"IT may use technology to drive outcomes, but it takes people and a team to really do that," says healthAlliance CIO Claire Govier, with some members of her team. From left: Ashok Kalyanji, project manager; John La Hood, project manager; Claire Webb, project coordinator; and Diane Wood, project managerClaire Govier joined healthAlliance last year to lead a series of major technology upgrades, including the shift to the Windows 7 operating system for its 26,500 users.

Before the end of 2013, she became its chief information officer.

healthAllliance is the country's largest shared services organisation, providing IT and non-clinical services for the four Northern district health boards. With more than 18,500 screens, nine data centres and 2500 servers, it has been number one for the past three years in CIO100, the annual report on the top ICT using organisations in New Zealand.

This year, healthAlliance will grow further, and will start to deliver finance, procurement and supply chain services to the 16 other district health boards (DHBs) in New Zealand.

"We will still provide all the IT services for the Northern Region," explains Govier. "But the supply chain and finance and procurement services will progressively roll through New Zealand."

Govier says healthAlliance will operate like a national business process outsourcer (BPO) for these services.

"For my team, we're onboarding another customer," she says. "That's a new challenge for us in IT -- to actually think about a national network for healthAlliance staff rather than a regional network."

The organisation was born of a merger in 2011 of the IT and non-clinical services for the four Northern Region DHBs. These DHBs and Health Benefits, a crown agency, each own 20 per cent of what is now the most significant shared services organisation in New Zealand.

Prior to the merger, healthAlliance was providing shared services to Waitemata and Counties Manukau DHBs. Thus, says Govier, the organisation already has a strong body of knowledge, processes and efficiencies.

"It's really gained some traction -- and delivering savings and focus," she says. "There's really a strong case for growing that throughout New Zealand."

"The whole impetus behind healthAlliance and what Health Benefits are doing is to try and release some of the funding back into the core healthcare," she says. "This means more MRIs [magnetic resonance imaging], more clinical staff and faster throughputs in clinics."

DHBs have such a massive challenge juggling their budgets and their priorities so it's a very finely tuned instrument when it comes to making decisions on where to invest and how to invest, she says. "And every year there's more and more demand.

And as technology, either in the clinical or IT world improves, there are new ways of doing things. But you have to invest first to get benefits, so there's the usual dilemma of where to invest."

At the same time, she is cognisant of the growing budget for public health. In New Zealand, she says the latest figure is around $14.6 billion annually. "If we don't change anything, with the aging population and requirements, we are going to need $17 billion very soon," she says. "As a country with our tax take and our population size, we can't afford that.

"So working smarter, finding ways to solve problems, finding ways to deliver healthcare differently to reduce cost and add value, is such a growth area."

From corporate to public health

Govier has been involved in business transformation programs through more than two decades of working in IT, but these were in the enterprise space, mainly in finance and telecommunications.

"It's a very different frame of reference from corporate life," says Govier of her move to healthAlliance.

"The way decisions are made is different from an organisation that has a strong risk association like financial services, with a very different attitude and a very different process for risk and for profit and bottom line."

"To some extent we're still maturing with the model that we've got," says Govier, whose previous employers included Vodafone, Westpac, AMP, Ernst & Young and UK Post.

At the moment, healthAlliance IT has around 280 members, plus about a dozen contractors.

In the past 12 months, the four DHBs also have each appointed a "CIO-type" role. Govier says this group -- composed of Linda Wakeling in Auckland, Sarah Thirlwall in Manukau, Darren Manley in Northland and Stuart Bloomfield at Waitemata -- meet every week.

"Between us, we have to balance out the priorities of the resources [for] what gets done, when. It's a shared resource pool, essentially. So the more regional things we can drive, we do once and everybody gets it.

"The goal is to be driving that convergence as hard as we can to drive out the duplication, to standardise, take the cost out. So [instead of] doing everything four times, we do it once for four organisations."

Nationally, the equivalent CIOs for the other regions (Midland, Central and South) meet every quarter.

