CIO Interview: The key to health system transformation: Good old-fashioned teamwork

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Picture: Darren Manley

CIO Interview: Darren Manley, Northland DHB CIO

As part of our series of columns from health CIOs, Darren Manley makes a case for collaboration as the key to getting things done.

In their recent eHealthNews.nz columns, both Ann-Marie Cavanagh and Scott Arrol mention the importance of, and the challenges with, collaboration.

Cavanagh wonders whether we are making the most of our small and connected sector. And Arrol recommends that we move from talking about collaboration to just doing it. I support both of these sentiments, and thought I’d add my two pence worth through some reflections on the 2018 leg of our journey in the Northern Region.

We’ve been a “joined-up” region for many years – we published a shared IS Strategic Plan in 2009, we’ve had regional information systems for longer than that, and we established our shared service partner healthAlliance in 2011.

But despite many notable successes, it’s felt like we were investing a disproportionate amount of our resources in figuring out how to work together. We’ve experienced our share of the usual symptoms – slow decision-making, unclear strategy, tech solutions that miss the mark on clinical outcomes, competing priorities and so on.

A transition to a new stage

And then 2018 saw us begin the transition from the ‘forming’ to the ‘performing’ stage. The year ended with us completing current versions of our regional Long Term Investment Plan, our regional ISSP and the supporting investment roadmaps, plus designing the delivery framework for these.

We’re now well underway with establishing the delivery framework and beginning implementation of the roadmaps. Foundational investments we have underway this year include finalising our planning for the move of our infrastructure to the private cloud, high-level designs for Identity and Access Management and Health Information Platform, and moving to Windows 10 and Office 365.

Regional investments in clinical capability include the Collaborative Community Care project, the replacement of the Auckland DHB patient admin system, and the migration of Auckland and Northland DHBs onto the shared instance of the Concerto Portal. Through these investments we’re increasing momentum towards the more joined-up, person-centred, responsive and capable health system that we all know is needed.

Reaching a tipping point

So what changed in 2018? In my view, a big part of what’s helped us turn the corner is teamwork. In the Northern Region our efforts to collaborate have reached a tipping point.

There are a few building blocks needed to create the environment for teamwork to thrive. Firstly, there need to be clearly defined shared outcomes. With the development of our Northern Region ISSP, we have a clear shared language to describe our complex health system, its current state, the desired future state and our investment priorities and roadmaps to get there.

The second building block is an environment in which everyone understands their role and is able to play to their strengths. Health is unquestionably a team play, and the team comprises of … well everyone – consumers, technology partners, primary and community providers, DHBs and so on.

It’s the third building block that has helped us reach our tipping point. This is the governance framework that describes how the team works together, how decisions are made. With the scale of “team health”, and the huge variety of role functions – clinical leader, senior supplier, project senior responsible officer, steering group member, sponsor, data architect, consumer, etc, etc – health truly is a complex system.

The governance framework helps us navigate how all these moving parts come together to make decisions on investment priorities, enterprise design, solution design, scope changes and so on. It means everyone’s distinct expertise can be applied, while still supporting us to speed up decisions and build momentum.

By the way, I’m not describing some idyll where we’re all holding hands and singing Kumbaya. Team work is hard work, and as we move through forming and onto performing, we’re bound to be clumsy.

We’ll miss stakeholders with important contributions to make, most of us will have to make compromises on our personal visions and, critically, we still need to be able to accommodate the unique and the unexpected. But it’s teamwork nevertheless, and we’ll keep learning and refining our plans and frameworks as we go.

Making it work nationwide

And of course the Northern Region team is part of team New Zealand. The recent Microsoft agreement is a great example of how we can as a national health system get our stuff together to obtain a shared outcome. But to paraphrase Cavanagh, what more can we be doing to join ourselves up across this tiny country?

In my view, the time is ripe to up the ante on more meaningful and enduring sharing of our regional digital visions, goals and plans. We recently held some workshops with the Ministry of Health’s digital strategy team to review our respective (Northern Region and MoH) plans for cloud adoption and health information. It was a collegial roll-up-your-sleeves atmosphere, and it was exciting to see the alignment of thinking and agreement on a practical plan to support ongoing teamwork on these health-sector wide challenges.

Cavanagh and Arrol make reference to some of the structural constraints in the system, for example, resource-intensive decision-making processes and constraints on funding. Some of these we’re probably stuck with at least for the foreseeable. But as we converge to a greater shared understanding of our mission and goal, and our collective capability, these challenges are diminished.

Darren Manley is the chief information officer for the Northland District Health Board.