"We no longer were able to meet the demands of our users. More and more equipment was being added to the computer network, phones, televisions, instrumentation, health equipment, hundreds to thousands of pieces. The user doesn't see it, which is good, but it was no longer manageable. At the same time, even management didn't understand what we were responsible for," Zažímal recalls the turning point. That's why he and his colleagues started by writing down everything the IT department was responsible for and embarked on a gradual transformation. It was necessary. IT in hospitals is specific. On top of the traditional maintenance of computers or mails, you have to add the operation of medical technology.

"Devices like monitors in intensive care units are taken care of by bioengineers. But then it's up to us to transfer the data or have the doctor view the images in a program. In addition, the whole process also starts with us, because the doctor submits the request for an examination via the NIS (hospital information system), the heart of the hospital's IT, which is used by everyone and cannot go down for even a single minute because it would not be possible to issue prescriptions, requests or set up medication. An estimated 80 per cent of everything to do with technology goes behind the scenes," says Zažímal, providing a little-known perspective.

You talked about the fact that you were no longer able to meet the demands. What did that mean?

My colleagues in IT started to break down. They were used to delivering the service to a certain standard, but that was no longer possible. I had been working here for a long time by then, so I started gathering requirements and tips from each department and gradually put together a complete restructuring. It was essential to filter out the "IT people" from the regular users. We have more than 2,000 employees in the hospital, and at the beginning there were nine of us in IT. We were always getting calls, emails and doorstepping. There was nothing we could do about it. So we created an IT call center where we have two colleagues who receive everything and put it into the help desk, and we cut the phone lines to the other colleagues. There was a lot of fuss about it, but in the end it works great, and the colleagues are more empathetic and they solve a lot of small things on their own.

But that alone was probably not enough.

No, the other important part was that our staff has grown from nine to today's 19. Colleagues from another university hospital did a survey a few years ago to find out how many IT system positions are based on the total number of employees, and they got to an average of 1.5 percent in the Czech Republic. Meanwhile, in the banking sector, it is nine per cent and we are only at around 1.5 per cent now that there are almost 20 of us. But we have managed to build it up gradually and today we have three departments.

That sounds like a corporate IT structure. Hospitals don't normally have that, do they?

They don't, IT work in hospitals is often limited to "plug, unplug". It varies a lot depending on the type of facility, it's one thing for university hospitals and another for small district hospitals. Many colleagues come to us for reference visits, get excited, but then go back to their "hell".

What is it?

There are not enough people, there is a lack of competence and there is no money, but that does not necessarily mean that there is nowhere to ask for it. A lot of it has to do with a misunderstanding of the position of IT and its marginalisation. It's just that without technology, nothing happens in a hospital today. I worked for ten years also in the regional administeration as an e-health coordinator and I saw exactly what the problem was: people keep changing, there are still not enough of them and management does not support them.

One of the things you've set up over the years is that your staff logs into shared computers with cards to increase security and monitor traffic. How was that?

To be honest, I wonder how we could have been doing it differently until then, because even though it was a different time, it was terrible. We're always trying to make people's jobs easier, but when we entered the Microsoft Office 365 world, logging in was a pain. For example, the nurses in the exam rooms share one computer, they need to log in quickly, but it was often the case that one didn't log out, or did, but her login details were left behind. We deployed a domain in 1999 and we struggled terribly to get people not to share accounts so that more than one person would log on. We went through a lot of phases, and in the end it helped that we tied the usernames to payroll.

Then O365 came along, so we looked for a new solution that was both simple and secure. This happened at the same time that we fell under a new cyber law, which required a new approach to security. So we took that and put it together and created what has become the most user-successful project in the 26 years I've been here. Even some of the chief technology officers/developers later competed to get us to prioritize their departments in the deployment.

So what does the new log-in entail?

Speeding up and simplifying access. All users, even nurses and doctors, have an ID card that opens doors, pays for parking spaces or logs them into lunches, and it also works on computers. They don't have to enter a password, which is actually a card that they tap, and then they just enter a 4-digit PIN on the computer. We also have set time delays after which the systems logs off or the computer locks. Other places don't have this, but I know many hospitals have it in their project plans.

Another big project is the CCTV system. How does it work?

It started after the heparin killer case, when it was said that hospitals needed to be safer. We started with 21 cameras, and now we have hundreds, which is probably the most extensive system of this type in the country, and it's paying off in many places. Take parking lot control, we have police here almost every week and we give them footage. The other thing is the corridors, where ordinary people aren't supposed to be, but where we have troublemakers breaking things all the time, or somebody assaulting somebody. It also allowed us to respond to a confused Alzheimer's patient who suddenly left the waiting room and we used the cameras to look for him. The non-recording cameras in the rooms are a big help, as they are monitored online by the nurses and are then right there when they are needed. And the last good example is the sobering station, where we also often download footage to the police because drunks often complain about being assaulted. It's a controversial subject, but the CCTV system has really worked well for us.

What do you think has been the biggest improvement?

For me, the migration to O365 has helped us the most, because for us it doesn't just represent emails and office suite, but we also have security and we also address the digitalisation of processes through them, saving everyone time. A lot of hospitals come to us for inspiration because we have our own travel order system in there, for example, we check if a person has reference exams, we have multi-stage approvals, we are going to have a supervisor portal, in short a quantity of processes.

So what all needs to come together to make this work elsewhere?

Several factors. The IT manager has to be part of the management, not just under the economic deputy, for example, and has to have their support, especially that of the CEO, which is something that happened here and was absolutely key. It requires a stable environment without constant personnel changes and also its own budget – a financial and investment plan. You can't go asking for each and every toner whether you can buy it. Yet that is still happening in many places.

The topic of digital transformation often starts and ends with a lack of money. Is that the case here?

There are a number of grant opportunities, money is not such a problem. The bigger issue is the lack of strategy at the national level and then at those below them down to the level of individual hospitals. We have a strategy we write for each year and each year we set out exactly what we want to work on in the next period. One thing is that hospitals need to know what they want to do, but they also need to be clear about who is going to do it. Then it becomes a vicious circle, where, under the pressure of a grant, they quickly write a project so that they can draw money, but it does not fit into the context and often there is no one to do it because there are no people. As a result, when there was, for example, an IROP on cybersecurity, a lot of money was poured in, but in many cases it didn't really improve security.