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Influencing the Digital Agenda – A nurses’ tale John Rayner Regional Director - EMEA

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•  Airey Neave assasinated •  Antiques Roadshow 1st Broadcast •  Blunt Treason Revealed •  Death of Blair Peach •  Hitchhiker's Guide to the Galaxy Published •  Lord Louis Mountbatten assasinated by IRA •  Margaret Thatcher becomes Britains 1st

Female PM •  Public Sector Strike Begins •  Space Invaders Hit UK •  The Clash Release London Calling •  Worlds first £1 Million footballer is bought

What year is it?

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•  Airey Neave assasinated •  Antiques Roadshow 1st Broadcast •  Blunt Treason Revealed •  Death of Blair Peach •  Hitchhiker's Guide to the Galaxy Published •  Lord Louis Mountbatten assasinated by IRA •  Margaret Thatcher becomes Britains 1st

Female PM •  Public Sector Strike Begins •  Space Invaders Hit UK •  The Clash Release London Calling •  Worlds first £1 Million footballer is bought

What year is it?

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Introductory Course 38 (IC38)

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Qualified 1982…. To present •  Staff Nurse Theatres •  Staff Nurse General Surgery •  Charge Nurse Theatres •  Charge Nurse ICU •  Order Comms Project Nurse •  Clinical Information Manager •  Resource Management PM •  General Manager Medical Services •  General Manager Surgical Services •  HA Programme Manager IfH •  HA Director of Modernisation •  Assistant Director THIS •  CIO and Managing Director THIS •  Director of Professional Development (HIMSS UK) •  Regional Director EMEA (HIMSS Analytics)

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Qualified 1982…. To present •  Staff Nurse Theatres •  Staff Nurse General Surgery •  Charge Nurse Theatres •  Charge Nurse ICU •  Order Comms Project Nurse •  Clinical Information Manager •  Resource Management PM •  General Manager Medical Services •  General Manager Surgical Services •  HA Programme Manager IfH •  HA Director of Modernisation •  Assistant Director THIS •  CIO and Managing Director THIS •  Director of Professional Development (HIMSS UK) •  Regional Director EMEA (HIMSS Analytics)

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•  Two patients fell off the operating table

•  Multiple drug errors •  Operation on the wrong hand •  Wrong radiological examination •  Patients given drugs that they

were allergic to •  Anaesthetic accidents •  Multiple recording errors

•  Blood transfusion issues •  Operator error •  Countless missing or

unavailable case notes •  PM on wrong patient •  Faulty placement of mattress •  Diathermy and instrument

burns •  Equipment injury

In 40 years….

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250,000 US Citizens die each year as a result of Medical Error…..

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250,000 US Citizens die each year as a result of Medical Error….

9.5%ofthetotalnumberofannualdeaths8000ofthosearedrugerrors

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The NHS causes 40,000 deaths a year…..

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The NHS causes 40,000 deaths a year…..

7%ofthetotalnumberofannualdeaths900ofthosearedrugerrors

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More than 200 million medication errors occur in NHS per year, say researchers •  A study has revealed an estimated 237 million medication errors occur in the NHS in

England every year, and avoidable adverse drug reactions (ADRs) cause hundreds of deaths.

•  Researchers from the Universities of York, Manchester and Sheffield report that an estimated 712 deaths result from avoidable ADRs. They say, however, that ADRs could be a contributory factor to between 1,700 and 22,303 deaths a year.

•  Of the total estimated 237 million medication errors that occur, the researchers found that almost three in four are unlikely to result in harm to patients, but there is very little information on the harm that actually happens due to medication errors.

•  Elliott R, Camacho E, Campbell F, Jankovic D, Martyn St James M, Kaltenthaler E, Wong R, Sculpher M, Faria R, (2018). Prevalence and Economic Burden of Medication Errors in The NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK. Policy Research Unit in Economic Evaluation of Health and Care Interventions. Universities of Sheffield and York

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An easy mistake to make…

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An easy mistake to make…

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Making the local news…

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World Health Organisation….

