Michelle talks about the impact Software Engineering can have upon the Healthcare sector focussing on real world examples where technology has had a demonstrable effect on the lives of patients and consumers.
Michelle talks about the impact Software Engineering can have upon the Healthcare sector focussing on real world examples where technology has had a demonstrable effect on the lives of patients and consumers.
My name is Steve Westgarth and this is the engineering leader if you're listening to this, please hit the subscribe button. That simple act will help people you know in the industry to raise the bar and build better software products for our customers. As a personal favour, I will also be so grateful if you could take a moment to share a link to the engineering leader.com on your LinkedIn or Twitter. This podcast is all about building a community of like minded people who want to share best practice in the engineering space. And your help and sharing a link will help us to connect to more engineering leaders. Today on the engineering leader, I'm joined by Michelle Kearns. Michelle is head of it for boots island where she is responsible for the IT operation across the boots Irish business. Prior to boots, Michelle was CCIE over the Irish health service executive digital health adviser to the World Health Organisation, and also the founder and chair of One Health Tech Island. Michelle, it's a pleasure to have you on the engineering leader today. Let me tell you a secret. You also write bad code. If you disagree. You might as well switch off. Before we begin. Can I just confirm that you also wrote bad code?
Michelle Kearns:I definitely write bad code, Steve. Absolutely. But where's the moss? I do love that opening gambit. There's one thing about bad code that yeah, that's part of it. But bad documentation is nearly worse. Oh, I
Steve Westgarth:can agree with that as well. Bad documentation is horrendous. How's your documentation?
Michelle Kearns:A lot better.
Steve Westgarth:Michelle, I've been really looking forward to talking to you because as you know, I've recently joined GSK consumer healthcare was global head of engineering, and in your world and your professional experience has been deeply rooted in the healthcare space. What is it about healthcare tech that really gets you excited?
Michelle Kearns:Ah, wow, that is a that is a big question. Where would you even start with that, I suppose, I think technology has so much to offer health care. And when it's done right, we can make a huge difference in patients lives. And that sounds really, I don't know, cliched or to, you know, powerful or something like that. But it's actually the the truth. And when I was CIO and carry doc, we ran a programme called Smile. And what it did is use wearable devices and technology in people's own home. And what we have in the background, we're telephone triage nurses supporting them. But the simplest of things, the simplest of interventions can really, really help people. And I think sometimes we can overcomplicate things in healthcare. And in health tech, the thing that kind of scares me sometimes is when you have companies who come in from a non health background, and go change the world, we can do all this cool stuff. But realistically, they kind of sometimes missed the point that it is a patient, it's an individual, it's a person, there's only so much technology can do. And you need that wrap around of a person as well. But from a tech perspective, I think we can get simple basic things right and can make a huge difference. There's some difference. There's some like amazing stories out there of people who have, you know, simple things like blood pressure monitor, weighing scales, you know, Fitbit telling you when you're sleeping, and when you're not sleeping, these have actually made huge, huge differences to patients lives, because what the nurse is doing in the background is tracking their information, what's happening. And they can see when there's a difference when their blood pressure is elevated when they've missed, you know, missed readings for a certain length of time what's going on in their lives. And it actually allows you to delve into something that is the whole mental health side of things where you know, you just need a human maybe to talk to you for a bit or to go okay, you miss some of your readings, what's going on here. And that's kind of just on a very simple, simple side of things. But when you look at the bigger picture, what can Health Tech do? Health Tech has the ability to change how healthcare is delivered, how we consume health, and how we really look after ourselves. But it's not necessarily the big huge life changing. You know, Elon Musk type things sometimes this is this basic simple intervention that actually makes a huge difference.
Steve Westgarth:And I think there's something there about scale isn't there because you're you think about health care, you think about the size and breadth of even just the NHS in the UK. And I mean, that's a massive organisation for quite a small country. you extrapolate that into other countries, whether you're talking about the US or China or some some countries in other parts of the world. They really do have billions of people and you can kind of See how companies kind of come in thinking that they have to change the world? And they don't make an impact? So I think it's really interesting you kind of draw back to what is the reason we're actually doing this as your for a patient? What are we trying to achieve?
Michelle Kearns:Yeah, and it's funny, I think one of the the lessons I learned earlier on in my career, I had an awesome manager whose name was Fonzie mcaren. And he had he, for years was involved in the hospitality industry. And he owned hotels on his comparison, because if a person came into a reception, they don't care if it's 10 o'clock in the morning, or 10 o'clock at night, they expect a certain level of service. So why in hospitals and health care, once it hits six o'clock, do we all of a sudden go, oh, well, no one's going to get sick. After six o'clock, we'll just you know, Rob donor services, and definitely no one gets sick at weekends. So we won't do this. And we won't do that. And the one thing that he always said to me is that if if you can, you can introduce all the tech in the world. But if it doesn't help a clinician to do something for a patient, they're not going to do it. So if you have all these bright ideas, but at the end of the day, it either hinders the clinician or the patient. Well, what's the point in this? And I think that buy in from from, from people when you're kind of when you think you've got this brilliant idea? And might be a brilliant idea, but you need to explore how is it actually going to impact the person? How is it actually going to support the clinician is going to support their journey? Or what's it actually going to do for them? Because, you know, sometimes it might be the coolest thing in the world, or it might be the coolest gadget in the world. But ultimately, is it actually gonna make a difference to that person.
