What HCPs value: Achieving relevance and results with account insights

Transcript

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[Captions auto generated] Hi, everybody. I’m Harry from Rubica, where we help organizations

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unlock radical performance improvements that benefit customers, patients, and

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employees.

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I’m very pleased to welcome you all to the next webinar in our series on what

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HCPs value, achieving relevance and results with account

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insights.

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Please help to co-create today’s discussion by adding your questions throughout the

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webinar for the Q&A at the end.

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We also have the resources section, so have a look in there.

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The session is being recorded, and we’ll share it after for you and your

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colleagues.

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On with today’s event, where I have the pleasure of talking with

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Dr Penny Kechagioglou

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Penny, welcome.

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There we go. Hi, Penny. Good morning.

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Morning, everyone. Hi, Harry.

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A very warm welcome. Penny, can you give us a little

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background on yourself and what you do?

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Yeah, of course. First of all, thank you for invite me this morning.

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My name is Penny Kechagioglou. I’m a consultant medical oncologist in the

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NHS at Coventry. I have been a consultant

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for the last

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16 years, and working in the NHS as a clinician for the last

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23.

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I also work in other management roles in the NHS,

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previously as clinical director, as

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deputy chief medical officer at Coventry, and over the last

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five years as the chief clinical information officer, which means

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I deal with digital transformation, electronic patient

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records, and other innovations that have to do with digital and data.

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I’ve got some national roles. I’m chairing the Digital Health

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Network CCIO advisory panel.

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I chair the

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EPR network, part of the Healthcare Innovation

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Consortium, and I’m also the medical director for ICON UK,

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which is a private integrated clinical oncology

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provider.

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You are pretty busy, with other words, then.

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Yeah, pretty busy. That’s the word.

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Well, I’m very pleased that we get the chance to dig into some of that

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experience and the different roles that you have.

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Can we jump into exploring your

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reality and the opportunities to improve care?

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And let’s start with

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your clinical role. So as a practicing oncologist, where do

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patient pathways most commonly slow down

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or split today? Where does it not work as well as it could?

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First of all, we need to appreciate that oncology pathways have become

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more complex over the last few years,

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in a positive way because we have got more

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tests to understand and personalize our cancer care

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treatments,

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which means sometimes it takes longer for those tests to come back before

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we make decisions about care.

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Right.

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Because of the complexity of the treatments that we have nowadays, which

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is good, people live longer with cancer, get

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cured from cancer more frequently because of those

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new treatments. The pathways have become more complex, and

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we, as clinical leaders, need to navigate those complex pathways

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so that our patients get treatment on time.

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So that’s the context.

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Mm.

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In terms of where things

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can get delayed is across multiple steps in those

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pathways.

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Let’s not forget that cancer care is multidisciplinary.

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There are many-

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Mm

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… professionals involved in the care of those patients.

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Surgeons, oncologists like myself, radiologists,

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pathologists, and specialist nurses,

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physiotherapists, you name it. There’s a whole

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multidisciplinary approach, which is the right thing.

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Yeah.

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So the communication between the clinical professionals is

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paramount,

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and of course, the data flow across the different steps on the

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pathway from the patient-

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Mm

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… seeing the GP to being referred to a surgeon to be referred to

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an MDT, which is where we make clinical decisions about patient

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care, to be seen in clinic and be referred for treatment.

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You can see how many steps there are there in the process-

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Yeah

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… and where delays can arise in every step.

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So what do we need to do as leaders is, first of all,

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appreciate those complex pathways,

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break them down, and make sure we remove any waste that’s unnecessary.

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Mm.

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Get the patient to treatment at the right time with the right clinical

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professional, and ensure we’ve got all our results of this

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patient ready.

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I think data and IT

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interoperability of

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digital records-

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Mm-hmm

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… it’s a barrier at present, and I think-

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Mm

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… the delays in getting all the information together is one of

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the key reasons why things delay in the process.

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Of course, there is capacity. Treatments like

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chemotherapies, we need to be able to have a chemotherapy chair for that

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patient for the whole day.

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Yeah.

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Or radiotherapy machines, they have to have capacity to

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accommodate those patients.

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And where we see delays in some areas is actually

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having access to that capacity.

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Mm-hmm.

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So access to treatment.

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And of course, we can talk about

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the fact that

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that access varies depending on the areas in the country, and-

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Yeah

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…

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if we go down into a pure population level,

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some patients do not want to travel, and-

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Mm-hmm

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… access to treatment can be difficult at times.

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Again, we, as clinical leaders, as management, we need to

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ensure that we offer equitable care to most

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patients, to all, if we can.

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There’s so much in that. You talked a bit about

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the communication and the data flowIn

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practice, what does that look like in your trust?

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So somebody presents at primary or probably primary

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care, what then happens? How does that data move through the

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system for a cancer patient?

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Yeah. I’ll speak about my trust, because we are quite

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fortunate, and I’ve led the implementation of our electronic patient record a

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couple-

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Yeah

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… of years ago,

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which has really helped a lot in having all the

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information in one place. So what happens is the GP will

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send a referral, the referral will be picked up through the EPR, and

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patient will be booked into an urgent cancer clinic.

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Mm-hmm.

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And then onwards-

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Cool

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… after the surgical review and the initial tests, the

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patient will be discussed at our cancer MDT,

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whichever the specialty. We’ve got cancer MDTs for

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every cancer condition-

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Mm

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… in our trust and in others. And then the patient will be seen by

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either surgeon to have a surgery or oncologist to have the

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chemotherapy, radiotherapy. But the important thing is to gather, as

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you say, the collection of information.

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And that data can sometimes be from different sources.

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So for example-

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Right

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… some specialist tests of the tumor that we

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sample may need to go to different laboratories in the region-

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… or even to come down to London sometimes if we need some specialist

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advice. So ensuring that the results come

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back to our electronic patient record, is visible for the teams

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that see the patient and care for the patient-

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Mm

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… and we make decision

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on the whole picture of-

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Right

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… the condition. We achieve that every week,

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but it’s remarkable how much effort is needed to

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actually-

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… get to the point.

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So

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you’ve described a picture where the complexity or the

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potential delays or impacts on treatment are coming

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from the communication, the access to

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treatments, to beds, chairs,

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the coordination between all the different stakeholders and so on.

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Let’s move on to how do

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we, the improvement and change around that,

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and decisions around that

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improvement, actually. So if we think about when you started moving into your

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senior digital

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roles or senior leadership roles in general,

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what surprised you about how decisions are made at the

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system level to make those kind of improvements?

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I guess one of the areas that

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is challenging is

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siloed pathways.

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Mm.

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And part of the organization in acute trust does X,

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then primary care does Y, then when the patient get discharged, gets

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picked up by others. And it’s connecting those dots is the

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important bit.

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So to give you an example, because I like to actually illustrate what

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I mean.

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Given the complexity of the pathways now,

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one of the main

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focuses of the government is actually to move from hospital to community.

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Mm.

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For less complex care, patients will value being

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closer to where they live, and also being able to continue their

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normal life on maintenance treatment.

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Right.

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And that needs a lot of leadership at system

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level as well as organizational level.

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How do we move less complex care closer to home?

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And who needs to be involved? Who are the stakeholders that need to support those

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patients to get back into their productive lives whilst having

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maintenance treatment?

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Yeah.

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And I think collaboration here is key.

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Clinical leadership is absolutely key, because we-

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Mm-hmm

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… are closer to the patients. We can understand their needs.

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They tell us what’s working and not working.

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And then we need to take that clinical leadership

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and translate it into the management team to actually say, “What is the

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problem that we are trying to solve?

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We want to do this. We want to change and move these less complex

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treatments in the community to free up more complex

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capacity in the hospital.”

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Right.

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So we need to have a really strategic plan

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and operationally executed really well so that the

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patient’s care is safe in the community.

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And to do that, we need collaboration with industry, which we are-

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Mm

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… already doing at Coventry.

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We need our data systems to link back again into the data flow,

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and we need that communication between community and acute care.

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Mm.

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And how does continuity of care back to the GP gets,

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obviously, transferred. So you can see those complex

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pathways that need to be linked, and clinical leadership

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is key in making that link.

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You mentioned there industry collaboration, and

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the

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people joining us today are largely from industry and really care

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about how they can help improvement in the healthcare

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system. So from your perspective, inside the

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healthcare system, what does genuinely helpful

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partnership

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look like for you in practice?

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First of all, there is not going to be practice without

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partnership, okay?

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Mm.

