The key ICT issue in healthcare is the same as in all areas of the public service: project delivery productivity, according to the Victorian Department of Health and Human Services CIO, Dr Steve Hodgkinson.
“For the effort, time and cost, we simply don’t deliver enough successful technology-led innovation projects. We have got to boost the productivity of our ICT project delivery processes.
“Technology-led innovation requires more projects, delivered more quickly, reliably and securely at less cost.
This is certainly something that Hodgkinson and his team has achieved across the Victorian Department of Health and Human Services. Hodgkinson has modernised the way the agency innovates by introducing an ‘platform+agile’’ approach and cyber security uplift program.
The result? His tech team has implemented more than 35 new business systems over the past three years and investment confidence has increased with the agency’s discretionary IT project budget rising from $20 million in 2015/16 to $120 million last financial year.
These systems range from major enhancements to core platforms through to the creation of new systems using Microsoft Azure, Salesforce and ServiceNow.
“These systems have been critical enablers of policy reforms with many stakeholders across multiple agencies, sensitive data, complex integration and rapidly evolving business requirements,” says Hodgkinson.
New security solutions, combined with the advantage security of modern cloud services platforms, have significantly improved the department’s cyber security posture, he says.
Hodgkinson joined the department in 2015 on a mission to fix the department’sbroken approach to ITprojects. He created the platform+ agile approach while working as an industry analyst at Ovum.
The approach leverages trusted platforms and in-house staff to start projects quickly and to deliver results in an iterative manner using user-centered design and agile methods. It enables fast delivery of new systems in complex organisational settings at less effort, cost and risk than the usual procurement+waterfall approach.
Hodgkinson says that when he joined DHHS, he was fortunate enough to have inherited a sizeable and capable service design and application development team that had some prior experience with agile methods.
“The key ingredient initially was simply to set the direction and authorise them to get on with it. I introduced the platform+agile approach as a way to empower the in-house team to avoid unnecessary procurement by leveraging the cloud services platforms available to us under whole-of-government enterprise agreements and to adopt agile methods at scale using these platforms,” he says.
Hodgkinson and his team started with smaller projects and built up the number and size of these initiatives as results were delivered and as skills and capabilities matured.
The key breakthrough projects were the housing register online application system and the family violence referral portal in 2016, he says.
“The projects created the ‘ah huh!’ moment when everyone realised that we were doing something different that actually worked at scale for ‘serious’ systems. We were winning awards for project delivery rather than being slammed for project failures,” he says.
Hodgkinson says it would have been tougher for him personally to have persisted with a traditional ‘procurement+waterfall’ approach because he would have been terrified of the high risk, big bang projects.
“Because the platform+agile approach enabled result to be delivered early and incrementally, everyone started to become more motivated and engaged and it created an upward spiral of growing confidence in our capabilities. As I like to say, a ‘mind once expanded by seeing a MVP [minimum viable product] delivered quickly never regains its original dimensions.’”
Another notable platform delivered using this approach include the Victorian health incident management system (VHIMS) which improves the safety of patients and staff because incidents of harm and near misses are more quickly and accurately reported.
“We are also exploring platform+agile approaches in healthcare with the VHIMS being first cab of the rank in a new approach to deploying a cloud service and API-enabled application across health services,” he says.
Among the 35 new innovations there’s also a family violence referral system that ensures women and children receive services more quickly. People suffering financial hardship using stored value cards to access timely and secure payments through a personal hardship system. Babies will also be less at risk because the Australian perinatal and mortality audit system will enable more timely and accurate reporting and analysis of adverse clinical events.
Tech at the centre of healthcare delivery
Hodgkinson says healthcare delivery is becoming more technology, information and data intensive in all aspects from advanced imaging, robotic surgery and incident management analytics to genomic medicine, electronic medical records and real-time prescription monitoring.
“In addition, the administration and logistics of running health services require increasingly sophisticated systems – as is true in any large organisation,” says Hodgkinson.
“Technology-led innovation is essential to enable improved practices, better information sharing, improved patient safety and the ‘more with less’ miracles that are necessary for health services to meet demand and budget expectations.”
Saving a failed project, promoting diversity
When asked how he collaborates with and influences the department, Hodgkinson says his main approach with the senior executives is to ‘make myself useful,’ to work collaboratively to fix things that need fixing.
For example, Hodgkinson says he rescued the real time prescription monitoring projects from a failing national approach led by the federal government. The initiative had failed the make progress for many years and he was able to lead the way for Victoria to proceed unilaterally through a partnership with Telstra and Fred IT.
This project, SafeScript, is near completion and will become the preferred solution for national adoption
“My rescuing of this project has been widely regarded by many executives and has opened the doors for other strategic discussions. Influence stems from being useful.”
Hodgkinson has also created a diversity program called ‘Rise at DHHS.’ The program creates employment opportunities for a two year period for 8 people with autism.
He promotes gender diversity in his team – two of his five direct reports are women and the overall team is evenly split 50/50 between men and women.
“Cultural diversity in the IT team is high, we are a very multi-national team. We have also implemented a successful program to create IT careers for disadvantaged young people. This program employs several non-tertiary educated young people every year, most of whom have gone on to successful careers in the department,” he says.