CIO100 2018 #22: Stuart Bloomfield. Waitemata District Health Board

The Waitemata District Health Board has transformed from low uptake of clinical systems to one of the top three (of 20) district health boards (DHBs) in electronic medical record adoption maturity over the past five years, says its CIO Stuart Bloomfield.

“With a catchment of 600,000 people, and 7000 staff, it is now seen as a leader in clinical systems, as well as patient experience and outcomes.”

He says this transformation has largely been due to the Leapfrog programme, a set of strategically important clinical projects that lay the foundations for ongoing innovation and improvement.

“I have driven the implementation and embedding of Leapfrog, in partnership with the Clinical Director of Innovation. The aim of the programme is to fast track strategic projects to bring about a step change at the DHB – moving from where we were to where we wanted to be.”

The applications under this programme include medications prescribing and administration, nursing observations, ordering of radiology procedures and laboratory tests, and a Patient List app for clinicians – all underpinned by widespread wi-fi and mobility enablement.

Each project was required to demonstrate impact in the short-medium term on the DHB’s main priorities – improving patient health outcomes and patient and whanau experience of the health system. The programme has been successful at establishing a multidisciplinary Leapfrog team of project leaders from clinical, IT and quality improvement backgrounds.

These new systems also provide richer data for analytics, identifying at-risk patient groups and gaps in care. The IT platform is allowing Waitemata DHB to move from strength to strength. The mobile app, Smartpage, has just been deployed for managing Orderly tasks – enabled by the mobility platform built under Leapfrog, Bloomfield says.

“We recognised early that implementing the new clinical applications represented a significant cultural change for clinicians – not just doing things differently, but in some cases changing the balance of power and creating uncomfortable transparency of practice.

“Each project has a clinician lead; someone who will be using the system. That lead was well supported by my team. I continually communicate at all levels within the DHB that Leapfrog is our highest priority programme.” Bloomfield says.

“Through Leapfrog, Waitemata DHB has been recognised as a national leader in innovation. Our implementation of the medication prescribing and administration system, Medchart, is the largest single instance in Australasia, creating technical and cultural challenges with no precedent solutions.

“I have always tried to support the project team members to innovate to solve problems – and they have done this. One such innovation was a metal stand for iPads invented by the Medchart clinical lead so that the screen could be upright and visible in small clinical spaces. A local tradesperson made the bespoke stands to our specifications for a very reasonable charge.”

Prioritising partnerships

“I have a strong belief of the value of partnership with clinicians – doctors, nurses and allied health professionals – which goes beyond collaboration; clinicians must become IT staff, and IT staff must at least understand clinical language,” says Bloomfield, on his leadership approach at the DHB.

“Pushing through bureaucratic barriers is another of my key strengths, encouraging a culture of finding ways around brick walls, while remaining focused on the goals of improving the IT experience for clinicians and improving access to health information.

“My leadership style has been described as creating a culture of doing; leading by example and by empowering others to believe in themselves and take risks. In complex systems, extensive planning has limited value,” he says.

“Complex systems require boundaries to be set, goals to be communicated and adopted as values, and broad plans drawn up. From there we go to work, and constantly re-align progress to our goals.

“I have an awesome team of highly skilled and motivated professionals. Other CIOs have commented on the depth of talent at Waitemata.”

Bloomfield points out he and the team already have a track record of working close to the business, motivating and empowering the people who need to lead change at the clinical interface.

“What I have learnt as CIO is the importance of communicating to and persuading the top decision makers – the executive teams, Boards and the Ministry,” he says.

“A few early miss-hits taught me to stay on point, remove jargon, avoid discussion, think innovatively about presentation, and wear a tie,” he says.

“Our team presented the phase 2 Leapfrog projects to the Board in a Dragons’ Den type format, which entertained as well as persuaded the Board to adopt a new suite of projects.”

Robyn Whittaker, clinical director of Innovation at Waitemata DHB, says Bloomfield’s leadership is vitally important to address the barriers and blockages to ensure the fast paced progress of the organisation’s projects, as well as to support and advocate for the programme at the Board and executive levels of the organisation.

“He works closely with our shared IT service, healthAlliance, to ensure the projects are given the necessary level of visibility and priority. His on the ground support of the clinical and IT project leads ensures they can focus on leading these projects and solving issues as they arise,” she says.