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“Never waste a good crisis” could be the mantra for CIOs trying to do what’s best for their organisations in a digital age that’s defined by almost constant change. But for Ross Fullerton, CIO at London Ambulance Service (LAS), turning an IT crisis into a better way of doing business has been his job since day one in the role.
Fullerton started working for LAS in May 2017. He joined in the wake of an IT disaster that had seen the service’s computer-aided dispatch system fall over “quite spectacularly” in the early morning of New Year’s Day 2017. Part of the reason Fullerton was hired was to help the organisation learn from that experience and to stop it happening again.
“We depend on our IT systems 24 hours a day to deliver the response of services that London expects of us,” he says. “We do have a really sophisticated set of fallback systems that we’ve tuned over the years, because we know that technology can fail. And if we’re solely relying on technology, then that’s a risk. So we do regular things like testing paper working in the control room. We’ll leave the IT running, but we’ll just stop using it, so that everyone who works in the control room is well-practised in the business continuity side of things,” he says.
“But you never want to have to be using that. So the focus has had to be – and really was for the first six to nine months in post – getting under the skin of the things that make it crucial that we can do the brilliant stuff we do.”
Creating a better service
Unlike many of his healthcare CIO peers, Fullerton has spent time working across a range of sectors and organisations. After starting out in the ICL graduate scheme, he worked on major defence systems before joining PA Consulting, where he worked with blue-chip clients. Following five more years working in defence as an independent consultant, he joined LAS.
“It was time to try my hand at something else,” he says. “I don’t think there’s anything more important than the health and responsiveness of the NHS to Londoners. This was a service that was having a bit of a cry for help.”
“We depend on our IT systems 24 hours a day to deliver the response of services that London expects of us”
Ross Fullerton, London Ambulance Service
Fullerton recognises he inherited an IT system that had a “reputation for being problematic”. It was a challenge that he was eager to embrace – and he believed the answer to many of the organisation’s technological problems lay in its data.
Using data to enable change is the part of the job that Fullerton finds most exciting. The initial process and technology problems that led to the service outage were solved relatively quickly. What has continued to inspire him over the past two years is the opportunity to be part of the leadership team at the only pan-London NHS trust that provides services to patients when they’re in their greatest need.
“Being able to make that a much better service, which is what we’re really doing, is what I’m really excited about,” he says.
Making better connections
Fullerton’s efforts to remedy the organisation’s problematic computer-aided dispatch system helped LAS hit the national ambulance call-out target of seven minutes for the sickest patients last year. In fact, the team – which responds to 1.2 million emergencies annually – went below the seven-minute threshold.
“We were on the scene in an average of six minutes and 28 seconds across the year. In London, getting anywhere on the roads in six minutes is incredible, never mind the fact that those results are timed from the moment the phone starts to ring. Last week, a call came in – and within five seconds of us picking up that call, the vehicle was on its way to the patient,” he says.
“That’s quite amazing. And that’s us doing everything from understanding the location, asking the first questions of the caller to understand whether the patient is breathing, and then – based on specific keywords – automatically identifying the most appropriate resource to send, and triggering that electronically without any other human intervention.”
Fullerton says the smart use of data helps ensure the highest possible level of patient care. He gives the example of a patient in a palliative care situation, who should be directed to a nursing home rather than a busy emergency department. Fullerton says technology can also provide big benefits to LAS staff, particularly hard-working paramedics who could be on the road for a 12-hour shift, four days a week.
“That’s pretty tough,” he says. “So how do we get you connected back with the rest of the world and give you the tools to do a better job? IT had been under-invested in, in terms of picking that up and really making a difference. That’s what motivated me to take the job, and still motivates me to keep on pushing because there’s a lot more to do.”
Leading cultural change
Fullerton says his data-led approach to ambulatory care focuses on two areas: culture and technology. Culturally, his strategy has been about helping the rest of the organisation to understand the art of the possible rather than just the risks of IT.
“At the leadership level, that’s about getting the board to understand how we could be transforming care, and delivering a much better set of outcomes for patients by looking at all the good that can come with digital transformation,” he says.
Fullerton says that focus is a significant pivot for an organisation that has struggled with its problematic IT systems in the past. The key to turning perceptions around has been for the technology team to focus a lot more on engagement with non-IT staff to understand what they want and need.
These partnerships haven’t only been focused on internal relationships. Fullerton says LAS IT professionals spend a large amount of time getting out and talking to their partners in the health and care system, the fire service, the police, and the Greater London Authority. Where the ambulance sector has historically been quite insular, the watchword now is engagement.
“It’s all about changing the culture to get my team and my colleagues who run our operations to go and see how the rest of the world is working, and to think about how we can translate that approach into our own business,” he says.
Getting the basics right
When it comes to technology, Fullerton says his key priority has been equipping the organisation’s staff with the right skills. Bringing internal IT staff up to date involved a combination of getting them out of the building they work in to see the rest of the world, and giving them access to learning and development.
Then – given the organisation’s issues with legacy IT – Fullerton set his skilled workforce on “getting the basics right”. He says much of the LAS technology infrastructure was creaking at the seams. The IT team has replaced the network, including the introduction of reliable Wi-Fi, updated the 999 phone system and refreshed desktop infrastructure.
Ross Fullerton, London Ambulance Service
“It’s the unseen part of NHS technology that is actually the part that matters most to clinicians,” he says. “It’s great having the shiny stuff, but if it takes me 10 minutes to log on to a PC, what’s the point?”
Fullerton says once you’ve got the basics right, people will be more open to engage in a conversation about the “art of the possible”. While there’s always more to do in terms of operational IT, the rest of the organisation now understands that technology systems are workable and reliable.
“We’ve changed perceptions of our service to the extent that the chief executive said, ‘I don’t get people complaining to me about IT anymore, Ross’. That was a seminal moment,” says Fullerton.
Delivering innovative technology
With the basics ready, Fullerton and his IT colleagues are now working on the art of the possible. They’ve rolled out around 4,500 4G-connected iPads to every frontline clinician. His IT organisation is also investigating how it can use Facebook as a messaging platform to help health staff on the road to connect and collaborate.
LAS is working with NHS Digital to become the first healthcare trust in the country to provide access to patient care records without needing an NHS smartcard. Smartcards, which are similar to Chip and PIN bank cards, allow healthcare professionals to access clinical and personal information that is appropriate to their roles.
Rather than having to use smartcards, LAS healthcare staff can use their iPads to access care records, as Fullerton says the Apple technology includes enough in-built security features. While that project has involved a lot of preparatory governance work alongside NHS Digital, it has had a transformative impact on healthcare provision.
“Our staff absolutely love the fact that it’s really easy,” says Fullerton. “It’s not another password; there’s not another thing to remember. It’s quick access to the basic information they need about a patient to deliver better care on the scene.”
Fullerton says video is another exciting area of innovation. LAS is pioneering the use of video on-scene. Workers in the control room text a link to the caller’s phone. The caller can click on this link and send video securely back to the control room. LAS staff can then assess what type of back-up resources might be required on-scene, such as advice or an air ambulance.
“That’s really exciting in terms of the opportunities of much better patient care,” he says, reflecting on the level of change since New Year’s Day 2017. “We are now the focal point for a lot of what’s happening in the NHS in London for these advanced technological developments.”
Read more NHS CIO interviews
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- As well as the usual IT leadership tasks, the Health Education England CIO James Freed is also responsible for helping to develop digital skills.
- NHS Business Services Authority chief digital officer Darren Curry talks about using technology to change people’s lives, developing accessible services and transforming the health service.