Mark Dundon's thoroughgoing overhaul of business intelligence and advanced analytics in NHS South Yorkshire will not only improve patient outcomes by identifying preventative interventions but also save unnecessary expenditure and help plug a projected £30bn NHS gap by 2020. Job titleCIO and CTO of NHS South Yorkshire. When did you start your current role?April 2014. What is your reporting line?CEO. Do you meet with and discuss business strategy with the CEO every week?Yes. My contribution as CIO is fundamental to the business strategy. Are you a member of the board of directors?Yes. What other executive boards do you sit on?I am chair of a non-exec board running a programme for around 1,000 community volunteers in South Yorkshire. Does your organisation have a CDO?No. What might be considered CDO responsibilities are integral to my own role as CIO. What non-technology responsibilities do you have in the organisation?I account-manage a portfolio of commercial and board-level relationships with customers representing a contract value of £40m. I meet regularly with CFOs, CEOs, COOs from within CCGs (clinical commissioning groups) and FTs (foundation trusts). I ensure the services they pay for are delivered according to contract. I ensure our contract value is protected. I assist in their commercial strategy development, which in turn develops opportunities to develop new business. I have direct P&L accountability and accountability for launching new products to market. I also represent the company across all Yorkshire and Humber NHS entities (CCGs, GP practices, hospitals, community care centres, etc) taking care of six million patients. And I proactively contribute to the development of city-wide digital strategy by sitting on city-wide strategic boards. How many employees does your organisation have?1,100. What number of users does your department supply services to?We supply services to six million patients in Yorkshire and Humber, serviced via 720 GP practices and 100 hospitals. We have 30,000 end-user mobility and desktop/laptop accounts. How do you ensure that you have a good understanding of your business and how your customers use your business's products?I spend 70% of my time with customers and managing their accounts. I listen to their needs and together we formulate strategic direction while discussing real immediate problems that need to be overcome. I take the time to visit and participate in local medical councils (made up of leading GPs). I visit practices and hospitals to see the technology and intelligence that we supply in action. I personally lead and drive the thought leadership initiative of what excellent commissioning is and how intelligence supports it. I arrange events and speak and hold panel discussions at events. I network across NHS England to understand the wider market context across the health economy and its financial and political challenges (for example, Simon Stevens’ five-year forward view for the NHS). I keep an eye on current affairs politically and economically. I actively participate in board-level strategy and discussions. I proactively work with other directors to understand their needs and collaborate to identify solutions. I regularly remind myself that we are here to improve patient care. NHS Yorkshire and Humber CSU technology strategy and agenda Is your organisation being disrupted by the internet, mobility or technology-oriented start-ups?Yes. Are you empowered by your organisation to disrupt from the inside?Yes. Describe a disruptive measure you’ve led or played a major part inI defined and stakeholder-managed a leadership and organisational restructure to become commercially focused across our service delivery to customers while at the same time focusing on taking care of staff by professionalising functions through certification and allowing for career development. Customers (and ultimately patients) are now starting to see the benefits. The model was used corporation-wide, not just in my directorate. Digitally we have introduced common technical solutions well used in the private sector while driving innovation over the top. For example, a key initiative is to fully exploit the benefits and potential of unified communications. I chose MS Lync as an integrated solution and partnered with a cloud provider. This is proving very beneficial with rapid deployment and upscaling to keep pace with demand. Already we are cutting down on travel expense and productivity inefficiency as senior leadership travel around 16,000km to the tune of £2m a year. We have persuaded GP practices to participate in a pilot for unified communications and videoconferencing tools. Remote diagnosis and monitoring of patients is done via videoconferencing, and reviews of clinical documentation can be done using desktop collaboration. This allows for the vulnerable and elderly who cannot travel to still be seen, treated and cared for. It also increases GP productivity by reducing the number of missed appointments and wait times for appointments. Field nurses can access patient records and medical scans on mobile devices inside a patient's home, allowing the elderly to live in their own home instead of care homes, and we have smartphone-enabled health monitoring equipment. In the case of diabetes, smartphone can be used with additional equipment plugged in as peripherals to take measurements and provide real-time results with blood tests for sugar levels to GP surgeries. Real-time messages can be relayed back to the patient via the GP surgery. What major transformation project has been recently completed or is under way at your organisation?There has been a major £10m overhaul of business intelligence and advanced analytics services to cater for the care needs of six million patients. BI services had been segmented and duplicated, largely inefficient and used outdated and expensive technology, with minimal automation and significant manual effort required. Advanced analytics was minimally leveraged. As part of my 