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We are living in an era where whether it’s digital or whether

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it’s clinical care that is digitally enabled,

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we need, as clinical and operational teams, to actually

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partner. And what good partnership looks like is

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adding value to the patient journey.

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Mm.

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And we need then to define what value meansIf we

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think about the aims of the integrated care system is to

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improve care outcomes, care experiences

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at reduced cost, and also reduce health

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inequalities.

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Mm.

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And I think

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these are the overarching, really, goals that we should be

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aiming.

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Mm.

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And then broken down into different, I guess,

260
00:12:35.856 –> 00:12:37.556
mini goals that we have to achieve.

261
00:12:38.616 –> 00:12:38.936
So

262
00:12:39.856 –> 00:12:43.796
when I, as a clinician and as a manager, engage with industry,

263
00:12:44.916 –> 00:12:48.416
this is a two-way relationship. I like to

264
00:12:48.456 –> 00:12:52.256
communicate the challenges across the whole pathway, not-

265
00:12:52.396 –> 00:12:52.476
Mm

266
00:12:52.496 –> 00:12:53.696
… just one part of it.

267
00:12:54.696 –> 00:12:58.536
And I guess from the other side, from industry colleague, it’s important

268
00:12:58.576 –> 00:13:00.626
to appreciate that whole pathway-

269
00:13:01.336 –> 00:13:01.516
Mm

270
00:13:01.656 –> 00:13:04.656
… and look at the benefits of that

271
00:13:04.676 –> 00:13:08.636
collaboration as a whole. So what are the benefits

272
00:13:08.716 –> 00:13:12.696
for patients? What are the benefits for me as a clinician, for the

273
00:13:12.716 –> 00:13:14.996
organization, and for the system as a whole?

274
00:13:15.376 –> 00:13:17.196
And then we look at societal benefit.

275
00:13:18.156 –> 00:13:18.315
And there are-

276
00:13:18.356 –> 00:13:18.636
And what-

277
00:13:18.746 –> 00:13:19.356
… many of them

278
00:13:20.196 –> 00:13:22.896
So say you’ve got a provider,

279
00:13:23.856 –> 00:13:24.466
an industry

280
00:13:25.516 –> 00:13:29.126
supplier of pharmaceuticals or tech or something else.

281
00:13:30.016 –> 00:13:32.676
What does understanding the patient pathway look like?

282
00:13:32.936 –> 00:13:36.456
What do they really need to get their heads around in order to be able to add

283
00:13:36.516 –> 00:13:36.976
value?

284
00:13:39.076 –> 00:13:42.996
It goes back into your first question, what are the possible delays and-

285
00:13:43.336 –> 00:13:43.556
Mm

286
00:13:44.096 –> 00:13:47.976
… things that can go wrong that will delay patient care or reduce

287
00:13:48.016 –> 00:13:48.756
the quality?

288
00:13:49.356 –> 00:13:49.516
Yeah.

289
00:13:50.756 –> 00:13:53.396
Particularly in oncology, we need to be

290
00:13:54.136 –> 00:13:57.936
aiming to offer personalized care,

291
00:13:58.076 –> 00:14:01.196
which means we need to look at what the

292
00:14:01.216 –> 00:14:03.456
individual needs, what they-

293
00:14:03.616 –> 00:14:03.666
Mm

294
00:14:03.676 –> 00:14:06.886
… want, what are their values and aspirations,

295
00:14:07.536 –> 00:14:08.506
as well as

296
00:14:09.856 –> 00:14:13.616
what is the type of disease that we are treating at molecular level, what tests we

297
00:14:13.676 –> 00:14:15.416
need, what specific drugs we need.

298
00:14:15.936 –> 00:14:16.116
Mm.

299
00:14:16.216 –> 00:14:18.735
We need to see the patient as a whole. Okay?

300
00:14:19.316 –> 00:14:21.355
And I think industry colleagues

301
00:14:22.595 –> 00:14:26.156
need to move away from the specific area that they

302
00:14:26.276 –> 00:14:27.656
cover to look-

303
00:14:27.686 –> 00:14:29.036
… at that patient as a whole.

304
00:14:31.076 –> 00:14:31.936
So rather than

305
00:14:33.236 –> 00:14:36.906
the piece where the products or service that

306
00:14:36.936 –> 00:14:40.256
they have developed fits, it’s about

307
00:14:40.336 –> 00:14:41.616
understanding the whole,

308
00:14:42.776 –> 00:14:44.856
of course, where it fits into the patient pathway.

309
00:14:44.916 –> 00:14:45.536
But is there an

310
00:14:46.396 –> 00:14:49.976
expectation or an ask from you to do more than be the

311
00:14:50.016 –> 00:14:52.216
supplier of a single kind of

312
00:14:53.156 –> 00:14:55.176
drug or tech-based intervention?

313
00:14:55.226 –> 00:14:59.136
What would partnership across the patient pathway

314
00:14:59.156 –> 00:14:59.796
look like then?

315
00:15:01.216 –> 00:15:04.816
If we take a drug in particular, okay,

316
00:15:05.076 –> 00:15:08.896
let’s say a new chemotherapy drug, we need to think about

317
00:15:08.976 –> 00:15:12.916
what tests are available to diagnose side

318
00:15:12.956 –> 00:15:13.996
effects earlier-

319
00:15:14.006 –> 00:15:14.165
Right

320
00:15:14.165 –> 00:15:16.756
… or predicts whether the drug will be effective.

321
00:15:17.316 –> 00:15:21.016
That kind of,

322
00:15:22.676 –> 00:15:25.336
I guess, exploration around the specific product-

323
00:15:25.696 –> 00:15:25.816
Mm

324
00:15:25.916 –> 00:15:26.716
… is important.

325
00:15:27.076 –> 00:15:27.236
Mm.

326
00:15:27.676 –> 00:15:31.556
Or if we are talking about services, if we are talking about a

327
00:15:32.156 –> 00:15:35.996
digital tool that patient can self-monitor in the

328
00:15:36.036 –> 00:15:36.626
community-

329
00:15:36.906 –> 00:15:37.346
Mm. Mm

330
00:15:37.346 –> 00:15:39.796
… what does that look like? How do we train the patient?

331
00:15:39.916 –> 00:15:43.876
How do we train the carers? How does data from that device,

332
00:15:44.156 –> 00:15:48.056
which it could be measuring physiological parameters as a result

333
00:15:48.096 –> 00:15:48.736
of the treatment-

334
00:15:48.816 –> 00:15:48.825
Mm

335
00:15:48.825 –> 00:15:50.856
… we are giving, get back to us as a clinician?

336
00:15:51.916 –> 00:15:53.156
That’s what I mean by-

337
00:15:53.416 –> 00:15:53.846
Got you

338
00:15:53.856 –> 00:15:54.516
… whole person care.

339
00:15:55.416 –> 00:15:59.096
Yeah. So it really integrates into the pathway, or there’s an

340
00:15:59.136 –> 00:16:00.676
alternative pathway which

341
00:16:01.696 –> 00:16:03.096
will provide better outcomes or-

342
00:16:03.156 –> 00:16:03.736
Absolutely.

343
00:16:04.036 –> 00:16:04.196
Yeah.

344
00:16:05.416 –> 00:16:07.596
If we flip it then and think about where

345
00:16:08.696 –> 00:16:11.596
well-intentioned initiatives from industry,

346
00:16:12.976 –> 00:16:16.516
where do they sometimes create extra burden or friction

347
00:16:16.576 –> 00:16:20.136
or disengagement? What can go wrong

348
00:16:20.236 –> 00:16:22.616
about industry approaches sometimes?

349
00:16:25.216 –> 00:16:25.636
I guess

350
00:16:27.176 –> 00:16:31.156
is trying to get

351
00:16:31.216 –> 00:16:35.196
a technology or a product in and trying to retrofit it in a

352
00:16:35.276 –> 00:16:35.775
pathway.

353
00:16:35.846 –> 00:16:36.886
Right.

354
00:16:36.936 –> 00:16:40.676
I think we have to flip the discussion around and saying what is the

355
00:16:40.716 –> 00:16:43.846
problem in the pathway that we are trying to solve here.

356
00:16:43.856 –> 00:16:43.906
Mm.

357
00:16:45.196 –> 00:16:48.476
And trying to see how can the technology or the

358
00:16:48.516 –> 00:16:51.116
product or the service can actually help us.

359
00:16:51.876 –> 00:16:52.396
Mm.

