLP) to extract details from the narrative on clinical records, which have been anonymised using our research pipeline.
Recently, we presented to the trust executive board to make them aware of progress to date, as well as to highlight the need for emphasis and endorsement of our cybersecurity initiatives. We are working with NHS Digital as an early adopter of the cyber programme.
The biggest challenge we now have is not the technology (that is a given), but helping our staff to adopt and exploit the technology. We are working with many groups across the trust to help digitise the workforce, especially our quality improvement (QI) group.
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?
- Microsoft: SLaM has developed a strategic partnership with Microsoft over the last two years. We were the first trust to go fully Office365 for 5,000 staff with the objective of futureproofing our platforms. As a minimum, all staff have email, OneDrive, Skype, SharePoint and Yammer (for online collaboration) as we aim to change the way the trust staff communicate, moving away from the email culture. We are also in the process of delivering a new business intelligence platform for the trust. We and the MoD were the first two organisations to adopt the UK Azure cloud via private preview. We continue to have a strong relationship with Microsoft as a trust that is an early cloud adopter.
- Mindwave Ventures: With a successful prototype delivery of a new PHR, we obtained a charity grant to agree a contract with MWV for the development of Healthlocker for SLaM. Although the original Myhealthlocker has existed for several years, it didn’t necessarily follow the appropriate design principles. However, valuable lessons were learned, and I have extensive experience from the games industry, and introduced user-led design and iterative development of prototypes at pace.
- Advanced: We have agreed a unique model for the hosting of the Carenotes clinical system, whereby we will be hosted in advanced datacentres, separate from the ‘vanilla’ multi-tenant platform. This model will allow clinicians and CTI project teams to develop innovations and enhance the user experience (UX), while ultimately developing new care pathways and algorithms for standardising care. We are also working for the delivery of an API that will allow data transfer between the new PHR and Carenotes.
How have you tried to develop the diversity of your team?
This is a difficult one as recruiting into the NHS itself has been challenging.
However, in saying that, all candidates are considered based on merit and experience, and we actively try to bring in talent from outside the NHS, as I’m a firm believer that we should take the best principles and practices from across all industry sectors and adapt and implement them.
Describe how you organise and operate IT and how this aligns effectively with business strategy and operations
We have an IT senior management team (SMT) which manages several departments such as clinical information systems, IT operations, information governance, business intelligence and clinical informatics (research). IT SMT meets every two weeks.
We have had an IT balanced scorecard in use for 18 months, which we review every month at every second IT SMT meeting.
Our BI team is working closely with the operational exec to develop performance data and to develop the overall service provision for the trust.
The IT strategy was developed and aligned with the strategies from estates and facilities, HR and commercial, as well as underpinning key trust strategic objectives to deliver mobility of staff, digitising of services and removal of paper, and the development of a futureproof BI platform for the delivery of a ‘single source of truth’.
What strategic technology deals have you made in the last year and who are your main suppliers and IT partners?
We use a number of suppliers for provision of services and are a cloud-first digital services department.
As part of my new role as chair of the London CIO Council, I now sit on the steering board for the London Procurement Partnership (LPP), which is a member organisation funded by NHS providers to obtain efficiencies and savings through collective leveraging of commercial spend. This will allow me to participate in ensuring that the NHS providers in London obtain the best deals from the market.
What are your key strategic aims for next year?
- Hopefully obtaining global digital exemplar (GDE) status for mental health services in the UK.
- Digitising the workforce. This will be a massive focus for us and will require a detailed programme of activity and marketing campaigns on a continuous basis.
- Starting the delivery of the local digital roadmaps (LDRs) and putting the framework and governance in place to achieve this.
- Developing the clinical pathways and algorithms with our supplier (Advanced), and in collaboration with our clinical leadership and QI programme.
- Delivering a connected health and social care ecosystem for London with colleagues from NHS Digital and NHS England, as well as the Health CIO Council and the local authority CIO Council.
How are you preparing for any impacts Brexit might have on your organisation?
To be honest this is not a major concern, but in thinking forward when we were working with Microsoft to adopt cloud services, we agreed that our business intelligence and research pipeline would be configured in the UK Azure. When Microsoft announced that it was opening up UK datacentres, SLaM and the MoD were the first two organisations on the platform in private preview.
The result of putting our data into the UK Azure ensures that we don’t have any issues or concerns with data being held outside the UK, allaying any concerns about holding patient information in the EU.
When did you start your current role?
What is your reporting line?
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?
Chief clinical information officer. This is a complementary role and we work closely to ensure that what we do will ultimately benefit our patients and staff.
How often do you meet with your organisation’s CEO or equivalent?
Quite often – monthly and at strategic executive monthly meetings.
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?
2.1% of £375m
What percentage of your budget is operational spend (ie keeping the lights on) and how much new development (ie innovation, R&D, exploratory IT)?
70% operational, 30% on new models, innovation, new platforms.
Rank the following sources of advice/information in order of importance:
- CIO peers
- Industry bodies
- Analyst houses
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?
Our head of information governance manages the security programme and reports to me. I, my deputy director and head of IT ops meet every month as the security committee.
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
- machine learning/artificial intelligence
- devices (mobile)
- devices (desktop)
Which technologies or areas are you expecting to be investing in over the next one to three years?
- data analytics/business intelligence
- machine learning/artificial intelligence
- devices (mobile)
- devices (desktop)
What emerging technologies are you investigating or expect to have a big impact on your sector or organisation?
AI will certainly be used. We will develop this to detect patterns in clinical records and make recommendations which will form the personalisation of care. Our new PHR will be part of this.
We have already developed a small VR prototype for use in young people with OCD, and will be looking to develop more prototypes. I have a background in the games industry and have many contacts with whom we are discussing opportunities to apply VR in the health space.
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?