618 - Real World Challenges & Successes in Implementing Healthcare Technology with Rauland Australia & New Zealand

Host: Hey, if you're interested in digital health but you're not sure where you fit, I made something that you should check out. I'm pretty excited about it too. It's the THT Digital Health Career Toolkit. It's a free five day email series designed to help you on your health tech career journey. There's lots of valuable insights in there, no matter what stage you're at. Head to TalkingHealth Tech Toolkit to get your free access

Speaker B: Foreign.

Host: I'm here in Melbourne, Australia for the Talking Health Tech Healthcare Leaders breakfast where we brought together about 80 individuals with a long subscriber list of people wanting to get in the room. And we brought together an expert panel to talk about the real world of implementing healthcare technology and to record this episode of the podcast today. If you want to find out about these sessions before they happen so you can be here live in the room, make sure subscribe to our newsletter@chalksandhealthtech.com Newsletter Collaboration starts with a conversation Team Health Tech let's make it up. Firstly, I need your assistance in welcoming who I have on the stage here, Vicky Knight, General Manager for Clinical Services, and Jacqueline Leeds, CEO from Rowland, Australia and New Zealand. So, uh, actually I might throw to uh, Jacqueline first. Can you introduce yourself, tell us a bit about you, the role that Roland plays and um, get the conversation started.

Jacqueline Leeds: Absolutely. Morning everyone. So, firstly Jackie, uh, why we're here and I guess the role we play is we've had the privilege of partnering with many hospitals and uh, healthcare districts all across Australia, New Zealand, for gosh, it'd be more than 30 years now. You know, we've been well established in really solving for, for patient outcomes and doing it with some pretty intelligent and advanced technology. And this was a great opportunity this morning to really talk to a lot of the experiences and the fact that we live and breathe these deployments and we work in that environment every day. There's a lot of learnings. So in terms of what we can share, we feel we come from a good place of context, how we do it and the approach. Looking in short, and to break it down into something that is pretty advanced, but we built a platform and we call it Concentric Care. But this platform is sitting between clinical systems and the ICT infrastructure of the hospital environment. And it's essentially bringing together all of these systems and ensuring that they can talk to each other. Now for most of you in the room, you would well know there's a lot of systems, there's a lot of touch points and getting that Interoperability is certainly a complex challenge, uh, let alone the legacy systems that come into that. But that's where the opportunity, uh, is to really bring together and ensure that technology works. So what we're doing then is to ensure that we're getting those streamlined clinical workflows and we're unifying all that communication, uh, across those systems. There's also a really important part of that platform, which is an engine we call Reach. That engine is handling all the intelligent messaging, the critical messaging. So if you think about all the types of workflows, uh, and certainly the data, uh, and alerts that are coming across everything from building management systems, clinical systems, the entire environment, how do you unify that and direct it to where it needs to go? How do you make sure you're getting really productive outcomes, let alone the right responses to it? So the platform's incredibly intelligent in that sense, uh, and in terms of how we actually bring it all to life and in the context of the deployment. Well, we have a great team, I have to say, very proud of the team, uh, that's been built that a combination of software engineers, solution architects, clinicians, and they're working together in an environment to not only build the technology, but they partner incredibly closely every day in the hospital environment at network level, working with ICT teams, working across clinical teams and many other stakeholders and third parties that are in the environment. So what they allow us to do is bring those outcomes. And those outcomes are everything from making sure your nurse call, uh, your patient engagement, your safety systems, fall detection, let alone importantly your data and insights that you're surfacing through the environment. How do we ensure that all works? It integrates and it delivers the clinical outcomes, uh, everything from ensuring that we've got reduction, uh, in alarm, fatigue, uh, reduction in, you know, response times and overall a much better experience as to how we run that environment.

Host: And, and is that when. Cause I know in the past we've talked about, you know, when you're pulling all those bits and pieces together. Is that what you talk about when you're mentioning enterprise thinking? I've heard you use that term a bit because I guess, you know, it's one thing to think about all those moving parts in a new build, but also there's a lot of existing infrastructure and kind of silos going on. But tell me about quickly how you think like one or two pieces on enterprise thinking.

