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Damian Green - Podcast

Damian Green | Insights from Industry Leaders

Damian Green is the Chief Information Officer & Deputy Director-General of eHealth Queensland. He recently sat down with Managing Director, Wayne Bruce to discuss his career.

What was your first job at university, and what role did that play in shaping your future career?

My first job when I was in university was actually as a sales assistant in Myer. I didn’t have any idea what I wanted to do going through university, but once I completed my economics degree, I went for an interview at Andersen Consulting and got offered a position as an analyst in their change management practice. Andersen Consulting focused very much on ICT, strategy and consulting back in those days. I was very quickly grounded in the importance and the need to build on ownership of workforces and develop skills of workshop workforces to embrace not only technological change but also adapt to a new process and new roles in the context of introducing new IT. That’s probably shaped my thinking ever since about planning and management of programs in the ICT field. It can’t just be about ICT; we’ve got to start with people first and end with people first.

Who has influenced you during your career?

When I started at Andersen Consulting, change management as a profession was quite new. I was always inspired by the partners in Andersen who built that practice up. There were female leaders within Andersen, who saw the need to connect the ICT agenda with this people agenda. Particularly people like Jane Henstridge, who was the leader of the change management competency/practice in Australia for Andersen Consulting. Katrina Brash who took over from her and the various senior managers that I worked for as an analyst, Diane Martin, Gillian Hearton are part of a range of people that I still think of very fondly today. Both in terms of the passion that they had around this people agenda and how important was for the ICT agenda and the skills and time they took to coach and invest in my development.

I heard you say all change via technology or otherwise involves people in our world. What was it that Anderson recognised, how did they drive the people aspect of the change?

Part of the thing that we were always very conscious about was ICT and in itself. It’s got to be driving some sort of improved outcome for the organisation that it’s investing in. Early on, I learned that it’s important to communicate the vision, what’s really behind that outcome, what the results are, and to seek early on by engaging people in that vision and that conversation, get feedback, build buy-in ownership and regularly measure and hold yourself to account that you are achieving that outcome. That’s not a touchy-feely piece of work, it’s actually something that you need to plan for, you need to set milestones for and that you need to measure and hold yourself an account and bring a bit of vulnerability to the way you plan and lead a program because if you are serious about it you need to accept that you’re not always going to get it right and you need to have mechanisms available to you to be able to tap into stakeholders, listen to their point of view and adapt accordingly.

When I first met you when you were at the Gold Coast Health Service close to 10 years ago, you had quite a broad remit then, but I know it included the people and culture agenda. Has your career been mainly in that ICT stream, people and culture, or gone across a couple of different functional areas?

It’s a good question, and it’s something I’ve always thought about myself. I’ve never seen myself as an ICT person. As a management consultant, I was always keenly interested in business strategy and connecting business strategy to the ICT agenda. I’ve always been very aware that if it was going to be successful, you need to get the people and process agenda right at the same time. If you look at my career, I’ve always tried to deliberately be a bit of a generalist.

I’ve done a lot of deep work in ICT fields and I know my subject and I’ve got experience in my subject. But I’ve always been curious and made sure that I’ve worked across multiple industries, worked with a different range of stakeholder groups, whether it be senior at an executive level, right down to the frontline workforce, trying to teach someone to use a new computer who’s never learned to read or write before. That was one of the early challenges that I struck at Queensland Rail in implementing SAP and also just making sure that I’m keeping abreast of what is going on in the industry and its impact.

One of the early insights I had in health was in healthcare we often approach problems as if it’s the first time the problem has been identified, for example, how do you improve running an operating theatre, and yet in other industries, the application of good supply chain management techniques are similar to managing a theatre. So, I’ve been able to look at other industries and see what other people have done, it’s been an absolutely critical part of my work in healthcare.

You can see that in digital transformation in healthcare, we’re really in the early stages of digital transformation, but there are other industries that are very well advanced in terms of where they are at the digital transformation agenda. We can learn a lot from those industries; some of the challenges that they’ve been confronted with, particularly the role and power of a consumer, has in terms of influencing business strategy.

Which industries do you think are most beneficial to look at if you are in the health industry?

One of the ones I’ve been recently looking at is what’s happening in the media industry. It’s an industry that is really struggling to come to terms with the role of the consumer and what people’s buying choices are. In fact, they have had to transform their product offering quite remarkably to survive.

In government, I’ve been particularly interested in terms of the strides that the education sector is taking to embrace the adoption of digital tools and technologies in the delivery of education. I go into a school now and look at the way that schools are set up and the way the expectation is built into the day of students to work in a digital workplace. I step back and think, in healthcare we’re not even at that stage yet, and we’re going to be confronted in five or six years’ time with a cohort of students who are used to working in a digital way, we’ve got to catch up with a lot of speed and make sure our workplaces are digital-ready to meet their expectation.

