Last month we spoke with Dr Leon Douglas, CIO at Whittington Health NHS Trust to find out more how the organisation is utilising technology, data and analytics to drive operational efficiencies. We asked Leon a few questions about the past 12 months, what the organisation is working on at the moment, and their achievements, challenges and learnings.
Can you tell me about your role and background?
I am responsible for a wide remit covering core infrastructure; data centre security, networking connectivity, telephony, client devices including service desk. I also take care of information performance and clinical coding which sits within that as well as patient systems which looks after all kinds of clinical systems; there are many other systems too!
Digital strategy is only a portion of what we do, the team is just over 70 (if you include the clinical coding team). However, just for the digital transformation team, there are around 15 to 20 IT staff.
I am a doctor by background with a varied career behind me; I have worked in the commissioning world and I have worked in Academic Health Science Networks which was my preceding role to my current role. I gained a lot of experience from working with a lot of London trusts, such as understanding what the challenges are and how you bridge that gap between the things that are exciting in the innovation world with what is actually practical in being able to deliver a sustainable service day in day out. I’ve done a bit of everything and that helps when trying to navigate the politics and practical implications involved and what the different drivers are.
Could you tell me about your organisation’s work with healthcare analytics and business intelligence?
We partnered with Draper & Dash Healthcare in our data and analytics space; they really helped us to bring information to our fingertips, which is part of our fast follower strategy.
They started us on our data visualisation journey, they gave us some initial support around precaned or accelerated insights and dashboards in areas such as Inpatients, Emergency Department, Outpatients, Cancer Waits, Community, Mortality, Stranded predictor, Finance Ledger and more – giving us a sense of what information you can have available and quickly, at a supported and self-service level for individuals across the organisation.
One of the things we knew we needed to do was to help our different teams understand what it was like to use data to drive decision making more effectively and really having much more live real-time information. I think that is the key change where they have a clear picture of what is going on in their area down to the minute, hour or over a few days, and try to incorporate that into day to day decision making. Ideas have been taken from our membership to the D&D AI and ML working group and these could allow us to use our information in more intelligent ways, with the application of AI/ML.
The trust has always been good at using reporting with the financial returns and data returns and a KPI to manage its services, but the difference is now having that data at a day to day level to influence day to day decision making – that’s a step change and a cultural change for people. It requires you to take the information a step further in your organisation, rather than your director of operations and your clinical leads understanding the information that they are given, you also need your matrons, your consultants and so forth to get involved. You’ll probably appreciate that that is a big change for some of those individuals having access to information and what to do with it, how to have those easy or difficult conversations with each other; their colleagues and senior staff.
You go through an exercise of improving the quality of your data where they spot obvious things that are misattributed or where the process isn’t being followed particularly well. Then people start to get into the ‘is this service balancing its books, is it meeting its KPIs, is the clinical practice the same here as it is over there’ type of discussion.
Draper & Dash Healthcare have helped us do quite a lot of training with our users who then reiterated all of our dashboards; we had our precanned solutions, but then reiterated dashboards based on more intelligent user feedback as they got more experienced and advanced users of the data. By D&D providing the trust with regular updates and training, we have not only increased the user adoption of our dashboards, but have also understood the organisations strategic goals to include the correct technology enhancements for our future roadmap.
The biggest change happened in the community; data collection in the community was far less structured in that it didn’t conform to a national standard. As our community teams have got access to data, they have become much savvier, bringing more structure to community data with commissioners consolidating what they are really interested in. There was quite a significant uplift to the community dashboard which allowed us to give a much more effective executive overview and give us our general manager director of operations service level overview right down into the teams. Fundamentally, that supported our community services improvement work, where the underlying data has become better, the interface has improved and that has then supported the teams to do the overall quality improvement work that they have agreed with their services or with their commissioner or their partner.
What projects are you currently working on or plan to work on over the next 12 months?
It is an ongoing programme for us, where there are two major aspects to that; there is the infrastructure fit for purpose part – which we have made really excellent progress on over the last 2 years. We moved to windows 10, our data centre infrastructure is all up to date.
The trust has been very positive about ensuring that its underlying infrastructure is fit for purpose and the same with end user devices – we took the opportunity to replace those devices which were end of life.
We will probably go through an optimisation to make sure there are no gaps in our processes over this year. On the other side there is the ‘fast follower’ programme which delivers more of the front facing side of the digital strategy, so that started in May 2018 and the real focus of that is clinical staff – the burden for doctors, nurses, physiotherapists, pharmacists who are seeing patients day to day, face to face has grown through initiative after initiative after initiative.