Jacqueline Leeds: Well, certainly coming from a background of my entire career of having to think, think and look at an enterprise as most importantly a single system. And I think that's where the thinking starts. Look at this as we're taking a very complex environment. There are legacy systems and there are many considerations of how we're going to get this technology to work and lots of stakeholders and interfaces. I know in some of our recent deployments, uh, I recall hearing and seeing up to 100 interfaces that had to be considered. So start with a design. I think in any great, uh, plan to address the future, bring the stakeholders together and think about the design and do it together. So you're looking for the clinical outcomes and the operational outcomes and you're mapping those ahead of time. You want to ensure the technology works. So, uh, the time invested at that stage to ensure that it will is vital. And I think it's one of our biggest lessons that we see in the business. I think second to that, why think like an enterprise? I don't believe there's anyone in the room that isn't thinking about scale and sustainability. We need to think about how we deploy a future patient room and an environment that not only is standardised and configured to work across, uh, different wards, different footprints, multiple sites, and we want to get those efficiency gains out of it and that cost to deploy as well. And so in any traditional, even enterprise model, you're thinking about faster time to deploy less servers, an environment that you can mobilize with far more speed and integrate, and obviously a lower cost to serve in the longer term as well. So for us it's a natural evolution of what we're doing. Uh, and any of the partnerships we have is to think like an enterprise. And uh, as I think Vicki will touch on the experience then also down the line, when you're actually deploying, whether that's a new, a, uh, greenfield site or you're, you're overhauling a brownfield site, uh, the experience and the outcome, the likelihood of success is much higher.

Host: Yeah, I'm, I'm keen to thank you. That's. That the framing is wonderful for the conversation we're about to have. Vicky, um, I always love chatting to you because I guess, um, the, like, all of that thinking about the big picture strategy side, it's, it's complicated, it needs to happen. Uh, but we've all been there where there's the, this is the strategy and then someone's got to do the thing. You're the resident doer. And then there's the real world of the um, uh, implementing in healthcare. So from your experience of um, uh, going from strategy to execution, uh, what have you seen or where do you See it fall down the most or, um, see the most success.

Vicky Knight: Yeah, I think there's a lot in, um, that journey.

Host: Point up at it.

Vicky Knight: Point up like this.

Speaker F: Yeah.

Jacqueline Leeds: Okay. Do this closer to the M and

Host: M.

Vicky Knight: Yeah, that's right. Um, there's a lot in that journey that is often underestimated. Um, and, you know, I work in a lot of deployments. Weekly I'm out on these sites that are, you know, deploying really big health infrastructure projects, digital transformation projects. And the two things that really stand out for me as being points of contention and points that often can lead to failure and lack of clarity with achieving the outcomes that we want. The first is just the sheer breadth of the work that needs to be done. So it's no mean feat to transform to build a hospital, but also to transform a hospital in the way that it works. It's a huge body of work, and I'm a nurse and I know what it takes to actually change clinical workflows. It's not easy to change clinical workflows. You know, you need to map the workflow as it currently is. Including, um, yesterday on one of the panels, my esteemed, um, nursing colleagues were talking about all the workarounds. So it's not just mapping the actual workflow as it's meant to happen, but it's all of the workarounds that we clinicians put in place because the tech doesn't work the way we need it to work and it doesn't follow our workflows. So you have to map all of those workflows and then you have to work with the teams to change the business rules or the policies. And that requires a huge body of work. I might need to meet with four different executive sponsors across four different standards, with four different. Lots of teams to try and get consensus on, on this change that someone is trying to implement. It's a huge body of work. And so that takes me to my second point, which is who resources that and who does that work? Right. It often falls to the clinical teams, the redevelopment teams, the CNIO teams, uh, the ICT teams. And often they're not resourced to actually take on that work. So what do we do? We have shortcuts, and that's what leads to us not actually achieving the digital transformation that we want to achieve. We need to give the fact that the work is really complex and it's a lot of work. Kudos. It needs to be resourced, I guess.

Host: You know, on the flip side, it's a bit of a pain getting everyone involved from the very start though, uh, and it does slow a process down. There's always a trader I'm going somewhere with, I'm serving you up, uh, this

Host: is what I do.

Host: Uh, there's always a trade off with everything. So you know, in return for, you know, fast tracking through the process and involving different stakeholders at the end. What are you foregoing? What is the spend essentially?

