CIO interview: From Wannacry to wanna change

‘Digital's really coming into its own in the NHS, especially in the last say two to three years but the pandemic has really ramped up its profile.’ Begins Shauna McMahon, ‘I think people have hit the wall and realised that, we can't function without digital.’

Things are changing so quickly. I believe the biggest piece during COVID was the need for virtual communication. We needed to have access to data and business intelligence and that further emphasised the role that digital has to play. We were getting asked to provide data every day into the centre to help with the pandemic. People even at the centre realised how critical it was to have access to quality information and we can only get that through good digital systems.

I personally think healthcare is a digital business, it just happens to be in the service to support people on their health and wellness journey. Research, artificial intelligence, all of that couldn’t happen without digital as  the foundations.

We are a mobile workforce; we need mobile devices. How often do you see doctors or nurses sitting down? This has made us rethink the variation and the variety that we need to provide in a very dynamic industry like health care.

Patients also need to have access to the same information in many ways. They need to be a partner in their health and wellness journey. It can't be left up to a health care provider. I as a citizen need to take ownership for some of my health and care because a doctor or nurse cannot possibly keep track of everything on everyone.

What’s the digital future of health care?

Companies like Google, Apple and Amazon have made the digital world easier to access. So now, people are asking “why can't I do that in healthcare? Why can't I get that?” While some people have figured it out ways to do this and worked around the system, the generation coming through (who has grown up with digital) will figure it out and not tolerate anything less. If we don’t want an obsolete NHS, we’re going to pick up the behaviours of the digital generation and move forward with the times.

So, when I think about health care in the future we're already seeing where lots of what used to be invasive surgeries are being done by robotics. The surgeon can be in a totally different location and manage that surgery. They don't even have to be in the same city, to perform an operation.

In healthcare, there can be a culture of not enabling people to make their own decisions. “I’ll look after you”, as opposed to providing the information so you can look after yourself. It’s quite a tough ask to get people to change their thinking in healthcare. We've created monolithic hospitals that are no longer fit for purpose. In the future, people won’t need to go into a hugely expensive building for a 10-minute outpatient appointment. That will change as they will not accept it.

How essential is digital to healthcare?

Digital is becoming as important as the lights, the heat, the water - you can't run a sustainable safe healthcare service without it. To negate the risks of transformation we need funding to achieve a more equitable digital maturity across the NHS. We need to level up so we can provide solutions with the confidence they will perform well and securely.

As a sector we still have some areas where there is a perception that IT is about hardware - the servers and the kit - but digital isn't about that. It's around relationships. It's around how we connect with people. It's around how we manage the processes.

How does WFH work with GDPR?

I managed a health information department many years ago and records would get lost - we'd find them in the cafeteria. A clinical person decided to take charts home and the paper ended up flying all over the street. How secure is it to send thousands of pieces of paper around a hospital? It really isn’t. I think digital is much more secure now, but, that said, if you do get a breach, the risk is you lose thousands of records rather than just one or two. This is why confidence in the technology foundations are so important

We are now at the  place where we accept that risk is just an inherent part of life. Like every major change we've had in our history, there's always a risk. Airplanes, driving a car - we accept risk every day. We're never going to get rid of risk. What we do is make the best decisions we can to protect our data – but accept it’s never going to be 100% secure.

How do you develop your team and foster a CPD culture?

I've been always a strong proponent of continuous learning and I've always supported my team as they develop their professionalism and their credibility. People often think it’s the employer that should take the lead, but I've always said to people you need to control your career. You are responsible for you, I try to support that journey.

Leading is all about relationships, being able to work with diverse people, and then being able to coach, mentor and help people to rise up. Sometimes you lead and sometimes you follow. But you have to be really good at taking that step back and taking a wider view. It is a wonderful feeling to see when people develop and come into their own and discover their own leadership.

Leaders need to be comfortable having people who will be smarter than you. I don't like to see good people leave but once you start mentoring and helping people discover and come into their own, sometimes they have to leave to have a different growth experience and you have to be comfortable with that.

How do you inspire the upcoming professionals to become our future CIOs or CNIOs?

I believe to inspire you have to always be passionate and excited about your work. You have to bring some challenge - people like to be challenged so you have to offer those opportunities.  It's really important that you create an environment where people can see other opportunities. And it's not to say some people might be happy in the role they do and that's fine but you want them to still be inspired and feel they're part of something bigger and that they are contributing.

I recently had a staff meeting where we went through what BCS could offer, ‘how many in the department had their RITTech?’ ‘can anyone look at the FEDIP?’ While at the start, some people might have been a little hesitant, we used anonymous voting to find out who wanted to take up the BCS opportunity. A good half of the group wanted to get membership with BCS, get some training and credentialing. That is where I can support them.

How important do you think it is to have that professionalism and that network to go to?

I've done my certified health CIO. I'm a BCS fellow, I've have my FEDIP leading practitioner - which are all important if you aspire to be in a leadership role. That you’re chartered gives you credibility and that you are continuously learning as a professional - and you have the credentials to demonstrate that you can handle that level of work. Many trusts still don’t have a CIO or CDIO at a board level - which seems mindboggling given its importance.

The road to innovation has a few bumps along the way

As a leader, you have to be comfortable being uncomfortable. You have to be taken out of your comfort zone, the courage, especially in digital, to try something new and to risk something. You can't be in digital and not be innovative and you can't be innovative if you're not trying something new - and that means you're going to have to have some failures.

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It's funny, we get really uptight about failures in healthcare, but how did we ever get a first heart transplant? Or a lung transplant? It took courageous people to look at the bigger picture. To take a step forward and risk failure to innovate.

To be a good digital leader you have to be willing to say, “what if we tried this? What would this look like?” You want to nurture those front-line champions who have a similar ethos, those people that really want to do things differently.

How does innovation happen in the NHS?

There's usually a group of physicians and some digital people that want to change the status quo and do something ground-breaking. They might have a supplier that’s willing to help them do a pilot or prototype - and then they just keep at it until they discover something amazing. We have that happening across healthcare, using AI for detecting cancers etc. There's a Professor Shafi Ahmed, he’s been using immersive technology (virtual reality) that gives the perception of being in physically present in a non-physical world. This can be used to teach your physicians, practise new surgery techniques.

What about networking outside of the NHS and other industries?

In my career, I started as a teacher, moved into banking, HR and then private industry before I joined the public sector. Networking in private industry is huge, it's almost a requirement. You go out, you network because you're creating business and partnerships.

It’s critical to network with people outside the NHS to see what other industries are doing, how they're managing flow, how they deal with huge numbers, creative use of data, how they handle capacity. I mean there's so much creativity happening in other industries that we can learn a lot. I think that the challenge with healthcare is that it can be very complex because of the number of different variables and that adds a certain complexity to it but you can learn a lot from others.

If you can open the door to sharing and best practice you help avoid duplication, repeating mistakes, you then build some friendships of like-minded people, you have go-to people when you're stuck, you're struggling. So, I think we're stronger together than when we're alone. Networking is really critical.

Learning how to manage risk

I went to the Gartner IT symposium in Barcelona a few years ago. One of the speakers was the CIO at Maersk, the shipping company. The head of Technology, Adam Banks, talked about having just arrived in that role, when they had a massive computer outage around the world. He was describing what that experience was like - thousands of ships with millions of dollars’ worth of cargo, stranded. So, to hear someone like that speak and what they went through and how creative they had to be to get things running again, it makes you see outside the box. To see beyond your own experience and learn from someone else.