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CIO interview: Hugo Mathias, CIO, Northampton General Hospital NHS Trust

For all the talk of a ‘paperless NHS’, replacing legacy systems and eliminating paper records is a challenge – but one that Hugo Mathias is tackling through real-time information and cultural change

Any patient interaction with the NHS is likely to involve the pushing of paper. From the Lloyd George envelopes that store patient records in local doctors’ surgeries to the big folders that store healthcare information in hospitals, UK healthcare processes are still hugely reliant on paper – even in an age of digital transformation.

Health secretary Matt Hancock might have banned the NHS from buying fax machines, ordering a complete phase-out by April 2020, but that doesn’t mean removing legacy systems and a reliance on paper is a straightforward task, no matter how many times the government promises a “paperless NHS”.

However, that complexity doesn’t scare Hugo Mathias, CIO at Northampton General Hospital NHS Trust.

“My priority is removing paper records over the next two years,” he says. “I want to digitise the records and then make the information available. We are going to be an information-led hospital.”

Making healthcare better

The CIO’s aim is in sharp contrast to many other healthcare organisations. As many as 26 of 73 NHS trusts still use pen and paper for vital records, according to a recent report from Nuance Communications that was based on a freedom of information request. Yet Mathias is confident he can meet his objective – and he’s feeling positive because he has sponsorship from the senior executives in the trust.

“I wouldn’t be here otherwise,” he says. “I’m heavily incentivised to go as fast as I can. I work very closely with all the board members of the trust. If you’re helpful, the executive team likes you. So we have a good arrangement and we work very well together. They all know they can call me – there’s no such thing as stupid questions, just stupid answers.”

Mathias was appointed CIO at Northampton in June 2017, having previously been CIO at Great Western Hospitals NHS Foundation Trust. The rest of his technology experience across a 30-year career has been split between work at the sharp end of healthcare and stints at major consultancy firms, including Capgemini, KPMG and McKinsey.

“The great thing about healthcare is that it’s a business that cares most about quality and outcomes. I’m able to influence and help implement change. I am determined, by hook or by crook, to make this trust better”

Hugo Mathias, Northampton General Hospital NHS Trust

“The great thing about healthcare is that it’s a business that cares most about quality and outcomes. We work hard to make sure that we do things right, not what’s cheap. In other businesses I’ve been in, I’ve watched people cut corners all the time,” says Mathias.

“Having done consultancy for so many years, [I found I was] handing my concept to people and saying ‘here are the answers’, and then watching as the organisation didn’t have the skills to be able to implement it. Instead, in healthcare I’m now able to influence it and help implement change. I am determined, by hook or by crook, to make this trust better.”

Providing access to data

Mathias points to two major achievements thus far: wider access to real-time information and a vast change in attitude towards technology within the trust.

He has already implemented real-time dashboards that provide up-to-date insight on healthcare in the accident and emergency department and on the hospital wards.

“Ward rounds were typically done and managed before on an old whiteboard with a marker pen,” he says. “It functioned, but it meant there was no visibility when a patient left – and that didn’t work for managing the flow of a hospital that’s really, really busy. What we needed was more real-time information to understand where the patients are going, and have that visibility so we can manage the constant pressures.”

Mathias honed a bespoke, open source system he’d already developed at Great Western to draw this insight together. He gave doctors access to electronic whiteboards, as well as computers and tools to visualise patient information. When doctors do their ward rounds now, they have the information they require, and a set of associated tasks are given to NHS staff on the ward, so everyone in the trust can be sure patient care is moving forward.

The information is displayed on an electronic board in the ward. But because the insight is built in open source and published via HTML5, it could also be displayed on a tablet or any other device. “That’s why we built the system that way,” he says.

Creating a change in attitude

When it comes to the second of his main achievements, which is leading a cultural transformation in the hospital, Mathias says he has drawn on his consultancy experience to help create the right kind of leadership approach.

