Welcome back to our podcast HTN Let’s Talk
For this episode we interview Niamh McKenna, chief information officer at NHS Resolution. We discussed the key digital projects Niamh has been involved in throughout her career, the strategic priorities for NHS Resolution going forward, the key factors are needed for innovation in healthcare, and more.
Niamh is the CIO at NHS Resolution, an organisation that provides expertise on resolving concerns and disputes, shares learning for improvement and preserves resources for patient care.
“I’ve been doing this role for about two and half years now,” Niamh said. “Prior to that, I worked for most of my career in a variety of professional services roles, both consulting and outsourcing. Immediately prior to taking on this role, I looked after Accenture’s healthcare practise in the UK. So I’ve been working in healthcare for a while now.”
Key digital projects and programmes
NHS Resolution is currently focusing on a huge amount of transformation, Niamh said, adding that it is a very exciting time.
“When I’m recruiting, I’ll often tell people about all the different work we’re doing because there’s a unique chance to get involved right at the beginning, when an organisation really transforming almost everything it’s doing from a technology perspective,” she said.
She explained that NHS Resolution is focusing on transforming a set of legacy core systems at present. “They underpin our advice service, our appeal service and our claims service. So we’re in the middle of transforming those – but as any technologist knows, there’s a huge amount of other things that have to happen.”
It’s not always glamorous, she joked. “Everyone knows about the apps, the digital surgeries, all the glamorous stuff. The dull tech is about underpinning the infrastructure – but you need it for any of the glamorous tech to work. There’s no point having a fancy app if it doesn’t connect to anything, if it can’t access data, if it’s not stable. So we’re doing a huge amount of core infrastructure work. We’re focusing on modernising our technology estate, moving things to the cloud, getting more resilience in there, improving our cyber security posture, all things like that.”
Other important transformation work focuses on data. Niamh explained that NHS Resolution has a “huge” amount of insightful data, calling it “the largest database of its type in the world, providing an incredible insight into claims and causes of harm. We’ve got records of the last 16 years or so, and a statutory duty to use that information for learning.”
It’s been difficult to access, she noted, and highlighted the complexities around data location. They are “giving the team better tools to do their job,” she said, and focusing on making sure that data is “organised and structured in better ways to allow easier access, then improving the reporting that we’re giving to the business as a result.”
NHSR strategic priorities
Following the publication of NHS Resolution strategic priorities, Niamh described how her team is working to support every element with the number one priority focusing on delivering fair resolution. She highlighted how the team need to be able to “concentrate on the job rather than being hindered – perhaps they have tools that are no longer fit for purpose or don’t reflect changes in how things are now done. For example, one of the things we’re doing is keeping things out of court as much as possible and providing alternative dispute resolution schemes. Having systems that can really support those alternative routes is important.”
Modernising the data estate is “absolutely critical” to being able to use data insights as a catalyst for improvement, she said. “If we can’t get our data into shareable formats and we can’t give those insights to the business, then we can’t use them for improvement work.”
Niamh noted that maternity is a big focus for NHSR at present. “It obviously costs a lot of money in terms of any harm that happens at that level, at that stage in maternity,” she said. “But at the heart of everything you’ve got to remember there’s a baby, a family who have been impacted. Being able to deliver improvements in that area is so important for us.”
It comes back to data. “If we can help give additional insight, find some information that we can share with colleagues around how to do something or change something, then that’s so important. It’s very motivating for my team, to feel that they can make a difference.”
The final strategic element Niamh highlighted is on “investing in our people and systems to transform our business.” An important part of this work is around reducing friction, she said. “When I first came in, one of the things I noticed was that there are lots of little areas of friction in the way that we do things – logging on, for example, accessing our systems.”
Niamh commented that given her background, she likes to pay attention as to how she can reduce these pain points. “It’s like in the wider NHS – there’s the famous 14 log-ins that every clinician has to deal with. We’re not quite frontline clinicians, but it’s still irritating!”
Key factors needed for innovation in healthcare
In this area, Niamh said that commitment from the top is vital, but noted that the path to innovation is never straightforward.
“There’s always stuff that trips you along the way. I’ve never in a 30-year career had anything implement absolutely smoothly without any problems whatsoever. There are always hitches and so you’ve got to hold the faith.
“Having the backing of the board and senior colleagues is really important – not only so that they can support you, but so that they can provide leadership when inevitable problems happen. They can help teams to understand that this is normal, that we’ll get through it.”
Niamh also highlighted the importance of multidisciplinary teams, with the need for technology and business teams to work together. “It sounds trite, but actually achieving this in practice is not always easy. As humans we naturally divide into our different tribes, and even within a single organisation there’s always a team culture – this can sometimes include reluctance to work with other teams.”
She added: “I think having true partnership working in place is vital. It doesn’t matter what team you work in, if you’re an external supplier, a contractor, a member of the organisation, tech team, business team; we all work together to deliver the same outcome.”
Challenges and how to tackle them
Building on the above point, Niamh commented on the need for team building to drive the right culture. “Don’t forget to do some of the fun stuff together, even if it’s just doing a little coffee morning, a quiz, or whatever it might be,” she said. “Find ways to engage with people at a personal level as well as a professional level. It can be difficult in a remote working situation, but I think we learned a lot during the pandemic.”
She stated that having a no-blame culture is also very important to her. “I’ve always held that view as a supplier to clients and I still hold it now. If something goes wrong, it’s never about the person – it’s not about finding an individual and hanging them out to dry. If something goes wrong in my area, then that’s on me and I need to take accountability for the team.” She highlighted the importance of being able to have open conversations behind-the-scenes, to discuss what went wrong and how to improve.
The other challenge Niamh has experienced is the tension that can arise “between business as usual and transformation. It’s very, very demanding on the support teams, particularly the technology support teams. We’re pulling people in lots of different directions and that can be very difficult to manage.”
She explained how NHSR has a technology team in place to run their live services, who work to protect those services and ensure that project teams go through the right process. “It’s really important, as we get excited about innovation, not to throw out all of those really good disciplines around service introduction. We need to manage the workload of those technology support teams and make sure we don’t overload them.”
It can be very easy to keep asking for more, she acknowledged, and said that support teams are often “not great at saying no to additional work, because their job is to help so they accept things and it can become more than they can handle. So we have to make sure that when they say yes, that they do have the time and the capacity.”
What ‘good’ looks like in the future of health tech
“I really want to see us leveraging technology to transform in a couple of areas,” said Niamh. “One is the back office. I think that is one of those areas that is underserved. So many startups are trying to solve patient-facing problems, which can be very helpful. But actually there’s so much back office pain, areas of friction as I mentioned earlier. I’d love to see more technology solving those problems.”
She noted that data is key to the future of healthcare, acknowledging that it is a difficult topic to broach in the NHS. “We have this incredible resource and so much angst about how to use it, how best to use it, how to get data flowing properly. I think in the pandemic we unlocked a bit of that, but there’s still a great nervousness. I absolutely appreciate why people are cautious, but it does feel like it sometimes holds us back.”
Niamh also stated that data sharing agreements can be “quite complex to get put in place and it feels a shame that we can’t get a more systematic way of dealing with it.” She commented on how she welcomed the Goldacre report, “which touched on some really good ways around trusted research environments and how to how to unlock that data. But it feels like if we could fix that and get the right data into the right hands to do the right kind of insight and analysis again, we could really push forward with some incredible innovation.”
We would like to thank Niamh for sharing her time and thoughts with us.