360
00:16:52.496 –> 00:16:53.036
If we

361
00:16:54.516 –> 00:16:57.866
do it that way, it’s more likely to engage clinicians and to-

362
00:16:57.896 –> 00:16:57.906
Mm-hmm

363
00:16:57.906 –> 00:17:01.276
… engage managers to say, “Okay, I’ve got this wicked problem.

364
00:17:03.496 –> 00:17:06.556
How can we solve it together as partners?”

365
00:17:06.747 –> 00:17:10.257
And doing that, you enter into more a design

366
00:17:10.416 –> 00:17:12.056
thinking process where-

367
00:17:12.076 –> 00:17:12.086
Mm

368
00:17:12.086 –> 00:17:15.826
… you run a workshop, and you listen to

369
00:17:16.336 –> 00:17:18.436
the clinical and operational challenges.

370
00:17:19.056 –> 00:17:22.816
You discuss different options, and then you say,

371
00:17:22.876 –> 00:17:26.757
“Okay, well, this particular product or service will work well for you.”

372
00:17:27.216 –> 00:17:27.477
Mm.

373
00:17:27.546 –> 00:17:29.476
“Demonstrate it. We have demonstrated.

374
00:17:29.896 –> 00:17:30.236
Let’s

375
00:17:31.276 –> 00:17:33.876
do a pilot. Let’s scale it if it works.”

376
00:17:33.976 –> 00:17:34.036
Mm-hmm.

377
00:17:34.086 –> 00:17:37.476
“Not just stay it in a pilot phase. Let’s measure it.

378
00:17:37.916 –> 00:17:41.516
Let’s PDSA, use improvement methodology to improve it.”

379
00:17:42.416 –> 00:17:46.176
And that process is really important because it can be

380
00:17:46.196 –> 00:17:49.996
embedded then everywhere. And in other systems, it can

381
00:17:50.116 –> 00:17:51.996
scale up the product and the service.

382
00:17:52.776 –> 00:17:56.336
And that sounds wonderful to me, and I’m wondering

383
00:17:56.346 –> 00:17:58.156
about what is the

384
00:17:59.336 –> 00:18:03.296
capacity and capability of clinicians

385
00:18:03.356 –> 00:18:06.476
or colleagues in other parts of the healthcare system to do that kind of

386
00:18:06.536 –> 00:18:08.956
exploratory work with industry?

387
00:18:11.736 –> 00:18:14.856
Well, a lot of people will say there is no capacity to do-

388
00:18:15.036 –> 00:18:15.166
Yeah

389
00:18:15.376 –> 00:18:19.044
… this, but I wouldI would challenge that and say that if we

390
00:18:19.164 –> 00:18:22.604
don’t do this, we will never create capacity.

391
00:18:22.664 –> 00:18:22.864
Yeah.

392
00:18:22.904 –> 00:18:26.444
When we do those exercises, and we do them together,

393
00:18:27.724 –> 00:18:30.044
firstly, people get very engaged.

394
00:18:30.304 –> 00:18:30.374
Mm-hmm.

395
00:18:30.404 –> 00:18:33.424
They see the meaning behind it and the purpose of why they are-

396
00:18:33.444 –> 00:18:33.464
Mm

397
00:18:33.484 –> 00:18:34.474
… working so hard,

398
00:18:35.364 –> 00:18:38.034
and they can take it and own it back in the clinic-

399
00:18:38.044 –> 00:18:38.054
Mm

400
00:18:38.644 –> 00:18:40.824
… with the clinical teams in clinical care.

401
00:18:41.434 –> 00:18:44.844
And when people own something, an innovation that’s aiming to

402
00:18:44.904 –> 00:18:48.004
improve patient care and end staff experience,

403
00:18:49.024 –> 00:18:52.024
they become passionate about it, most likely to succeed.

404
00:18:52.424 –> 00:18:52.704
Mm.

405
00:18:53.144 –> 00:18:57.064
And you get the benefits out of it. If we do the same thing and

406
00:18:57.104 –> 00:19:01.064
we don’t devote time to do those design thinking

407
00:19:01.784 –> 00:19:05.244
workshops and implement small changes,

408
00:19:05.824 –> 00:19:08.893
nothing is going to change, and our capacity will never get better.

409
00:19:09.404 –> 00:19:12.224
Yeah, the investment of the time up front to-

410
00:19:12.284 –> 00:19:14.184
It will pay later on

411
00:19:14.204 –> 00:19:14.434
… yeah.

412
00:19:15.464 –> 00:19:18.324
And what is an attractive idea to you, then?

413
00:19:18.424 –> 00:19:22.084
So an industry partner comes and says, “Look, we really want to collaborate around

414
00:19:22.124 –> 00:19:25.444
this. We know this is an issue for patients.

415
00:19:25.504 –> 00:19:26.924
We’ve understood the pathway.”

416
00:19:28.064 –> 00:19:29.424
What are you looking for

417
00:19:30.484 –> 00:19:33.824
in order to say, “Yes, okay, let’s spend that time in a

418
00:19:33.884 –> 00:19:36.004
workshop or let’s run that pilot”?

419
00:19:37.084 –> 00:19:40.554
What do you need to feel that this is a worthwhile investment of time and

420
00:19:40.604 –> 00:19:41.264
resources?

421
00:19:43.224 –> 00:19:46.904
Well, first of all, I would like to understand the

422
00:19:46.944 –> 00:19:48.664
value to the patient, the evidence-

423
00:19:48.944 –> 00:19:49.244
Mm

424
00:19:49.604 –> 00:19:51.724
… and where it has worked before, or is that-

425
00:19:51.744 –> 00:19:51.754
Mm

426
00:19:51.754 –> 00:19:52.994
… the first time that we are-

427
00:19:53.004 –> 00:19:53.014
Mm. Mm

428
00:19:53.084 –> 00:19:55.264
… trialing it? I think that’s really important.

429
00:19:56.944 –> 00:19:57.404
Once we

430
00:19:58.224 –> 00:20:01.984
know which one of the two it is, if it has been implemented before, how can we

431
00:20:02.024 –> 00:20:03.994
learn from elsewhere and bring-

432
00:20:04.024 –> 00:20:04.034
Mm

433
00:20:04.034 –> 00:20:05.444
… that into the organization?

434
00:20:06.484 –> 00:20:10.464
If it hasn’t, then let’s start with engaging clinicians to

435
00:20:10.484 –> 00:20:12.144
understand the value for them.

436
00:20:12.184 –> 00:20:12.244
Mm-hmm.

437
00:20:12.314 –> 00:20:15.224
What’s in it for them, what’s in it for the patient.

438
00:20:15.264 –> 00:20:18.544
Important to involve patients in the process as well.

439
00:20:18.564 –> 00:20:18.654
Yep.

440
00:20:18.804 –> 00:20:21.344
Hear their voice. And as I explained,

441
00:20:21.644 –> 00:20:25.624
it’s an iterative process. You use a

442
00:20:25.674 –> 00:20:26.304
methodology-

443
00:20:26.364 –> 00:20:26.374
Mm

444
00:20:26.374 –> 00:20:30.114
… which we use very well in Coventry to actually do exactly that,

445
00:20:30.304 –> 00:20:32.394
go from an idea to an implementation,

446
00:20:33.244 –> 00:20:34.884
measure it, and then scale it.

447
00:20:36.424 –> 00:20:39.104
That’s where I would see value coming out of it.

448
00:20:40.384 –> 00:20:43.984
And whilst you’re mentioning there that you’ve got some skill

449
00:20:44.044 –> 00:20:45.304
in-house around

450
00:20:46.424 –> 00:20:49.044
design thinking and so on, are you also

451
00:20:50.164 –> 00:20:53.824
looking for potential partners to have that, to be able to

452
00:20:54.684 –> 00:20:57.584
manage the process a bit as well? Is that helpful?

453
00:20:59.004 –> 00:21:02.884
Yeah, absolutely. And the

454
00:21:02.924 –> 00:21:06.544
private sector do that more consistently, I would say.

455
00:21:06.564 –> 00:21:06.604
Mm.

456
00:21:06.784 –> 00:21:10.614
So there’s a lot to learn from the private sector, from industry regarding that,

457
00:21:11.024 –> 00:21:13.934
and we have seen example in our trust how we partnered,

458
00:21:15.244 –> 00:21:19.124
and we learn from that design process, and we use that now consistently

459
00:21:19.204 –> 00:21:21.684
in our practice. And at the same time,

460
00:21:21.784 –> 00:21:25.304
industry partners have a lot to learn from us.