Steve Westgarth:And one of the challenges that we often see, particularly in healthcare, when you talk about that new innovation, or that new gadget is the safety concerns that people have. So you know, maybe people have been doing things a certain way, or it seemed that in order to be safe, it needs to have some sort of human intervention, or some sort of checking to make sure that it's okay to use, do you see that as a particular challenge within the healthcare space, as we start to adopt some of these smaller interventions that maybe aren't, you know, being rolled out on a global scale?
Michelle Kearns:You don't want Steve, it's all about trust. And if you're a clinician who can't open their email, because the machine you're working on is too old, and it takes you 14 minutes, because the network isn't good. If some IT person comes to you and says, Here's a shiny new tool to use, is that just gonna be there? So because back I think the fundamentals of you know, what are you actually trying if like, just say, if you're in a big hospital or something like that, if you come in with a new gadget, but then the person has to queue to use a computer, because there's not enough computers around. If you're not solving the small things on the ground, then are you going to have the trust in us to be able to deliver these things. So there, there's, there's this huge big gap, I think, between what is possible for people to do with technology, but then what's going to be trusted. And I think we have a long way to go. Because we have amazing technicians who will buy into the technology and get on with it. But then you'll have other people who will be very, very wary of it, because their experiences with technology has been quite poor. And they might necessarily not necessarily chose what they're doing. They're not what they're doing. They might not necessarily choose what the technology is doing, or if they can actually go Alright, well, I wouldn't percent do this. But I think the safety element is you don't people are afraid to let computers make decisions? Because where does the governance live with that? Who doesn't lie with? And that is a huge question that needs to be answered. And that's why you have your HIPAA while you have all your, I suppose your, you know, standards or protocols making sure that, you know, when you're if you look at the apps, there are so many apps out there, how do patients trust an app? How do the patients you know, know what they're going to use in the future?
Steve Westgarth:So speaking as an as an engineer, you know, I guess a lot of those safety concerns you're talking about are actually in the hands of people like me and the teams that I work with, and to make sure that trust really is built up. So So what can we as engineers do in order to help clinical professionals and people who are working in healthcare, to trust the technology that we're building?
Michelle Kearns:Build a relationship with a clinician and build the relationship with the people around you to understand what they're doing, and understand their workflows and understand what they're actually trying to get out of it. I think the worst thing you can do is deliver a piece of tech and say, Here you go. Just use this. If they've had no input, or they haven't had an opportunity to say, Okay, this part doesn't work, but this does for me or the way I work, then you're really I suppose you're on the backfoot because what you've done is you've gone in and you've assumed that, you know how how they should work, rather than speaking to them and saying, how do you work and how How can we use technology to support you and to enable what you're doing, rather than take over and try and solve a problem that doesn't necessarily need to be solved by technology. But I think, listening to like, when you're trying to implement something, via a piece of software, or you know, a piece of tech, you've got to really understand what problem are you actually trying to solve? And are you doing it because you think it's cool? And you know, you think it's going to work? Or is there an actual, like, clinical need that you're trying to resolve?
Steve Westgarth:See, it's really interesting, you say that, because I spend a lot of time advocating that we need to get engineers closer to the end user. And I think historically, you know, when when engineering teams have kind of been put together, they've had requirements documents to kind of work off, or maybe business analysts have kind of looked at the business problem. And they've kind of worked out, you know, what needs to be done in order to solve it. And then that's been handed wholesale, to a group of engineers to go and implement with no opportunity to challenge the reason why we're doing it
Michelle Kearns:in Danger, danger, danger.
Steve Westgarth:Exactly that I mean, there have been some, some really interesting use cases, you know, where, obviously, as we build agile development teams, and we connect engineers directly to product owners who are really close to the end user into the technology, and really learn from those customer insights, it how much more effective that is, in my view, I mean, so at the moment, we are actually working on an apogee, SK, which will be launched into the Italian market. And I was actually talking with our engineers about, you know, do we actually need to go to Italy to understand more about, you know, what that market is all about, and to actually embed ourselves within it. I guess, in an ideal world, having people who actually understand the Italian market, the people we're going to be working with, ideally, even Italian engineers to actually build the product, because they're best place to actually respond to the customer need.
