TEMPLE STREET CHILDRENS UNIVERSITY HOSPITAL DUBLIN IRELAND
BACKGROUND INFORMATION
My name is Dairín Hines I am currently employed as the “Clinical Informatics Manager” in
“Temple Street Childrens University Hospital” Dublin, Ireland.
Our Hospital is 140 years old this year to find out more log onto www.cuh.ie.
My own background is that
I have worked in Healthcare for the last 27years initially qualifying as a General Nurse and later
specialising in Paediatrics. My clinical work years have spanned 3 countries Ireland, England and
Belgium working in specialities that included Emergency Departments, Intensive Care Units and
many other Clinical and Management environments. Whilst working clinically I would have been
exposed to varying levels of “automation”
When nursing documentation started to move into the realm of “systems” I remember vividly one
of the bug bears I had was that of staff printing out a form carrying same to the point of care filling
it out and later transcribing into the computer. This duplication of effort and poor design of the
form in question started of my interest in what is now coined as “informatics”. It was at this point
in my career that I completed my first course in informatics.
Let me talk a bit to my Role
When talking about role it is important for those not directly involved in this area to appreciate the
broad scope of the role as is evidenced in the Key Roles that the HIMMS 2011 survey report
found.
When I initially took up a post in Informatics I was part of an Informatics team that existed as part
of a larger ICT department in a major academic Teaching Hospital in Dublin. My title was
“Assistant Nurse Co-ordinator of Computer, Information and Management Services”. I worked in
that position for 5 years and in that time worked in all the areas identified in the HIMSS survey
report that of Systems Implementation, Systems Development, Quality Initiatives, Informatics
Education, Liaison, Strategic Planning, Nurse Education and Operations.
The main differences now between that role and my current role as Clinical Informatics Manager
are that the previous role was very much focussed on Nursing only whereas this role is focussed
on the entire multidisciplinary team with nursing a part of that team. I am also the only person in
post as opposed to a team, although contract staff are taken on when large project roll out are
happening. Initially my role would have spanned Clinical and Non-Clinical Projects this has now
evolved to allow separation and distinction to these with the appointment of a resource to look
after the non-clinical projects and to allow me to concentrate solely on the clinical projects.
My current environment also gives me an extra challenge as it is a dedicated Paediatric
Healthcare Environment so that even Internet access carries extra nuances to be considered.
From a practical stance I am located into ICT Department and report to the ICT Manager
although there are strong links with Nursing given that they are the largest group of Healthcare
Professionals working on site and the fact that I am from a nursing background.
It is difficult to focus just on a few key messages as there are many but I feel that having worked
for 13 years in this speciality here are some key messages for successful implementations:
Dairín Hines RGN, RCN, BSc HSM, MSc Health Informatics.
Temple Street Childrens University Hospital Dublin Ireland www.cuh.ie
“Buy in” this is probably the most important aspect of any implementation as no matter how
good an IT system is, if it is not used then it is not a success. Point in Case - if an ICT system is
designed to replace paper and paper persists then the system could be perceived as a failure.
On the converse if the ICT system being implemented is not ideal the passion and dedication of
staff using the system will get the best possible from that system.
So how is “Buy in” achieved?
In my experience it is a combination of elements that include Leadership and Communication.
Leadership both from the top of the organisation and within the relevant Clinical Department, this
is not to be confused with someone in charge or in a position of management. The person who is
leading out needs to be respected by their peers and have gained their trust to embark on this
road to change.
Change when automating any area in healthcare is inevitable as it is not wise, prudent or efficient
just to automate current practice. Change however causes a reaction in any work environment,
how this is handled is where a decisive leader is required and at times courage is needed as
areas can be trying out new ways of working that even they cannot fully conceive what the final
impact will be. Hand and hand with this decisive approach there needs to be good communication
to all the members of the department concerned and the wider organisation as rarely do clinical
departments exist as silos, they are usually intricately entwined with other departments and their
workflows.
This communication needs to take many forms as people hear messages and respond differently
to various forms of communication. The message needs to be delivered on a repetitive and
ongoing basis; it needs to be heard at many platforms from the top of the organisation down and
from the ground level up.
This communication needs to be honest and straight as promises that cannot be delivered on are
not helpful in managing this change.
The 2nd important aspect is that of “Project Scope” Although most organisations will follow some
form of project methodology where this is defined at the start of a project.
In my experience this will be revisited along the timeline of a project and can often require
redefinition for two reasons; to prevent scope creep and to readjust deliverables within the time
and resources available.
Scope creep will happen in every project if not kept in check as an initial change even what
seems small such as a review of a form or a particular work practice can lead to a whole other
mini project if not keep in check. Even new hardware can instigate a whole new design of a
clinical area.
Out of Scope decisions are faced along the journey of a project as delays can and do occur for a
multitude of reasons and this normally necessitates revisiting the original scope to make a
reasonable assertion as to what can now be delivered in the timeline set out by the project. This
piece of work will in the main usually ensure the on time delivery of a project but with a reduced
scope and usually in the context of scheduling of resources and training. Elements that are then
out of scope can be revisited post implementation when the initial push for Go Live has been met.
And finally “Acceptance” of what can be achieved within the constraints of a project this is very
hard when you know what could be delivered or what should be delivered. This is where it would
be advantageous to have decisions happening at a higher level than within an organisation i.e.
nationally.
Dairín Hines RGN, RCN, BSc HSM, MSc Health Informatics.
Temple Street Childrens University Hospital Dublin Ireland www.cuh.ie
FUTURE PLANS
What does the future hold? Here in the ICT department and for myself.
Here in the ICT Department there was always a culture of planning out the year ahead with
regard to projects and other work so that resources could be appropriately allocated to achieve
the goals set for the department for the year. However in more recent times it has become
apparent that these decisions sat better with a larger decision making faculty and as a Hospital
we have brought these decisions to our ICT Steering Committee to prioritise the projects for the
next 12-18mths. This process has many advantages as it allows transparency in the decision
making process but also gets engagement and commitment from the highest possible level in the
organisation.
The ICT Dept is also currently finalising a new 5 year Strategic Plan to support the Hospitals
Strategy over the coming years.
Career progression in Clinical / Nursing / Healthcare Informatics is not a career that has a defined
career pathway in Ireland currently. There are courses that are run in Informatics most notably
masters in a few of the larger universities. Having completed one myself, this would still not
currently ensure a career in Informatics as positions in practice are few and far between and
varied in the manner in which they exist. Some hospitals/healthcare settings take on people from
clinical practice areas to a particular project for the defined duration of that project, others will
contract in the expertise provided from the company. The Project Management element can vary
from using existing project managers from within the organisation or indeed contracting in
resources.
I do however believe that through work achieved by national groups such as HISI-NM that the
agenda of Informatics will as has been achieved on the educational stance gain more momentum
and appreciation as to the role it plays in delivering technology in Healthcare and that this in turn
will drive the career opportunities.
Temple Street Children’s University Hospital is striving towards “creating a centre of excellence
to care for children’s health” into the future and is embracing technology as an enabler along
this journey to achieve this goal.
Dairín Hines RGN, RCN, BSc HSM, MSc Health Informatics.
Temple Street Childrens University Hospital Dublin Ireland www.cuh.ie