Even simple things like sepsis protocols and the like which we have tried to do nationally, there is a big job in trying to integrate that in an efficient way into the practice of our front-line staff. The programme is really focused on delivering tools that help them do their job safely, effectively and efficiently.
There is quite an upgrade around technology available on the wards which sets a foundation going forward for some other things. We have also delivered clinical handover for the trust through ‘care flow connect’ and that is available on any device. We have a bring your own device policy that came with that, so the technology will allow you to use that securely on your device where you can delete certain items from your device easily if required. As a slow cultural change, we significantly enhanced our staff’s WI-FI to make sure they were not using their own data for example.
What is your biggest achievement over the past 12 months?
I would probably highlight a couple of things. The first is meeting the deadlines around Windows 10 and other end of life Microsoft products; there is a real commitment to doing the right thing for the trusts and it took a whole organisational approach to ensure that all the systems and pieces of equipment had plans in place to deal with whatever that solution in particular was. There was very little of the organisation that we didn’t speak to, whether it was to replace their desktop, change their operating system, change their device or secure it in some way. Often these things get missed when you are talking about achievements but it does take an almighty effort and so that was a big one in being able to make the deadline was a big deal.
Secondly, to be able to put in vitals and handover for frontline staff is a big deal and has given the programme a lot of credibility, so the teams on the ground believe that they are doing it with our help and it is not just a whim; the justification of why we are doing it has been thought through. We are on the extreme end of diligence when it comes to governance, trust management groups and so forth making sure there are checks we are doing safely, effectively and sustainably and we really see it as a platform for them then to go and optimise, to do quality improvement work and we do not think we have got the answer, we are there to help them gain the capability. We set them on the journey, and then they decide where the journey takes them.
What advice would you give to other trusts that may be about to embark on similar projects to your own?
The number of inbound visits to us is extremely high; we have many friends in the system and we are also very keen on visiting others for advice.
There are a few key messages that we give them. Firstly, use the evidence base to help justify the clinical part – it just helps to take away lots of the discussion that doesn’t need to happen.
The second is, don’t make it a digital project; I am lucky to have more than two people working on a project at any one time and one of those is the project manager. We encourage people to enable their frontline teams to shape the solution on the ground; this gives you two benefits, firstly they can refer to a peer colleague, and secondly, they can understand the change or the opportunity for change and that’s where your sustainability comes really. You are only enabling them with the change, they have to think about how to take it forward.
The third thing is to make sure that your governance is good, so don’t rush for rush sake; make sure you’ve got the weight behind your governance so then it will stick. We absolutely do not avoid certain conversations; we just prepare everything to have gone through a rigorous governance approach. Then, if someone was questioned, you can direct them back to when the discussion was had.
What are the challenges that you have faced?
I’m not sure I have faced many things what I have viewed as problems or challenges. I think translating some of the work into end stage of efficiency gains, changes in practice takes time and that’s with other pressures such as money or national priority, that kind of thing. I don’t necessarily see this as a problem, just more like a natural progression. We are pushing the suppliers really hard, and so one of their challenges is trying to keep up with delivery at a pace which we want to have the programme delivered at.
Do I see this as a problem or challenge, or do I see this as the natural course? Perhaps a more pertinent challenge would be how to moderate the mixture of how money comes in to fund this work against the priorities of both the organisation, the STP and the national teams. Then the counter pressures of being seen as a cost centre – not so much in the organisation but from the outside; and you’re cutting money out of that budget you are trying to invest in; trying to balance that is a wobbly tightrope and I’m not sure that we, as a national organisation, have a very clear steer as to how we invest in something whilst still making efficiency gains. A lot of time is taken walking the tightrope of getting things done but also in a sustainable way.
I think the crux of this is what you are trying to deliver is capability for your teams, your clinical teams and your administrative teams to utilise, that gives them a runway to travel down beyond the delivery of the programme.
I would encourage all organisations to think about the underlying capabilities that allow you to do other stuff; getting rid of paper notes is a big deal. There are lots of organisations that are starting on that challenge, but if you want to do data sharing and interoperability, you need to be able to have the data and also want to share it. Your local organisations have to be able to do the fundamental building blocks, have the right infrastructure and the right kind of systems. You have to digitise the organisation – there’s a huge amount of work to do within the system to get anywhere close, otherwise you may find you end up with no data within that system.