Michelle Kearns:Absolutely. And that's something actually, with the Council of tensile information officers on there is one very active in the UK as well on their on the digital health network. And what they are trying to do, what we tried to do with the Ireland with the council as well, is that you want to have chief clinical information officers working hand in hand with your CIOs, you want them there to say, okay, what are you building? Right? Here's our technical input, here are the team to work with. And that is what they're trying to do across the NHS, and across the HSE. So that you have the clinicians and the technologists working together, because it's not going to work otherwise. Because you know, as you said, you'll get a, I suppose, how we interpret things as engineers or a software developers, and how clinician actually works with a patient, we might think something is more straightforward. So I think the big thing there is, yes, be agile, be iterative. And don't be afraid to go back and say, okay, sorry, that didn't work. I think the worst thing you can do is persevere and go no, no, no, it'll be fine. At the end will be fine. No, no, you know, just hands up, right? This is not working. So I think you need those stakeholders all along the way. Because if you're, this is an example that I lived through, as, as a patient, as opposed to being on either side of, of the device was when I was in hospital, having my youngest, John, my consultant had just received a new software package. And it was very funny, because he didn't know that I had any understanding or involvement, or you knew anything about what was going on. But he just said to me, this piece of software, it makes no sense. It's changing how I've practised for the last 30 years. And I said, What do you mean? And he said, Well, just a simple flow of how they're recording more details. I don't do it like that, I do it a certain way. And then maybe other people do it a different way. But then simple things like having to, you know, go into different tabs, just the the layout of it, the feel of it, it actually was changing the way he was interacting with patients. And what he said to me is, like, I wish someone had just sat down with me for five minutes, so I could have shown them what I did. And then they would have been able to learn from me. So I think exactly what you're saying, You need to have that partnership at the very beginning. Have people you know, really, when you get your your set of requirements, go and actually talk to the people as well. And as you're building, make sure that they are on board as you're going along along the way. And if they are importing and saying actually hang on, this doesn't look right, or I don't think we should do it this way. You know, listen to that. And yes, absolutely. You might want to develop it in a certain way and have those end goals and share them, but then also be willing to take the feedback of a hang on that's actually not going to work in a clinical setting. And there may be a very practical reason for us. There may be you know, a very simple clinical well we complex, you do it in that in that way. So I think that's what you need to have people, those people in at the very, very beginning,
Steve Westgarth:it's really interesting to share that experience. And last year while I was working with boots, me and my team had the opportunity to go into one of our boots, pharmacies, and to look at how a pharmacy operates. So the boots pharmacy system that operates your all of the pharmaceutical, drugs and all of the other prescriptions, it's called Columbus. And we were talking to one of the pharmacists there. And he was demonstrating how he used it. And he said, you know, this, this button here that's on the screen, because it's because it's not on this screen over here. Every time yeah, maybe click this button 6070 times a day. But it adds an extra four or five clicks to my life in order to do that. So if there's one thing you could do, which really helped me, just move this button from this screen to this screen, and it would save me hours over the course of a year. And we did it, you know, we made that simple change. But that all came about because we went into a pharmacy and had a direct conversation with somebody who was actually using the system, where it's actually an engineer who's sitting, you're behind behind the screen, who's never worked in the pharmacy before simply wouldn't understand that. So I think that there's direct parallels there from what you're talking about.
Michelle Kearns:Yeah, absolutely. No, it's all it's all about learning what the other person is doing, learning about their environment, and what they have to do with because, as you said, sitting in front of a computer screen is very different than when you have a patient in front of you. And what you want to do. And I think that's, again, it goes back to what we were talking about earlier on is, you know, its fundamentals of getting things right. You know, if I think it's listening to that feedback, and what we have at the moment in healthcare is we have a lot of different systems that don't integrate with each other, you have clinicians logging in and out of different systems, you have, you know, they need to go one system for one piece of information, not the system for another bit of information, your laboratory systems, you have your X ray systems. And what you want to do is you want to try and bring them together. And I think that's, I think that's probably where we we have in the past and continued to seem to be to fail. And, you know, there are some places who have got it right, and have that connectivity and interconnectivity, and they have that integrated approach to things. But then I think what we've done in healthcare sometimes is you run with a new idea and go right, let's all do this, and then forget that there's so many other elements and components to it. And unless it's something, it's conversation, we've had many times before API's, you know, where are we getting the information from? What information do we actually need? What information do we have to share? How do we do it safely? How do we to do it securely? How do we make sure that the right care at the right time, the right piece of information is with the right person at the right time. So if you are a clinician, what information do you actually need at that point in time? If you're dealing with a lab looking at a sample, what information do you need at that right point in time, I think he's trying to bring all those systems together is where we've traditionally just gone and procured different systems for everything, and then afterwards gone, this a brilliant system, it does this amount of it, that's fine. And all it doesn't matter really, really well. But it just means that you have to log in as a as a, as a doctor, you have to log into six different systems to get all of this information that you need. So we haven't actually cracked that cohesive piece together.