461
00:21:25.464 –> 00:21:26.004
They have a lot-

462
00:21:26.064 –> 00:21:26.184
Mm

463
00:21:26.254 –> 00:21:30.204
… to learn of how we navigate those challenges in practice.

464
00:21:30.364 –> 00:21:34.244
What do we do with our data? And I think the combination of that

465
00:21:34.284 –> 00:21:35.904
knowledge is very powerful at the end.

466
00:21:37.764 –> 00:21:41.614
We’ve been talking a little bit about what does industry need to do and

467
00:21:41.624 –> 00:21:45.264
potentially making some changes in how they approach collaboration.

468
00:21:45.304 –> 00:21:47.284
What about from the healthcare system side?

469
00:21:47.324 –> 00:21:51.284
Where do you see the helpful and less helpful behaviors from

470
00:21:52.744 –> 00:21:53.064
your

471
00:21:54.104 –> 00:21:58.064
wider colleagues there in the healthcare system

472
00:21:58.144 –> 00:22:00.604
when it comes to collaboration with industry?

473
00:22:01.004 –> 00:22:01.263
Mm.

474
00:22:02.204 –> 00:22:03.224
Yeah. I think

475
00:22:04.084 –> 00:22:04.844
sometimes we

476
00:22:06.264 –> 00:22:09.724
think in the NHS that working with the industry and the private sector

477
00:22:10.404 –> 00:22:13.284
is something very different, and it’s almost like the dark side.

478
00:22:13.304 –> 00:22:13.844
But actually-

479
00:22:15.064 –> 00:22:15.084
Mm

480
00:22:15.944 –> 00:22:18.844
… there’s a lot to learn from other industries.

481
00:22:19.264 –> 00:22:19.524
Mm-hmm.

482
00:22:19.904 –> 00:22:23.794
There’s a lot that we have learned from other industries, like aviation

483
00:22:23.844 –> 00:22:26.044
industry, like human factors-

484
00:22:26.304 –> 00:22:26.484
Mm

485
00:22:27.504 –> 00:22:31.324
… and as we said, the design process and the engineering of

486
00:22:31.384 –> 00:22:34.864
how you create something, a service which is new.

487
00:22:35.404 –> 00:22:38.804
I think we need to break those silos down, and we as clinical leaders

488
00:22:38.864 –> 00:22:42.724
should own that process, and

489
00:22:42.764 –> 00:22:45.554
we should be curious to understand what happens elsewhere.

490
00:22:45.604 –> 00:22:49.454
What do other trusts do? What is the private sector doing,

491
00:22:49.564 –> 00:22:52.214
and how can we learn? How can we collaborate?

492
00:22:53.384 –> 00:22:53.824
And again,

493
00:22:55.004 –> 00:22:56.104
as system leaders,

494
00:22:57.184 –> 00:23:00.084
we need to take that seriously. We need to think differently.

495
00:23:00.504 –> 00:23:02.044
We know that

496
00:23:02.864 –> 00:23:06.564
cancer is going to become even more complex moving forward-

497
00:23:06.924 –> 00:23:06.934
Mm

498
00:23:06.934 –> 00:23:09.764
… and all other disciplines as well.

499
00:23:09.804 –> 00:23:11.904
We are talking moving into

500
00:23:12.044 –> 00:23:15.204
a molecular era,

501
00:23:15.284 –> 00:23:16.094
understanding-

502
00:23:16.724 –> 00:23:16.734
Mm

503
00:23:16.734 –> 00:23:20.384
… more complex data sets, using AI, protecting

504
00:23:20.464 –> 00:23:21.344
patient data.

505
00:23:22.284 –> 00:23:25.904
So really, the way we work has changed, and

506
00:23:26.404 –> 00:23:30.324
working in partnership with the industry can only

507
00:23:30.384 –> 00:23:33.844
enhance patient care and make the

508
00:23:33.944 –> 00:23:36.744
whole system around the patient stronger.

509
00:23:38.264 –> 00:23:40.544
You mentioned AI there, of course.

510
00:23:40.864 –> 00:23:42.864
And

511
00:23:44.624 –> 00:23:47.864
I think historically, an

512
00:23:47.924 –> 00:23:48.744
industry

513
00:23:50.664 –> 00:23:53.784
or a company may have approached the NHS with

514
00:23:54.204 –> 00:23:57.344
a pharmaceutical product or with a piece of tech,

515
00:23:59.224 –> 00:24:01.504
and that’s not enough anymore, right?

516
00:24:01.604 –> 00:24:04.944
We are talking about patient pathway

517
00:24:05.064 –> 00:24:05.984
change

518
00:24:06.944 –> 00:24:10.794
and more holistic solutions. Are you seeing that

519
00:24:11.864 –> 00:24:15.264
change in the industry, that they’re bringing a more comprehensive

520
00:24:15.304 –> 00:24:17.574
combination of product, service, and

521
00:24:18.604 –> 00:24:21.004
other stuff around that? What’s happening there?

522
00:24:22.240 –> 00:24:24.800
Yeah, I think the dialogue has started to shift

523
00:24:25.780 –> 00:24:29.300
towards a more patient pathway,

524
00:24:29.400 –> 00:24:30.640
holistic care.

525
00:24:30.700 –> 00:24:31.270
Yeah.

526
00:24:31.320 –> 00:24:34.440
I think what we need to also think about the traditional

527
00:24:34.840 –> 00:24:36.440
research type of

528
00:24:37.420 –> 00:24:41.200
activity, in a way, takes about 20 years to

529
00:24:41.220 –> 00:24:44.840
get something, a product or a service, into a market.

530
00:24:45.360 –> 00:24:45.440
Mm.

531
00:24:45.480 –> 00:24:49.460
I think we need to gradually step away, if we can, and

532
00:24:49.580 –> 00:24:51.200
look at more real-world data-

533
00:24:51.920 –> 00:24:51.950
Mm

534
00:24:52.000 –> 00:24:54.140
… and use AI to analyze that data.

535
00:24:55.340 –> 00:24:57.860
We see so many patients on a daily basis now.

536
00:24:57.920 –> 00:25:00.580
We’ve got EPR systems which are mature.

537
00:25:01.160 –> 00:25:04.920
We should be able to link those data sets, and we should be able to

538
00:25:04.980 –> 00:25:06.260
ask the right questions,

539
00:25:07.180 –> 00:25:10.220
and make improvements on that richness of

540
00:25:10.260 –> 00:25:13.699
data. And the industry can help us with that.

541
00:25:16.020 –> 00:25:19.180
That changed

542
00:25:19.220 –> 00:25:23.170
relationship, and change in general, anything I think that we’re

543
00:25:23.200 –> 00:25:24.040
talking about here,

544
00:25:24.940 –> 00:25:28.180
from bringing a new product or a service or how the industry looks, it’s all about

545
00:25:28.260 –> 00:25:29.620
change and behavioral change.

546
00:25:30.520 –> 00:25:33.700
And that’s where we love working for you.

547
00:25:34.980 –> 00:25:38.280
What helps those changes to stick

548
00:25:38.380 –> 00:25:42.080
in your trust or in the other organizations that you’re

549
00:25:42.120 –> 00:25:44.150
working with so that it doesn’t just

550
00:25:45.640 –> 00:25:48.900
snap back to what you were doing before?

551
00:25:48.980 –> 00:25:51.580
Yeah. Very good question. I think first of all is

552
00:25:52.880 –> 00:25:54.080
a very compelling vision-

553
00:25:54.580 –> 00:25:54.710
Mm

554
00:25:54.710 –> 00:25:56.420
… that comes really top-down.

555
00:25:57.480 –> 00:26:00.050
Where are we going as an organization, and how-

556
00:26:00.100 –> 00:26:00.120
Mm

557
00:26:00.130 –> 00:26:00.940
… do we align

558
00:26:01.980 –> 00:26:05.120
our strategy with the government

559
00:26:05.160 –> 00:26:08.940
priorities? That’s really, really important, and

560
00:26:08.980 –> 00:26:11.820
communicating that strategy is really important.

561
00:26:12.710 –> 00:26:12.710
Mm.

562
00:26:12.740 –> 00:26:15.500
Then understanding what are the enablers of that strategy,

563
00:26:16.220 –> 00:26:20.100
and make sure that we are reviewing this strategy regularly because

564
00:26:20.200 –> 00:26:21.820
things are moving really fast as you-

565
00:26:21.960 –> 00:26:22.120
Mm

566
00:26:22.320 –> 00:26:23.100
… work in healthcare.

