Using ICT systems to improve outcomes – skills needed to influence change

1. Using ICT systems to improve outcomes – skills needed to influence change Alastair MacdonaldClinical Advisor, Outcomes Team ICT DepartmentSouth London and Maudsley NHS FT

2. Given title... • Outcomes • Skills • Influence • Change

3. Given title...and • Outcomes • Skills • Influence • Change • What has this got to do with CCIOs?

4. Outcomes heroes Avedis Donabedian so-called “Structure-Process-Outcome” model of healthcare quality Misunderstood by successive administrations as Structure quality Process quality Outcomes quality  

5. Outcomes heroes Florence Nightingale Expert on death as outcome “If the function of a hospital were to kill the sick, statistical comparisons of this nature would be admissible. As, however, its proper function is to restore the sick to health as speedily as possible, the elements which really give information as to whether this is done or not, are those which show the proportion of sick restored to health, and the average time which has been required for this object ...”

6. Outcomes heroes Ernest Amory Codman The “end result” idea 1900-1940 “The common sense notion that every hospital should follow every patient it treats, long enough to determine whether or not the treatment has been successful, and then to inquire 'if not, why not?' with a view of preventing similar failures in the future.“ “Each patient who entered the operating room was provided with a 5-inch by 8-inch card on which the operating surgeon filled out the details of the case before and after surgery. This card was brought up 1 year later, the patient was examined, and the previous years' treatment was then evaluated based on the patient's condition. This system enabled the hospital and the public to evaluate the results of treatments and to provide comparisons among individual surgeons and different hospitals.”

7. Health Outcomes “attributable effect of an intervention or lack of intervention on a previous health state” (UK National Centre for Health Outcomes Development 2008) “Outcomes research seeks to understand the end results of particular health care practices and interventions.” (US AcademyHealth 2003) “The attributable effect of an intervention (or its lack) on a previous health state.”(UK Department of Health 1994) A change in the health of an individual, group of people or population which is attributable to an intervention or series of interventions.” (NSW Health Department 1992)

8. Health Outcomes “attributable effect of an intervention or lack of intervention on a previous health state” (UK National Centre for Health Outcomes Development 2008) “Outcomes research seeks to understand the end results of particular health care practices and interventions.” (US AcademyHealth 2003) “The attributable effect of an intervention (or its lack) on a previous health state.”(UK Department of Health 1994) A change in the health of an individual, group of people or population which is attributable to an intervention or series of interventions.” (NSW Health Department 1992) ICT

9. A 3-dimension model of outcomes (Broadbent, 2001) Intervention Outcome Condition/ Context

10. Outcomes vision • Clinical teams reflect on aggregated outcomes data and fine tune their interventions and processes accordingly • Clinician and patient dyads reflect on outcomes, measured independently by each, in relation to interventions and adventitious events • Commissioners do NOT purchase outcomes but purchase an interest in them (Goodhart’s law)

11. Outcomes heroes Chief Information Officers?

12. Tim SheppardDirector of Dell’s public services division ... “It is important that the chief executive makes this a role that will attract the right people,” he adds. “There is a necessity for chief execs to drive it.” Which means taking the argument for the CCIO – and let’s face it, this is a person who will not come cheap – to CEOs. Sheppard senses that CEOs today are more receptive to this kind of argument than they ever have been.... EHI 21 September 2011

13. I smell a good job. But what sort of clinician can significantly influence... • Change in the culture of the organisation • Change in the culture of the commissioning environment and • Change in central government policy ... towards outcomes-orientated healthcare?

14. MORE CHIEFS REQUIRED Whatling, J. ITNOW March 2012 30-31 Combining 1) respect as a clinician and 2) leadership in the use of clinical information

15. Man on two horses,,, Clinical Horse Information Leadership Horse

16. ..good at AND ( ( ? ..OR

17. OR ALL THREE?

26. Respected clinician and good at ..  

27. But who wins wars? MORE CHIEFS REQUIRED ? OR

28. Reservation 1: There are more/stronger demands of ICT at Board level PbR targets Clinical information Other central Demands Commissioning Targets Finance Targets

29. Reservation 2: CCIOs need to know I T • in IT everything is possible; the only issue is how long it will take • IT staff, keen to please, often disappoint • because they themselves cannot predict what they will find (e.g. migrating data from Oracle to MS SQL, or rolling out Windows 7) • CCIOs must be able to judge the folly of a request as well as the folly of the response • If the CCIO has no useful IT skills at all he/she will be just another manager to them • If they have at least some skills they can take some of the work off IT shoulders, earn brownie points and achieve more

30. CCIOs should be a useful part of the Information/ICT department, where things get done (or don’t get done), not swanning around at Board level meetings, away days and transformation seminars • CCIOs would then be seen as an ally of IT and not yet another customer (they have enough customers already)

31. Picture of man on three horses!! Leadership Horse Clinical Horse IT Horse

32. fin