The other aspect of that is I think consumers are going to become more demanding in healthcare. I think any industry, whether it be retail, media, etc; and the way that they’re beginning to engage and embrace consumer choice and offer choice, is going to be particularly important in terms of the way we begin to craft and establish healthcare services; and that creates an enormous opportunity for digital health.

How did you get into the healthcare area?

As a consultant, what became Andersen Consulting, eventually became Accenture. I first started working in healthcare in 2004 and was assigned to a clinical services redesign project at Nepean Hospital. I remember that project really well and very fondly, it was a challenging project. I remember the first workshop I ran, the Director of the Emergency Department walked out because it wasn’t meeting his requirements. It was a great lesson for me, I could have made a decision to say that person’s not buying in or I can make an effort to go and engage that person one-on-one and find out why they left, why it wasn’t working for them and what I needed to do differently. That experience is probably been one of the most enjoyable experiences I’ve had, and one of the reasons why I really enjoyed working with frontline clinical teams and why I continued working in the field.

What do you think’s been the biggest impact of technology in healthcare to date? What do you see in terms of the future?

We haven’t started yet, It’s so exciting. Some of the things I am beginning to see. A simple thing was back in 2008 when I started working for Professor Adrian Nowitzke, who was the Chief Executive of Gold Coast Health back then, was the idea of putting a record in place so that clinicians who are working alongside patients could see what was happening to the patient, no matter what setting they had been in. The idea if you had been in the emergency department and you were progressed to an inpatient record, that the information was there at your fingertips and that the clinicians didn’t have to guess that information. Seems like such a simple challenge today, but that was a real challenge back then.

I don’t think we give enough credit to the fact that we have begun to solve some of those challenges in terms of just providing the provision of that information; but I’m also acutely conscious that we’re sort of halfway there, we’re creating a bit of a digital divide.

If you go to Cairns Digital Hospital, you’ll get great care and all the clinicians involved in your care will be able to access that record. But if you come from a remote community and are referred to Cairns Hospital; the clinicians who work alongside you in that remote community won’t have access to that digital record and won’t necessarily have had the information from the care team to help them continue your care journey. It’s been a big change, a great change, but we’re only halfway started, we’ve got so much more work to do on that front.

So presumably the plan is to get it out to those more community health centres at some point?

Yeah, and I guess there are questions around how we can review and improve the plan that we’ve gotten. We’re obviously doing that. But a simple thing that I’m working with the team right now, consulting with our clinicians at the hospital health services around how we can quickly give them at least read-only access so that everyone’s aware of what’s happened to their consumers in other settings.

Prior to this, I shared some of our preliminary findings from our recent research into divergent career options for clinicians, what stands out the most to you in that data?

Yeah, it didn’t surprise me. In fact, it was great to see data that sort of evidenced the gut feel I was developing. The key thing that we’ve been doing as we move from providing ICT systems of record, the traditional IT system, is creating or setting up digital platforms which our clients in healthcare, our clinicians can use to develop new solutions, whether it be analytical solutions to help them with decision making or improving care or new apps that they can use to respond, and help them do screening better in airports due to COVID-19. That’s all clinician-led in the digital world rather than ICT led and that’s a big change that we’re going through.

What I’ve been observing and it goes to the point I made earlier, there’s a new breed of work out in our healthcare organisations, there are people who have been trained in healthcare, who are clinicians but have also been trained in these digital skills and know-how to use and interpret digital systems and are quite curious about it. We’re seeing these clinicians typically at the registrar level, mid-clinician level, who are really interested in how they can use these technology solutions to drive better care outcomes.

I’m seeing a raft of registrars who are interested in not giving up their day jobs and continuing to work as clinicians, but actually wanting to have part-time involvement in problem definition, ideating potential new solutions and then deploying them in into the healthcare ecosystem. Some of them are less interested in the traditional health specialists’ career, e.g. the idea of fellowship doesn’t interest them, they want to actually continue being a doctor, but also get more involved in developing and growing their career in the digital health space.

I see that as a really exciting trend. An example would be when I was at the Gold Coast just leaving and this was happening, we delivered the integrated electronic medical record. The pharmacists got together and saw the possibility where we had real-time information at our fingertips of what doctors were prescribing onwards and they quickly worked out that with that data, they could build an algorithm to send a real-time alert to pharmacists working on the ward that there might be a medication dispensing error about to happen because of some combination of drugs that have been incorrectly dispensed or diagnosed. Therefore, pharmacists onward were able to intervene in real time and prevent that medication era from occurring.

Really exciting stuff in terms of achieving our goal in digital help of reducing medication era, serious medication error and we’re achieving that in a digital hospital program. This is all coming from the role that these clinicians, these new digital workers are taking, where we’re now giving them the digital assets and they’re beginning to take them and develop them and grow them. I think we’ll see more and more of that, so I think your survey just painted a picture of what’s actually evolving in healthcare.

In terms of people you have seen being successful in leading digital initiatives, are there any common experience sets and/or personal qualities that are key to success?
What are the skills of those working in the healthcare sector that you feel need to be strengthened?