567
00:26:24.280 –> 00:26:28.100
The communication down to all levels of the organization is key because people

568
00:26:28.180 –> 00:26:29.780
need to feel part of that strategy.

569
00:26:30.479 –> 00:26:34.060
This is not something that it happens in an executive suite and

570
00:26:34.620 –> 00:26:38.590
is pushed down. It’s something that is actually designed and

571
00:26:38.680 –> 00:26:42.080
driven by the organization, and that’s what we’ve done in Coventry.

572
00:26:42.540 –> 00:26:45.730
We run a large consultation-

573
00:26:46.440 –> 00:26:46.530
Mm

574
00:26:46.620 –> 00:26:50.300
… and we are doing the refresh at the moment, in fact, with our staff,

575
00:26:51.100 –> 00:26:54.360
with our patient partners, with our community,

576
00:26:55.980 –> 00:26:57.620
to ensure that people buy into it.

577
00:26:58.100 –> 00:26:58.280
Mm.

578
00:26:58.340 –> 00:27:02.260
People need to buy into it and understand what’s in it for them and what is-

579
00:27:02.440 –> 00:27:02.470
Mm

580
00:27:02.470 –> 00:27:03.020
… the role in it.

581
00:27:03.700 –> 00:27:07.540
Mm. And I really hear you about the need for the

582
00:27:08.100 –> 00:27:12.000
compelling vision, feeling high conviction as

583
00:27:12.020 –> 00:27:13.620
an individual that you want to

584
00:27:14.820 –> 00:27:18.740
change. You understand that the vision that is

585
00:27:18.780 –> 00:27:21.940
being painted and the strategy is attractive. It makes sense.

586
00:27:23.600 –> 00:27:26.600
And then sometimes the day-to-day gets in the way because

587
00:27:27.300 –> 00:27:31.100
incredibly pressured jobs, the demands

588
00:27:31.160 –> 00:27:32.380
are increasing.

589
00:27:33.660 –> 00:27:37.260
If we look at very practical day-to-day

590
00:27:37.360 –> 00:27:39.500
shifts for

591
00:27:40.520 –> 00:27:42.170
staff working in oncology,

592
00:27:42.980 –> 00:27:43.320
what

593
00:27:44.920 –> 00:27:48.840
helps them to adopt a different way of working, using a different treatment or

594
00:27:48.880 –> 00:27:50.820
whatever it is, in a very

595
00:27:51.700 –> 00:27:53.580
on the ground sense?

596
00:27:54.020 –> 00:27:54.260
Mm.

597
00:27:55.100 –> 00:27:58.300
Yeah. First of all, for me, is giving people

598
00:27:59.480 –> 00:28:01.540
actually the permission to take

599
00:28:02.760 –> 00:28:04.680
some time and just step back and-

600
00:28:04.820 –> 00:28:05.100
Mm

601
00:28:05.520 –> 00:28:08.560
… reflect. End of the week, beginning of the week,

602
00:28:09.880 –> 00:28:13.870
reflect on the goals on what we have achieved on that

603
00:28:13.980 –> 00:28:17.340
week, what does good care look like, and are we-

604
00:28:17.480 –> 00:28:17.500
Mm

605
00:28:17.510 –> 00:28:18.650
… actually achieving this?

606
00:28:19.520 –> 00:28:22.400
It’s very easy to get time and pressures.

607
00:28:24.140 –> 00:28:27.600
Every day gets by, and then the next day gets by, and then we-

608
00:28:27.640 –> 00:28:27.660
Mm

609
00:28:27.700 –> 00:28:29.810
… think about, but we don’t have time to think about.

610
00:28:30.420 –> 00:28:30.430
Mm.

611
00:28:30.430 –> 00:28:34.280
How do we, as leaders, give that space and permission

612
00:28:34.340 –> 00:28:38.280
to people to look at the care they provide and say, “Are we actually

613
00:28:38.320 –> 00:28:41.019
doing what we are supposed to do? What are-

614
00:28:41.060 –> 00:28:41.279
Yeah

615
00:28:41.290 –> 00:28:42.180
… patients telling us?”

616
00:28:43.060 –> 00:28:46.560
Going back into my point of taking space to look at the

617
00:28:46.640 –> 00:28:50.580
pathway. So for example, even the physical space is important,

618
00:28:50.660 –> 00:28:50.860
right?

619
00:28:50.930 –> 00:28:50.930
Yeah.

620
00:28:51.060 –> 00:28:53.300
So we’ve got an innovation hub at

621
00:28:54.400 –> 00:28:57.680
Coventry Trust UHW, where we run

622
00:28:57.820 –> 00:29:00.840
those days, and I wouldn’t call them days off.

623
00:29:00.940 –> 00:29:04.530
I would call them strategic days, essential days-

624
00:29:04.530 –> 00:29:07.940
… where we think about what good care looks like, what good

625
00:29:08.000 –> 00:29:11.659
communication looks like, what good partnership with the industry looks like.

626
00:29:11.760 –> 00:29:12.340
Yeah.

627
00:29:13.270 –> 00:29:15.900
And then bringing that knowledge back to the teams.

628
00:29:17.400 –> 00:29:19.300
That is what energizes people,

629
00:29:20.540 –> 00:29:21.710
and they will go back to work-

630
00:29:21.710 –> 00:29:24.980
To what extent do you involve external partners in that kind of

631
00:29:25.000 –> 00:29:26.160
innovation work?

632
00:29:27.960 –> 00:29:30.960
Well, we involve other trusts, we involve

633
00:29:31.380 –> 00:29:34.880
primary care, we involve social care, we

634
00:29:35.220 –> 00:29:37.670
involve private providers if it’s-

635
00:29:37.820 –> 00:29:37.830
Yeah

636
00:29:37.830 –> 00:29:38.370
… essential

637
00:29:39.440 –> 00:29:43.080
in that particular conversation. Absolutely.

638
00:29:43.830 –> 00:29:43.850
We

639
00:29:49.240 –> 00:29:50.180
see that the

640
00:29:51.500 –> 00:29:55.200
challenges to improve care, they exist within the

641
00:29:55.220 –> 00:29:58.620
healthcare system, and then we have solutions being developed over here,

642
00:30:01.460 –> 00:30:02.370
based on

643
00:30:06.000 –> 00:30:09.700
from a pharmaceutical perspective on the

644
00:30:09.740 –> 00:30:10.360
science.

645
00:30:11.820 –> 00:30:15.760
Sometimes these exist in isolation, and then sometimes they interact, but often not

646
00:30:15.820 –> 00:30:19.240
very early. So the opportunity

647
00:30:19.420 –> 00:30:19.820
to

648
00:30:21.240 –> 00:30:25.220
do that ideation, the early phases in the design, thinking

649
00:30:25.240 –> 00:30:29.070
about, “Look, these are issues. Here, how can we even start to think about these?”

650
00:30:29.160 –> 00:30:32.220
Rather than, “Okay, we’ve got a problem, and we expect you to have a ready

651
00:30:32.300 –> 00:30:32.860
solution-

652
00:30:33.220 –> 00:30:33.300
Yeah

653
00:30:33.360 –> 00:30:37.000
… to solve it.”It sounds a bit like that’s the direction that-

654
00:30:37.140 –> 00:30:37.660
Absolutely

655
00:30:37.680 –> 00:30:38.140
… you work in.

656
00:30:38.580 –> 00:30:40.040
That is the missing gap.

657
00:30:40.340 –> 00:30:40.500
Right.

658
00:30:40.740 –> 00:30:43.240
That engagement

659
00:30:44.220 –> 00:30:46.870
to bring a solution to life is key.

660
00:30:46.890 –> 00:30:46.920
Yeah.

661
00:30:47.070 –> 00:30:49.340
Because that’s how people will adopt it, first of all.

662
00:30:49.400 –> 00:30:49.540
Yeah.

663
00:30:49.680 –> 00:30:51.380
That’s how it’s going to be sustained.

664
00:30:52.520 –> 00:30:55.260
Have you had experience of that

665
00:30:55.380 –> 00:30:59.340
early collaboration with industry where there’s

666
00:30:59.400 –> 00:31:03.290
a problem or an opportunity in care, and you’re already at

667
00:31:03.340 –> 00:31:05.480
that point talking about it before

668
00:31:06.480 –> 00:31:10.120
it’s become a big thing, or maybe it’s a big thing, but there

669
00:31:11.660 –> 00:31:13.650
isn’t a clear solution out there?