Steve Westgarth:That there is definitely something about the interoperability of systems isn't that I mean, you. You mentioned open API ecosystems and those things, which can definitely help with that. But I still think that you're the challenge is how you how you solve the big picture, whilst while solving incremental kind of your problems. So you know, you want to, you want to make sure you're delivering value fast to a customer, you want to make sure the patients and in patients are getting value early. But you want to do that in a way that is contributing towards the bigger picture. So that actually you aren't trying to solve a silo problem. And time and time again, where you know, somebody will have a point problem, they're trying to solve a system that will do that. But in doing that, we only look at the point problem. And we don't consider the holistic picture of where we're trying to kind of fit into and how that's going to work for the wider ecosystem.
Michelle Kearns:Yeah, absolutely. Absolutely. And ecosystem, there we go. That's what we're trying to build. That's what we're trying to achieve. And some people have done incredibly well, in certain areas in healthcare, and then some not not so good. But um, I do think that unless, as engineers if you're if you're not going out and listening to the people and engaging and really seeing the problem that you're trying to solve, you're going to solve a different problem. Unless you're experiencing exactly what you need to solve. You will solve what you what seems sensible on paper. But as you know, what sensible paper is not necessarily the reality of, of a very complex case, or, you know, humans, humans are all you know, complex and crazy and bizarre and cool. Is when written well, is, you know, simple and nice and nice and tidy. And you know, looks well.
Steve Westgarth:Absolutely. And I've been thinking about your role within boots, you've been working on boots for almost a year now. How are boots approaching some of those challenges and and making sure that you're they really connect to the patients and to the end users when they when they implement the systems across their state? Well, I think the
Michelle Kearns:one thing that boots has done incredibly well is that they have pharmacists are at the heart of all of the projects that they're that they're delivering, and you will get the pharmacist and input. I think there are nice relationships between people. So far that I've discovered that you can always ask questions, and there's always people there to help you out. And as you said, I mean, you gave that you gave the perfect example, you went out, you spoke to the pharmacist, you move the button for them, you know, that's what you need to do. And that's what I think is key to do with COVID. And when you saw what happened in a very short space of time, we had to solve a need quite quickly. And that was going out talking to the pharmacist, what do you actually need? What is going to get you through this? And how do we do this as quickly as possible to get you to the next endpoint? And then how do we iterate on that and make it better and improve it as we go along. And I think those those are the conversations that you need to be having and those conversations that you need to keep going. Because we have such a focus on healthcare. Now within boots, I think that can only get better. Because the more people we talk to, and the more clinicians be engaged in the work that we've done with the NHS work that we do with the HSE. You know, one thing that they always do, and I think that we've done quite well in Boots is we talk to the people that we need to speak to, I suppose the danger is that we don't listen. And if we don't listen, you're not going to get the right products, and you're gonna get it wrong. But I think we have to be not afraid to be brave and go, Okay, I disagree with this or agree with this. And there are lots of strong personalities within boots. And I think that's one thing, I've actually experienced that if people do disagree with each other, they do quite well. And they have actually, you know, they'll they'll take the time to listen to each other. And I think that's really, really important.
Steve Westgarth:And I think you're right, that there is definitely something about healthy disagreement. Right? You know, it's a good thing to actually stand up for a point and make sure you've been heard and listened to, and collect the kind of discussing across the group. And coming to the best collective solution. That whole thing about your two heads is better than one definitely feels like it's applicable in that space.
Michelle Kearns:Oh, yeah, absolutely. Absolutely.
Steve Westgarth:So So thinking about you mentioned COVID, there, you know, some of the things which which Bootsy did in response to the pandemic, and some of the things you saw, that really had a direct impact on patients in Ireland, you know, maybe pick on two or three examples and talk us through some of your favourite innovative approaches that were taken.
