Royal Brompton & Harefield NHS Foundation Trust CIO Joanna Smith is midway through an ambitious digital transformation journey at the largest specialist heart and lung centre in the UK.
Smith, a perennial member of recent editions of the CIO 100, was discussing her cloud-first approach and some of the cultural changes required to transform an organisation at the 2017 CIO Summit in London.
The NHS Trust's ageing and siloed IT estate has been replaced with a cloud-based infrastructure and services, with CIO Smith balancing a tight budget, introducing new digital systems and ensuring the IT team and healthcare professionals are working together to use technology to improve patient care.
The Trust runs two specialist cardiothoracic hospitals in London: Harefield Hospital in Hillingdon, which began life as a treatment centre for Antipodean soldiers in the first world war and went on to help pioneer the development of artificial hearts, and the 170-year-old Royal Brompton Hospital in Kensington, the largest treatment centre for cystic fibrosis in Europe. The two hospitals merged in 1998 to become the Royal Brompton & Harefield NHS Trust.
Smith joined the organisation in January 2013, leaving a 15-year career in the pharmaceutical industry for her first role in the public sector. She joined an organisation that was struggling financially, and an IT department somewhat separate from the rest of the organisation.
"I couldn't really have made it much worse," she quipped at the 2017 CIO Summit. "It was an environment where there had been very little clear leadership and strategy for some time. IT and the organisation had gone their separate ways. It was - and still is - in the basement, but was quite disconnected. The organisation had abandoned talking to it. There was quite a lot of shadow IT."
The board recognised that investment in IT was critical, but no amount of spending would lead to an overnight transformation. Before the organisation could become a digital hospital, Smith had to remove the numerous prevailing barriers to innovation. Around half of the Trust's 3,500 PCs had no antivirus installed, and the systems and software used by staff were so diverse that Smith estimated they had in excess of a billion combinations.
Her first move was to devise a strategy and mission statement. To do this, she drew on her experience being invited to sit in theatre watching surgeons operate on beating hearts while the patient's lungs are still inflating, following images on a PC screen that they had keep having to kick to escape the screensavers mandated by IT.
"From my perspective, a very firm, clear message to me and my organisation is we are here to help our colleagues deliver great service to patients," she says. "We are not here to do what we think is great IT."
Platform for digitisation
The first three-year roadmap aimed to set the Trust up for success.
Smith used the analogy of clearing up an overgrown garden and preparing the ground before she can start planting trees and flowers.
Her key strategic principles were to make the Trust cloud-first, avoid investing in developing in-house IT services that third-party vendors can do better, and improve communications between IT and the rest of the organisation. After the plan was approved in spring 2014, the Trust lived up to its promise to back its CIO.
"I've not experienced that when I've worked in global pharma," Smith said. "It's quite interesting. The NHS is constrained, but when they get it, they get it. But that's the power of being an autonomous individual organisation. But I still have to jump through the regulatory hoops, which I can assure you, are extraordinarily painful, particularly procurement."
The Trust spent around £2 million on its network, hundreds of thousands of pounds on a hybrid cloud infrastructure and a significant figure to get off Windows XP. It also invested in firewalls and perimeter defences that helped protect the Trust from the WannaCry attack. Other innovations introduced by Smith included Skype, virtual desktop infrastructure (VDI) and expanded single sign-on.
The journey to the cloud was based on a thorough market assessment. They spoke to vendors and sought the advice of Gartner, who recommended approaching Microsoft and UKCloud. Between them, Smith said that "they came in at 10 to 20 times cheaper than the other vendors".
In addition to all the new infrastructure, Smith has also had to incorporate a new patient administration system and electronic prescribing and document management solutions. The Trust recently set its digitised case notes live, after scanning 50 million pieces of paper for a couple of hundred thousand patients.
The IT department has almost doubled in size during Smith's time at the Trust, partly as a result of it acquiring a number of new areas, including medical devices, records and imaging.
Hopes for the future
The impact of the improvements has been felt throughout the organisation. At times in Smith's first year at the Trust, operations would have to be cancelled because IT systems were down.
"That happened to me several times in my first year," she says. "That doesn't happen today."
It hasn't all been smooth sailing. Project management has been a barrier, and Smith said that it had sometimes been a struggle to convince staff to embrace change and sign up for training in new areas.
Despite the challenges ahead, Smith remains optimistic about the future. Even the Trust's deficit of £40-50 million has a positive aspect for IT, as there is now a widespread understanding that it will only be overcome by embracing technology.
"There is absolutely unanimous recognition that that will only be achieved through digitising the hospital and doing care differently," says Smith. "The nice thing for me is that, broadly speaking now, I'm in a good place to help them do that."