670
00:31:15.440 –> 00:31:16.140
Absolutely. A

671
00:31:17.300 –> 00:31:21.080
few months ago, we ran a workshop

672
00:31:21.160 –> 00:31:24.680
with an industry provider looking at a neighborhood

673
00:31:25.460 –> 00:31:26.960
health model for oncology.

674
00:31:27.340 –> 00:31:27.580
Right.

675
00:31:27.660 –> 00:31:29.560
So exactly what I described before.

676
00:31:29.680 –> 00:31:33.340
How do we take some treatments which are subcutaneous or

677
00:31:33.520 –> 00:31:33.800
oral-

678
00:31:33.980 –> 00:31:34.100
Yeah

679
00:31:34.360 –> 00:31:37.390
… and they move into a community setting?

680
00:31:37.730 –> 00:31:37.730
Mm.

681
00:31:37.780 –> 00:31:40.670
How does that service look like? What are the governance

682
00:31:42.720 –> 00:31:44.420
framework that we need to think about?

683
00:31:44.860 –> 00:31:45.000
Mm.

684
00:31:45.050 –> 00:31:47.060
The data flow, the commissioning bit.

685
00:31:47.720 –> 00:31:50.740
It was really successful, and we went live with that

686
00:31:51.340 –> 00:31:51.920
service-

687
00:31:52.240 –> 00:31:52.250
Mm

688
00:31:52.250 –> 00:31:56.160
… which is run by specialist nurses in the community, and it

689
00:31:56.220 –> 00:31:58.100
has started to make a difference.

690
00:31:59.600 –> 00:32:03.500
Amazing. And what partners, you don’t have to name the partners, but

691
00:32:03.540 –> 00:32:05.840
where were they coming from? What was the background?

692
00:32:05.900 –> 00:32:08.420
Who were you working with to bring that kind of

693
00:32:08.500 –> 00:32:11.060
a solution to life?

694
00:32:12.220 –> 00:32:13.660
From the pharmaceutical industry.

695
00:32:13.960 –> 00:32:14.160
Right.

696
00:32:14.760 –> 00:32:18.520
Of course, their experience, as we talked about,

697
00:32:19.060 –> 00:32:23.040
goes beyond that. It looks at the whole pathway, and that skill set

698
00:32:23.100 –> 00:32:25.740
and enablement and knowledge-

699
00:32:26.220 –> 00:32:26.740
Yeah

700
00:32:26.750 –> 00:32:29.520
… got forwarded to us, and then

701
00:32:30.660 –> 00:32:34.240
we explored in a day’s workshop, and we are now

702
00:32:34.540 –> 00:32:37.540
up and running the service. It’s really, really powerful.

703
00:32:38.380 –> 00:32:39.060
That’s amazing.

704
00:32:41.140 –> 00:32:44.739
I want to ask our audience to

705
00:32:44.840 –> 00:32:48.320
fire in some questions. And whilst they do

706
00:32:48.420 –> 00:32:48.860
that,

707
00:32:52.140 –> 00:32:54.340
let me kick you off with one. So

708
00:32:57.020 –> 00:33:00.760
what behaviors would you say from,

709
00:33:01.260 –> 00:33:04.580
I suppose, industry partners signal that they really understand your

710
00:33:04.640 –> 00:33:06.020
priorities rather than,

711
00:33:07.140 –> 00:33:09.140
I suppose, just going through a process?

712
00:33:11.200 –> 00:33:15.180
Understanding of the patient pathway.

713
00:33:15.480 –> 00:33:16.020
Having some-

714
00:33:16.100 –> 00:33:16.110
Yeah

715
00:33:16.110 –> 00:33:19.160
… knowledge of that pathway rather than starting

716
00:33:19.960 –> 00:33:22.060
describing it from scratch.

717
00:33:22.460 –> 00:33:22.640
Yeah.

718
00:33:23.190 –> 00:33:26.770
Understanding who the key stakeholders are and who the

719
00:33:26.840 –> 00:33:28.040
decision makers are.

720
00:33:28.760 –> 00:33:28.960
Yeah.

721
00:33:29.920 –> 00:33:33.860
And then be willing to listen and be willing to work a

722
00:33:33.960 –> 00:33:37.080
solution that might be slightly different to what,

723
00:33:38.300 –> 00:33:40.560
I guess, they hoped or planned from the beginning.

724
00:33:40.600 –> 00:33:41.140
Right.

725
00:33:41.160 –> 00:33:42.920
Be agile about this.

726
00:33:43.500 –> 00:33:44.380
Love that. So

727
00:33:45.320 –> 00:33:48.809
when they approach you or your

728
00:33:48.880 –> 00:33:52.040
colleagues, they’re really coming having done their homework about-

729
00:33:52.340 –> 00:33:53.350
Yeah

730
00:33:53.400 –> 00:33:55.120
… what’s going on in the patient pathway.

731
00:33:55.260 –> 00:33:57.800
Who are the stakeholder groups involved?

732
00:33:58.700 –> 00:34:02.180
They have some ideas about a potential solution, but they are

733
00:34:03.980 –> 00:34:07.400
open to being flexible on that so that it

734
00:34:08.440 –> 00:34:12.000
genuinely meets the needs that you have and can create value.

735
00:34:12.500 –> 00:34:12.980
Is that fair?

736
00:34:13.520 –> 00:34:17.281
Yeah. That is very fair. And I mentioned

737
00:34:17.321 –> 00:34:20.900
before about using implementation science

738
00:34:21.560 –> 00:34:25.120
in all of this. So start evaluating a

739
00:34:25.180 –> 00:34:25.841
change-

740
00:34:26.580 –> 00:34:26.660
Mm

741
00:34:26.680 –> 00:34:29.080
… from the beginning of that change, not

742
00:34:29.920 –> 00:34:33.080
wait until the end to start measuring.

743
00:34:33.089 –> 00:34:36.611
Measure the before, measure the after, and put some

744
00:34:36.640 –> 00:34:38.531
investment on it because-

745
00:34:38.580 –> 00:34:38.841
Mm

746
00:34:38.861 –> 00:34:42.620
… we are good in the UK of ideation, but when it

747
00:34:42.680 –> 00:34:46.341
comes to implementation and evaluation, we are less good at.

748
00:34:47.841 –> 00:34:51.781
But those small scale projects are a good opportunity to put

749
00:34:51.801 –> 00:34:53.640
investment on the evaluation piece.

750
00:34:54.920 –> 00:34:55.420
Wonderful.

751
00:34:56.620 –> 00:34:57.940
We’ve got some other questions coming.

752
00:34:58.520 –> 00:35:02.160
And I will say to the participants as well, I’ve just shared

753
00:35:03.500 –> 00:35:06.460
the momentum check on screen, which is a simple diagnostic

754
00:35:07.300 –> 00:35:08.680
that helps you see where

755
00:35:09.660 –> 00:35:13.600
your team’s working with healthcare systems and in other areas might be

756
00:35:13.620 –> 00:35:16.440
able to accelerate performance. So check that out.

757
00:35:16.460 –> 00:35:18.960
Okay, next question then.

758
00:35:23.680 –> 00:35:27.500
Oof. Okay. Looking ahead, what will matter more in the next

759
00:35:27.580 –> 00:35:28.520
few years

760
00:35:29.800 –> 00:35:31.560
that teams

761
00:35:34.020 –> 00:35:37.820
should start adapting to now? So if we think

762
00:35:37.860 –> 00:35:40.580
about this or my interpretation of that is,

763
00:35:43.940 –> 00:35:47.540
the industry teams that are looking to collaborate

764
00:35:47.820 –> 00:35:51.740
and also your internal teams, what do they need to be changing in how

765
00:35:51.780 –> 00:35:55.080
they’re thinking about healthcare now in order

766
00:35:55.140 –> 00:35:56.600
for what’s coming?

767
00:35:58.700 –> 00:36:02.610
So we know there’s a lot of change happening in the strategic

768
00:36:02.610 –> 00:36:04.100
commissioning space.

769
00:36:04.240 –> 00:36:04.400
Mm.

770
00:36:04.520 –> 00:36:07.740
Yeah. And I think we’re going to see a lot

771
00:36:07.940 –> 00:36:11.680
more value-based commissioning in the

772
00:36:11.720 –> 00:36:15.260
future, so outcomes based, essentially.

773
00:36:16.120 –> 00:36:17.200
I think we need to start

774
00:36:18.100 –> 00:36:20.720
earlier now understanding what value means.

775
00:36:20.820 –> 00:36:23.500
How do we measure those outcomes?

776
00:36:23.920 –> 00:36:24.180
Mm.