Vicky Knight: Yeah, look, I think the biggest thing that falls off the table is the co design or the ability to co design. Right. So if you don't know the workflows and you don't know uh, the workarounds and you just go with your product or your solution that you think is going to do what it's, that's going to achieve what it's going to achieve, you lose that ability to actually co design what it is you're trying to do. And most technology or digital health solutions don't fail because they're not good. They're usually extremely good. They fail because they don't match the real world and that's the co design you need. So it's not necessarily designing the technology and working with uh, the SQL programmers, et cetera. It's about co designing it to fit the real world implementation real quick.

Host: I get asked a version of this question all the time and it's I want to work in digital health but I don't know where to start. And I think the challenge a lot of people have is it's not they're uh, short on the interest to get involved. They don't have the clarity on what to do next. Like they've been watching this space for a while or listening to podcasts like this one that then you don't know what your next move is. So in an effort to be helpful, I put together something that I call the Digital Health Career Toolkit. It's a free five step email series where we cover mindset, your existing strengths, where the real opportunities are in this industry, how to upskill and how to build a network that actually opens doors for you. So if you've been looking around this space for a while and want to start getting involved in it, head to TalkingHealth Tech Toolkit and get access. It's free and it's easy because it just lands in your inbox each day and people think it's useful. So I hope you like it. That link's in the show notes of this episode too. TalkingHealth Tech Toolkit.

Host: And lastly from both of you, I'll start with Vicky. If there was one thing you'd hope that um, healthcare leaders take away from these conversations and generally, um, in deploying new technology within health systems. What's one thing that you think would um, be useful if they were to

Host: remember in that deployment?

Host: Does it have to be one, just one. You want to bring the panel on, that's why.

Vicky Knight: Okay, so I'll try and put it into one. I think that the implementation needs to be co designed, well resourced and well planned.

Host: Yeah, that works.

Vicky Knight: That's right.

Host: So you're going to say comma. Yeah,

Vicky Knight: it needs to have that effort put in at the beginning of the project to ensure that we get the success that we're trying to achieve.

Host: 100%.

Speaker F: Yeah.

Jacqueline Leeds: I think the research, and I get it, it is onerous bringing lots of stakeholders together. And the great thing is though, I've seen an environment where there is now digital teams, engineering teams, clinical teams and even some of the nuances within that that we talk about change management that are brought to the table. So I love seeing those conversations are actually happening. But putting the research and the time, uh, understanding how the technology maps and I think we, we do that, we take pride in doing that really well when, when we partner. But to understand how it will map to the outcome, don't focus on the tech itself. Focus on the workflows, on the communication paths and thinking about the whole ecosystem. And if you're putting that legwork in at the beginning, uh, the, the as I shared the likelihood of success and less friction as you're deploying, uh, certainly will be well worth it.

Host: I feel like that's some really good context and framing for the conversation we're about to have. So Vicki, Jackie, I really appreciate you making the time. Okay. Okay. I would like to welcome up to this stage our esteemed panelists. For the next conversation we have, uh, Robin Mann, uh, Chief Digital Information Officer for Monash health, Richard Taggart, CEO for eHealth New South Wales. Jane Barclay, National Director for healthcare at St. Vincent's and Emily Mayles, executive vice president for Optimum Healthcare. IT. Please join me in. Welcome to the stage.

Speaker F: Cool.

Host: Hey team.

Speaker G: Cool.

Host: So, um, uh, the context for this discussion is really the real world, um, the realities of digital health implementation. And um, I was saying to someone before that I really pulled a lot of relationship credits to pull this one together. Can I just say, uh, so I feel like I've got some work back to pay back to these individuals. But it's I guess testament and credit to um, uh, the individuals here who have some great perspectives to share and have done so. Um, willingly. I didn't. Yeah, willingly. Right, yeah, yeah. I'll give you back your stuff after. Yeah, so let's, It'd be great to hear from all four of you. Um, and we'll maybe start with Robin and then come down. That's probably a sensible way, um, help frame the discussion. Can you um, introduce yourself a little bit more if that wasn't a helpful uh, read of your bio, but. Oh, sorry, your title. Um, maybe also sharing a, um, an example of a technology implementation that you've seen in the real world and how it's compared to what the aspirational strategy was when it first started.