Michelle Kearns:I think what COVID did, it was really, because at the beginning of COVID, I was in a different organisation, I was working with care doc, and we were a healthcare organisation delivering at various GP care on hospital in the home care. And it was quite interesting, because with our organisation, all the other organisations, pharmacies, everybody wanted to work together, everybody wanted to achieve something. So everybody pulled out all the stops. And when I moved over to boots, we were working on trying to deliver a software to support the COVID vaccination journey within boots or the sorry, the piece your journey within boots on the COVID vaccination journey as well. But what we did is we worked with the HSE. We worked with other organisations to figure out how can we do it the best. And I think that's one thing that traditionally, I think people can be quite reticent to just make decisions and get over things. Well, we didn't have a choice. We just had to get on and do it. And we had to deliver something good. And we had to, we had to make sure that it worked for everyone. I think what I really, really found fascinating was just how willing people were to change all the time. And how for different cohorts and different age groups from a software engineering perspective, you know, you're changing small little things like, you know, you're eligible now, because you're over 60 Oh, now you're eligible, because you're over 50. But that's still deploying new code every time because you're changing the decision engine in the background, you're changing what applies what doesn't apply, you know, who's eligible for a vaccine now, who's eligible for one later? How are you going to try and keep that information? What we find is the teams that we were working with, they just they helped us and they supported us to get that to where it needed to be. But that required again, our pharmacists, who knew the legislation inside out being able to translate that into the the engineering teams and the software teams to say, you know, this is what we're trying to do. Cheese, this what we're trying to develop, these are the flows, this the information that we need. Now, this is what we need about this vaccination. These are all of and I suppose that's the thing about health care, you then all over have to take in all this legislative piece of say, we have to ensure patient this, we have to make sure they understand this, how do you capture that how you're capturing all the information. And when patient records, you can't change patient record, you have to have the correct audit trail, you have to make sure that you have everything date stamped time, some who's you know, interacting with the records, who has the ability to change us. And you know, if a patient answers, I'm not allergic to something, then you give them the vaccine. And it turns out they are you have to go back, if they can't go back and go, Oh, I checked the wrong button or the right. But you know, you have to make sure you have all those small little things correct. And that can only be done by working with people and change your process. As you go along and listening to people. I think that's what boots did incredibly well. And when I joined, they were rolling out that the software for PCR testing. And that was something that again, we had to be very, you know, cognizant of, how are we going to work interact with the labs in the back end? Who do we need support from? Could we do it all ourselves? Did we need third parties? Um, a few other thing, it's that piece of not being afraid to coordinate is some people want all of the code for all of themselves. But you know, what, can you share it? What can you do better? How would you actually make that difference? And I think, I suppose I wasn't unique to just booth there was so many organisations who just got together and work together to see what they need to do and what they need to deliver.
Steve Westgarth:Yeah, I think that there was definitely a sense as we kind of report the pandemic of, of organisations wanting to come together and to help each other, you know, there was there was much less of a focus on making sure we had the right IP arrangements or making sure that you know, the right agreements are in place with the organisations and much more focus on what what do we need to achieve? And I guess not, not all of that is good, right? I mean, obviously, we need to come back away from some of those things in order to protect your what organisations want to achieve. But I think one thing that I did observe during COVID, that your was definitely a different way of operating with how we approach financing things, not just in boots, but in many organisations across the globe, your traditionally, your things are always tied to an investment case, which may be tied to a three year plan or to a budget cycle. And when COVID hit suddenly, you know, money was available organisations recognise we just needed to to operate quickly. And we didn't have time to deal with some of the bureaucracy that we potentially would have ordinarily had to deal with. I just wonder what your experience is of that? And the Oh, do you think that that's something that we can learn from your might be able to keep in a post COVID world,
Michelle Kearns:I hope it's something that we can definitely keep. Because I think sometimes we can be too restrictive in what we're trying to do. And it was funny, I moved from enough for profit organisation to a global boots, organisation with a you know, Walgreens boots lines and to see the complexities and the structures and everything that was in place there it was, it was mind blowing for me, because I had come from a much smaller organisation where it was a lot easier to just get in and get things done. It's something I don't know if it's a good thing or a bad thing or code to live by. But it's better to seek forgiveness than ask for permission. Sometimes that is the best and fastest way to get things done. It's not necessarily as you said, it's not necessarily the right way. But sometimes some programmes just need that. And I think, because of the way a lot of the financing works, and it is very, very complex, you have to make sure that you do have the right governance arrangements in place that you are doing the right things. But also, I would hate to lose the ability to make those decisions quicker, which definitely happened throughout the pandemic, people saw need, they addressed that need, they implemented it. And that was that I would hate to think of going back to a time where you have to go through way more lengthy processes. And as you said, Yes, you need processes, you need them. Well, we've proven that they've can be done quite quickly, we've proven that they can be done quickly and safely. So don't lose all of that. You know, I think definitely you have to keep that momentum going.
Steve Westgarth:Definitely. And I mean, I guess link to that and that quick iteration maybe to play devil's advocate a little bit I know you're really passionate about change, and that being really key to successful implementation of any new technology and I guess that's both it change and the business change right you know, so just because I can do something quickly with an it doesn't mean the businesses necessarily ready for it unable to adapt to it. So what what do you really think is needed to drive connected and integrated healthcare delivery?