777
00:36:24.260 –> 00:36:28.160
So things like patient reported outcome measures, patient reported

778
00:36:28.200 –> 00:36:30.920
experience measures. I think there will be a time

779
00:36:31.540 –> 00:36:35.500
whereby care will be commissioned if we meet those,

780
00:36:36.060 –> 00:36:36.740
and if we are-

781
00:36:36.780 –> 00:36:36.810
Mm

782
00:36:36.810 –> 00:36:40.520
… performing well in those. I use the word performance, that’s probably not the

783
00:36:40.560 –> 00:36:43.684
right word, but-We are not currently

784
00:36:43.724 –> 00:36:46.484
consistently collecting PROMs and PREMS.

785
00:36:47.164 –> 00:36:47.384
Mm-hmm.

786
00:36:47.664 –> 00:36:49.644
But I think that’s something that will come.

787
00:36:49.664 –> 00:36:53.224
And if we are ahead of the game, and solutions, drugs,

788
00:36:53.324 –> 00:36:54.244
services

789
00:36:55.304 –> 00:36:57.024
incorporate that,

790
00:36:57.844 –> 00:37:01.504
and we can do that digitally nowadays, I think we will be ahead of the game.

791
00:37:03.624 –> 00:37:06.764
Am I right to interpret then that as meaning

792
00:37:07.724 –> 00:37:09.724
pharmaceutical companies also need to be

793
00:37:10.724 –> 00:37:13.974
presenting data beyond just the efficacy of their-

794
00:37:14.924 –> 00:37:15.604
Yes, exactly

795
00:37:15.784 –> 00:37:15.834
… drugs?

796
00:37:15.904 –> 00:37:16.603
Absolutely.

797
00:37:18.184 –> 00:37:21.404
And is that already coming into your decision-making?

798
00:37:22.844 –> 00:37:24.004
It’s slowly coming in.

799
00:37:24.404 –> 00:37:24.964
Yeah.

800
00:37:25.024 –> 00:37:28.624
Again, I’m currently trying to build an

801
00:37:28.704 –> 00:37:32.644
ePROMs solution within our EPR, and again,

802
00:37:32.704 –> 00:37:35.964
engaging with industry and seeing how we can work that out.

803
00:37:37.464 –> 00:37:39.104
It’s really, really important.

804
00:37:40.784 –> 00:37:44.604
You said earlier on in the conversation about learning

805
00:37:44.744 –> 00:37:46.604
from other industries.

806
00:37:47.904 –> 00:37:51.764
What have you been able to

807
00:37:52.544 –> 00:37:55.424
borrow or be inspired by in how

808
00:37:56.724 –> 00:38:00.184
public-private collaboration works in other places?

809
00:38:02.704 –> 00:38:03.864
Well, many stories.

810
00:38:05.604 –> 00:38:06.384
Certainly,

811
00:38:07.904 –> 00:38:11.564
one of the highlights in my career is working with

812
00:38:11.624 –> 00:38:14.404
a private company and

813
00:38:15.364 –> 00:38:16.164
using another

814
00:38:17.224 –> 00:38:20.784
private provider expert in human factors-

815
00:38:21.124 –> 00:38:21.344
Mm

816
00:38:22.484 –> 00:38:25.554
… because the lead consultant there was an

817
00:38:25.584 –> 00:38:26.924
ex-pilot.

818
00:38:27.624 –> 00:38:27.804
Right.

819
00:38:27.884 –> 00:38:29.364
So he essentially

820
00:38:30.324 –> 00:38:33.944
taught me, as a senior leader of that private organization, how to

821
00:38:34.084 –> 00:38:37.904
think like an aviation pilot when we talk about safety.

822
00:38:38.624 –> 00:38:38.784
Mm.

823
00:38:38.864 –> 00:38:42.704
Safety in oncology, safety in radiotherapy processes, checking

824
00:38:42.784 –> 00:38:44.984
processes, and what could go wrong.

825
00:38:45.684 –> 00:38:47.864
Can you explain that a bit more? What does that look like?

826
00:38:49.184 –> 00:38:51.963
So there is something around behavior science.

827
00:38:52.504 –> 00:38:55.944
When a process you think you know and you do it every day,

828
00:38:57.184 –> 00:39:00.764
it’s very likely that a very known process,

829
00:39:00.924 –> 00:39:03.244
you’re going to relax your controls, right?

830
00:39:03.324 –> 00:39:05.184
You’re going to say, “Okay, well, I know this.

831
00:39:06.084 –> 00:39:07.804
I don’t need anybody to check this.”

832
00:39:07.844 –> 00:39:08.224
Mm.

833
00:39:08.984 –> 00:39:12.704
When you relax those controls is where errors

834
00:39:12.784 –> 00:39:13.884
happen. And in-

835
00:39:14.044 –> 00:39:14.154
Right

836
00:39:14.164 –> 00:39:16.364
… the aviation industry, we’ve got classic examples.

837
00:39:17.024 –> 00:39:19.644
So what we did with

838
00:39:20.464 –> 00:39:22.664
that company was actually film

839
00:39:23.664 –> 00:39:26.164
a complex process within radiotherapy.

840
00:39:26.373 –> 00:39:26.944
Mm.

841
00:39:27.064 –> 00:39:29.684
Patient coming in, checking patient’s ID,

842
00:39:30.704 –> 00:39:34.484
and moving into that process of going into the radiotherapy

843
00:39:34.584 –> 00:39:36.884
room, getting the treatment, and coming out.

844
00:39:37.764 –> 00:39:39.444
What could possibly go wrong?

845
00:39:40.024 –> 00:39:40.283
Mm.

846
00:39:40.464 –> 00:39:42.564
And by using those principles of

847
00:39:43.684 –> 00:39:46.434
checking, double-checking, speaking to one another-

848
00:39:46.764 –> 00:39:46.944
Mm

849
00:39:47.104 –> 00:39:50.804
… speaking about the steps that we are following at the time when you are

850
00:39:50.824 –> 00:39:52.044
doing it loudly,

851
00:39:53.104 –> 00:39:57.084
we’ve measured and we’ve proved we reduced significantly the

852
00:39:57.144 –> 00:40:00.974
number of incidents in that space, which is sustained-

853
00:40:01.304 –> 00:40:01.373
Fabulous

854
00:40:01.373 –> 00:40:03.284
… many years after that work.

855
00:40:04.584 –> 00:40:05.884
And for the

856
00:40:07.164 –> 00:40:08.464
highly experienced

857
00:40:10.964 –> 00:40:14.644
colleagues, potentially very senior, how did they respond

858
00:40:14.804 –> 00:40:18.684
to the idea that somebody else checking

859
00:40:18.744 –> 00:40:22.624
or using checklists, these kind of tools that are sometimes adopted from the

860
00:40:22.664 –> 00:40:23.764
airline industry?

861
00:40:24.644 –> 00:40:25.684
How did they respond to that?

862
00:40:27.404 –> 00:40:30.784
Well, that’s where the culture of the organization is very

863
00:40:30.804 –> 00:40:31.524
important.

864
00:40:31.634 –> 00:40:31.634
Mm.

865
00:40:31.644 –> 00:40:33.944
Because in order to do that,

866
00:40:35.004 –> 00:40:37.614
senior leaders need to ensure they

867
00:40:38.464 –> 00:40:41.164
act as role models on psychological safety.

868
00:40:41.504 –> 00:40:41.634
Mm-hmm.

869
00:40:42.004 –> 00:40:43.974
Being open about

870
00:40:45.244 –> 00:40:48.844
what goes wrong and why, without blame, is really

871
00:40:48.884 –> 00:40:49.464
important

872
00:40:50.784 –> 00:40:54.264
to enable people to come forward and say, “Okay, let’s look into this,

873
00:40:54.784 –> 00:40:55.224
and do-

874
00:40:55.244 –> 00:40:55.254
Mm

875
00:40:55.254 –> 00:40:56.424
… something to change it.”

876
00:40:58.264 –> 00:41:01.924
I think psychological safety is all over this, and-

877
00:41:01.984 –> 00:41:02.244
Mm

878
00:41:02.444 –> 00:41:05.864
… senior leaders need to promote those projects-

879
00:41:06.284 –> 00:41:06.484
Mm

880
00:41:06.624 –> 00:41:10.524
… because they have demonstrated immense improvements in

881
00:41:10.584 –> 00:41:11.864
how we provide care.

882
00:41:13.304 –> 00:41:16.564
That’s great, isn’t it? When you’ve got those immediate benefits that you can

883
00:41:16.624 –> 00:41:17.104
share.

