“There has to be a win in there for everybody,” says NHS CIO Cindy Fedell of the importance of collaboration. Fedell was talking about the highs and lows of collaboration in the NHS at the Innovation Leadership Summit, held in the autumn of 2017 by the Horizon CIO podcast.
Bradford Teaching Hospitals NHS Trust serves 500,000 residents and says it provides further services to 1.1 million. Maternity through to elderly via intensive and children’s care are provided and there is a strong research arm to the hospital in areas such as eye care, hip fractures and dementia. As a teaching hospital Bradford has simulation centres for the teaching anaesthetics, emergency, obstetrics and theatre where close to real scenarios are taught. As Fedell told the largest gathering of CIOs in the UK, the hospital has one of the busiest accident and emergency departments in the country.
Fedell, originally from Canada, is leading a number of cross-trust developments in Yorkshire including the rollout of a new electronic patient record (EPR) system with Calderdale and Huddersfield NHS Foundation Trust and the adoption of digital health across Bradford, Airedale, Wharfedale, and Craven through supporting the development, implementation and evaluation of the impact of innovative new digital health technology. This high level of organisational collaboration has huge opportunities and some challenges.
“Everyone would agree and believe that the NHS naturally collaborates. As a patient you move from your GP surgery to a hospital to social care and back around. We are a health system in that way, but we move people around very deliberately, we pass people back and forth.
“Two years ago the NHS launched a strategy called the Five Year Forward View, this strategy said just go out and get it done,” Fedell says of the authority to develop new models of care. The CIO says this has enabled NHS trusts and their CIOs to develop different ways of delivering services, “the delivery of care in a network or a collaborative way”.
“From an IT perspective, the enabling technologies need to be there,” she says of the role of the CIO in the new collaborative NHS. In collaboration NHS trusts are looking to improve patient care and reduce costs. In a week where the challenges of the cuts to the NHS have dominated the headlines, the need for trusts to modernise comes sharply into view. Fedell says her trust has already experienced improvements in bargaining power with suppliers through the efficiency of scale as a group rather than as a single trust: “We have saved £5m, so that is very important,” she says on the Horizon Live CIO podcast.
“The British Medical Journal claims that 20% of radiology tests are not necessary and collaboration can reduce this,” she adds. But it isn’t just about cost reduction, the 2017 Wannacry malware attack hit the NHS particularly hard and Fedell says collaboration brings cybersecurity skills together. “No trust has a huge cybersecurity team, but if we work together we can provide some resilience,” she says.
The importance of relationships
“More collaboration will drive more collaborations,” Fedell says, but the CIO warns her peers that the strength can also become a weakness. “We are a small world in the NHS. We all know each other, so if one project doesn’t go well, that is going to impact the others, so just as good breeds good collaboration, so bad collaboration is a virus”.
“Relationships are the key, the goal is agreed,” Fedell says relationships have to be well managed and a constant part of the collaboration. The CIO says that the relationship management has to extend to the top of organisations with the full support of chief executives and boards. Fedell says this is critical because if boards or chief executives are “not keen to work together that will impact your time lines,” she says.
Fedell advises that goals are agreed and that all wins on the journey to the goal are: “A win is there for everybody. As soon as someone starts losing, it becomes difficult to retain momentum, and momentum is time and time is money.”
Just as CIOs have moved to agile and iterative development of technology and processes, so collaboration too has to be begun small and developed in achievable chunks.
“Starting small is a better way to go. Not small in ambition, but in investment and scope,” Fedell says one collaboration that her trust is involved in “was began by one person, the commitment was one thing and it has built and built and the bigger picture has moved nearer,” she says as an example.
“Collaboration exit clauses should be as good as those in your vendor contracts.”
Fedell advises CIO peers to structure and bake in collaboration to a project, telling CIOs to “allow time” for collaboration on the project plan. The reason for making time is the number one in the three pillars of business technology leadership – people.
“We often ignore the people, we look at costs, timelines and budget and the people are very important, so everybody needs to be heard. There is history, rumours and gossip and it needs to be addressed on a one-to-one basis.
“There is always the big player in the room, for us it is Leeds Teaching Trust, they are the second largest trust in the UK and people gossip about them,” Fedell says of the NHS trust that now has Richard Corbridge as its CIO, as the Horizon CIO podcast revealed in August of last year.
“You have to take time to talk to everyone that is being a little bit noisy and little bit challenging and listen to their concerns. I can think of instances when I thought people were being just a little bit gossipy and when we went out and talked to them it turned out they had very good concerns and when they were addressed it turned out they were very important for the collaboration,” she says.
“Working together is a risk,” Fedell says and she advises CIOs to create an exit point in cross organisational collaborations.
“Planning for an exit point was a useful tool for us. We agreed that at a point of time, any trust can leave at six monthly points and two years later every trust is still involved, but it relieved the pressure,” she says. “Collaboration exit clauses should be as good as those in your vendor contracts.”