Michelle Kearns:Oh, wow. I think an openness and a trust and a lot of transparency. I think when you want to change, you need to bring your stakeholders in early and keep it's, I suppose it's back to that same vein that we've been talking about, it's making sure the right people are involved at the right time. But it's also having champions, it's having people within the organisation that agree with your idea that can champion your idea. It's peers, talking to peers. And I think it's not being afraid to be in an open forum. And if someone challenges you, rather than just shutting them down, actually listening to them and saying, Okay, I understand why you're nervous about this, or I understand, but also then reading a room when you're in a room full of people, because there's always going to be people who speak up. But there are also people who may be too nervous to speak up or who don't feel like they can just, you know, put their hand up and ask a question. So I think it's creating that kind of theory, that open door policy, or you've created something that people don't feel like they can't speak to you. But also to be aware, because if you're a leader in an organisation, you want to know the people around you are comfortable and trusting you and trust in what you're doing. But you'll also be able to see if someone's kind of uncomfortable or nervous, and rather than shutting people down, if they disagree with you, or if you can tell that, you know, maybe they want to ask the question, you know, even being available to go to them afterwards and say, here or drop me a line anytime, you know, just email me ask the questions. And it's always creating that channel of communication really is it is communication, communication, communication, that old cliche, it's making sure what, what your idea are or what you're trying to achieve, that you have communicated what you want to win with every month, but also giving them the opportunity to come back and say, well, maybe I don't agree with this, or maybe I do agree with this, we're trying to work through it with them, as opposed to just saying, Oh, nevermind, we're doing it my way. And that's that, it's just working with people and kind of communicating the message out to people, but also it is persevering through it, because you will have people who disagree with you. And you will have people who are not going to like the idea. And you also have to, you know, deal with, you know, that that kind of instant reaction where you're like, they're not listening to me, or, you know, they don't like my ideas. So I don't care. You know, they might not like your idea, but they might have a reason that they don't like your idea. So it's listening to them and communicating with them as well. I'm just, I think, if you have that champion, or if you know, that idea is going to work, and you have someone to be able to, you know, be on your side, basically and say, Alright, let's try and do this. Let's get through it. It's so it's so so important, and not to try and exclude anyone. And it's very hard to be inclusive of everybody. But do and try do try that and do ask the question, you know, do you think we have everybody that we need in this room? Have we asked the people to the right question. And it's back to, you know, who's involved at a certain length of time, because obviously, you don't want to involve absolutely everybody and make it super complicated. But you do want to make sure that the right people know about it, and the right people are imploding at the right time. And always give people a chance to come back and say, Oh, can I can I bring a question to you now? Or, you know, what do you think about this now?
Steve Westgarth:And I guess some of that is tied with the work that you did with the World Health Organisation, I know, you previously led the Global Forum on change management, which was all about encouraging members to exchange learnings and promote continuous improvement. Just wondering, maybe reflect on some of the learnings you took from that experience.
Michelle Kearns:It's really difficult to get people to share, people will always tell you the good stories, they will always gloss over the kind of what was hard. So one of the key things we did there was try to encourage people to share what didn't work well, what didn't go right for them. And I think you can't improve or you can't, you can't have continuous improvement. If you're not going to accept or not willing to accept that, occasionally things will go wrong, and you will fail. So if you share those with others, how do you learn from that? How do you, you know, how what what would I have done differently? What would I have done better? Like people want to go out and sell the good story, they want to sell the successful story. And I think it's creating that environment where people are comfortable to share. And what we did first is kind of we, you know, we shared the stories of the good and the bad, you know, why didn't this work? It didn't work because we didn't talk to the right people at the right time. Or we went in with our idea and thought it was the best thing ever and didn't actually, you know, ask the other people what they wanted. So, I think if you're going to continuously improve, improve, you have to share your failings as well as your successes, but try learn from them. I mean, you know, don't just say, Oh, we failed, let's proceed on the carpet, you know, try and talk through, why did it fail? Why did we think we could have done differently, but also invite feedback from people to say, how do you think we could have done it differently? Or did you do differently? And what did you do differently? Because I think that's the only way we can learn from each other. Because at the end of the day, you know, when you look at healthcare across the world, we're all trying to make people better, we're all trying to do you know, fundamental things just to improve people's quality of life, to look after people to empower them, to educate them. And a lot of the time, we might think we know best. But you know, if you include the patient, if you include someone who has had a, you know, a long term illness, you have a very specialised knowledge on the short space of time on something this person has been living with this illness all their lives. So engage them, talk to them, share them, and don't be, I think, sometimes, forums, and people can be quite exclusive with things and oh, we know best. Try not be exclusive. Try being like, try include everyone in the conversation to you know, a lot of the time though, you're going to be pushing open doors, because people who are going to jump on forums or contribute, are the people who already wants to do this. So it was how to? How do you try and engage other people? Or how do you try and engage those who are a bit sceptical about what you're trying to do?
Steve Westgarth:Definitely, and I guess you're talking about successes and failures. And one of your big successes is definitely that you established one health Island. And the vision within that organisation is to build a more inclusive and innovative and future health system. So why is diversity and inclusion so important to you and that space?