Speaker B: Thank you Peter. Um, thanks also to Roland for sponsoring. I'm not allowed to promote anybody, but I am allowed to say thank you and um, Peter, for organizing this event. Um, so Robin Mann, I'm the Chief Digital and Information Officer at Monash Health. Um, and um, Monash is quite big. I think we did one in 15 episodes of hospital and Specialist Care in Australia. So we are significant um, in terms of scale and that makes my job quite interesting. The question, what was the question?

Host: Real world.

Speaker B: Real world. Well there was one. So we're in the middle of uh, actually uh, Hypercare for our shared laboratory system implementation, um, which has gone live in the Alfred, um, Bayside and Western and now uh, went big bang with Monash Health a while back. Um, I don't really want to get into the nitty gritty of that but we're not out of the uh, hypercare phase yet. We're still dealing with some day to day challenges. Um, there is one implementation actually that is where I met Richard, um, going back a few years which was the eMeds rollout in New South Wales Health. Um, and the original um, project, uh, business case for that was $350 million worth of benefits for $170 million of investment. Um, and we started that uh, project about 18 months in. Um, and in the end we uh, have delivered, I think that project when it concluded and it kept going afterwards after I left. But we delivered to twice as many hospitals, delivered $120 million of benefits, more um, in less time. The reason why that worked was because we actually redesigned the entire program. We started and we did a federated model of implementation where each of the health services was given a uh, budget to deliver the system that they wanted. Um, bought off a ah, standard ah, statewide contract and it was empowered and basically developed the capability to roll that out themselves. Um, and I still think that look back at that as being one of the more successful, um, scaled implementations. And it was a particular point in time as well, of course, because, um, New South Wales didn't have a central e health body at that point. M and that was just being set up as we were um, in the middle of the thick of that. But the reason why that worked I think was because of the people, um, because there was a commitment and because the benefits and the problems that we were solving were really, really clear. And to me the message is always, what are you solving for? Um, are you doing this because government said so? Are you doing it because you're uh, replacing legacy system? What is actually success? And go for that from the outset.

Host: Thank you.

Speaker H: I'm Richard Taggart, the chief executive at ehealth New South Wales. And I think the story that I would share is actually, um, let me start by saying there's never been a better time to be in digital health, right? There's never been a time when the technology was just so accessible, moving so fast. You could do so many things with uh, AI, with great capability. But there's also never a bit of worse time. It's harder than ever. The expectations are off the charts. Every health executive, every clinician, every consumer now expects that any problem to be solved is going to be solved by tech and they're all going to come to digital health people to help do that. So you have enormous expectation and enormous demand. And when I started doing digital health projects, what was cybersecurity? We just built stuff. So things have changed a lot. What I've just seen recently is an example of how you crepe through that noise. And that's the launch of our raise it program in New South Wales Health. Uh, we had a really tragic event a little while ago where a young boy, two year old, his uh, name was Joe Masters, presented to the emergency department in one of our hospitals. His parents were worried that he was getting worse, kept raising the flag, really felt that they were not heard and unfortunately Joe didn't make it. And what we found as a result of that story was actually there isn't a consistent way across New South Wales Health where you can raise the alarm as a consumer or a loved one. That's the same everywhere. There was a process in every hospital, but it wasn't the same everywhere. There was some that was a telephone number, there was some that you had to go and use, uh, a send a text message. It was various degrees of the same program. And the power of that story, the engagement of the consumer's family, the Masses, family, the engagement of the clinicians, the fact that everybody had this common idea that actually we could make that better by making it the same, allowed us to very quickly put a single telephone number across every single hospital and clinic in New South Wales. Allows you to speak in language, allows us to escalate consistently and report on a daily basis. The consumers that were worried that it getting worse and the power of that storytelling meant that all those folks that had those workarounds and processes we could get coming back to them and saying actually we can do better by standardizing. And people would say actually I'm willing to let go of my little uh, process that I've developed over many years to work with you to solve that broader problem. And I'm really pleased to say that that program has been very successful and is now being used on a daily basis.

Host: Powerful example. Thank you Jane.

Speaker G: Uh, good morning everybody. Uh, Jane Barclay. And one word missing off my title. I'm not actually the National Director of healthcare period at St. Vincent's it's healthcare platform. So very different. So I get to look after all the tech stuff, not, not the entirety of healthcare. But anyway that was very flattering.