90-day plan when I started in April 2014 I spent six weeks on the road listening to our customers, CEOs and CFOs. I also made my own observations internally and reflected against what I saw BI needs to be nationally across the NHS to support the commissioning of patient-based services and the financial contract management. The outcome was the definition of an advanced analytics BI strategy to support health commissioners across the UK and help prevent a £30bn NHS deficit gap by 2020. The strategy was defined and is now being delivered. This level of strategic activity and customer engagement around BI to support commissioning has been unique. Customers and commissioning support unit (CSU) staff now speak the same language and terminology. A key component of the strategic delivery was the joint venture with another CSU, which I personally brokered. Significant technical transformation will be required across legacy infrastructure. There will also be significant transformation across the structure and operating model to deliver the strategic service to customers. Leadership will be required to engage and pull together multiple entities into the virtual team operating model and a common set of goals. The ultimate outcome is not only to provide pretty graphs and reports but a real intelligent capability. What impact will the above transformation have on your organisation?Business intelligence is required across every service line within the NHS. The CSUs with a strong market-competitive BI/analytics strategy will survive; those without one will be consolidated. The primary aim is to improve patient outcomes by identifying preventative interventions and ultimately save unnecessary expenditure. For example, BI can identify people who have the propensity to develop a condition based on intelligent data analysis of what is happening with them. GPs are under pressure; they have lots of patients and are treating on a transactional basis, so don’t easily have the ability to monitor trends and project propensity. Another scenario is to prevent patients moving into secondary care such as hospitals by treating them in GP practices and health centres. Secondary care is very expensive and is under pressure. The more intelligence a CCG has about its patient population, the more interventions can be made to improve patient experience and also save significant amounts of money. How has your leadership style contributed to the outcomes of the transformation project?I have had to be brave, creative, tenacious and expert at managing stakeholder relationships, engage with customers, and demonstrate technical capability but also commercial acumen and market-context awareness. Ultimately I’ve had to use my reputation and expertise to instil confidence of direction and bring together a board of directors, 23 CCG board-level customers, and 400 staff to head in the same direction. I have had to draw on every facet of my ability to lead in a dynamic way depending on the type of people, culture, and environment I am operating in. Every CCG operates differently despite being fundamentally the same type of organisation. What key technologies do you consider enable transformation?Technology agility is critical. Don’t be too pedantic about specific technologies or tools. Very few transformation programmes are the same, and each will have varying demands on technology. There are, however, some key consistencies across every piece of transformation that I have led: creativity, communication, collaboration, organisation and tenacity. Use any technology that can promote and improve these to achieve delivery and outcomes. Creativity.iThoughts for mindmapping and brainstorming is a cracking tool. I haven’t seen anything better. Communication.Verbal dialogue cannot be beaten – telephone! Better still VC – unified communication tools. Email is not the technology for this. To communicate strategy and transformation, I like to be visual and stand in front of stakeholders to communicate. Apple KeyNote and MS Powerpoint have their flaws but they are excellent tools to help deliver key communication. Collaboration.Unified communications for cross-geography desktop sharing and editing of documents. Organisation. Programme delivery methodologies cannot be understated. The key risk to any transformation programme is the detail behind planning. Lack of planning is a common failure point. Use Gantt charts, WBS, proactive and proper critical path management. A personal favourite of mine is MS Project. Tenacity.I use the likes of Wunderlist as a task manager; as it is cloud and social-based, I can delegate tasks and monitor their progress. I can also receive feedback and updates. Ultimately they all help to get things done. Attention to detail cannot be underestimated. Are you expanding the number of cloud applications or infrastructure in use at your organisation?Yes. What is your information and data analytics vision for the organisation?BI is not just about data and graphs, but about providing real insight and intelligence to health commissioners to make the right decisions for their patient demographic. Data sources, tools and dashboards are only a means to an end – the intelligent interpretation and triangulation of information along with the context and a real understanding of local health economy needs to be harnessed. Patient segmentation is an example of advanced statistical analysis and predictive modelling that will allow every CCG to cut across and understand its population of 250,000. Patient-level costs and inefficiencies will be exposed and aid decision-making around pathway improvements and areas of expenditure. Patient-level costs and intelligence from the segmentation exercise will facilitate more precise commissioning and performance management contracts with providers and will in turn provide financial benefit to the CCG. How is mobile and social networking impacting operations and customer experience?Mobility is an integral part of telehealth, telemedicine and