It’s not about gadgets, it’s about change

Ask any chief technology or information officer why IT is so intrinsic to the delivery of healthcare and they will have no problem telling you.

But ask a trust board the same question and the response may not be so clear. This despite national attention on the information and technology agenda never having been more intense.

On 5 February Lord Carter published his review into hospital productivity. Within it he criticises the NHS’s lack of digital maturity, and calls for trust boards to be made accountable for ensuring IT systems are used to their full potential.

As William Smart – director of information management and technology at the Royal Free Foundation Trust – points out, hospitals cannot run without IT.

Unfortunate legacy

“Hospitals can operate for a significant amount of time without certain functions but most will stop quite quickly if networks fail or systems go down.”

So if IT is as vital to the delivery of healthcare as Mr Smart says, why did Lord Carter suggest insufficient board engagement on the issue?

Joanna Smith, chief information officer at Royal Brompton & Harefield Foundation Trust, feels it may be an unfortunate legacy of the now dismantled National Programme for IT (NPfIT). Founded in 2002, the programme was centrally driven, with few decisions left to providers.

“The programme took a lot of responsibility for funding and decision making around what needed to be done [for IT]. So the board didn’t need to be engaged as much,” she says.

Deeper involvement

Research has quantified this lack of engagement, finding only a small proportion of NHS providers give their IT lead executive level responsibilities. For Mr Smart, this is a problem.

He takes the view CIOs need to be operating at board level because “[they’re] key to the delivery of day­-to-­day services”.

Neil Darvill, director of informatics at North Bristol Trust, agrees CIOs should be on the board and bemoans the fact that IT portfolios are often given to executives whose primary focus is elsewhere. This, he argues, leads to “[trusts] not having the right level of strategic involvement in IT”.

However, Lisa Emery – a CIO who sits on the board at West Hertfordshire Hospitals Trust – argues the relationships she builds are more important than her formal role.

“If you’ve got good relationships with your executive colleagues and if you’re really able to explain to them and show them what you’re delivering together, that is going to make the difference.” She says boards need to understand healthcare IT is less about gadgets and more about transformation.

“This means not looking at how many devices we can put out or when we can get Wi­Fi, but actually saying I need to change these business processes, how can [my CIO or CTO] help?”

Ms Emery and Mr Darvill may disagree on whether IT leads need to be executives, but both agree boards need to engage CIOs so as to make the most of their skills. Mr Darvill’s concern is whether there are enough CIOs with the right skills to turn to.

“The reality is, there just aren’t enough people around who can do the job well. I think we’re in transition, where we recognise the need for more CIOs than ever, and we have got more than ever, but it is still nowhere near enough and we’re moving quite slowly.”

Two way street

The South West executive suggests CIOs or CTOs do not need to be “technical geniuses”, but do need a clear idea of “how to take an organisation on a journey”. He argues this is difficult to learn and advises boards to “try to develop their IT people, expose them to leadership roles and help them more”.

Justin Whatling, chair of BCS Health, part of The Chartered Institute for IT, suggests employers need to build a culture of professionalism within healthcare IT. That would involve standardising the skillset needed for IT roles.

“Rather than having lots of different role profiles we need to standardise it. Then against those role profiles, [trusts] can look at what skills they do and don’t have. This enables a proper discussion with people on how to gain those skills or how to recruit those skills.”

Tangible benefit

However, Mr Whatling is keen to emphasise it’s a two way street and some responsibility lies with CIOs and CTOs. “Individuals need to be contributing to the overall business strategy. They need a mindset to not just keep IT applications running, but to understand how that contributes to business objectives.”

Mr Darvill says this contribution is easier to make if IT leads use the board’s own language to  communicate ideas. “I’ve found IT­ orientated people are input people, so they like explaining how things happen.

But generally the board is interested in outputs. So it’s almost a translation of the solution into a tangible benefit,” he explains.

Translation is a concept which comes up frequently among this group of healthcare IT experts. As Ms Emery puts it: “You need to come at it from an angle of how information and technology can help people do their jobs. It’s about positioning yourself as an enabler.”

Mr Smart argues that includes emphasising how IT could help with the NHS’s productivity challenge. “I think technology offers a lot of the underpinning solutions that will enable us to drive some of those efficiencies we need,” he says.

The NHS has come a long way in its attitude to healthcare technology, but there is still some way to go before IT is used to its full potential.

For Mr Darvill, progress will only occur once CIOs and CTOs are put in the same league as other executive roles. “We’re in the second division and we need to push forward,” he says.