"When you're trying to drive convergence, it is a case of shaping the jigsaw pieces so that you can lock them together. The thing I think is so critical is making sure that you've got the picture on the front of the jigsaw box," says Govier.

"Everybody's got the same picture [so] the pieces actually fit. Otherwise, there's a risk you might shape one that does not quite fit.

"Creating that shared picture is part of a national piece. And for us, there's a regional level of that as well. How can we share more systems? And, of course, when each DHB has grown up individually and [is] self-sufficient, even if you've got the same technology solution, you've configured it differently and your process might be different because you've chosen a different f low on your script.

"So there's a real challenge because it's not a case of actually collapsing your systems. It's actually standardising your business processes so that you can collapse your systems and drive more efficiency. The jigsaw puzzle is not just the systems puzzle; it's also the process and the business operation puzzle."

She says the broader DHB and healthAlliance teams are also looking at how they will deliver healthcare outcomes in a "digital world", using mobility and collaboration tools.

One way they are doing this is through "cross-functional teams" where IT staff work with healthAlliance staff, including clinicians, on different projects. "They share the experience. They also share the accountability of delivering the outcomes, with healthAlliance driving the technical outcomes and senior DHB clinicians driving the clinical and business outcomes," says Govier.

As well, healthAlliance staff exchange ideas and queries with contacts across the world that they meet at events or online. "There are really healthy debates from both clinicians and technology people. There is some good crossover."

Moving industries

Govier says joining healthAlliance enabled her to learn about a new industry but says the challenges it faces are not entirely different from enterprises -- multiple users, lots of data, and legacy systems.

She came in when healthAlliance was looking for a person to drive some technology programs. The then chief executive resigned and Johan Vendrig, general manager information services, left and joined HSA Global as chief operations officer. The new chief executive, Mike Schubert, combined her original role of IT director with that of the CIO.

"healthAlliance is an organisation that gets under your skin. You have to care about what happens in healthcare with the complexity [of its systems]," she says. She says part of the impetus for joining the organisation was her family's experience with the public healthcare system. Her mother has had a number of surgical procedures in Wellington, and her sister was treated for breast cancer two years ago.

"It does change a family when you go through something like that together, and you really do have an appreciation of the people who work in those services," she says.

Govier was CIO of Vodafone when her sister was undergoing treatment for breast cancer. When the opportunity to work at healthAlliance came up, she recalled her family's personal experience with public healthcare. "I would not have looked at it much more seriously than I would have if we hadn't had that experience."

"IT is a people game," she states. "It may use technology to drive outcomes, but it takes people and a team to really do that," she says. "It is 24 hours a day, 365 days of the year."

Healthcare is the same. "There is having the skills and the tools to do a job. The other is having the willingness and commitment to do the job," she says.

There are "cultural" and "leadership" pieces in the organisation that are needed if you want to drive change.

"A lot of my roles over the years are focused on lifting performance and managing change and driving a different way of doing things. That all has to be achieved through people."

At healthAlliance, this involves getting a team that is fully committed and works at a very high work rate and then asking them to do more as they add services and support national growth.

"The ability to focus people and to get them working as a team to drive those outcomes" is important.

"In this kind of organisation where we have to respond to so much in real time, you can't run a strict command of control. You have to trust the people in their job, doing their job, and give them the tools to help them do their job."

She has her sights set on how to manage this challenge. "In any complex environment you find the things that you can make a difference on and you focus and you drive it. Don't try and do everything at once. That's the real temptation when there's so many opportunities.

"Bite off some stuff that you can really make a difference on and push through on that. Now my focus is on getting my team really well-oiled and well-focused and having clarity on their accountabilities and outcomes. This isn't a one man game.

"If I can get 280 people really focused on one or two outcomes each, that drives a hell of a momentum working with their DHB colleagues," she says. "Whereas if I've got 280 people all working on completely different priorities, then you dissipate the focus." Photos by Jason Creaghan

This article is the cover story of the April 2014 issue of CIO New Zealand.

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