telecare initiatives. Tablets and smartphone devices owned by patients can allow them to take greater control of their health, engage with clinicians when they need diagnosis and be monitored in real time when they are being treated. These initiatives are changing how we interface and integrate with health provision. Describe your strategic vision towards shadow IT and BYOD. How do you influence and engage executives and employees around choice?We have a small R&D function with creative personnel who are empowered to engage the market for appropriate potential partnerships and create innovative shadow IT solutions in a protected ringfenced environment. Some interesting solutions have arisen out of this function and we are now exploring potential partnerships as a result. For example, one of the more advanced stage partnerships will allow us to expand our telehealth initiatives, supplying GP practices with equipment that connects to smartphones and can allow patients to better manage their own health pre-emptively but also on a continuous monitoring basis. I have no plans for BYOD holistically, but I do have an agile working strategy to allow field nurses, for example, to be with patients in their homes but still have access to what they need when they need it. Equipment is provided in the main and there is some flexibility to utilise own devices where convenient. Cloud-based outsourcing such as email, telephony and unified communications have allowed for this as it removes any dependency on specific platforms or infrastructure. Instal, login and go. What strategic technology deals have been struck and with whom?Virgin Media is partnering with us to consolidate services such as telephony (mobile and fixed) as a managed service, network management and on the back of network reach to other organisations provide opportunities for new business development with our in-house solutions such as VDI/desktop in the cloud that we can take to market and provide to any entity including non-NHS. Virgin provides the infrastructure, we provide the services. This increases revenue potential and profit can be reinvested back into patient care services. Who are your main suppliers?BT, Cisco, Virgin Media, Kingston Comms, HP, Juniper, Aruba, Dell, Apple, Microsoft. NHS Yorkshire and Humber CSU IT security and budget Has your organisation detected a cyber intrusion in the last 12 months?No. Has cyber-security risen up your management agenda?Yes. Does your organisation understand the potential cyber-security threats it faces?No. Has this led to an increase in your security budget?No. What is the IT budget?£30m opex and capex. How much is the IT operational spend compared with the revenue as a percentage?15%. What is the strategic aim of the CIO and IT operations for the next financial year?Organisational change: complete the operating model and people-focused initiatives around personal development, succession planning, and university partnerships for graduate recruitment. Strengthen foundations: rationalise and consolidate the technical estate post-merger. Solidify the financial viability and quality of service delivery provided to customers. Improve patient care via our commissioning customers: deliver transformation and strategy across advanced analytics/BI and telehealth/care/medicine (digital and mobile technology solutions used in GP practices, hospitals, etc, putting care into the hands of the patient). Are you finding it difficult to recruit the talent you need to drive transformation?Yes. Has recruitment and retention risen up your agenda as a CIO?Yes. Are you looking for recruits in the EU to fill the skills shortage you have?Yes. Does your IT organisation operate an apprenticeship scheme?Yes. NHS Yorkshire and Humber CSU technology department How would you describe your leadership style?I once critiqued my leadership style in a paper I wrote as part of my MBA. I concluded that I was a personable, people-focused, yet task-focused leader with a dynamic leadership style that met the needs of the culture, environment and context of delivery within the organisation I worked in. Explain how you’ve supported and developed your senior leadership team to support your overall objectives and visionAt the start of my role I was informed of a merger between two organisations. I was asked to lead the merger of the two sets of technology and intelligence directorships and I became the CIO for both. I had to very quickly ascertain the needs of customers, the current position of capability and structure within the two organisations, define a vision and create a supporting operating model and consequent organisation structure to support that operating model. Invariably this resulted in gaps within leadership. It also created opportunities for me to onboard existing leadership with the vision. It transpired that there was a real appetite for change and a fresh approach as the status quo was recognised as not adequate. My leadership team didn’t exist, so I had to create it. I provided it with the foundation of a clear vision and set of objectives that already had stakeholder buy-in. I took every opportunity to repeatedly talk about the vision and strategy that I had defined. I created a story line with key salient points so that whatever the opportunity I knew what to get across and could expand as much or as little in the allotted timeframe. I empower my leadership team to lead and deliver in the way they feel best. While the how is important, and has to be in harmony with the culture and values I lead with, I support my leadership team to produce outcomes in their preferred way. My direct reports each have defined objectives that are clearly traceable back to the vision and strategy. They report back on those objectives in my weekly leadership team meeting. How many employees are in your IT team?400 full-time staff, around 50 contractors. What is the split between in-house/outsourced staff?About 90:10. Does your team include key skilled workers from the EU?Yes.