Dr Daniel Birchall, Consultant Neuroradiologist and Chair of the Information Systems Strategy Board Newcastle Upon Tyne Hospitals NHS Foundation Trust

Dr Daniel Birchall Consultant Radiologist & Chair, Information Systems Strategy Board, Newcastle upon Tyne Hospitals

Context  There are increasing requirements to provide effective and high quality, integrated, financially viable healthcare to patients;  Healthcare organisations are in a phase of rapidly progressing technological capability;  Pre-existing organisational structures and strategic alignments have evolved in a period in which the importance of information systems to the Trust’s strategy was not as central.

Premise 1. Information systems are at the heart of delivery of high quality effective and efficient healthcare; 2. Appropriate organisational structures and processes need to be in place to support the delivery of an effective Information Systems Strategy; 3. It is necessary to have a lead Clinician as a focal point of the Information Systems strategic organisational structure.

Newcastle-upon-Tyne Hospitals Foundation Trust  2,000 beds;  > 1,000,000 patient engagements each year;  Nearly 14,000 staff – one of the largest employers in the North;  Flagship Cardiothoracic Centre, Institute of Transplantation, Great North Children’s Hospital, Trauma Centre;  Recently completed one of the country’s largest capital investment schemes.

Newcastle-upon-Tyne Hospitals Foundation Trust  Recognition of centrality of information systems to provision of high quality health care;  Major investment in information systems;  Cerner collaboration 2008/9;  Executive decision to refresh information system strategy and operations;  Invitation to undertake strategic review.

Personal  Consultant Radiologist – facilitative role;  Head of Department – managed significant change;  Management training – MBA Newcastle University Business School;  ‘Clinical’ and ‘Management’

Organisational Review Organisational Structure 2. Operational Delivery 3. Clinical / Front-line Engagement 4. Reporting Mechanisms 5. External focus

Organisational Structure  Disparate groups, leading to lack of clarity of purpose and scope, and lack of co-ordination;  ‘Enthusiastic individuals’;  Unclear linkage with overall Trust strategy;  Lack of an over-arching information systems strategy;  Suboptimal central governance structures.

Operational Delivery  Proliferation of unconnected information systems;  Limited central governance, and limited knowledge of individual systems;  No comprehensive Project Portfolio;  Inconsistent project management;  Inconsistent prioritisation.

Clinical / Front-line Engagement  Limited front-line engagement;  Little clinical governance / input into developing overall strategy;  Little clinical involvement in implemented projects;  Limited communication with the front line;  Disconnect between ‘IT’ and ‘front line’.

Reporting Mechanisms  No over-arching standardised Executive reporting;  Ineffective reporting of key issues arising;  Uncertain accountability.

External Focus  Limited communication with primary care;  Suboptimal interface with University.

Review 2009  Formal review  Executive report  Recommendations  Executive support  Implementation of Change Management plan

Requirements 1. To ensure that appropriate organisational structures and processes are in place to allow effective support of the Trust’s overall strategy using information systems; 2. To ensure that an Information Systems Strategy is in place and operationalised, and closely aligned to the Trust’s strategic objectives in providing high quality patient care; 3. To ensure that Information System Strategy needs to be closely integrated with clinical and other front-line functions in support of patient care.

Trust Aims 1. To put patients at the centre of all we do, providing the safest and highest quality health care; 2. To be the healthcare provider for Newcastle, and a national specialist centre; 3. To promote healthy living and lifestyles; 4. To be nationally respected for our successful clinical research leading to benefits in healthcare and for patients; 5. To maintain financial viability and stability.

Change Management Plan 1. Organisational Structure; 2. Operational Delivery; 3. Clinical and Front-line Engagement; 4. Reporting Mechanisms; 5. External Focus.