Michelle Kearns:Yeah, one health tech, Ireland is part of a global network that was started in the UK, and we now have chapters all over the world, and it grew out of, I suppose that need for, if you're just solving, if just one person is solving a problem, or if one person is just writing code with their unconscious bias with their, their, you know, their thoughts, if they're designing technology for just themselves, or the people they know, you're going to get a very, you know, I suppose a narrow view of the world and narrow view of everything. So what you need is you need people from different backgrounds to come in with their ideas. And that's why in one health check, it's not only about diversity of background, or gender, or sexual identity or anything like that at all. What we actually want to bring is even people from different different backgrounds, not in healthcare, so aeronautical engineering, or, you know, something else that someone has done, because everybody has a different way of looking at things. And I think, like, it's just, it's that bias that you will create, if you do not try and include people. And if you don't try to be inclusive, it's, and it's something that I suppose in one way seems kind of obvious, yes. When you look at the people who are writing software, or who, who are like you and I are in a privileged position, where you know, we've have a lot of education, we have really good jobs, we, you know, we have houses, we don't have to worry about where our next meal is going to come from, you know, if you if you kind of step back a bit and go, right, are we actually designing software and tech for everybody? Because we're we've talked a lot about, what can we do with technology? What can we do about that, when we haven't addressed is? Well, what if I don't have a smartphone? What if I don't have an internet connection? What if I can't afford data? From my phone? What if I can't afford any sort of what kind of what if I can't afford electricity? So this whole area of digital poverty that exists as well. And on unless you're thinking about that, or unless you're bringing people on board? Who are going to think about that, you're always going to solve a problem for just one cohort of people. Whereas really, you need to be thinking wider, you need to be thinking, how can you how can you solve for a much bigger problem. And I think that's actually one thing, from a boots perspective, that I think they're trying to achieve with, you know, with their technology in stores, that if people don't have a phone, if people don't have a laptop, they don't have those things. They can use the technology within store, you can phone or you can have a video consultation with the GP. You can go in you can speak to your pharmacist, you can get advice that way. But I think we always have to, I suppose be cognizant of that. But then also like digital literacy as well. You know, how many people are going to No, oh, I'm going to download this app and I'm gonna look after my health and everything's gonna be cool. There's that whole quarter coverage, people that are not going to be able to do that. So how do we keep them involved? How do we make sure that we're thinking about them?
Steve Westgarth:There is definitely something about groupthink. And if you get your a bunch of people into it into a room with the same background or the same experience, they will all tend to think the same sort of things. And by bringing that diversity of experience alive, it really does make a huge difference to the products you're developing and how that needs to work. I think in a related vein, one of the things I was most proud of the booths did during the pandemic, was opening up its stores so that your if you were a victim of domestic violence or need to act, you access somebody who could help in that space, you go into a boots pharmacy and use the consultation room, and they may have telephones and your and iPads and things available for you to access support that you need. And when you start thinking in that world and think well, actually, some people haven't got access to that technology. And there was hundreds of people use that service across the landscape, both in the UK and Ireland. And I mean, the very fact that people did decide to to use that. It was fantastic, you know, what a success in terms of what what was created, but also really heart wrenching to think that such a service is actually needed in 21st century Britain?
Michelle Kearns:Well, that is the problem, I suppose. And again, that comes back to when you're when you are coming from a more privileged position, or you don't have to worry about those things. Are you necessarily thinking about them? When you're designing an app or a piece of software? No, you're not. So it's how do you make sure that you are thinking of these things? And that you are thinking about the population that you know, are at risk are in danger? And how can you support them?
Steve Westgarth:Definitely. I mean, that really brings us back to software engineering. So you know, as an engineering leader, I'm really passionate about enabling your people through the use of technology. And all of the things we've been talking about there is all about enabling people, enabling patients, enabling consumers to access technology and do some really cool things they wouldn't be able to do if we weren't able to execute in the digital space that we do. But that really does need a really clear alignment between the product vision and engineering execution. And your, from your perspective, how do we how can we better align those two those two areas?
Michelle Kearns:It comes back to that understanding and engagement piece, what problem are you actually trying to solve? What are you trying to trying to achieve? And it will always be different for different questions. But it is about people, and it is about working together. And it is about understanding the landscape that you're in and understanding the problem that has been asked of you, you know, can you solve this problem? Okay, what are we actually trying to solve here? How are we going to do it? And it is that that talking together, and it's not being I think, what we have done quite well is getting the right people to talk to talking to each other. And I think the more you do that, the better your product is going to be at the end of the day, because you're actually going to be solving that, you know, the problem the person actually has, as opposed to what you think that they have. And it's not, it's being not afraid to kind of go or take step back and go right, okay, that we didn't get this right, let's go back and see what we actually need to do. Like, don't be afraid to change. And, you know, the world is always changing, the landscape is always changing, and we just have to always change with it. Because I think if we get into this, and it is That danger, isn't it, that whole waterfall model of okay, here's the federal requirements, come back in four years and deliver it and you know, the whole everything has changed. There is that need to just constantly be listening and going back and being agile and and talking to people and including people as you go along the way. I think from an engineering perspective, it's it's, it's it's getting people, as you said, and it's getting people out into stores. From a healthcare perspective, it's making sure people are understanding the patient journey, the clinicians journey. What are you what are they actually trying to solve and from I suppose when you look at it from the CIO CIO perspective, it's making sure that you have the right people around the table. And that you know, from when you're if you're designing a piece of software for a hospital, you need the app and side of things, you need the nursing side, they'll need something different than the doctor needs. They'll need something different than the physiotherapist seat, they'll need something different than the radio for needs. So it's just always making sure that you're thinking about what everybody's doing and whatever everyone actually needs. But again, it's just about getting people together and talking.
