A Perspective on the PACS Programme

David Whitfield

20th April 2005

2

A Perspective on the PACS Programme

Introduction and Context

Scene Setting

Bidding

Contracting

Early Delivery

Growing Pains

Conclusion

3

Scene Setting (1)

Features of Successful Programmes

– Have a clear vision and real sponsorship (otherwise failure is not left to chance)

– Concerned with outcomes rather than deliverables

– Embrace systems, processes and people aspects

– Involve the stakeholders and deploy clear management

– Embrace & control change rather than resist & stifle it

Some Danger Signs

– Over ambitious

– Over complicated

– Over long

– Few early benefits planned

4

Scene Setting (2)

Some things to remember:

By default, large programmes fail / under-deliver

You cannot contract for the behaviour you require

– Partnership is essential – it’s a long term relationship

– Shared objectives, recognising different measures of success

– The behaviour that you incentivise rather than penalise

– Contracts are baselines/agreements not management handbooks

– Contracts are the reference of last resort – in court

Nothing of real value is achieved without a struggle

…. it’s meant to be hard!

5

Bidding – to April 2004

Small procurement team

Bidder-to-user contact

– Limited by process

– Good reaction to supplier initiatives

– Information baseline

Detailed requirement specification

– National solution from multiple vendors

– Consultation process

– National integration vision

Sequence change without impact analysis

Moving goalposts and short timescales

6

Contracting (1)

Supplier selection: end April 2004

Then, all of a sudden, nothing happened …..

…... and after a while, nothing more happened …..

….. and then it was July …..

….. when “things” really did start to happen

Discussions on contractual matters:

– commenced

– faltered, and then

– resumed in earnest

– early engagement at 3 Trusts

7

Contracting (2)

Small procurement team handling multiple LSPs

IT procurement model based on the core contract model

Top-down deployment targets drove:

– “cookie cutter” model with rapid responses committed from the NHS

– introduction of “encouragements” for the contractors

– significant obligations agreed on the Trusts (and the wider NHS)

Governance and management model

A number of cliff-edge moments

After nearly 7 months had elapsed from supplier selection:

– agreement reached on 11th November 2004

– with no change in deployment target dates

8

A Business Change Programme

Systems

Processes

People

…. with a contract which focuses on

the delivery and operation of

the enabling IT component

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…. which is only about this ….

Southern Cluster Primary Image Store West Dorset Server Rack

10

Transcribe &Report approved

Patient Registered Exam Performed

Patient DataRe-Entered

at Acq Device

Previous Examshung in Reading

Room

Return Filmsto File Room

Re-assembleFilm Jacket

Send Films &Report to Referring

Clinician

Retrieve Films &Report from Referring

Clinician

Radiologist Dictate & Un-hang films

Develop Film

Quality Assurance

HangFilms

….. to facilitate the changes from this …..

11

Patient Registered Exam Performed

Radiologist ReadDictate & Approve

Referring ClinicianAccesses Report

and Films

Quality Assurance

….. to support the vision of …..

12

….. film-less and paper-less imaging

13

The Going-In Environment

Centrally established requirements

Standardised buying method

Output based service charging

Limited user involvement

Information centralisedand then….

Huge urgency

Lean scaling

Unclear financial arrangements

Limited communications

Lack of ready answers on important topics

….. hence some “tricky starts” were to be expected …..

14

Early Engagement

A fast start was essential but had to be sustainable and strategically aligned

Pre-contract work provided a framework for wider engagement

Focus on delivering early results

Temporary Order mechanism avoided many start-up delays

Initial equipment configured and ordered for 3 Trusts and for the Cluster Image Store within 5 weeks

Working with the Trusts rather than “doing PACS to them”

Finding ways round obstacles / challenges rather than using them as “explanations” for delays

Striving to fill the information gaps for the Trusts …..

….. and feeling a way through the governance arrangements …..

15

Stakeholder Relationships around PACS

XYZ Hospitals NHS Trust

SHA

National Programme for Information Technology

Southern Cluster

16

Contractual Relationships for PACS

XYZ Hospitals NHS Trust

SHA

National Programme for Information Technology

Southern Cluster

17

Deployment Sequence

InitialMeeting

PrelimConfig

FinalConfig

BusCase

Approval

PlaceOrder

Rec &StageEqpt

Install &Integrate

Test &Accept

Go Live

OngoingService

Temporary Order

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Deployment Status - Today

InitialMeeting

PrelimConfig

FinalConfig

BusCase

Approval

PlaceOrder

Rec &StageEqpt

Install &Integrate

Test &Accept

Go Live

Ashford & St. Peter’s

Milton Keynes SalisburyOngoingService

Dartford &Gravesham

North Bristol,NOC, East Kent

Cluster Store

Gloucestershire

PooleWorthing &Southlands

Royal Surrey, MTWPlymouth

Brighton& Sussex

RoyalCornwall Temporary Order

West Dorset

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Growing Pains

Life changes after any major service goes live:

– Priorities: restoration, continuity, enhancement

– Environment continually changes - PACS is not an island

– Technology presents new opportunities

The service must evolve or risk becoming irrelevant

The current “early nursing” is not scalable

– Broader engagement ahead

– Industrial strength processes to be institutionalised

– Governance and management gear change

– BUT each Trust sees their PACS deployment with fresh eyes

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Conclusion

The urgency was a significant factor in building momentum

The end of the beginning has now arrived

– One Trust may not a Cluster be . . . . but it is at least a tangible start!

– There is no realistic way back

It will get harder …..….. before it gets even harder

….. but lessons can be learned to make it easier

Change will be both an imperative and a potential threat

The deployment will inevitably cause the vision to evolve

….. and finally…..

“Enabling a step change in healthcare provision”

PACS . . .