Clinical Engagement & Leadership
A key principle we will enshrine in our programmes is that all will be guided by clinical leadership. While technology is an enabler of clinical development, international experience clearly underlines the importance of clinical leadership as a necessary pre-condition for successful programmes. The pressures experienced at the clinical front line create a particular impetus for strong involvement throughout the project lifecycle from conception, through to design and adoption. A clinical role to lead on Informatics will be filled within each programme. The role of Chief Medical Information Officer of the HSE will be developed to support this overall leadership and to support the delivery of integrated care. This approach aligns with international best practice, e.g. the appointment of a Chief Clinical Information Officer in the UK and leading roles for Chief Medical Information Officers in the United States.
Council of Clinical Information Officers
There is a need to ensure that the clinical engagement achieved in getting the Knowledge & Information strategy to this stage is continued and strengthened. A Council of Clinical Information Officers will be formed that will provide oversight to the portfolio of clinical information systems proposed. This group would be provided through an investment of time from clinicians throughout the Irish healthcare system and is considered to be essential in the assurance that the delivery programmes are based in the clinical need and reality of what can be delivered into care settings in the Irish healthcare systems.
This council will provide support, and in many of the delivery cases, governance for the delivery of solutions defined as part of eHealth Ireland. An example is how we will embed clinical leadership into the Electronic Health Record Programme. This clinical leadership will have the key design authority role over each phase of the programme: from the case for change, to the specification of requirements, through to the delivery phases of the programme.
Clinically Led Engagements
In addition to the formal governance, Knowledge & Information envisage that all major change programmes or change processes will be clinically led. When a programme or change process is clinically led it is more likely to succeed then when clinicians only engage in the programme or process but do not lead. A clinically led programme leads to higher levels of clinician early adopters and high levels of clinician buy-in overall. Some additional design principles to support strong clinical engagement are proposed below:
- Establish an open forum for clinical development with a focus on collaboration and idea exchange
- Administrators must be willing to relinquish control to clinicians where appropriate. Proving rather than saying that they are decision makers
- Balancing evidence based approaches allowing the clinician to leverage their interpretation, judgement and contextualisation
- Using data to measure outcomes and refine
- A strong alignment with the integrated care programmes and the clinically led national clinical care programmes.
Knowledge & Information Performance Management
The formal governance structure will be underpinned by a set of key performance indicators (KPIs), which culminate in a Knowledge & Information scorecard at the top, and cascade from there down to different levels. This scorecard centric approach aligns with the broader approach to organisational performance management outlined in the HSE Accountability Framework.
This approach means that all Knowledge & Information functions are aligned with a coherent, integrated set of objectives and targets – which are meaningful and valuable to the health service as a whole - and each is clear about its contribution towards these. Performance reporting processes in both change delivery and service delivery will support the generation, collation, quality assurance and interpretation of the KPIs and their trends, to support effective decision making within the different instances of the governance framework.
Example Scenarios of Governance working within the Operating Model
The following flows outline, at a high level, the operating model at work, showing simplified key activities undertaken in two common scenarios, along with the interactions with the appropriate governance.Governance drives quality and consistency across both processes and the experience of users and customers interacting with Knowledge & Information. Successful governance depends on all stakeholders having a clear understanding of the structures so that governance remains accessible, easy to interact with and agile. To this aim, our model seeks to balance appropriate levels of rigour and control with these factors.
| Figure 12: Scenario 1 - Service Lifecycle for Incidents and Problems | ||
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PACs outages on several occasions are logged by the service desk and assigned to the PACS supplier following the incident process |
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The recurring issue is noted and problem management asked to investigate |
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Problem management work with the supplier to identify root cause as being due to more concurrent users than designed for |
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Capacity issues raised with supplier and mitigation actions agreed |
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Service lead monitors service availability following mitigation actions and reports to business through the Head of Service Service Lead |
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Update on mitigation and outcomes to business representatives. Ongoing growth in demand flagged |
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Anticipated demand feeds into the capacity planning led by the head of service and reallocation of resources recommended |
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Reallocation of resources agreed by K&I leadership, but further infrastructure investment need identified |
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Specification of infrastructure required to meet future demand requirements documented and estimated
Investment request fed into overall investment planning process managed by PMO function |
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Investment request fed into overall investment planning process managed by PMO function |
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Legend: |
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Service Desk
Incident Management
Service Performance Review| Figure 13: Scenario 2 - Mobilisation of a Medium Sized Change Project | ||
| Activities | Governance | |
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A hospital group identifies a need for an enhancement to the PACS system. This is raised with the BRM
Solution architect assigned from Enterprise Architecture function to investigate & shape the change
Shaped demand is fed into demand planning |
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K&I leadership confirm appointment of a project manager |
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PM creates business case with BA & Enterprise Arch. input
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Ultimate investment approval is received from K&I steering group |
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Resources scheduled for delivery
Supplier is procured and mobilised |
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Ongoing project status meetings take place where risks, issues and progress are discussed |
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PMO monitor and QA key project metrics |
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Project progress is reported to the business on a regular basis
A resource bottleneck is escalated & capacity from service delivery is temporarily made available |
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Legend: |
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