CIO Interview: Along came 2020

VIEW – Stuart Bloomfield, CIO, Waitematā DHB & Counties Manukau Health

In 2019 I shared my views on how to build a change-fit culture. I believe our DHBs were fit for the challenges 2019 threw at them: the measles epidemic, the mosque shootings and Whakaari White Island eruption were such challenges. 

Measles stretched our hospital capacity to its limits – hitting Counties Manukau hard. 

The Whakaari eruption tested our ability to share resources across DHBs at short notice. Since burns units are scarce and Counties is the National Burn Centre, we came up with imaginative ways of how we could share those resources the most effectively.

Waitematā DHB does not have a specialist burns unit, so they took hip fracture patients from Counties to free up capacity for more burns patients. 

Thankfully, the scale and longevity of this tragedy was not so great that sharing resources could not be organised using our existing IT systems, and the humble phone call.

And then along came 2020

From the outside, New Zealand must look largely unaffected by Covid-19 with fewer than 2000 cases in total. 

The truth is that preparation for the potential crisis in our hospitals, the set-up of the community testing centres, contact tracing, healthcare delivery through telehealth, working from home, border management and redeploying staff took massive digital and data support. 
 
Before Covid we had aspirations to share data across DHB boundaries systematically, but there was no clear kaupapa and we were not even sure that we had the social licence to do so. 

Suddenly, we saw the threat of overrun hospitals and our boundaries became less important. 

Data sharing regionally and nationally happened quickly, giving the Ministry a near real-time view of intensive care capacity and occupancy across the country, and in our northern region we set up near real-time dashboards and explorers to track our pandemic response. 
 
Strong foundations

The IT foundations we had built prior to 2020 served us well and allowed us to create new functionality and cross-organisational sharing into a familiar toolset and platform. That meant IT staff could develop quickly without climbing the steep part of a learning curve in a pandemic. 

We are now at the point where we have space to move our technology platform cloud-wise in preparation for the next challenge.
 
So, was our culture fit for the change from DHB ownership and control, to the collaboration and compromise required to share resources? 

Anyone who has been flatting knows that there is good and bad that comes with sharing. Still, when we came up for air, we realised that nothing terrible had happened when we shared – we did not lose our data and digital sovereignty, and visibility across DHB boundaries helped our Covid services immeasurably. 

I don’t believe we will return to our siloed systems; new opportunities for sharing are frequently arising now, and we have the foundation to build on.
 
A living strategy 

Was our response strategic or tactical? We did not need to take the strategy from the shelf and dust it off - we lived that strategy of clinician leadership, incremental change and sharing data and digital resources. 

Peter Drucker once said “Culture eats strategy for breakfast”. I believe he meant a strong culture would determine your success and whether you move along your strategic path.

Stuart Bloomfield is chief information officer at Waitematā DHB & Counties Manukau Health