Meet the livewires

Lyn Whitfield and Claire Laurent interview six chief executives who have put technology and information at the heart of their strategy and culture

CAROL CLARKE

Solihull primary care trust and chair, NHS chief executive information forum

'We became a primary care trust in 2001 and inherited a community system that was in poor condition and an old health authority system that was even worse.Most of the information we had was coming from our providers weeks and weeks after the event. So we made a decision to invest substantially in information management and technology development.

'We got a good director, Neil Serougi, and put together a strategy, deciding what we should fund ourselves and what might come from the national programme for IT.

'We also built capacity in the PCT. Because we didn't have the skills we decided what we wanted and went out to find people to do the work. Then we created a data warehouse that we could put information from various systems into and feed it back to staff.

'It has taken 12 months to get real use from that, because we had to populate it with useful data. Now we are able to do trend analysis and drill down into the data by cluster of practices. It has been quite powerful.

'Initially people were sceptical of the idea of a data warehouse. People had come from organisations where data sharing was not a priority and some didn't even have PCs. The scepticism reduced when people saw things happening: now we have some district nurses out using notepads [handheld computers] on a GPRS [wireless communication] system.

'For the last year and a half, we have also been gearing up for the national programme [which will deliver electronic records and other centrally procured systems, such as e-booking and prescribing].

'We have run something called 'lunch and learn', where we get to talk to people and they get lunch in return for giving up their time. It has been pretty successful, but it is slow going because we have a lot of clinicians to get round. There will always be sceptics - it is our job to go out and convert them.

'We have been working closely with our local service provider and have a team working on process redesign, because that is the bit that everybody could miss.

'But I am excited by the programme. It is what people have been waiting for - even if they do not know it yet.'

CHRIS REED

Gateshead Health trust

'With the national programme There is a massive amount of awareness-raising among staff to do.We need to find early adopters in order to cascade systems among our trust.

'It is about changing culture and behaviour to get people to start using computers more.

But this happens over years rather than weeks or months.

It is evolutionary change.

Computer training can be done through personal development plans.We have about a 95 per cent level of compliance with our objective setting and performance and personal development sessions. Personal development plans can be used to map training needs.We have an in-house computer training centre as well as partner-based training, but of course It is always a problem to release staff for training.

'IT has to be seen as time-saving for staff to take it on.

For example, with pathology, instead of scrabbling around looking for a piece of paper or chasing the path lab on the phone, you can punch up the results on the computer. And we need to make computers a part of the clinical environment rather than just one workstation sat at the nursing desk.

'We have a fairly comprehensive e-mail system like everyone else and increasingly use it to communicate with as many staff as possible. People may still print off paper, although we are trying to move away from that.

E-mail makes for speedier communication.

'We give them a useful intranet site that helps with their daily lives: such as being able to check on what's available in the dining room, an up-to-date listing of current internal job vacancies and online access to standard forms. If you build this into the intranet, people will use it and then begin to use it for other things, which is why we have built the access to PROMIS (performance reporting online management information systems) on the intranet.

'It includes quite a lot of clinical information which becomes available about seven to 10 days after the event so It is not quite real time but getting close. It means that our service managers and clinicians can look at how their work contributes to the overall performance of the trust. They could look at the overall trust performance on key performance indicators, such as waiting list indicators, and drill down to their directorate and see whether it was green or amber. If amber they could see whether it was a particular consultant or condition causing that. It means they can see which patients they need to concentrate on in their area of responsibility.

'It might make people edgy in some places, but we had a review done several years ago and one of the things it commented on was that we had a 'no-blame' culture.We have an open learning environment. That is very important not only for compliance with incident reporting but for targets. PROMIS is also an important aid for clinical audit work.'

IAN RUTTER

North Bradford PCT (winner of the information management and prime minister's awards at last year's HSJ Awards)

'Trying to deliver high-quality care and improving the health of our local population is at the heart of our organisation. But to do that you need good information and IT can give it to you.

'I am a practising GP in a paperless practice, so I could see the benefit of using IT in a clinical environment.Many of the practices in Bradford were in the same position, so I wanted to link them up.We said we wanted to improve the quality of chronic disease management, starting with coronary heart disease, asthma and mental illness.We agreed what codes we would use and that information should be shared through an intranet site.

'Another aspect is the information we get from the acute sector.We have been analysing all the information we get from local hospitals, so we have a clear idea of the number of surgical procedures we need each year.

'Our biggest problem has been the national programme for IT. All the practices in Bradford use systems from Emis, the biggest supplier of GP systems - and were about to go on to a PCT server.

'That would have given us one database from which to extract anonymised data so GPs wouldn't have to send in returns, but Emis has refused to release it. [Emis is in dispute with the national programme and has refused to contract with any providers. ] The programme will be good, but it is holding us up.'

ROBERT NAYLOR

University College London Hospitals trust

'We signed the largest IT contract ever in the NHS about nine months ago - a£60m contract with IDX three months ahead of the NHS deciding to use IDX as the software provider for London and the South East. This was a risk - we could have been signing up to a legacy.

'A significant proportion of that£60m is going to go on training.We have about 5,500 staff working in the trust and every one of them will need training.Medical staff will need a high degree of training whereas porters and catering staff will need less.We are developing a training programme for every category of staff with a view to putting them through these in the next six months, leading up to the opening of the hospital and implementation of the new IT systems.