“We started this programme called ‘being helpful’. We had a huge shift – and so I used my consultancy background to create tools to help with that. We’ve used things like mood elevators, red teaming, and all these kind of things that we know work,” he says.

“My job is to play to people’s strengths and get them working better, not to hit them with a stick”
Hugo Mathias, Northampton General Hospital NHS Trust

“We have routine meetings on a regular basis, where it’s the whole of IT. We do those meetings every month and in those meetings we’ll do team-building exercises. My job is to play to people’s strengths and get them working better, not to hit them with a stick.”

Mathias has also strived to create a cultural shift beyond the IT department. “We’ve taken the IT steering group, which would normally manage everything, and split it into two. So one side is operational and the other side is strategic, and that’s about looking at where we’re going as we move forward,” he says.

“It’s at that stage that we bring all the clinicians in because they need to help us shape the future. They need to be part of the decision-making process, because I can’t pretend I know what’s right for the consultants.”

Introducing process management

Mathias says removing paper and creating an information-led hospital will give doctors and nurses the knowledge they need. He says digitisation relies on managing both structured and unstructured data. The trust is implementing an Alfresco content management system to help with the move towards being a paperless organisation.

“I want to take all the information we have and put it on a screen,” says Mathias. “We can use the content management system to index data, to add meta tags, and do version control – and that all means I’ve got complete control over how information is used and shared.”

While Mathias says the trust remains very paper-based at the moment, he says digitisation efforts, such as critical-noting solutions and back-office automation, where his trust is using Alfresco, will help his team to get rid of paper at a price that’s right for the board.

“I think Alfresco brings best value for money,” he says. “It was a no-brainer – it was something that gave me flexibility to be able to do my planning and, at the same time, wasn’t going to cost the earth to implement.”

Mathias introduced process management around data use, which will also help to stop people around the trust using Excel spreadsheets as databases. While it’s important for hospitals to stop relying on paper, it’s also important that digitisation creates integration and interoperability. With information held in central databases, Mathias says he will be able to start implementing useful data and technology initiatives for the trust’s staff.

“Every computer I’ve been buying recently has a touchscreen,” he says. “The doctors will also be able to add digital dictation. We use best-of-breed software that gives us the best value and we’re using integration tools to bring all that together. We’re also adding single sign-on to these systems, so that it’s easy for the consultant to navigate our services.”

Giving people information

While Mathias says he has made big strides in terms of cultural change over the past two years, he also believes the biggest potential barrier to digitisation remains people. He says cross-organisation education is his biggest challenge, as NHS staff are used to an ingrained way of working and are often resistant to change.

“I’ve tried to stop using the word transformation, because that’s a big word – it’s a scary word,” he says. “While I want people to be outside their comfort zone, I don’t want them to be in the panic zone. And that’s where the word transformation seems to sit when it comes to most people’s heads.”

“The hospital won’t look very different in two years, but it will run differently. You should see very little paper”
Hugo Mathias, Northampton General Hospital NHS Trust

Mathias says he’s presenting his digitisation efforts as a gradual evolution rather than a big-bang transformation. Once again, his consultancy experience plays a role, where the aim is to help people around the trust to recognise that the long-term aim is to get the organisation to a place where everyone is working the best that they can.

“We’re going to work at our pace – I can’t go any faster than my people can go,” he says. “And if I have to go slower, I’ll go slower. But I’m going to go as fast as I can.”

Matthias believes his information-led evolution will produce a lot of benefits. He says the majority of savings the NHS can make are related to back-office processes. But his aim is to lead a cross-organisation change in approach.

“If I can start automating the back-office function, and reducing the time spent on processes for consultants and nurses, then they can do more. Most of the tools we’ve got at the moment are on the clinical side – I’m trying to start doing things for patients and the patient record,” he says.

“The hospital won’t look very different in two years, but it will run differently. You should see very little paper. IT systems will still be seen in the back office of the hospital but, out on the wards, you’ll have people walking around with devices. This change is not about implementing technology, it’s about giving people information.”

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