1. #CCIO

2. Moving from why to how:CCIOs
and the power of collaboration
#CCIO

3. Dr Colin Brown
CCIO, University Hospitals of
Morecambe Bay NHS Foundation
#CCIO

4. Leadership support requirements
during a significant system
implementation
#CCIO

5. Dr Colin Brown CCIO
University Hospitals of Morecambe Bay
Kings Fund - 26th November 2013
Leadership Support
through a System
Implementation

6. Single Patient Record Agenda
Dr Colin Brown – Nov 13
INSERT AN IMAGE / IMAGES INTO HERE

7. Shape of a System Implementation
A Process – Not a Single Go-Live Event

8. Leadership Support through a System
Implementation
• Describe Morecambe Bay journey
• Lorenzo EPR as a core component of our
Single Patient Record strategy
• Interoperability / Portal Capability
• Leadership
• Clinical Engagement
• Change Management

9. Morecambe Bay Locality

10. Morecambe Bay Locality
• 1000 square miles
• 320,000 residents (400,000 activity base)
• 98% GP registered
• 95% of all patient activity at local Trust
• 3 Hospital sites (2 Acute) with 900 beds
and 2 community treatment centres
• 12M visitors to the lakes each year (2 x
Scotland)

11. Background Leadership 1990’s to 2007
• Longstanding Single Patient Record Vision
• Head of Health Informatics since 1992
• Generational change in consultants
• Strong Executive leadership
• Full visibility at Trust Board level (3 successive
TB’s)
• Organisational transformational
project (NOT IT)
Step 3: Develop a change vision
Simplifies many decisions
Inspires / motivates
Coordinates actions
Imaginable, desirable, feasible, focused, flexible,
Communicable

12. Multiple
Journey
My Start
1996 2013
Labour Government
Treatment and Cancer
Access Targets
Reduce to
2 Acute Sites
FT Status
Dr Foster High Mortality
Trust Breach of
FT Authorisation
Bettercaretogether
MBHT 3 Way
Trust Merger
Patient Records in the 21st Century
Step 1: Create a sense of Urgency
50% fail – underestimate how hard it is to
make people change
Overestimate success
Lack patience
ver

13. Lorenzo Regional Care Management
• Go-Live in June 2010
• Clinical Documentation (forms, notes and letters)
• Care Management (PAS function)
• ADT’s, Access Planning, OP management
• Resulting
• PACS viewing
• Sequential capability
• TTO prescribing (Nov 11)
• Advanced Bed Management (Nov 11)
• Emergency Care (Jun / Nov 12)
• Test Requests (Sept 13)

14. Transrectal ultrasound biopsy of prostate clinic
using clinical note and CDC forms

15. single Patient Record (sPR)

16. 0
500
1000
1500
2000
2500
3000
3500
4000
Immediate Discharge Summaries
Created in Lorenzo Jan 2011 - Sept 2012
single Patient Record (sPR)
Step 6: Generate Short-term wins
Long term change needs short –term wins within
14-26 months
Visible and clear wins
Reward change agents
Reduce credibility of cynics and resistors
Convert neutrals to weak supporters, then to
strong supporters

17. R&R: Inc. External Report

18. R&R External Report (Gastroscopy)

19. GP Summary Care Record

20. Clinical Problem Recording

21. EPR Implementation Process
• High-level Project life cycle
Project
Initiation
and
Deploy
Go-Live
and early
life
support
3000 users
introduced to
a new systemWell run
Project with
good
governance
and controls
Stability by
November 2010
Adoption
System and SOP
familiarisation
UHMB Trust Board
sign off Jan 2011
Acceptance
Process and content
becomes irresistible

22. Patient Records in the 21st Century
Risk Management
Crossing the system transfer void
• Good Communications
• Good Governance
• Good Project Management
• Proactive management of the risk envelope
– Don’t attempt too much, keep it manageable and credible
– Change process before cut over or after not on the day
– Engineer break points, Emergency Department?
– Keep the big in big bang as small as possible
– Keep the data migration as tight as possible
– Look for a good day

23. Process of Clinical Engagement
Informatics-led to Clinically engaged to Clinically-led Informatics
Go Live
Newly appointed
Clinical Lead for
Informatics
IDS go live TTO go live EC go live
New Clinical
Directors in post
Establish
CCIO
Clinical
priority
setting
Step 2: Create a guiding coalition
Position power
Expertise
Credibility
Leadership

24. Clinical Engagement 1
• Hearts and minds, hearts and minds
• Good communications
• Small wins
• Infection Control Team
• Surgeons CPD
• Reward supporters
• Hardwire systematic change through “red
line” steps

25. Clinical Engagement 2
• Mandated red line steps
• Possess a smartcard (March 2011)
• View NP referral letters on screen (June 2012)
• “Training Workshops” - 228 of 230 consultants
(Sept to Nov 2012)
• Adopt IDS as sole discharge communication with
GP’s - Dec 2012
(83 % within 24 hours)
• “Paperlite” outpatient project (April 13 to June 14)
Step 4: Communicate the vision for buy-in
Most companies underestimate
communications by factor of 10
Stalls transformation
Comm’s – vivid, simple, repeatable,
invitational
Leaders – “Walk the Talk”

26. Requirements
Work Package &
Plan – sign off
Sign off
train,
Start Finish
5 weeks
Content built
Dry run Pilot
* Technical enablement of diagnostics
** Train technician/clinician
7 weeks
Treatment Function - High Level Plan
“Paperlite” Outpatients Project
Step 8: Make it stick – Incorporate change into new culture
Change norms of shared values and behaviour
Inertia can be maintained by longstanding staff, need to
overcome
Prove new way is better than old
Success is visible and communicated
May lose some people in process
Reinforce new norms / values with incentives and rewards
Reinforce new culture with every new employee

27. Morecambe Bay Future EPR Developments -1
• Complete Paperlite Outpatient Project June
2014
• Inpatient Paperlite Care
– Rollout Test Requesting
– In Patient Prescribing and Meds Admin (IPPMA)
– Documentation (inpatient and ED)
– Observations
– ICP’s
– Theatres
Step 5: Empowering broad-based action
Reduce layers of management
Align to customer (user and patient)
needs
Devolve responsibility
Excellent communications
Remove troublesome supervisors,
honesty, change or remove

28. Morecambe Bay Single Patient Record
Development
• Interoperability
• GP Systems – Documents, Messages, Reciprocal
Summary Views
• Medical Devices
• Community Services , Social Services (Strata)
• Connect up an e-Health Economy
• Local Trusts (Blackpool, Preston, Blackburn)
• Support whole patient pathways
• Empower Patients
view and interact with records
Step 7: Never letting up
Consolidate gains / produce more change
Maintain critical momentum
Drive new behaviours and practice into
embedded culture
Needs concerted effort, new projects, new
people recruited,
Do not declare victory
Leaders steer for the long term

29. Morecambe Bay Single Patient Record
Development
• Has Morecambe Bay been successful ?
Not yet
(goals keep changing)
Healthcare is evolutionary
It is all part of a journey