'Generally, the staff are positive. I think the biggest advantages are likely to be in clinical information. The fact that a doctor or nurse can go to a patient's bedside and access via a screen all the information they need to make a decision about treatment means they will no longer be sitting around waiting for the latest results.

'It will facilitate clinical decision-making enormously and it will greatly increase safety. These are intelligent computer systems, so if a doctor orders a drug That is counter-indicated it will prompt the doctor or nurse, which will reduce the number of errors.

'We are the most complex trust in the UK.We run eight hospitals, have a£400m annual budget and four years ago we signed a contract for the biggest private finance initiative NHS building. It was designed as a virtually paperless building.

'We are putting together one of the building blocks for what will become a comprehensive national system in the next five years. If we achieve that we will be light years ahead of any other health system in the world.'

HEATHER LAWRENCE

Chelsea and Westminster Healthcare trust

'The vision here is very clearly about patient-centred care delivery by a multidisciplinary team and everything we do makes sure that is taken forward.

'There is a lot of change in the health service but the changes coming with IM&T are transformational - if the staff can see it leading to patient benefits then everyone wants to be involved.

'Making IT a part of the culture is about leadership; It is about clinical champions - doctors or nurse managers getting the whole team involved.

'Our burns unit is using a multidisciplinary and paperless system and the nurses went over to it very quickly.However, what they've been recording and what they have to use to record have not been helpful.

It is not possible to have a computer terminal for every member of staff so sometimes There is a queue at the end of a shift.We then got mobile devices in but they were very heavy to lug around.We are looking to link with Patientline so that staff can access patient information at the bedside. Our nurses will be able to take vital signs and record them and in time we expect to use them for prescribing, too.

'Since we installed a pharmacy 'robot' in our medical wards, we have reduced the delay in medicines to take home. Our pharmacists are now up on the medical wards. They attend the ward round and do over 30 per cent of the prescribing. They transcribe the drugs and send that electronically straight to our state-of-the-art pharmacy. It helps with junior doctors' hours, and the delay in discharge while patients wait for their drugs has been significantly reduced.

'It also makes the pharmacists' jobs more interesting because they engage with the doctors and patients in explaining medication. This also helps with compliance, which can be a problem.

'We are piloting outpatient prescribing for the whole of our HIV population, which is huge, and our next key projects are inpatient prescribing and e-booking.

Our vision is to have GPs booking patients into outpatient slots from the surgery for certain minor surgical conditions.

'Before the national programme we already had eight practices electronically linked to us. The difficulty was there was no single spine so everyone working on their GP system had to come out of that and log into our system, which could take up five to10 minutes - a whole consultation.With the national programme we will be working on one system, which will be much speedier for people to use.

'It is very important that nurses, doctors and therapists in training know how we deliver care in hospitals.We hope that they are not being taught a model That is out of date and that they are in placements where they can pick it up. And, of course, all young people use a computer, text and mobiles all the time, so It is easier.'

NICK CHAPMAN

Taunton and Somerset trust. He is also taking overall responsibility for implementing the national programme for IT in Somerset

'I think there was a huge shift in thinking about IT when Wirral Hospital trust chief executive Frank Burns published IT strategy Information for Health in 1998.

'Previously, IT had either been something in the background that didn't make it very far up the corporate agenda or it was regarded as a statisticsproducing machine. In fact, it is how you do the job.

'A small example is that everybody is focused on four-hour waiting times in accident and emergency.

There is a simple problem, which is that every A&E department has lots of patients being seen in different places, so how does one know where they are and how long they have been waiting?

'There is a simple solution: have a little program on every computer in the department that shows where people are. On screen the patients change colour: people waiting less than two hours are green, people waiting over two hours are amber and people waiting over four hours go red.

'Everybody in the department can see at a glance where the hot spots are and where problems are building up. It is not a grand scheme, but it is a good example of how to use IT to achieve corporate objectives.

'This programme was developed in-house by our IT guys. Like a lot of trusts in the South West, we have old EDS systems. I do not want to get sued, but they're pretty Stone Age.We need to move on, but We are waiting for the national programme for IT.

'I think the national programme concept is absolutely right, because in the past we have fragmented the NHS's efforts - every trust did its own thing and we ended up with 57 varieties of everything.

That had to change.

'If there are concerns, they are about the number of layers of control in the national programme, and the extent to which individual organisations can influence the implementation.

'There is a national layer, a cluster layer, a strategic health authority layer, a health community layer and an individual organisation layer. There is going to have to be a huge change in the management programme, because we will be changing processes as well as IT, and the danger is not being able to do that as well as it might be done, because there is such a complex structure.

'I am always struck by the supermarkets' integrated scanning technology.What do people hate? Standing in lines. Did the supermarket chains think about that? You bet they did. And it is all linked to pricing information, stock control and customer profiling. That depth of integration of IT into the business is something we should aspire to.

'There is a sea change happening.We are going to have joined-up systems that mirror patient and information flows, so system-wide thinking is being reinforced by the national programme, instead of each organisation being an island.

'Organisational, standalone systems are going; we need to think of systems as communication devices. So we are putting IT at the heart of the health service; we just need to be very, very smart about managing it.

'And we need to make it patient centred, to make sure it helps people make decisions for Mr and Mrs Smith and to improve the way they are cared for. There is a big opportunity cost in spending£6bn on IT.We have to be very aware of that.'