•  2018 – 10 Facts on patient safety

•  https://www.iapo.org.uk/news/2018/nov/6/world-health-organizations-10-facts-patient-safety

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•  It is estimated that there are 421 million hospitalisations in the world annually, and approximately 42.7 million adverse events occur in patients during these hospitalisations. Using conservative estimates the latest data shows that patient harm is the 14th leading cause of morbidity and mortality across the world.

Fact 1: Patient harm is the 14th leading cause of the global disease burden.

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•  Estimates show that in high income countries as many as 1 in 10 patients is harmed while receiving hospital care. The harm can be caused by a range of incidents or adverse events, with nearly 50% of them being preventable

Fact 2: While in hospital, 1 in every 10 patients is harmed

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•  Medication errors occur when weak medication systems and/or human factors such as fatigue of personnel, poor working conditions, work flow interruptions or staff shortages affect prescribing, dispensing, administration and monitoring practices, which can then result in severe harm, disability and even death.

Fact 3: Unsafe use of medication harms millions and costs billions of dollars annually

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•  Recent evidence shows that 15% of total hospital activity and expenditure in OECD (Organisation of Economic Cooperation and Development) countries is a direct result of adverse events, with the most burdensome events including venous thromboembolism, pressure ulcers and infections.

Fact 4: 15% of health spending is wasted dealing with all aspects of adverse events

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•  Investment in reducing patient safety incidents can lead to significant financial savings, not to mention better patient outcomes.

•  In the United States alone, focused safety improvements led to an estimated US$ 28 billion in savings in Medicare hospitals between 2010 and 2015.

Fact 5: Investments in reducing patient safety incidents can lead to significant financial savings

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•  Of every 100 hospitalised patients at any given time, 7 in high-income countries and 10 in low and middle income countries, will acquire health care-associated infections (HAIs), affecting hundreds of millions of patients worldwide each year. Each year around 3.2 million patients are infected with HAIs across the European Union and a total of 37 000 of them die as a direct consequence.

Fact 6: Hospitals infections affect 14 out of every 100 patients admitted

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•  Findings by WHO suggest that surgery still results in high rates of morbidity and mortality globally, with at least 7 million people a year experiencing disabling surgical complications, from which more than 1 million die.

Fact 7: More than one million patients die annually from surgical complications

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•  Research shows that at least 5% of adults in the United States experience a diagnostic error each year in outpatient settings. Recent postmortem examination research spanning decades has shown that diagnostic errors contribute to approximately 10% of patient deaths in the United States of America. In Malaysia, a cross-sectional study in primary care clinics ascertained a prevalence of diagnostic errors at 3.6%.

Fact 8: Inaccurate or delayed diagnoses affect all settings of care and harm an unacceptable number of patients

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•  Worldwide, there are over 3.6 billion x-ray examinations performed every year, with around 10% of them occurring in children. Additionally, there are over 37 million nuclear medicine and 7.5 million radiotherapy procedures conducted annually. Inappropriate or unskilled use of medical radiation can lead to health hazards both for patients and health care professionals.

Fact 9: While the use of radiation has improved health care, overall medical exposure to radiation is a public health and safety concern

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•  Recent literature reviews have revealed that medical errors in primary care occur between 5 and 80 times per 100 000 consultations.

•  Administrative errors - those associated with the systems and processes of delivering care - are the most frequently reported type of errors in primary care. It is estimated that from 5 to 50% of all medical errors in primary care are administrative errors.

Fact 10: Administrative errors account for up to half of all medical errors in primary care

KEYFINDINGS

Lesson1:HealthITisnotsufficientlyfundedandsupportedinEuropeAlthoughthevastmajorityofthehealthcarefacilitiesseeITasanenablertoimprovepatientsafetyandcare,mostrespondentsjudgetheirITbudgetstobeinsufficient.TheyalsofeelalackofcentraldirectionandsupportinordertoprogresstheireHealthagendas.

