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
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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;
2. Appropriate organisational structures and
processes need to be in place to support the
delivery of an effective Information Systems
Strategy;
3. It is necessary to have a lead Clinician as a focal
point of the Information Systems strategic
organisational structure.
1.
Newcastle-upon-Tyne Hospitals
Foundation Trust
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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
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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
1. Organisational Structure
2. Operational Delivery
3. Clinical / Front-line Engagement
4. Reporting Mechanisms
5. External focus
Organisational Structure
 Disparate groups, leading to lack of clarity of
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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
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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;
2. 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;
3. To ensure that Information System Strategy
needs to be closely integrated with clinical and
other front-line functions in support of patient
care.
1.
Trust Aims
To put patients at the centre of all we do,
providing the safest and highest quality health
care;
2. To be the healthcare provider for Newcastle,
and a national specialist centre;
3. To promote healthy living and lifestyles;
4. To be nationally respected for our successful
clinical research leading to benefits in
healthcare and for patients;
5. To maintain financial viability and stability.
1.
Change Management Plan
1. Organisational Structure;
2. Operational Delivery;
3. Clinical and Front-line Engagement;
4. Reporting Mechanisms;
5. External Focus.
Organisational Structure
1.
Establish Information Systems Strategy Board
(ISSB)
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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]
3.
Responsibility for all Trust information systems
development, implementation and maintenance
Organisational Structure
4.
Align ISSB Purpose with Trust’s Aims, Values, and
Strategic Objectives;
5.
Clear statement and communication of Purpose &
Scope of ISSB:
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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
1. Establish comprehensive Project Portfolio;
2. Set clear strategically-aligned SMART goals
for the near term (1 – 3 years);
3. Rigorously review progress towards set
goals;
Operational Delivery
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Objective prioritisation of Project Portfolio;
Identify business-critical projects;
Executive review and endorsement;
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 reprioritised) 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?
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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?
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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