The Waikato District Health Board is one of the larger of the 20 DHBs in New Zealand.

As a tertiary DHB, it covers an area from the Coromandel in the north down to near Mt Ruapehu in the south, a large portion of which is rural area.

The health board operates five hospitals, with its main campus in Hamilton and four rural hospitals, and offers a wide range of community-based and health promotion services to circa 450,000 people.

Health services are either provided directly by the DHB or through primary care and community based partners.

The DHBs Vision is focused on Healthy People. Excellent Care, with the Mission being to enable us all to manage our health and wellbeing, and to provide excellent care through smarter, innovative delivery.

The DHB strategy, which aligns with the New Zealand Health Strategy, is linked to six key strategic imperatives:

· Health equity for high need populations/ Oranga

· Safe, quality health services for all/Haumaru

· People centred services/Manaaki

· Effective and efficient care and services/ Ratonga a iwi

· A centre of excellence in learning, training, research and innovation/Pae taumata

· Productive partnerships/Whanaketanga

18 months ago, in recognition of the period of substantial change which the DHB was about to enter and to enable the leveraging of innovation and strategic opportunities, its CIO Geoff King led the restructuring of the Information Services team and, along with the IS Leadership Team, the commencement of a DevOps based transformational journey, along with underpinning Service Improvement Plans.

“DevOps is ultimately a culture rather than a methodology and our behaviours ultimately influence our culture. DevOps is a multi-year transformational change,” he says.

DevOps has a strong focus on cultural development through embracing responsibility, accountability, ownership and setting in place SMART (specific, measured, achievable, realistic and timely) performance based objectives. CALMS (Culture, Automation, Lean, Measurement, Sharing) is the overarching theme adopted for the objectives and DevOps values have been aligned to the overall DHB strategic framework.

A key component of the transformation is the recognition that within IS often people are promoted from technical leaders into people leadership roles, without necessarily equipping them with the skills to excel, as they did as technical leaders, in their new role as people leaders.

As such, there has been a focused investment in the development of all managers and team leaders management and leadership skills, says King.

He says the delivery of the DevOps transformational change is regularly monitored through performance against agreed KPIs, customer perception, and independently run reviews.

“A key focus of the measurement of its success has deliberately been from a customer perspective."

Technology is seen by the executive, the board and the ministry as a key enabler to the substantial change initiative in the way that clinical services are delivered, and what the focus is for the health system – moving from treating people who are sick to enabling us to manage their health and wellbeing.

The DHB has a strategy for information services focusing on:

· Mobility

· Integration (Systems & Providers)

· Automation of processes and workflow

· Digitisation of patient records

· Regionalisation

· SmartHealth and VirtualHealth

Within the community supported by the Waikato DHB, patients are often in a shared care model (either because of the treatment requirements for a single condition, or due to the patient having multiple conditions), and increasingly will be in community-based care, says King.

“It is important that they receive the best quality care and that risk is minimised. Evidence clearly shows that providing all of the clinicians involved in the care of a patient with the patient’s full health record (across the multiple care providers), results in a significant improvement in patient care (quality, risk reduction, and avoidance of duplicate testing).”

Thus, he says, one of the DHB’s strategic priorities is the development of productive partnerships focusing on effective community based care.

As a result, interoperability and integration across the primary care and community providers is a high priority.

Waikato DHB Information Services has had to develop and adapt to changing business requirements for local, regional and virtual DHBs (SmartHealth), whilst still delivering the tried and proven and most importantly keeping patient safety top of mind.

"Healthcare is fast changing and under constant pressure; Waikato DHB IS has recognised this and taken the front foot towards being a business enabler and as such embarked on our journey of embracing a new type of change - constant change," says King.

DevOps, ITIL, Agile, and WASP (Waikato A Service Provider) are the foundations for our journey and working on our business as well as in our business is considered a key factor for success, he says.

This period of considerable change translates into a portfolio, at any point in time, of 100 projects delivering IS enablers.

“We have clear targets for the allocation of resource between operational support versus the delivery of new initiatives, which is actively tracked and reported,” says King.

“We have customer service, operational, risk and delivery KPIs, which are actively monitored and reported against a monthly basis to ensure we maintain an appropriate balance.”

As CIO, he reports and presents bi-monthly to the Performance Management Committee, which is a subcommittee of the DHB Board, and quarterly to the Audit and Risk Committee, also a subcommittee of the DHB Board.

He is also a member of the Business Resource Review Group (BRRG), which is made up of the executive leadership team. BRRG reviews and approves all business cases and sets the priority for all approved initiatives.

The IS team has a strong focus on ensuring solutions delivery is aligned to business requirements, which in the case of the DHBs core business are clinical.

As a result, the IS team meets monthly with the Clinical Information Reference Group (CIRG) to ensure alignment of strategic priorities, operational support and delivery.

Rodney Fletcher