Lesson2:Focustopicsforthenext12monthsareElectronicMedicalRecordsandHealthInformationExchangeTheimplementationofElectronicMedicalRecordsandtheenablementofHealthInformationExchangearekeypriorities(orchallenges)atthemomentandarelikelytotoptheagendasoverthenextfewyears.

Lesson3:eHealthshiftstowardsthePatientPatientHealthRecords(ownedandmanagedbycitizens)aswellaspatientself-monitoringtoolswillreceivemuchmoreattentionandfundingoverthenext2-3years.EvenincountriesthatstillstruggletoenableclinicalstafftoworkwithelectronicmedicalrecordseHealthprofessionalsrealisethatthetideisshiftingmoreandmoretowardspatient-centricsolutions.However,EMRsandregional/nationalHIEswillbekeybuildingblocks.

Lesson4:Electronicmedicalrecordsarealreadymuchmorecommonthanpaper-basedones.Exceptinsomecountries.WhileinIrelandlessthanhalfofpatientrecordsaredigitised,AustriaandtheNetherlandsonlyhavearelativelyshortwaytogoinordertocompletelyeliminatepaper-basedmedicalrecords.Acrossallcountries,about75%ofpatientdataaredigitisedinEuropeanhealthfacilities.

Lesson5:eHealthprofessionalswanttoimprovetheirleadershipskillsHealthcarefacilities,ITsoftwarevendors,governmentalhealthauthoritiesandotherprofessionalorganisationsalloverEuropeshouldprovideopportunitieswhereemployeescanfurtherdevelopcrucialleadershipskills.ThefutureofeHealthreliesoneHealthleadersspeakingupandhelpingleadtheirorganisationsdownthepathofdigitisation.Italsoreliesonsmartmindsdoingtherightthings.Anddoingthemright.

eHealthBusinessclimate:ThebusinesstrendforeHealthcontinuestobepositiveinmostsurveyedcountries.AnexceptionistheUnitedKingdomwhereexpectationssignificantlydeclinedrecently.

LessonsoneHealthinEurope5

CURRENTE-HEALTHPRIORITIES–BYTYPEOFORGANISATION

WhatisthebiggesteHealthPRIORITYforhealthcareprovidersatthemoment?[Totalincluding“other”]

ThethreebiggesteHealthprioritiesatthemomentareEMRimplementations,projectstoexchangemedicaldatawithexternalpartnersandtheprovisionofaccessforpatientstotheirhealthinformation.Enablingpatientstoaccesstheirmedicalrecordsactuallyismuchlessapriorityforhealthcareprovidersthanforgovernmentalhealthauthorities.

Totaln=548

Governmentalhealthauthorityn=59

ITSoftwarevendorn=98

Healthfacilityn=233

Updatinghardwareand/ornetworkresourcesArchivinganddocumentation

MedicationsafetyUseofmobiledevices

TelemedicineClinicianaccesstoinformation

DataexchangewithintheorganisationCybersecurity

PatientaccesstoinformationDataexchangewithexternalpartners

EMRimplementation

AVAILABILITYOFCLINICALLYFOCUSEDITREPRESENTATIVES

WhichofthefollowingclinicallyfocusedITrepresentativesareavailableinyourorganisation–atdirectorlevelorequivalent?[Totalincluding“other”;onlyparticipantswhoareworkinginahealthfacility]

HavingaChiefClinicalInformationOfficer(CCIO)ismorecommonintheNetherlandsandtheUKthaninGermanyorSwitzerland.AformalisedpositionthatactsasleadingITrepresentativefromnursingstaffisstillratherrareinEurope.