884
00:41:18.444 –> 00:41:21.964
Got another question here. What tends to make something

885
00:41:22.124 –> 00:41:25.724
feel immediately relevant versus easy to ignore?

886
00:41:25.884 –> 00:41:26.144
And

887
00:41:26.984 –> 00:41:29.644
I guess what this question is getting at is, if a

888
00:41:32.064 –> 00:41:35.144
company from industry comes and presents something to you,

889
00:41:35.644 –> 00:41:38.904
you’re doing your initial assessment,

890
00:41:39.744 –> 00:41:41.724
what’s putting it into the

891
00:41:42.624 –> 00:41:46.264
bin, or what’s putting it into the “Okay, let’s explore this a bit more” pile?

892
00:41:48.364 –> 00:41:50.384
That’s an interesting question.

893
00:41:52.344 –> 00:41:55.704
Well, I will go back into the care principles, right?

894
00:41:56.274 –> 00:41:56.274
Yeah.

895
00:41:56.344 –> 00:42:00.194
If we always have the patient in the middle, in the center of what

896
00:42:00.224 –> 00:42:00.714
we do,

897
00:42:01.964 –> 00:42:03.594
it is very unlikely that

898
00:42:04.804 –> 00:42:06.984
we’re going to go rogue in our decision-making.

899
00:42:07.804 –> 00:42:08.144
Mm.

900
00:42:08.264 –> 00:42:10.844
We always need to think about the patient perspective.

901
00:42:11.144 –> 00:42:14.944
Is what we are doing going to make care better,

902
00:42:15.624 –> 00:42:19.084
ensure patient care is safe, and we’re not going to

903
00:42:19.124 –> 00:42:20.224
compromise data?

904
00:42:22.004 –> 00:42:24.184
I think if we follow those three principles,

905
00:42:25.064 –> 00:42:28.944
we can build on those and take maybe some

906
00:42:28.984 –> 00:42:32.704
risks, but without compromising ever

907
00:42:32.744 –> 00:42:34.464
patient safety or data.

908
00:42:35.164 –> 00:42:35.404
Mm.

909
00:42:37.384 –> 00:42:40.944
So there’s pretty standardized, essentially,

910
00:42:42.164 –> 00:42:45.224
assessment criteria that you’re using linked to the principles.

911
00:42:46.516 –> 00:42:50.176
Yeah, I think you need to have some overarching principles here which

912
00:42:50.236 –> 00:42:54.056
govern innovation and change. Absolutely.

913
00:42:55.356 –> 00:42:55.366
Yeah.

914
00:42:56.236 –> 00:42:58.316
Got a specific question here.

915
00:42:59.246 –> 00:43:02.876
Penny’s a

916
00:43:02.936 –> 00:43:06.376
clinician, I would say. When do you look for information on a pharma website

917
00:43:06.396 –> 00:43:09.076
instead of more independent medical information websites?

918
00:43:10.736 –> 00:43:13.396
Or we can expand that out into other sources.

919
00:43:13.916 –> 00:43:17.596
Where do I look for information for a specific pharma, you said?

920
00:43:17.616 –> 00:43:18.796
Yeah. So what would

921
00:43:20.756 –> 00:43:23.066
lead you to consult the

922
00:43:25.276 –> 00:43:29.216
provider of a drug for information versus

923
00:43:30.156 –> 00:43:30.956
another source?

924
00:43:32.796 –> 00:43:36.496
Well, first of all, I would say if it’s a new

925
00:43:36.556 –> 00:43:36.976
drug-

926
00:43:37.196 –> 00:43:37.206
Mm

927
00:43:37.206 –> 00:43:40.916
… then I will always consult that particular

928
00:43:40.976 –> 00:43:44.556
provider to understand. They usually have a good

929
00:43:44.616 –> 00:43:46.336
summary of the research-

930
00:43:46.816 –> 00:43:46.936
Yeah

931
00:43:47.096 –> 00:43:49.476
… and the data around it.

932
00:43:49.766 –> 00:43:49.766
Mm-hmm.

933
00:43:49.776 –> 00:43:51.256
And I always value,

934
00:43:52.396 –> 00:43:56.256
where is that data coming from? Is that data compelling?

935
00:43:56.836 –> 00:43:57.056
Mm-hmm.

936
00:43:57.396 –> 00:43:59.976
Because let’s not forget, we need to spend

937
00:44:01.116 –> 00:44:04.716
time explaining to our patients to help

938
00:44:04.776 –> 00:44:06.876
them make that decision, right? So,

939
00:44:08.076 –> 00:44:11.596
we often understand it as a clinician, but we’re not often thinking how we

940
00:44:11.636 –> 00:44:15.116
translate that evidence when we speak with our patients.

941
00:44:15.746 –> 00:44:19.596
And when we consent our patients for those treatments, are we

942
00:44:19.656 –> 00:44:21.756
actually telling them what they need to know?

943
00:44:23.116 –> 00:44:26.536
And is the data compelling? And are we actually being open about this?

944
00:44:26.896 –> 00:44:30.376
Because we know some treatments, we don’t have

945
00:44:30.916 –> 00:44:32.656
overall survival data yet.

946
00:44:33.476 –> 00:44:36.716
Do we actually explain that to the patients when

947
00:44:37.676 –> 00:44:39.476
they make decisions about treatments?

948
00:44:39.536 –> 00:44:40.456
And I think we need

949
00:44:42.736 –> 00:44:43.016
to.

950
00:44:43.116 –> 00:44:46.696
It is time to start bringing things to a close.

951
00:44:48.296 –> 00:44:49.336
What would you

952
00:44:50.256 –> 00:44:51.476
like to

953
00:44:52.436 –> 00:44:55.475
ask or encourage, the industry

954
00:44:55.755 –> 00:44:59.576
partners in pharma and med tech to

955
00:45:00.156 –> 00:45:03.295
really think about, focus more on when it comes

956
00:45:03.416 –> 00:45:06.236
to adding value to a

957
00:45:06.956 –> 00:45:09.136
clinician and a decision-maker like yourself?

958
00:45:10.336 –> 00:45:10.596
Yeah.

959
00:45:11.916 –> 00:45:15.896
My advice would be, you know your data really well, and you know the

960
00:45:15.936 –> 00:45:19.736
background of the research of the drug, if it’s a

961
00:45:19.756 –> 00:45:21.416
drug or a service.

962
00:45:22.756 –> 00:45:24.716
I would say the next step to that is

963
00:45:26.256 –> 00:45:29.816
work with the clinical teams and the management teams

964
00:45:30.156 –> 00:45:31.876
and look at the whole patient pathway.

965
00:45:32.196 –> 00:45:32.376
Mm-hmm.

966
00:45:32.776 –> 00:45:36.716
Look what other value-adding activities around your service or

967
00:45:36.776 –> 00:45:37.116
drug

968
00:45:37.936 –> 00:45:40.516
would be beneficial to that organization,

969
00:45:41.396 –> 00:45:44.416
to that service, and

970
00:45:45.176 –> 00:45:46.776
how can we start

971
00:45:47.636 –> 00:45:51.056
implementing those changes and evaluating them and

972
00:45:51.396 –> 00:45:52.156
sharing that

973
00:45:53.116 –> 00:45:56.836
outcomes so that something good that happens in one area,

974
00:45:57.236 –> 00:46:00.956
it actually gets spread and other people benefit as well.

975
00:46:02.916 –> 00:46:05.876
Wonderful. Look, Penny, thank you so much.

976
00:46:06.076 –> 00:46:07.916
Thank you to everybody for joining us.

977
00:46:08.576 –> 00:46:12.136
We will be back in the autumn for the next installment in the series.

978
00:46:12.256 –> 00:46:15.796
I’ll be talking with Anders Mørland Frafjord, who is the Deputy

979
00:46:15.916 –> 00:46:19.616
CEO of Oslo University Hospital, and also Chairman

980
00:46:19.676 –> 00:46:22.126
of the University Hospital of North Norway.

981
00:46:23.416 –> 00:46:26.616
Once the webinar closes, a short feedback form will pop up.

982
00:46:27.156 –> 00:46:30.276
Please complete it so that we can understand what attracted you to join the

983
00:46:30.296 –> 00:46:33.916
webinar, how valuable you found it, and suggestions for future

984
00:46:33.976 –> 00:46:36.586
sessions. So thank you again, and see you next time.

985
00:46:36.586 –> 00:46:36.976
Thank you very much.

986
00:46:38.156 –> 00:46:38.356
Bye.