Host: Uh, it wouldn't have fit. It wouldn't have fit on my little slide though.

Speaker G: That's so. That's okay. I know it's a ridiculous title. That's okay. Um, essentially I get to look after all my favorite and fun stuff, application data, AI and interop, which is always uh, challenging but uh, a lot of fun as well. And I think thinking about sort of implementations and ambition versus reality, it really um, helped me reflect probably on my early career. So I started off as a radiographer. I specialised in breast MRI very niche uh, back in the day and worked for a big private hospital in Brisbane. We ran a very large clinic that, that did both diagnostic and screening services. And probably 15 years ago when I was at MRI radiography I also was the in house sort of it, uh, shadow it person as well. That's how I started my career. Um, we actually implemented a number of different AI tools back in the day. Um, some of those were the early computer automated detection tools that we applied to MRI imaging. Um, we didn't have any governance, there wasn't really any business cases, et cetera. We got pictures from uh, vendors and we rolled them out and didn't really think about what those models or workflows would be. We also used um, one of the first uh, breast density scoring tools as well that was sold to us by one of the uh, MAMMOGRAPHY uh, vendors, again, really ambitious, rolled it out, had this extra screen that popped up for our uh, doctors, et cetera. Had no idea what to do with it or how to use it. When I fast forward now to my role at St. Vincent and I'm still getting lots of vendors trying to sell me sepsis algorithms and all sorts of things every day, which is fantastic. And there's some really great things out there. The biggest part though is one that governance and how they actually integrate into a model of care or workflows. So at St. Vincent at the moment we're doing the really boring unsexy stuff. So we've uh, done our AI policy, we've rolled out our AI framework as well and, and we're starting now to do a lot more governance around our data interoperability and also prioritising how does these tools sort of fit into those models of care and workflows. Um, which I'm really positive that we're going to get some really good outcomes from that. But it's really nice to see how that sort of come to fruition over the years.

Host: Yes, thank you very much.

Speaker F: Good morning. Hi everyone. M. Oh gosh. Hello. I know how microphone works. Um, hello, I'm Emily. I am the executive vice president for Australia, New Zealand for a firm called Optimum Healthcare. It great to be here but a few months ago I was the chief, uh, digital strategy officer for the Department of Health in Victoria. So I was brought in to lead digital strategy, AI cybersecurity. And I thought that I was going to be an innovation machine in that role. Super excited about all of the transformation that I was going to drive and realistically I was completely consumed by legacy and managing legacy and remediation. Um, and uh, this is not a new problem. I'm decades of accumulation of technical debt and legacy, but it feels much more acute than it ever has. I think for a few reasons. There are more solutions coming out of support. There are increasing cybersecurity vulnerabilities. There's also though this opportunity cost that's growing because we've got, whether it's a minister or a board saying I went and visited this place and I want this new widget. Um, there's a lot of innovation you can't participate in if your foundations aren't in place. I'll give one really small example, um, where last year I re platformed Lotus Notes from one environment to another. Okay. You might remember Lotus notes from the 80s. Trailblazer for someone who gets up on stage and talks about leapfrog opportunities and 10 year strategies. It was really humbling moment because in that moment we're like, first of all we have Lotus Notes. And then there was no budget, there was no appetite in the business to translate critical business processes into a new system. Um, and there was just no authorizing environment to do anything different. And so, and I think a lot of technology leaders at the moment are faced with similarly challenging issues that I, that don't. I see you right. It's kind of difficult to portray that at a conference that's all about the future, but that's the day to day. That's the gap I think between the aspiration.

Host: Yeah. So I'm just thinking then like, because you're talking about the example of the Jane, uh, with the, you know, vendors looking to sell sepsis, uh, algorithms and like the, from a vendor perspective, uh, you know, you look to healthcare systems. I'm gonna add Robin to this by the way. So I'm prepping you there. Uh, you know, like you need, like you would benefit from purchasing my solution. And it's like this is great because we've got to help the system who has budget to kind of buy things that where we want to sell because it will have a benefit to everyone. This is great. That's where it'll be done. And if you're in the health system, you're kind of like, I don't have any budget to do anything. I feel like there needs to be money from somewhere in the health system to be able to invest in this kind of innovation and think because uh, growth and expansion requires investment, uh, yes, of money, but also time and all the other kind of bits and pieces and the stakeholders. What's your kind of view on the health system's interest and capability at the moment to invest in innovation, um, these days and what do we do about it? Where does money come from?