TotalGermanyAustriaSwitzerlandNetherlands

NordicCountriesUnitedKingdomIrelandItalySpain

ChiefClinicalInformationOfficer(CCIO)n=113

ChiefNursingInformationOfficer(CNIO)n=43

Other*n=39

Nonefromaboven=87

Validresponsesbycountry:Total:n=282;Germany:n=26;Austria:n=15;Switzerland:n=36;Netherlands:n=35;NordicCountries:n=37;UnitedKingdom:n=33;Ireland:n=26;Italy:n=15;Spain:n=35

*„Other“clinicallyfocusedITrepresentativesare:HeadofIT,DirectorofInnovationineHealth,ChiefScienceInformationOfficer,CIO,ITtechnician…

ITASENABLERTOIMPROVEDPATIENTSAFETYANDCARE

IsITseenasanenablertoimprovedpatientsafetyandcarewithinyourorganisation?[Totalincluding“other”;onlyparticipantswhoareworkinginahealthfacility]

95%ofhealthfacilityemployeesseeIT–tosomeextent–asenablertoimprovedpatientsafetyandcare.However,intheUKorAustriathereseemstobeabitmorescepticismabouttheroleofITthaninSpainortheNetherlands.

Yes Somewhat No

Validresponsesbycountry:Total:n=236;Germany:n=24;Austria:n=13;Switzerland:n=30;Netherlands:n=27;NordicCountries:n=33;UnitedKingdom:n=20;Ireland:n=24;Italy:n=15;Spain:n=30

6.0 5.4 5.6 6.0 6.4 6.2 6.1 4.4 7.3 6.773% 63% 87% 64% 87% 84% 67% 42% 79% 80%0%10%20%30%40%50%60%70%80%90%100%

n=209

n=207

n=23

n=23

n=12

n=12

n=25

n=26

n=27

n=26

n=28

n=30

n=18

n=14

n=22

n=20

n=12

n=13

n=26

n=26

Total Germany Austria SwitzerlandNetherlandsNordicsUnitedKingdomIreland Italy SpainTotal

DIGITALMATURITYANDAMOUNTOFDIGITISEDPATIENTDATA

Howwouldyourateyourorganisationintermsofdigitalmaturity?[meanvalues;scalefrom1”notmatureatall”to10“extremelymature”;onlyparticipantswhoareworkinginahealthfacility]

Electronicmedicalrecordsarealreadymuchmorecommonthanpaper-basedones.Overall,almostthreequartersofpatientdataaredigitised.InAustria,theNetherlands,theNordiccountriesandinSpain80%ormoreofpatientdataareavailableinelectronicformat(althoughAustrianeHealthProfessionalsdon’tperceivethemselvesdobedigitallyverymature).Irelandstillcreatesalotofpaperrecords.

Extremelymature

Notmature

atall 1

10

Whatpercentageofpatientdatainyourorganisationisdigitised?[Scalefrom0%-100%;onlyparticipantswhoareworkinginahealthfacility]

DigitalMaturity(self-assessment) PatientDatainDigitalFormat(self-assessment)

n=209n=207

SUFFICIENCYOFITBUDGETIN2017/18

DoyouthinkyourorganizationhassufficientITbudgetfor2017/2018?[Totalincluding“other”;onlyparticipantswhoareworkinginahealthfacility]

There’shardlyeverenoughmoney.Amajority(62%)ofhealthcareemployeesperceivestheirITbudgetbeingtoolow.Physicians&nursesareevenmoreconcernedaboutinsufficientITbudgetsthanITemployees.Country-wisethesituationseemstobeparticularlydifficultinIrelandandItaly.

Yes

No

Validresponsesbycountry:Total:n=212;Germany:n=24;Austria:n=9;Switzerland:n=26;Netherlands:n=24;NordicCountries:n=26;UnitedKingdom:n=20;Ireland:n=21;Italy:n=15;Spain:n=26;ITstaff:n=115;Physicians&Nurses:n=40

46%

44%

65%

46%

46%

20%

14%

13%

28%

38%

54%

56%

35%

54%

54%

80%

86%

87%

72%

62%

GermanyAustria

SwitzerlandNetherlands

NordicCountriesUK

IrelandItalySpain

Total

25%75

%

Physicians&Nurses

43%57

%

ITStaff

…byprofession

4.6

4.5

4.4

4.3

4.2

4.2

4.1

4.0

4.0

Spain

Ireland

Italy

Germany

UnitedKingdom

Austria

Switzerland

Nordics

Netherlands

4.3

4.3

4.3

0.0

4.2

Governmentalhealthauthority

ITSoftwarevendor

Healthfacility

Total

IMPROVEMENTOFLEADERSHIPSKILLS

Howimportantisforyoutobeabletodevelopyourleadershipskillswithinyourrole/organisation?[Totalincluding“other”;meanvalues;scalefrom1“notimportant”to5“veryimportant”]