I think there’s always a bit of ‘can do’ in this thing. Often when you start with a digital problem, you actually got to start with a problem and some of our clinicians bring pretty big problems to the table that they want to solve. The people that I’ve been working with are very optimistic about their ability to work through a problem and get to a solution and have a really pragmatic sense that you can’t develop a perfect solution, you can’t get it 100 per cent right and they are prepared to ideate and continue to iterates the development solutions, so not spend forever trying to find the perfect solution. I think that aspect, it has been key in terms of what I’ve been observing on the people that have been particularly good at working alongside the digital ICT teams who have been supporting them.

I think there are personal qualities that you need in this space around the ability to be motivated, this is the ability to engage and listen and consult effectively because it’s not just your own point of view or your own requirements that you’re often got to think about when you’re doing this problem definition and solution development. You’ve got to think about your colleagues, you’ve got to think that the senior specialists that you’re working alongside, you’ve got to think about the people and the consumers who don’t necessarily have a voice or traditionally haven’t had a voice in the design and some of these ICT systems and in the digital world, all that changes.

Therefore, this idea to around engaging with multiple parties and stakeholders to build a coalition and ideate and develop its solutions iteratively, they are key skill sets. In terms of my own innovation team, where I’m looking to engage with both clinicians and build up that community of practice, they are qualities that I specifically do look for.

There’s a lot of interest by clinicians and non-clinicians, working in digital health, who have indicated that the health services do not have a clearly defined grasp on what their needs are or will be and therefore there is not a clearly defined education and workforce path.

What do you see is the future of the workforce and therefore the training that people will need to be productive and job-ready?

I agree that there isn’t a clear idea as if there is somehow the right answer. This space is evolving all the time, particularly in terms of the technology’s, what we can do with those technologies and when they will become mainstream in the organisation. Part of the clear idea comes with having a clear idea of what that technology roadmap looks like and how it will manifest itself in and become mainstream healthcare and when and that’s not settled yet, we’ve still got a lot of iteration to go.

I think the work that AIDH have been doing and the work that The Digital Health Agency has been doing are good, but they haven’t necessarily converted into an agreed competency model that has then been built into the clinical curriculums and workforce. That’s probably where I think is the gap at the moment in terms of the work universities need to invest in, in terms of developing their curriculums to recognise this space is occurring rapidly and ensuring that each of the professional bodies have a clear point of view and are beginning to engage in a conversation around how this is evolving. However, I don’t think we’re ever going to get to a point where we have a clear set of requirements.

Something that I’m very conscious of is that I think we pay a lot of attention to the skills that we’ll need to move into automation or artificial intelligence and leverage those type of technologies. There are some really basic skills that we need to be investing in and developing in just to get the basics right in digital health, so the importance of data collection and data entry and management to data and cleansing of data. These are so critical in terms of just having the establishment of a good digital health ecosystem and skills now, which we’re already well into now, the age of moving from reporting to analytics and data interpretation and visualisation, people often pick up these skills as an afterthought to their professional training. I think the future is going to demand that these are critical skills that people are trained on as part of their clinical careers.

The Digital Health CRC did some research and looked at clinical outcomes and various variables. They found that in some ways the biggest determinant of someone’s clinical outcome was which hospital they had their surgery. Even if the same doctor was operating in two different hospitals, they could have quite remarkedly different clinical outcomes.

Is this something that you are seeing that in the data you’re collecting through Queensland Health. Presumably, it’s data-rich and over time it will enable far better care for patients?

I must confess, I haven’t looked at that data for a while, particularly since the move into this role. But I can say that anecdotally, it would make sense to me based on my experience both as an executive director of people and executive director of transformation, that clinicians don’t work in isolation, they work as part of teams. They also work in an organisation where the rules and practices and behaviours are guided by the culture and the leadership of an organisation, so I profoundly believe that good clinical outcomes are based on all of those things being present. Good teamwork, good leadership and great culture.

What advice would you give aspiring leaders to be in a position to advance their careers?

I’ve thought about this question, I think it’s a good one, and I just reflect on my own experience. I think as a young leader, sometimes you’re driven to feel like you have to have all the answers and what I’ve learned over time is that my effectiveness as a leader has actually grown and developed when I’ve worked out that the trick is actually having the right question and the ability to listen and engage effectively to get to the right answer. If there was anything I could offer as advice to anyone in this field, particularly in terms of working throughout healthcare, the basics of working alongside people are critical, respect for the individual, being able to listen and just being a bit humble in the role. Recognising that you don’t have all the answers, the trick is working alongside people to get to them.

We’ve certainly found through research and placements throughout the years, often the technical skills might get you the job but it’s the soft skills that determine your ability to do the role.

I think in terms of the work that I do and what I’m looking for in terms of roles that I’m recruiting for, I’m actually less interested in technical skills, to be honest. They’re trainable, you can develop those, you can always grow those, it’s harder to get those business and people skills, which I don’t believe are soft skills. I believe their critical skills that are essential to having the role.

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