Speaker B: So, um, it's really interesting question. Uh, we have a, uh, large budget that we spend on managing legacy, um, and our existing systems and our existing partners. And the Monash is big, as I said earlier, and we have hundreds of vendors. Um, if I was saying uh, just this morning that if I, if I spend an hour a day, every working day meeting vendors, I would spend two years to get through all of them. Um, so new ones is great. Um, the existing ones we can always, we lose track of what people are doing and how those products are evolving. And um, you know, we're always chasing the shiny stuff, but there's always opportunities to leverage what you've got um, what we do. So I had the benefit. I learn as I go. Um, that's been the story of my career. I spent um, four years working for a company called Boston Consulting Group, um, and really actually learned how they identify where there is value in an organization. So you can, if you've got the data in the right place, you can start to look into that data and work out where is their variation, where is the excess spending, where are the pain points and really identify where do you start is the thing that's going to release the most. I use the word value but this is a value based healthcare kind of context. So better outcomes, lower cost, remove um, some of the barriers to your staff providing care. If you can realize that value back to the business quickly, then there's an immediate tangible um, sense of improvement. So we could innovate in a whole range of areas. Um, but the ones that release that pressure on the business are the ones that um, immediately have an impact and immediately build trust, uh, build confidence in what you can do and then you can build from, from that point onwards. And obviously to make that work you need to have a team that works in a efficient way. You need to have automated all those, those unpleasant processes, taken away a lot of the manual steps, um, that maybe are left ah, over from implementing products in the past where you haven't finished the job fully and then you move on to the next thing. So it's really about where is the value in the organization and how much is there in that. I'll just give you one example. So we've identified and um, we're working with a partner on this at the moment but we've identified that there's about $3 million worth of savings that we can make per year because of um, the translations, translating language, um, and that's a very small product. It's something that exists a long time but we can actually save a lot of money doing that. Um, we're not losing any staff and be careful about all the um, uh,

Host: this is an illustrator of the podcast that goes to the public. Just so you know

Speaker B: there's huge operational savings and we, when you think about our population that we, that we, the community that we serve at Monash, we have 45% of that population speak a language other than English at home. So there's a huge barrier to care. Um, and we have to spend a lot of money to help uh, do that at the moment. So using um AI to do the translation and making, proving that works in the real world is, is uh, one thing that we're doing at the moment. It's a, it's a small step, but it's a first step and it'll make a big difference. Yeah.

Host: And Emily, uh, the. I want to talk about expectation management for a moment, I guess, because, uh, it's exciting when there's new technology and there's a lot of emotions that happen in implementation. Uh, it's not nice emotions when, um, there's disappointment. And I think we can all think of examples of disappointing, you know, implementations of technology within health systems. What, what do you think is the reason why, you know, there are implementations of technology in health care that lead to disappointment? Is it about the technology itself?

Speaker F: There's a lot of answers that I could give to that, I think. Well, and Vicki made some really great comments earlier on, I think some of the specifics. So, you know, do the work, do the, do the process re engineering and the, um, preparation work. I'm going to answer this question from a system level though, because I think individual projects, they can, you know, there's varying levels of success, but they're all sort of within a standard deviation of. But at a system level, we have spent billions and billions and billions of dollars in technology, and obviously that is doing some good stuff, but we've not really made a demonstrative impact on system outcomes. And that's where I think we need to think a little bit differently. I'm going to add on to the answer that Robyn just gave in terms of one of the issues is that there's a huge capital outlay that needs to be spent if we are going to fundamentally change how care is delivered at a system level. We are moving from analog to digital, you know, in its simplest form. And in order to, um, execute on that, money's got to come from somewhere. In public health care, we're also competing against every other sector that hasn't invested in their legacy. So education has a $2 billion, you know, uh, spend that needs to happen in the next 10 years. So does justice, so does emergency services. The treasurer is like, come on, guys, like, you know, who's going to get part of this pie, right? So I think we need to be really creative with new commercial models. We need to take risk and reward with, um, the private sector. I, uh, think we also need to bring the CFO in really early. And so we've got the Digital Health Festival. I would really love to see over the next few years more financial professionals coming and participating as part of the digital community. Because there's two issues that they can help us solve how do we fund this hump over the legacy into more modern ways of working. And then how do we fundamentally change our operating budget so that we go from less than 2% of our budget on it to more like 15 to 20% because our business of healthcare will be run on digital platforms. I think some organizations can do that independently. Well, but we need to figure out how to do that at a system level and I haven't really answered your question.