Steve Westgarth:So I guess you've been at the heart of all sorts of deliveries across your career, right, that's delivered value to patients in no end of ways. You're looking back over over your career. What is the proudest delivery? You've been a part of?
Michelle Kearns:One of the really cool thing in booths is our robots are robotic or dispensing robot and Liffey Valley. Like that is pretty cool, too. And what it's done is that I think a lot of people are kind of like, oh, the robots are taking over. They're they're they're taken over jobs. But that's not the case what the robot has done. And they finally, it means that the pharmacist now has more time to spend with patients to engage with the person. Rather than spending their time just stocking shelves, which can be done by a robot. So the robot can stock the shelves, it'll sort out the medication. And then it also learns as it goes along. So if you just spend more amoxicillin than you do anything else, it will move the amoxicillin closer to the dispensing chute, so that it's easier and faster for it. So it's actually learning all the time. And it's always reclassifying, where everything is, and then cool thing cleans the shelves at the end of the nice.
Steve Westgarth:Evening, that sounds really important. And I mean, I guess you're all of the innovations kind of you're kind of out in the healthcare space over over the last few years, you're really is phenomenal, at the pace of change that we're seeing. And we've talked about some of that, over the course of the last hour or so. But I'm in crystal ball time, you know, what is what is next in the healthcare space? And what do we as an industry need to enable, in order for healthcare to be successful?
Michelle Kearns:It's gonna be the most boring answer ever. We need to get basic technology, right? I mean, you have the world on its mother talking about AI, machine learning algorithms, all the rest of it, what are they gonna do that? Like, I mean, the hospital records are down on, you know, sheets of paper and folders. miles wide, you know, we have to get the basic things, right, we have to get, you know, there is when you have a patient records, and you have a little yellow, sticky note stuck onto it with some important piece of information, how are you going to do AI and machine learning on that you're not, we have to get the basic things right, before we can do the really the, you know, the really cool future things. And that's the thing. There's so many amazing technologies out there, there's so many great ways to help patients and support patients. But it comes back to the fundamentals of you have to get the basics of what you're doing, right. And I know I harp on about this the whole time, I'm really boring, like, genuinely, just so boring, because I'm like, You got to get the basics, right, you got to build the chores. But again, if if a clinician is trying to open a record, and it takes them 10 minutes to open a record, that's 10 minutes that could have been spending with a patient. So you got to get those bits and pieces, right, and then look into you know, okay, crystal ball and Crystal gazing, you know, instead, like 10 years time, what I'd love to see, from an Irish perspective, what I'd love to see is I'd love to see an integrated a healthcare record, where you had a summary of the important points that a patient actually needs when they go into a hospital, and to have that movement of information from one hospital to the next, to have that seamless transfer of information that is required for the clinician to treat a patient. Because at the moment, if you go from one hospital to the next hospital, you're going to get the same tests over again, because it's just easier than trying to transfer information from one place to another. So I'd love to see that happening. To enable that you need again, in Ireland, we need our individual health, and that far you have your NHS number that does exist within Ireland. But when you start rolling it out into our systems, and creating that interoperability that doesn't necessarily exist at the moment.
Steve Westgarth:Michelle, the insights you've shared over the last hour have been absolutely fantastic. It's been an absolute pleasure to talk talking to you today. Thank you so much for agreeing to come and join the the engineering leader. And I'm sure that in the future, I would love to get you to come back and maybe talk more about some of the innovations you've been working on within the healthcare space. Thank you very much.
Michelle Kearns:Thank you very much, Steve. It's been an absolute pleasure.
Steve Westgarth:Talking to Michelle, it really hit home to me the opportunities that we have within the engineering community to directly impact the lives of people, particularly for those of us who are privileged to work with in the healthcare space. Listening to Michelle talk about the opportunity we have to use technology for Good is incredibly inspirational. And something I know I'm going to encourage the engineering teams that I work with to focus on. You've been listening to the engineering leader, a weekly podcast where I talk to people working within engineering and tech. I really hope you find the podcast useful. If you do, please reach out to me on Twitter at Steve Westgarth or search Steve Westgarth on LinkedIn. I'm also actively looking for people who would like to contribute to the podcast. If you have something interesting to say. Please don't hesitate to reach out. My name is Steve Westgarth and this is the engineering leader Let me tell you a secret you also write bad code if you disagree you may as well switch off