"Theonlysafeshipinastormisleadership."(FayeWattleton)There’sabigappetitetoimproveleadershipskills.E-Healthprofessionalsfromalltypesoforganisationsandfromallcountrieswouldliketobebetterleaders.Employersshouldconsidertoprovideappropriatetrainingopportunitiesinordertokeeptheirstaffhappy,butalsotoguidetheirorganisationsuccessfullythroughthedigitaltsunami.

…byCountry/Region…byTypeofOrganisation

5VeryImportant

1NotImportant

n=467

n=204

n=92

n=46

Validresponsesbycountry:Germany:n=54;Austria:n=30;Switzerland:n=54;Netherlands:n=57;NordicCountries:n=77;UnitedKingdom:n=32;Ireland:n=33;Italy:n=27;Spain:n=50

5VeryImportant

1NotImportant

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Trend 5

Improve Leadership skills Fact 5: eHealth professionals want to improve their leadership skills Healthcare facilities, IT software vendors, governmental health authorities and other professional organisations all over Europe should provide opportunities where employees can further develop crucial leadership skills. The future of eHealth relies on eHealth leaders speaking up and helping lead their organisations down the path of digitisation. It also relies on smart minds doing the right things. And doing them right.

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In summary…

•  Finance –  Making better use of insufficient resources

•  Electronic Medical Records –  The desire to digitise

•  Reducing the paper –  Still hearing the excuses but steady progress

•  HIE and interoperability –  External connections are more important now that ever before

•  LEADERSHIP –  The challenge for all of us

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Thoughts on the nurse influencer – It’s a leadership thing!

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•  Stay close to your people / team

•  Be accountable •  Take responsibility •  Discuss their issues in an open

and honest way •  Give your advice willingly

Be accessible…..

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•  The same things happen when you are there as when you are not there.

•  You don’t need to be present to uphold the standards

•  Culture is as strong as the strategy

Manager the culture - And the culture will manage the business

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Don’t neglect the detail but stay out of it for as long as you can..

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•  Permissions, procedures and policies

Push the boundaries – You never know what you can get away with…

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•  Organisational charts and fancy titles count for little.

•  The power of the leader comes from within not from the name badge.

•  Leadership is an action not a position

Position power

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“In a world full of data and information there is a danger that we confuse knowing with doing”

Leadership is a doing thing….

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•  The more power one accumulates the less you need to use.

•  Use it carefully, responsibly and meaningfully

•  Use power wisely

Use of power…

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•  Be a person of the people •  Make the coffee •  Drive the van •  Shift the snow •  Have respect •  Do you walk the talk?

Try and attract the best people….

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•  Reinvent yourself •  Reinvent your job •  These jobs are often what you

them

Be prepared to reinvent yourself…

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•  Have enthusiasm and optimism •  Leaders who moan and groan,

engender the same characteristics in their people

•  Crack on or quit •  Leadership is about doing the

right thing on a difficult day

Get up, dress up and show up

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•  Learn to summarise •  Summarise and move on •  Move on and summarise again

KISS – Leaders are great simplifiers

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•  Taking responsibility and being accountable occasionally means that you are going to piss people off

Prepare to be unpopular….

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Use the P = 40 – 70 principle

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•  But not yourself… •  Being able to see the funny side bursts the balloon of pomposity.

•  Being able to laugh at yourself and be self deprecating shows that you are not afraid.

Take your work seriously…

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•  Accountability is a two way process.

•  Keep decision making at the lowest possible level

•  Make any decision you can afford to make

•  When the going gets tough – devolve more

•  Judgement calls

Devolve leadership responsibility to everyone and anyone who wants it…

@Himssjohn

jrayner@himss.org