Host: That's a great answer though.

Host: Got me thinking.

Host: I want to build on it and go to Jane because you've obviously seen a lot of implementations as well. Um, and made me think as Emily was talking. I guess there is a big difference between, but we kind of use these terms interchangeably sometimes of um, implementing a new system in healthcare and changing the way health care is delivered. Because there's kind of two different. Like if we're just changing the system, we're kind of changing the underneath bit. But then in the end if we're still doing the same type of care, it's kind of different. Like what's that disconnect?

Speaker G: Yeah, it's a great question. Um, and I think if we look at what the majority of implementations we do, a lot of them are driven by uh, compliance or end of, end of life of systems and it's always urgent replacement. So there's not often a lot of time to do that, uh, reprocessing or change. And it's definitely very rarely driven by model of care. I can count on my fingers that um, you know, maybe even one hand the number of projects that have been truly driven by a model of care. I must say they have been my favourite projects though. Uh, uh, but they are probably uh, the rarer ones and I think we are seeing a big shift though because there is the constraints of budgets, et cetera. But we're also seeing a shift in the technologies that are available to us as well. So a lot more, more use of platforms that give us that ability to actually uh, put in new ways of working, uh, etc. And I think there are a lot more people that are aware of what's available and thinking about the change that needs to happen and the things that aren't sustainable. I think one of the um, you know, my favourite projects that I've ever done, uh, when I was in a previous role up in Mana in Queensland and it wasn't something that was actually on our strategic capital project budget, it was actually something that we did, uh, just under the operating budget and probably one of the cheapest projects I've done, but probably, uh, one of my. Definitely my favourite. And we had, um, some of the world's best neonatologists based in Brisbane, yet we had regional hospitals in Rockhampton and Mackay that really struggled to get locum specialists there to provide medical care. And we had midwives working all through the hours in those nurseries. We had high turnover of those midwives because they felt very isolated, um, et cetera. And yet we had, within our network or our organisation, the world specialist. So we were able to implement a solution where at the push of a button, those midwives could connect into a mini command centre in Brisbane and instantly access that clinical team that could talk them through resuscitation protocols or all those types of things, do their documentation and share them. And, um, that. That's probably one of my, My favourite projects, but was very driven by how can we do things differently. We thought about the model of care first and then we sort of enabled it with the technology.

Host: I was born in Rocky Base Hospital, by the way.

Jacqueline Leeds: M. Me too.

Speaker G: Well, I was, I was. I was born in Rockhampton as well, really.

Jacqueline Leeds: And I.

Speaker G: Actually, it was the hospital. And that was probably my. My, uh, other favorite part was that

Host: we're on the panel. Sorry, I did.

Speaker G: You can edit that out, Peter. We'll chat later about chows and beef.

Host: Um, some really good examples, Richard. We've heard of quite specific implementations of technology that might be, depending on what you're looking at, it could be a small implementation, you're familiar, uh, and involved in some very large implementations of, uh, technology in healthcare. Is there any material difference between, like, what are the biggest material differences between, like, a small deployment and You've seen plenty of other deployments as well, the big and the small technology deployments in healthcare?