Organisational Structure 1. Establish Information Systems Strategy Board (ISSB) 1. Single governance board; 2. Accountable to CEO / Executive; 3. Executive support / authority; 2. Clear definition of roles & responsibilities [50% Clinical (including Chair); IT Director; Head of Programmes; Development; Technical; Trust Operations; Finance] 3. Responsibility for all Trust information systems development, implementation and maintenance

Organisational Structure 4. Align ISSB Purpose with Trust’s Aims, Values, and Strategic Objectives; 5.Clear statement and communication of Purpose & Scope of ISSB: The primary reporting mechanism to the Executive relating to Trust’s Information Systems Strategy; The primary decision-making group with respect to implementation of Information Systems Strategy; The primary coordinative mechanism for optimisation of Information Systems Strategy; Oversight of all Trust information systems; Communication to Clinicians, Nurses, Directorate Managers, IT.

Operational Delivery 1. Establish comprehensive Project Portfolio; 2. Set clear strategically-aligned SMART goals for the near term (1 – 3 years); 3. Rigorously review progress towards set goals;

Operational Delivery 4.Objective prioritisation of Project Portfolio; 5.Identify business-critical projects; 6.Executive review and endorsement; 7.Optimise match between projects and organisational resources.

Operational Delivery 8.Standardise project management methodology; 9.Clearly and objectively track project progress; 10.Systematically re-prioritise and review status of Project Portfolio.

Clinical & Front-line Engagement  50% ISSB are clinicians;  Deputy Medical Director a sitting member;  Clinical Informatics Committee as a day-to- day clinical forum;  Clinical Advisory Group as a governance structure;  Two-way communications with Clinical Directors, Directorate Managers, Nursing.

Reporting Mechanisms  Systematise ISSB Monthly meetings, Minutes, Report structures;  Defined reporting responsibilities into ISSB;  Defined, structured monthly Executive reporting;  Key issues identified and highlighted.

Organisational Structure  Disparate groups ► Unified co-ordinated structure;  Lack of clarity of purpose ► Defined strategic and operational governance role;  Unclear linkage to Trust strategy ► Clearly aligned with Trust’s strategy;  No overarching information systems strategy ► Clearly stated Information Systems Strategy

Operational Delivery  Uncontrolled emergence of unconnected information systems ► Co-ordinated information system architecture;  Limited central governance ► Comprehensive governance / corporate responsibility;  Inconsistent project overview ► Comprehensive Project Portfolio;  Inconsistent prioritisation ► Prioritised (and re- prioritised) Portfolio;  Non-standardised project management ► Standardised project management.

Front-line Engagement  Little front-line engagement ► Effective front-line engagement;  Little front-line governance of strategy ► ISSB; Clinical Informatics Committee; Clinical Advisory Group;  Little front-line project engagement ► Clinical leadership of projects;  Little front-line communication ► Communication channels established.

Reporting Mechanisms  Unstructured Executive reporting ► Standardised, monthly Executive reporting;  Suboptimal critical issue reporting ► Monthly highlighting of key issues;  Uncertain accountability ► Defined responsibilities / ISSB review & reporting.

External Focus  Poorly supported primary care interactions ► Central inclusion in strategic approach;  Suboptimal interface with University ► Interface / forum established

What has been required to effect this change?  Strong Executive support;  An effective team;  Effective interactions between Executive, IT, and front-line users;  A key clinician leader to act as an enabler and as a bridge between ‘clinicians’ and ‘management’.

What attributes are required of the clinician leader?  Clinical leadership and credibility;  Authority with clinicians, and non-clinicians;  Clinical contextualising;  Clinical communication skills: influencing and listening;  Experience of change management and leadership in the clinical setting;  Co-ordinative skills;  Organisational skills;  Systematic approach;  An enabler.

What characteristics does a clinician leader need?  Clinician;  Innovator;  Communicator;  Change management skills / training;  Systematic thinker;  Good inter-personal skills – emotional intelligence;  Good ‘team captain’.

What does a clinician leader need?  The above skills;  Executive support;  A good team;  Time.

Business Benefits  Effective, unified strategic and operational structure aligned with the Trust’s strategic objectives;  Effective, high–performance Project Portfolio management supporting the Trust’s strategic objectives;  Effective clinical and front-line engagement with ISSB Strategy and Operations;  Effective Executive reporting of progress towards objectives, and of key issues arising;  Effective interaction with key external bodies in support of patient care