Healthcare IT managers should be on the board driving efficiency, conference hears
Technology ‘mavericks’ should be voted onto the boards of NHS trusts if IT solutions are to be taken seriously as a way of improving services and reducing costs, experts claim.
Experienced IT workers should not feel isolated, but should be ‘celebrated and harnessed’, according to speakers at the 2012 Health Informatics Congress in London last week.
They said that rather than being seen as a backroom function, IT should be viewed as a frontline service due to its potential to enhance outcomes and drive significant financial savings.
Unfortunately, not all boards see it as their role to take an interest in technology, but it is really important that they do
And having a voice on the board would help to overcome the problem most IT managers have convincing those holding the purse strings of these potential benefits, they claimed.
Steve Worrall, benefits lead for BT Health and membership secretary of the business change specialist group at BCS, the Chartered Institute for IT, said: “It’s about promoting technology as a change programme and not just a bit of kit. The most successful deployments come when the board is actively engaged and supportive. Unfortunately, not all boards see it as their role to take an interest in technology, but it is really important that they do. I think it is vitally important that someone from technology or informatics should be on the board.”
Glyn Evans, a senior associated fellow at Warwick Business School, added: “IT is an easy budget to cut, even though there are a few forward-thinking trusts that have increased spend in order to get the benefits.
You have got to engage the finance team as we have cornered the market in the use of the word ‘no’. But you have to persist as most of us have ‘got it’ and it is in everyone’s interest that we do
“We know that around 40% of managers have left, or are leaving, the health service and they are now even more remote from the board. Often they are at the third or fourth level of management, and while I accept they do not need to be at the top of the table, the further away they are the harder it is and the potential to use IT is lost.”
When they do finally get a voice within a trust, IT leaders were warned to put aside ‘techy speak’ and start talking about business cases rather than the ins and outs of technology.
Worrall explained: “If I was on a trust board, what would keep me awake at night? It is things like financial stability, QIPP, controlling the supply chain, and maximising the use of assets and resources. It is hard to put together a business case for IT investment when there is a significant upfront cost, so you have to make the connection to these benefits so the board will buy into it.
“IT managers need to build up an understanding and link everything back to concepts of value. They need to show what is in it for the patients and for clinicians.”
Evans added: “We have got to stop taking IT projects to the board. I don’t think any board is going to be interested in them. We have got to start going to the board with business change projects that involve IT. If a board is not interested in that there is something wrong.”
He also urged managers to find someone within the department who can make sure the benefits are fully understood.
Every trust has between 10 and 50 change and technical programmes on the go at any one time and that needs to be orchestrated and you need a framework to make sure you are doing the right things and getting the value from them as well
He told delegates: “If you advertise for someone who is technical, you can’t be surprised when you get someone who is technical. We employ people in public services who fit a mould when we should be looking for the mavericks. We need to get rid of techy speak.”
This drive to move from talking technology to talking benefits realisation was supported by Bob Alexander, director of finance at NHS South of England strategic health authority. Speaking about what makes finance managers and chief executives take notice, he said: “There are two tribes. The first has a short-term view of capital investment and they are the money men; the chief executives and the directors of finance. The others have a view of the benefits and look at things qualitatively. They are the techy people. The fact is the finance and business communities must come together with their information colleagues as the context in which we are operating now, and in the future, will demand this.
“Moving on it will be able about developing and procuring solutions that support business. Business cases are not an exercise in creative writing; the numbers are just as important as the words. IT managers have to make sure the benefits realisation exercise is properly done and have a great role in helping their colleagues to identify how these benefits occur and how they can be delivered on an operational basis.
“You have got to engage the finance team as we have cornered the market in the use of the word ‘no’. But you have to persist as most of us have ‘got it’ and it is in everyone’s interest that we have.”
Examples of where benefits realisation has helped to win the case for technology deployment include e-Prescribing, which has significantly driven up the quality of patient care and outcomes by reducing medication errors and speeding up discharges. Similarly, rolling out electronic patient records is reducing the estimated 25% of the day clinicians spend chasing up paperwork and making phone calls to co-ordinate discharges and handovers.
We have got to start going to the board with business change projects that involve IT. If a board is not interested in that there is something wrong
Worrall said: “Not all investments result in clear cash benefits, but if you can, for example, reduce the reliance on bank staff as a result of introducing e-Rostering solutions, then there is a monetary saving down the line. It is only by recognising these benefits that you will be able to fund the next wave of systems, and the next, and so on.”
He revealed that one trust had saved £300,000 and 830 bed days in just two years by introducing audio conferencing where community health workers, reablement leads, therapists, and clinicians speak every day to co-ordinate discharges from hospital. He added: “Small and basic technology can achieve results and deliver interesting outcomes. For example, child health workers have told us that if they had details of A&E visits and DNAs and could cross reference these, they would have an idea about incidents of abuse in the community.”
But Evans warned that these longer-term benefits would not be identified unless champions were earmarked within trusts. He explained: “The challenge is that most benefits realisation comes after a deployment project has ended and the project groups have been disbanded. You collapse the team and then expect the efficiencies to materialise and be recognised. If the project team is stood down you are not going to see this. There will be no one to drive compliance and no one to make sure the benefits are realised. You need a member of staff who will be responsible for each benefit to take them on.
IT managers need to build up an understanding and link everything back to concepts of value. They need to show what is in it for the patients and for clinicians
“To focus on the benefits in this way is crucial if we are going to get back to the board for support for the next project. Every trust has between 10 and 50 change and technical programmes on the go at any one time and that needs to be orchestrated and you need a framework to make sure you are doing the right things and getting the value from them as well.”