Breaking down the barriers to ICT excellence

Photo by Divina Paredes

“The CIO role continually evolves as we understand how best to add value to the organisation,” says Sarah Thirlwall, director, strategic ICT transformation, at the Counties Manukau Health (Counties Manukau District Health Board).

CIOs can not be seen as a ‘barrier’ to change and innovation in the organisation, she states.

“You can not be a barrier or they will go around you anyway, so how do we provide a framework to allow them to proceed at pace and securely, engaging the correct IT professionals as required.”

“Rather than saying ‘no you can’t’, you say ‘let me help you do that',” says Thirlwall. “We say ‘yes you can,  there are a few hurdles to get through but we can help with that. Or, this is great, there are a few things to consider and I can help you with that'.

“So how do we change our engagement with business leaders to say, ‘let me understand, let me be part of executive discussions so I understand where as an organisation we are wanting to go? And then, let me help you be part of the solution'.

“This is a journey many CIOs face,” says Thirlwall, who joined Counties Manukau Health in November, 2013. The DHB provides healthcare to Southern Auckland, with more than 520,000 residents, or 11 per cent of New Zealand’s population.

Related reading: State of the CIO 2017: 'Be prepared for anything'

Before this, she was a project director at healthAlliance, which provides IT and non-clinical services for Manukau and the other Northern district health boards Northland, Waitemata, Auckland and Counties Manukau.

Apart from her work alongside DHB staff and partners around utilising ICT for the organisation, “we are also working alongside healthAlliance to ensure IT assets are well managed, and new platforms are implemented and utilised in a way that adds value to the business of healthcare delivery”.

She says all of their programmes are part of the DHB project “Healthy Together 2020”.

She is sharing their experiences from the rollout, with the CIOs of the other DHBs, as they are too, to help in their collective planning for the next 10 years.

“There is so much shared work,” she says, so she meets with the CIOs of the other Northern region DHBs every  two weeks. The CIOs also meet with healthAlliance every month.

But it will not be unusual for them to be communicating daily, by phone or email.

From functional to transformational

She explains how her focus has shifted since she joined Counties Manukau Health.

“When I first came on board, the role was more strategically focused on ‘what does IT mean to us as an organisation that delivers healthcare?’

“Whereas now, it is balancing strategic [work] with delivery of new investments and overseeing operational performance, working collaboratively with the region,” she says of the other district health boards of Waitemata, Northland and Auckland.

“We got quite a harsh reality check on the state of our current technology,” she says. “We worked alongside healthAlliance, but really looked at if we are going to make large investments in modernising our technology stack, what would that look like and how would we leverage these to add value to healthcare?

“And, obviously, it makes sense to work regionally, while also looking at a specific focus for each DHB, Thirlwall states.

Data dilemma

She says the goal is around improving digital capabilities across the health facilities.

A lot of our records are on paper, she states. “If we want to support more mobile working, offer greater transparency and convenience for patients and if we want to be doing better data analytics particularly around assisted intelligence and performance management, we need to get our information captured digitally."

Clinicians use many different systems so the ICT team did some “shadowing”. They observed the clinical staff at work, experienced what works well, what the challenges are, and where time was wasted and frustrations experienced.

“There is a big opportunity to improve how efficiently clinicians access patient information,” she says.

“The clinicians are looking for information in paper charts, to supplement what was available electronically, only one person can access paper charts at any one time and these weren’t always located where they thought they would be.”

She says the goal is to bring all of this information at the “point of care”, in the different devices the clinicians use.

“We have to capture it electronically and present it in a way that makes sense in their workflow and that, again, is another challenge."  

Thirlwall says this by itself is a whole programme of work which is now going live system after system.

A challenge is the range of devices that the clinicians use. Somebody providing the care could be using their own smartphone or one supplied by the DHB. The clinicians can also switch from one device to another, either a laptop or a tablet depending on what they are working on.

“There is no one size fits all. We are looking at what we will be doing in providing access to different tools,” she states.

“You have got to put new systems on the devices, so they can capture information that is safe and fits in with their workflow.

“You don’t want to dump data to the patient record, you want to add what adds value for the clinicians in their care for the patient,” Thirlwall says.  

She say the DHB has a team who are looking across the whole rollout. “How do we best support our staff with the right training and awareness?”

The DHB has tapped staff whose roles were in education and training, while some clinicians volunteered to help coach the users. Some project managers also asked to be trained as “change managers”.

She says this support will continue “until the new systems become BAU (business as usual)”.

healthAllliance is responsible for the technical delivery she says.

“They are interested that we are change ready, as much as we are technical ready.  With change management, you have to do both.''

In addition, she says the DHB team has to make sure the correct policies and right disciplines are in place. This was done alongside healthAlliance and often shared regionally.

“We have to make sure we have the confidence and visibility of the security practices around the systems,” Thirlwall explains.

“Before you do transforming, you have to have the functional building blocks in place. When you have got your strategy, digitally enabled information and an engaged workforce, then you can be on the transformational side.”

She say they are now in the latter stage, “implementing new systems, cultivating and leading change efforts and redesigning business processes.”

She and her team also make sure they attend different meetings in the DHB, to talk about what they are doing and how it will affect the said unit.

“You are trying to get people engaged in systems design,” she says. “If I am not going to one [such meeting] every week, I am not doing enough.”

While doing this we are also trialing new things, she says.

“If we are not the one doing the innovation, we are supporting the others to innovate.”

For instance, “If you want to be looking at new mobile apps for a clinician or a GP, you want to know you are doing it in a clinically safe and cyber safe way.

“My role is to provide a framework around that.”

She says another major focus is on how to get the most out of the data they gather.

“We are already using predictive analytics to forecast patient demand in the hospital. But we need better tools to leverage the large amounts of data available to provide the evidence to evolve care planning and delivery.

“It is not just developing insights, but around using these to automate tasks. How do we use bot technology to remove repetitive administrative tasks?”

Mindfulness on the agenda

Counties Manukau Health offers a mindfulness course to all staff, and Thirlwall was among the first to participate.

The class she was in was attended by staff from different units of the DHB. She says the courses have become so successful the DHB is now running refresher courses.

“It is a valuable life skill in the age of distraction,” she adds. “There are so many inputs, so many ways information comes in and so many people want to talk to you. You are now available 24 hours a day unless you introduce some disciplines.

“Yes, you have a busy day, and there are people trying to contact you. But the person in front of you is who you give your respect and time to and you make sure as much as possible to have an enriching conversation, and it finishes on time."

This way, “you do not let down the next person in the queue.”

“It is exciting times, it is full of change,” Thirlwall concludes.

“If you don't manage that well, you can get exhausted. But if you manage downtime with a bit of mindfulness, it is a bit more bearable,” she says, smiling. “After all, you have to love what you do.”

Excellent review of #digitalhealthcare and how to get there... https://t.co/QieaazE2xS

— healthAlliance (@hAsharedservice) August 7, 2017

Sarah Thirlwall of Counties Manukau Health: The CIO as change agent, digital strategist & mindfulness advocate... https://t.co/87MOBWQ1zh

— CIO New Zealand (@CIO_NZ) August 7, 2017

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