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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.
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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 The Business Benefits of Clinical Leadership in Informatics
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 • Information systems are at the heart of delivery of high quality effective and efficient healthcare; • Appropriate organisational structures and processes need to be in place to support the delivery of an effective Information Systems Strategy; • 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 2009 • Organisational Structure • Operational Delivery • Clinical / Front-line Engagement • Reporting Mechanisms • 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 • To ensure that appropriate organisational structures and processes are in place to allow effective support of the Trust’s overall strategy using information systems; • 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; • 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 • To put patients at the centre of all we do, providing the safest and highest quality health care; • To be the healthcare provider for Newcastle, and a national specialist centre; • To promote healthy living and lifestyles; • To be nationally respected for our successful clinical research leading to benefits in healthcare and for patients; • To maintain financial viability and stability.
Change Management Plan • Organisational Structure; • Operational Delivery; • Clinical and Front-line Engagement; • Reporting Mechanisms; • External Focus.
Organisational Structure • Establish Information Systems Strategy Board (ISSB) • Single governance board; • Accountable to CEO / Executive; • Executive support / authority; • Clear definition of roles & responsibilities [50% Clinical (including Chair); IT Director; Head of Programmes; Development; Technical; Trust Operations; Finance] • Responsibility for all Trust information systems development, implementation and maintenance
Organisational Structure • 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 • Establish comprehensive Project Portfolio; • Set clear strategically-aligned SMART goals for the near term (1 – 3 years); • 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