We speak to Keith McNeil as part of our Digital Health Leaders series. The full article is available here.
What do you consider the most rewarding job you’ve had?
Without a doubt, the job that I have enjoyed the most, found the most challenging and most rewarding was being CEO at Addenbrooke’s Hospital in Cambridge (Cambridge University Hospital NHS Trust). That would be top of the pile for me.
All the jobs I’ve had have been rewarding in one way, shape or form, but that one was the pinnacle in terms of having the ability to influence across a wider system. Bringing together an eclectic academic environment with tertiary and community healthcare, I got to work with some really good people. We had some huge challenges, but overall it was a fantastic experience.
What was your involvement in the set up of the Academic Health Science Centre (AHSC) in Cambridge?
Cambridge with its academic heritage and biomedical campus was already well down the road when the AHSC’s came in. Cambridge had already achieved, ostensibly, what the academic partnerships were created to do; which was to bring the clinical community closer to the academic community with a focus on translational research. Cambridge had already been doing that to the tune of 46 Nobel Prize winners in health and science; and translating that into care on the ground. It was just an absolute privilege to be part of all that.
Being CEO there was very interesting. It was a prominent community role and I was a bridge between the academic community, the gentry of Cambridge – the historic land owners who are fiercely proud of their local events; and also, the relative newcomers on the block, the biotech industry. The UK was earning about £60 billion a year from the biotech industry, and £14.5 billion of that was coming from Cambridge. All of those people were new, and many were spin outs from the university. As CEO at the hospital it felt like I was at the center of that Venn diagram, and it was just an enormous privilege. It was fun, frustrating and hard but immensely rewarding.
What is the most interesting part of your current role as Chief Clinical Information Officer?
The most interesting part is getting people right across the system to understand the value of data and what we need to do to maximise that value. Critically involved in that is the clinical part, which is getting the data entry side of things i.e. the records, the systems into which people enter data, getting those systems really attuned and working effectively for clinicians on the ground. All of our health data comes from clinicians interacting with patients, exchanging questions and answers, and getting all that data accurately captured, aggregated and analysed is the real challenge, and the most interesting part of what I do.
How do you see digital healthcare space developing in the future?
I think the first thing we will see is that the term digital healthcare will disappear and just become healthcare, which will in the future all be provided on a digital platform.
We talk about digital healthcare in three horizons, the first horizon is getting the technology right and that’s putting in place for example an electronic health record or computer etc. That’s kind of where we are now with digital healthcare.
The next thing is to extract information from that technology and data and turn it into information. We’re scratching the surface of that, but once we’ve bedded that in and it becomes business as usual, healthcare will then become all about how we can maximise the value of that data with complex analytics, bringing in disparate data sets, asking questions that we haven’t been able to answer simply because the size of the datasets involved and the need for complex analytic engines like machine learning and artificial intelligence. That’s where I think it will go but the key to extracting value at any stage is feeding the intelligence back to decision makers, wherever they may be across an organization.
So called digital healthcare will thus become healthcare provided on a digital platform, turning every individual within the health system into a higher performing learning and knowledge-based worker.
What do you think has been the biggest benefit of advancing technologies has been to healthcare to date?
As an example, I would probably cite something like the development of PCR (polymerase chain reaction) which has enabled us to do so much in terms of understanding the pathophysiology of disease, and then being able to apply more tailored treatments to that disease. We will move more and more into the precision medicine world, which is really where digital healthcare is enabling us to go. We’ve then got a multiplicative effect of all the technology that comes to bear.
If you think about the huge disruptors in healthcare, you go from big public health initiatives around clean water, vaccinations, food and nutrition, sanitation etc, to treating the big infectious disease challenges with things like penicillin, or streptomycin (for TB). You then move into things like coronary interventions that have stopped people having to have their chest cut open with heart attacks, and really effective treatments of asthma as examples.