Speaker H: Well, the difference is obviously the number of people and resources that require, depending on the scale. Uh, but I think of a common thread, actually. The problem that we as digital health leaders, as industry, is people inside the health system trying to advocate for change using technology that we need to overcome is very often we find ourselves and our people just falling back to what the solution's about, rather than what the problem that we're solving. And the story around that problem and where the projects that I've seen have been most successful is we keep coming back to that elevator pitch is what are we solving and how is it making a difference for the clinician or the consumer? And it's really succinct. And everyone that you talk to can get behind that story. And what I see is, uh, something that you need to really bear in mind when you're implementing something at any scale in the healthcare system is that you need to be incredibly resilient because it is much harder than people appreciate to do anything new. There is so much inertia because we have so much people and process to overcome that you need to have such incredible adaptive leadership at every level. And where it works really well is when you have multiple layers of sponsorship. And where it works really well is when all those people are working together in partnership. If you have a strong clinician who understands that they want to make this happen, they've got a consumer story where they can actually point back to things that resonate with community. They've got someone in the executive behind them, they've got a politician behind them, and guess what? That industry partner, you might be a business development manager, you might be a senior executive in industry, but you're connecting the dots and amplifying that story of the problem being solved. That's when it works. When we go back to, oh, uh, well, we've implemented five new cloud technologies this year and we've implemented this AI widget. Actually, it doesn't get very far, but when we go about this is affecting real people, we're reducing this problem or improving this outcome. It scales quickly.

Speaker G: Yeah.

Host: To wrap up, I want to hear from each of you because I think there's been some great examples that I would hope some, everyone, uh, that's in attendance and checking this out after can, can maybe practically apply to their day to day. But we run the risk often of having these conversations where we all then listen to them and nod knowingly and say, I agree the system needs to change. And we've talked a bit about system level thinking and all of this, but I'm a big believer that there's a lot of power that everyone has as individuals to kind of influence the kind of change that we're after. And we all kind of know and feel that needs to happen, uh, within the healthcare system, particularly in Australia, if there was one piece of advice or a thing to do or something, you'd hope that people take away from this discussion to apply back at their work rather than just getting back after a festival and being like, well, back to the day to day, what might that be? Maybe we'll go Robin and then come back down.

Speaker B: Just one piece of advice.

Host: You can use commas and hyphens if you like, em dashes. If it's been generated by ChatGPT, let

Speaker B: me just generate it. Um, uh, look, I think that, uh, I'm going to use, I'm going to say two. So the first one is to really understand the problem, but to understand the problem that you're solving and the value of solving that problem, you actually have to really talk and listen to the people that are going to be using that system in the future or that have that problem. So to get under the weeds and really understand it, and whether that's a consumer or, you know, clinicians, I've just seen over the years a lot of nervousness about showing people something, some early thinking in case it's wrong. It's going to be wrong. So start with a bit of humidity and invite people to really explain what their issues are. And then you go from there.

Host: Pull from there by you.

Speaker H: Richard, can I have two?

Host: Sure.

Speaker H: Get as close to the action as you can. Get back to the floor so that you can see where you really need to make a difference. We don't make a difference in these rooms. It's on the hospital floor or the clay floor. And the second is just keep going, keep pushing.

Speaker G: I'll try to just stick to one. I think probably going on, on what Richard was talking about, uh, just previously. Um, we've got two big pieces of work happening at the moment, both that have been built on the same platform, but very different outcomes. And often when things go wrong, we point fingers at the vendor, at the technology, the change management, et cetera. But actually I think people need to, when we're at that business case level and at that executive table, make sure that we're trying to solve the right problem. And is technology the right fix for that problem

Speaker F: and mine? One that I'm going to do is, uh, looking at a technology implementation from start to finish. At the end, you want the measurable benefits. I think the most important thing, the non negotiable, is making sure that that business case upfront articulates the mechanism that you will realize that benefit. Is it, uh, like, okay, we're going to save money, but how? And just make sure that that's defined and make sure that there is someone on the hook for proving that that benefit has been realized or seeing through to the end that that benefit's been realized. And it's rarely the digital health officer. It's usually a head of infrastructure or head of supply chain or chief medical officer. That person needs to know about this business case. They need to know that their performance might be impacted if they don't support it. And that will give us a uh, much greater likelihood of actually being able to stand there and be like, look at that benefit that we created. Because otherwise it just disappears totally.

Host: I feel inspired and educated and even motivated after that session. So I'm super grateful for the time that you've spent on the stage with me panel. So please join me in thanking them for their experiences.

Speaker B: Thank you.

Jacqueline Leeds: We hope you enjoyed this episode of Talking Health Tech. Make sure you like and subscribe and share this episode with someone who might find it valuable.

Vicky Knight: For more information and resources about healthcare innovation, visit talking healthtech.com.

Host: Thanks again for tuning in. If you enjoyed this episode, the best thing you can do is subscribe, drop a review and send it to someone that'll get some value. Check out talkinghealthtech.com for more information.