The next big leap forward for the 21st century is going to be digital technology underpinning really high-level learning and knowledge-based systems. This will allow us to take what we do now and put it on steroids. Even with all that we know now, and all of the systems that we’ve set up and worked hard to get better and better; we still only provide 60% of our healthcare on an evidence-based platform, 30% of it is still wasteful in terms of the value it adds with duplication or the fact that it doesn’t work, and 10% of its actually harmful.
Until we can address that, and we can’t continue to do it as we have been traditionally been doing it, we won’t be able to address the calls of the triple aim of healthcare, and it is the digital space, the data and information space (data and analytics), that gives us the opportunity to address that 30% of waste and 10% of harm, much more effectively than we’ve been able to up until now.
Who has inspired you most in your career?
Hands down it’s the patients. The patients I’ve had the privilege to look after and take through a journey, from their rebirth with a transplant, through to people fighting tooth and nail to hang on to life with grace and dignity, accepting what they’ve been dealt in and getting on with it. They are just inspirational, all of them.
You previously served in the Australia Special Forces as a weapons expert, what was the experience like and how do you think it has influenced the rest of your career?
I was a trained sniper and weapons expert. At the time it wasn’t obvious how that would play out and when I look back some of the tools and techniques that I learned such as focus, resilience, and a never give up attitude, always understanding that when you think you’ve given everything you’ve always got a little bit more, taught me a lot about what you can rally when you really need to. I learnt a lot about leadership, both the good and bad side of it; what I now consider is good eclectic leadership and what I would consider as bad leadership or management. It was a critical part of the journey that got me to where I am. I don’t how I would approach life without it, and I often jokingly say that working in Queensland Health stood me in good stead to withstand the rigors of Special Forces interrogation training and vice versa, learning how to withstand interrogation has enabled me to cope much better with the rigors of working in the public health system!
What do you think is the major difference between working in the Australian healthcare system compared to the British healthcare system?
There’s not a lot of difference really, the systems are innately very similar. There’s more private medicine in the Australian system, but the ethos of what we try to do in terms of people not being held to ransom by their health needs is the same, and in both systems that is becoming a steadily increasingly challenge.
In Australia we can turn up at the front door of a hospital and get treatment, and the vast majority of times we get it right and people get good high-quality care. That is modelled on the NHS ethos from 1948, and the biggest difference I find between the 2 systems is, as Einstein famously said, “everything is relative”- if people think that life’s tough here in the Australian health system and that we’re under pressure and have big challenge, just go and work for a year in the NHS, then you’ll know how well off we are comparatively!
What is the biggest challenge facing the public health sector?
Interesting question, as I don’t think the biggest challenge is being faced by the frontline health sector, I think the challenge is faced by departments of health, politicians and treasury in terms of how they’re going to pay for the care that’s being provided. In the public health sector, the challenge for us is to be able to provide the quality of care that we aspire to within the confines of the resource that that we have available.
Contextualising that, challenge for us is to understand and implement models of care that are appropriate for the patient demographics we’re seeing now, as opposed to trying to fit the patient demographics into old models of care. When I was training everything was episodic, you’d come into hospital with one thing wrong, get it fixed, and then you go. Now that’s always going to be there, but we’ve got a whole different range of patients where that model doesn’t work. The challenge for us is how we move to the model that works for what is an increasingly large proportion of the demand cycle.
What are your top tips for aspiring leaders?
My first tip would be to build your networks. Don’t ever underestimate the power of personal interaction and personal contacts for getting things done, so build your networks. The second tip is to get to know yourself well, know what pushes your buttons and what it is about you that pushes other people’s buttons, so you can modify your behaviour to be able to influence effectively. If you can do that, you’ll go a long way to being able to achieve what you set out to assuming that you’re ‘influencing with integrity’. They’re my top tips, and there are a whole lot of other characteristics that people will either have or need to develop. You also need to develop a way of looking after yourself and developing a thick skin on occasion. Building a close network of people that you can reflect with, dump on and give you fearless and honest advice I think is really important, and that’s a network within your bigger network. So they would be my top tips.